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Biomedical subjects

G Kolarz

Publications and source records attributed to G Kolarz.

At least 19 recordsLinked to original sources
PubMed1998

[Comparison between early and late inpatient rehabilitation measures after implantation of total hip endoprostheses].

This study was aimed at answering the question of whether a four-week inpatient early rehabilitation programme, i.e. within the first two months following total hip replacement surgery, will have a favourable impact as compared to later-onset inpatient rehabilitation measures; a total of 219 patients was studied: 137 were admitted during the first two months post-op (group A), 45 within three to four months post op (group B), and 37 patients were admitted at a later date (group C). Assessments were carried out for pain, walking performance and self-help status (scores) as well as for mobility, gait patterns, walking aids, walking speed, and disablement. In group A patients, significant improvement was achieved for all of these parameters: at the end of the rehabilitation programme (2.4 months post-op) these patients already were more mobile than group B patients at the time of admission (3.3 months post-op). In group B, improvements were found for several parameters. At a later time, the natural healing process had brought about so good a baseline situation in the group C patients that no further improvement was possible. The 162 patients treated successfully, i.e. where score reductions occurred, had been admitted significantly (p = 0.0001) earlier (2.9 months post-op) than the remaining 57 patients (5.7 months post-op). Some 14 months after programme participation, follow-up examinations were possible for 90 patients of group A, and for 27 patients from groups B and C. Further significant improvements had occurred in group A patients only, notably relative to muscle strength and reduction of walking aids. It is concluded from our data that inpatient early rehabilitation will achieve the greatest effect and will substantially reduce the recovery phase with its mobility limitations and daily living handicaps.

Activities of Daily Living↗
PubMed1997

Modulation of nitric oxide synthase activity by ibuprofen.

Inhibition of NO synthesis represents a new therapeutical approach in the treatment of inflammation. Clinical use of NOS inhibitors will necessitate the design of drugs selective for iNOS, because inhibition of constitutive endothelial NOS may cause adverse cardiovascular side effects. This study examines the effect of ibuprofen and its stereoeisomeric components on the activation of iNOS and cNOS as well as on the NO production by human umbilical vein endothelial cells. At therapeutic concentrations Ibuprofen activated iNOS and inhibited NOS. In endothelial cell culture experiments activation of NO production was seen especially at supratherapeutic ibuprofen concentrations. Both stereoisomeric components of ibuprofen showed comparable effects. This drug can therefore not be used for the selective inhibition of iNOS.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1996

Intracellular distribution of ibuprofen within monocytes.

The interaction of ibuprofen (CAS 15687-27-1) with muscle proteins was investigated in vitro and binding to actin was found to be more marked than to other muscle proteins. Actin polymerization, however, was not influenced by this interaction. The kinetics of ibuprofen internalization by human monocytes/macrophages from peripheral blood at 37 degrees C and its partitioning to different cellular compartments was studied and compared to the actin content of these subcellular fractions. The bulk of cell-bound ibuprofen (89.7%) was found in the cell debris fraction (1,000 g sediment), 7.3% were recovered in the 10,000 g sediment, only 0.5% in the 100,000 g sediment and 2.5% in the cytosolic fraction. The distribution of F-actin to the different subcellular fractions was verified by fluorescence analysis using NBD-phallacidin. Four times more F-actin was found in the 1,000 g sediment than in the 10,000 g fraction, while the microsomal fraction contained only 8% of total F-actin. In the cytosol, significant amounts of soluble actin were detected. These data indicate that ibuprofen could theoretically interact with actin in all the cellular subfractions to which it is distributed after internalization.

Actins↗
PubMed1996

Development and evaluation of fuzzy criteria for the diagnosis of rheumatoid arthritis.

In 1987, the American Rheumatism Association issued a set of criteria for the classification of rheumatoid arthritis (RA) to provide a uniform definition of RA patients. Fuzzy set theory and fuzzy logic were used to transform this set of criteria into a diagnostic tool that offers diagnoses at different levels of confidence: a definite level, which was consistent with the original criteria definition, as well as several possible and superdefinite levels. Two fuzzy models and a reference model which provided results at a definite level only were applied to 292 clinical cases from a hospital for rheumatic diseases. At the definite level, all models yielded a sensitivity rate of 72.6% and a specificity rate of 87.0%. Sensitivity and specificity rates at the possible levels ranged from 73.3% to 85.6% and from 83.6% to 87.0%. At the superdefinite levels, sensitivity rates ranged from 39.0% to 63.7% and specificity rates from 90.4% to 95.2%. Fuzzy techniques were helpful to add flexibility to preexisting diagnostic criteria in order to obtain diagnoses at the desired level of confidence.

Arthritis, Rheumatoid↗
PubMed1996

[Effect of inpatient rehabilitation measures on patients with total hip endoprostheses--evaluation 15 months after operation].

