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Biomedical subjects

J Braun

Publications and source records attributed to J Braun.

At least 631 records · Page 35Linked to original sources
PubMedDate not supplied

CT-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with spondyloarthropathy: indication and follow-up with contrast-enhanced MRI.

PURPOSE: Our goal was to prospectively study the therapeutic efficacy of CT-guided intraarticular corticosteroid instillation of inflamed sacroiliac joints (SIJs) in patients with spondyloarthropathies and to evaluate the role of MRI as a procedure for establishing the indication and for therapeutic follow-up. METHOD: A total of 103 CT-guided corticosteroid injections of the SIJs were performed in 66 patients with inflammatory back pain (IBP): 37 bilateral, 29 unilateral. All patients did not respond to an immediately preceding 4 week nonsteroidal antiinflammatory therapy. Forty milligrams of a crystalline long-acting corticoid was instilled in each joint. All 66 patients underwent continuous clinical follow-up at 10 to 12 week intervals after corticosteroid injection to a maximum of 18 months. The degree of subjective complaints before and after the intervention was recorded using a analogue scale (0 = no pain, 10 = unbearable pain). Dynamic contrast-enhanced (Gd-DTPA, 0.1 mmol/kg body wt) MRI with quantitative determination of contrast enhancement was performed in all patients before the therapeutic intervention and in 38 patients at 8 +/- 4 months. RESULTS: Sixty-one of the 66 study patients (92.5%) showed a statistically significant abatement of subjective complaints from 8.8 +/- 1.3 to 3.3 +/- 2.3 (p < 0.01) at 1.7 +/- 1.1 weeks after intervention, and this improvement lasted for 10 +/- 5 months. The percentage contrast enhancement at dynamic MRI likewise showed a significant reduction from 100.3 +/- 48% before to 44.3 +/- 36.1% after intraarticular cortisone administration (p < 0.01). CONCLUSION: CT-guided intraarticular corticosteroid instillation in the SIJs may be regarded as an effective therapy for florid sacroiliitis. The severity of inflammation and the response to therapy can be determined quantitatively by dynamic MRI.

Adult↗
PubMedDate not supplied

Effect of an oral health training program on knowledge and behavior of state agency long-term-care surveyors.

This study examines the effect of a training program on long-term-care (LTC) surveyors' knowledge of factors affecting oral health and their behavior in citing oral health deficiencies of LTC residents. Twenty surveyors were recruited for the experimental group, along with a non-equivalent comparison group of 31 surveyors. The experimental group participated in a three-hour interactive, case-based training program. The experimental group had a significant increase in total knowledge (p < 0.002) post-test scores with a moderate effect size, eta 2 = 0.115. The training program resulted in a statistically significant increase (p < 0.0001) in oral health citation behavior for the experimental group for six months following training. This study provides evidence that an interactive case-based training program can affect participants' knowledge regarding oral health of LTC residents and participants' oral health citation behavior. As the elderly population experiences an increased life expectancy with increased need for assistance with Activities of Daily Living (ADL), similar training programs will become an important factor in assessing the quality of care provided to LTC residents.

Activities of Daily Living↗
PubMedDate not supplied

New mucin-like cancer-associated antigens (CA M 26, CA M 29 and CA 549) and a new proliferation marker (TPS) in patients with primary or advanced breast cancer.

In patients with breast cancer no tumor markers giving satisfactory results have been found yet. The aim of our investigation was to compare the usefulness of newly developed tumor markers with the most common used carcinoembryonic antigen and cancer antigen (CA) 15-3. We evaluated the concentrations of carcinoma-associated antigen (CA) 549, carcinoma-associated mucin antigen (CA M) 26 and CA M 29, and the proliferation markers tissue polypeptide antigen (TPA) and tissue polypeptide-specific antigen (TPS) in 84 breast cancer patients with disease progression and in 69 patients with no evidence of disease after surgery for breast cancer. Using receiver-operating characteristic curves (ROC curves) we were able to demonstrate increased sensitivity and specificity of all tested tumor markers in patients with metastatic disease compared with local disease. In our investigation TPA is superior to TPS in all disease states. In local disease, none of the tested markers shows satisfying results. In metastatic disease, the new mucin markers CA M 26 and CA M 29 show slightly better results than CA 15-3 although their ROC curves are nearly congruent. CA 549 is exceeded by the other mucin markers. The best results in this investigation were obtained with CA M 29. The overall results concerning the detection of small tumor masses (i.e. local disease) were unsatisfactory.

Adult↗
PubMedDate not supplied

Fluorescence studies on lung tumors.

Illumination of unstained 9 microns cryosections of lung tissue with 365 nm results in visible fluorescence light with a maximum intensity at about 460 nm. These fluorescence tomographical studies can be used for detecting carcinoma of the lung. The fluorescence pattern obtained can be matched nicely with histological findings. Since it takes less than 5 min for getting the fluorescence images, the fluorescence tomographical technique might be used in addition to established methods for determining the histology of a biopsy sample.

Adult↗
PubMedDate not supplied

Sweet's syndrome in a patient with acute Crohn's colitis and longstanding ankylosing spondylitis.

Acute neutrophilic dermatosis, also referred to as Sweet's syndrome according to the first description in 1964, occurs not only as an isolated phenomenon but also in the context of neoplastic and inflammatory diseases, occasionally including arthritides. Recently Sweet's syndrome has been reported in a small number of patients with chronic inflammatory bowel disease, mostly in advanced stages of the disease. Here, we describe the sudden outbreak of acute neutrophilic dermatosis in coincidence with the onset of severe Crohn's disease (CD) in a patient with long-standing ankylosing spondylitis (AS). This condition has not been described before and therefore Sweet's syndrome should be added to the spectrum of skin manifestations the rheumatologist has to think about in the context of the spondylarthropathies (SpA). Furthermore, this case report is of interest because the skin lesions of Sweet's syndrome are somewhat similar to psoriasis, which is a rather frequent