159 patients were examined approximately 15 months after hip arthroplasty. 116 of these patients have had at that time point a postoperative 4 week hospital stay for rehabilitation. A score that considered pain at motion and at rest, maximal walking capacity and activity of daily living was used for evaluation. The preoperative conditions did not differ between patients that had their postoperative hospital stay for rehabilitation (n = 116) and those that did not (n = 43). The results at the time of examination were regarded as excellent (group 1; score 3) in 64 (40.3%) patients, as good (group 2; score 4) in 56 (35.2%) patients and as poor (group 3; score > or = 5) in 39 (24.5%) patients. The amount of patients with a hospital stay for rehabilitation was significantly (p = 0.025) higher in the patient groups with excellent or good results in comparison with the patients with poor postoperative outcome. The most excellent results were obtained in patients who had their rehabilitation within the first two months after surgery (p = 0.008). Apart from the above mentioned score the following-additionally assessed-parameters differed significantly between the 3 groups: hip mobility; pain elicited by pressure on the operated joint; pain in the contralateral hip or knee joints; consumption of analgetics; walking time for 15 meters; degree of handicap as assessed by the patient or the occupational therapist or the physician; coping with household activities (for females only). We conclude that a poor result of hip arthroplasty may be due not only to degenerative joint disease of the lower limbs but also (or in combination) to the lack of a postoperative hospital stay for rehabilitation.

Activities of Daily Living↗
PubMed1995

[Clinical aspects of arthrosis].

Symptoms, physical, laboratory, and x-ray findings in osteoarthrosis are reviewed, special emphasis is drawn to the different clinical forms as compensated, activated, decompensated osteoarthrosis. A sample of 2,494 patients with degenerative joint disease or functional disorders as e.g. myalgia were studied with respect to symptoms and physical findings. As previously described in other studies it turned out, that osteoarthrosis of the knee specially in women is correlated with high body weight; furthermore it could be shown that foot deformities--hallux valgus and pes planus in gonarthrosis, hallux valgus and hammer-toe in polyarthrosis of the finger joints--are significantly more frequent in some degenerative joint diseases.

Adolescent↗
PubMed1995

[New approaches to computer-assisted diagnosis of rheumatologic diseases].

UNLABELLED: Since the 1960s, several knowledge-based systems for computer-assisted diagnosis in radiology have been developed. The great majority of these tools has been implemented as off-line systems. This requires interaction with the system solely for the purpose of consultation and therefore interrupts the radiologist's work flow. This and inadequate man-machine interfaces may have inhibited the routine clinical use of such systems. The goal of this paper is to describe the current research toward the development of the on-line expert system Cadiag-4/Rheuma-Radio. The underlying fundamentals of the system design, including client/server architecture, communication interfaces, and fuzzy set theory and fuzzy logic as methods for knowledge representation and interference, are presented. METHODS: In radiology today, computers are routinely used to acquire radiological images in hospital and radiology information systems (HIS/RIS) and picture archiving and communication systems (PACS). In our approach, we make use of pre-existent sources of information to build an expert system that minimizes the interaction between radiologists and the computer. To handle uncertainty and vagueness of medical knowledge, fuzzy set theory and fuzzy logic are used. Given data of a specific case, a deductive inference procedure combines the observed radiological signs, establishes confirmed and excluded diagnoses as well as diagnostic hypotheses, and provides explanations for these conclusions. Furthermore, proposals for confirmation or exclusion of diagnostic hypotheses are offered. RESULTS: For evaluation purposes, an early prototype of Cadiag-4/Rheuma-Radio was tested on radiological disorders of the hip joint related to rheumatological diseases. Twenty radiological cases were used as test cases, reaching a diagnostic accuracy of about 80%. CONCLUSION: The first results are acceptable and encourage further work to cover the whole area of rheumatologically relevant radiological signs and diagnoses. Furthermore, research into the development of user-oriented data acquisition tools will be carried out.

Arthritis, Rheumatoid↗
PubMed1994

Chest X-ray in collagen vascular diseases. A comparison of chest X-ray with bronchoalveolar lavage and transbronchial forceps biopsy.

The diagnostic value of chest X-ray following the ILO standards was compared with bronchoalveolar lavage (BAL) and the histology of transbronchial forceps biopsy in 83 patients with collagen vascular diseases. BAL in the middle lobe was considered abnormal in case of increased cell count per milliliter and/or lymphocytosis and/or neutrophil granulocytosis and this was found in 32 out of 42 cases (76.2%) with, and in 33 of out 41 cases (80.5%) without abnormal radiological finding. Pathological changes in the histology were found in 14 out of 20 cases (70.0%) with and in 40 out of 63 cases (63.5%) without abnormal chest X-ray in the upper lobe from which the transbronchial forceps biopsy specimens were obtained. In histological specimens obtained from transbronchial forceps biopsy, only fibrosis correlated with abnormal radiological findings in this region. Other inflammatory processes defied prediction by chest X-ray. This suggests that, regardless of chest X-ray findings, BAL should be performed together with transbronchial forceps biopsy for the histological examination of patients with collagen vascular diseases in which interstitial lung involvement is suspected.

Adolescent↗
PubMed1994

[Binding capacity of ibuprofen to muscle proteins].

From former studies it is well known, that ibuprofen (CAS 15687-27-1) binds to muscular tissue in a higher degree than to tendons or ligaments. It is not known, however, what constituents of muscle tissue are responsible for this binding. Therefore the binding capacity of ibuprofen to different muscular proteins was studied. Actin, actomyosin, myosin, myoglobin, tropomyosin, lecithin, and native human collagen type I were incubated with 14C-ibuprofen and the specific binding was measured in relation to the total radioactivity. It could be shown that ibuprofen binds most markedly to actin. This binding could be inhibited by pre-incubation of ibuprofen with soluble actin. In comparison to the other proteins studied the specific binding of ibuprofen to actin was 4 to 5 times higher. As actin is a constituent of the cytoskeleton which plays an important role in generating oxygen radicals, its possible inhibition by ibuprofen could additionally explain the antiphlogistic effect of this compound.

Actins↗
PubMed1993

Differences in anti-Fab antibodies in adult and late onset rheumatoid arthritis.

In the present study the ratio of antigen-bound anti-IgG-Fab antibodies (hidden aFab) to free aFab was found to be significantly increased in patients with adult onset rheumatoid arthritis (AORA) as compared to late onset rheumatoid arthritis (LORA). The overall amount of aFab was similar in both groups. The difference was only seen in seropositive patients. Within the seropositive AORA group, the aFab ratio was correlated with the duration and the stage of disease but not with the patients' age at investigation. This might reflect a higher affinity of anti-Fab antibodies and/or a greater diversity of the idiotypic repertoire in adult onset disease resulting in the formation of immune complexes, the stability of which might be enhanced further by the presence of rheumatoid factors. Although a pathophysiological involvement of aFab cannot be concluded from our observations, it is conceivable that different immunoregulatory mechanisms could be operative in RA with onset at different ages.

Adult↗
PubMed1993

HLA-DR1-positive patients suffering from rheumatoid arthritis are at high risk for developing mucocutaneous side effects upon gold therapy.

Population studies suggest an association between RA and, depending on the ethnic background, HLA-DR1 and/or -DR4. One standard regimen for the treatment of RA is the use of gold compounds like SATM to arrest progression of the disease. In the present study, the immunogenetic background of RA patients developing side effects upon SATM treatment was determined. A total of 53 patients under SATM therapy were tested for their HLA-DRB and -DQ alleles by DNA typing; a significantly higher frequency of HLA-DR1 (p < 0.004, uncorrected) was observed in patients presenting with mucocutaneous side effects (MCT) when compared with patients without MCT. The RR was 6.85. Thus, HLA-DR1 seems to be a marker for the susceptibility of gold adverse reactions.

Adult↗
PubMed1993

Bronchoalveolar lavage in rheumatoid arthritis.

Bronchoalveolar lavage (BAL) was performed on 70 RA patients, 28 without extra-articular manifestations, nine with pulmonary involvement, 13 with sicca-syndrome, 20 with other extra-articular manifestations such as renal involvement, cutaneous vasculitis and rheumatoid nodules. Fifteen patients without rheumatic or pulmonary disease served as the control group. Compared with the control group RA patients showed a statistically significant increase of lymphocytes, especially of activated (DR+)T(CD3+)-helper (CD4+) cells, resulting in a significantly diminished percentage of alveolar macrophages, B(CD21+)-lymphocytes, T-suppressor (CD8+) cells and an increased CD4/CD8 ratio. This cell distribution pattern was more pronounced in RA patients with lung involvement with significant differences to the other RA patients with regard to lymphocytes, DR positive cells and CD4 positive/DR positive cells. It is concluded that these results indicate an altered balance of immunocompetent cells not only in the joints but also in the lung. The changes are more distinct if local manifestations can be diagnosed clinically.

Aged↗
PubMed1993

Lung involvement in rheumatoid factor-negative arthritis.

Bronchoalveolar lavage (BAL) was performed on 13 asymptomatic patients with sero (rheumatoid factor)-negative arthritis (SNA); (6 with peripheral psoriatic arthritis, 2 with axial psoriatic arthritis, 3 with ankylosing spondylitis, 2 with sacroiliitis). BAL revealed a significant decrease of neutrophil granulocytes and an increase of B-lymphocytes in patients with SNA in comparison with 64 patiénts with rheumatoid arthritis (RA; 24 seronegative, 39 seropositive) and 15 healthy controls. Patients with SNA and RA had a significant increase of lymphocytes, especially T, T-helper and activated cells. In addition patients with RA had a significant increase of natural killer cells and a lower percentage of alveolar macrophages and T-suppressor cells. Transbronchial biopsy was performed on 9 patients with SNA and on 59 patients with RA. Abnormal histologic features of lung tissue were observed in 4 out of 9 patients with SNA (2 with fibrosis, 1 with follicular lymphoid hyperplasia, 1 with desquamative interstitial pneumonitis). The abnormal lung histology in RA patients was more pronounced, however, the differences between SNA and RA were not significant. The data from BAL and histology suggest, that the pulmonary involvement in SNA and RA is caused by an unspecified immunologic process.

Adult↗
PubMed1993

Bronchoalveolar lavage and lung biopsy in rheumatoid arthritis. In vivo effects of disease modifying antirheumatic drugs.

Bronchoalveolar lavage (BAL) and histology of transbronchial forceps biopsy was performed in 59 patients with rheumatoid arthritis (RA) to evaluate the in vivo effects of disease modifying drugs (DMARD). All patients had no clinical pulmonary symptoms and there was no evidence of drug induced alveolitis. Patients were divided into 5 subgroups according to drug treatment: 9 patients taking chloroquine, 15 patients gold, 8 patients penicillamine, 8 patients methotrexate (MTX) and 19 patients not taking DMARD. Duration of DMARD regimen was more than 3 months. No patient was treated with corticosteroids. BAL results revealed an increased percentage of lymphocytes and a diminished proportion of alveolar macrophages in patients treated with gold, penicillamine, MTX and no DMARD. In contrast, patients receiving chloroquine had a normal distribution of lymphocytes and macrophages as seen in a control group of 15 persons. Patients taking MTX showed a normal distribution of T and B lymphocytes and DR positive cells, whereas patients receiving chloroquine, gold, or penicillamine had an elevated proportion of T lymphocytes and DR positive cells and a diminished percentage of B lymphocytes. The latter was also observed in patients not taking DMARD. The percentage of natural killer cells was significantly elevated only in the penicillamine group. Patients receiving gold had higher absolute values of CD3, CD4 and DR positive cells. Abnormal lung histology was associated with an increased percentage of lymphocytes and with higher DR positive cells in BAL. Patients not receiving DMARD had a significantly higher percentage (42.1%) of abnormal histologic features of lung tissue than patients receiving DMARD (17.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Prediction of interstitial lung involvement in rheumatoid arthritis. The value of clinical data, chest roentgenogram, lung function, and serologic parameters.

We initiated the present study to predict interstitial lung involvement in rheumatoid arthritis (RA) by means of logistic regression analysis of clinical data, lung function, chest roentgenogram, and serologic parameters. Fifty-eight nonsmoking patients with RA were randomized from the rheumatologic unit and sent for investigation to the pulmonary department. Bronchoalveolar lavage (BAL) was performed in the middle lobe and the BAL fluid was considered abnormal in case of increased cell count per milliliter and/or lymphocytosis and/or neutrophil granulocytosis; these findings or combinations thereof were found in 42 (72.4 percent) of 58 cases. The patients' data that had an impact on the normality of BAL were the sex (p = 0.001), vital capacity (p = 0.028), peripheral blood T-helper cells (OKT4+) (p = 0.025), DR(+)-lymphocytes (p = 0.002), and antinuclear antibodies (p = 0.025). By means of the logistic regression analysis, it was possible to reach high significance in the prediction of interstitial lung involvement, with a sensitivity of 92.9 percent and a specificity of 75.0 percent (p less than 10(-6)). The efficiency of prediction was 87.9 percent. From these results, we conclude that interstitial lung involvement in RA is predictable from laboratory findings that have been yielded by noninvasive diagnostic techniques. These data should be used in clinical routine monitoring and they may help to facilitate the assessment of whether bronchoscopy is indicated.

Arthritis, Rheumatoid↗
PubMed1992

[Binding affinity of ibuprofen in human tissues].

In vitro binding of ibuprofen (CAS 15687-27-1) to various human tissues was studied to explain differences in tissue concentration after local application of ibuprofen cream. Radioactive ibuprofen, was incubated with human skin, subcutaneous tissue, muscle, tendon, joint capsule for 2 h at 37 degrees C. Tissue specimens were washed and radioactivity was measured by a liquid scintillation counter. The results show specific binding of ibuprofen to the various tissues of different degrees. Despite of interindividual differences muscle tissues showed the highest, tendons the lowest concentrations of ibuprofen. These findings may explain the in vivo results, where higher concentrations of ibuprofen were found in muscle tissue compared with subcutaneous tissue.

Aged↗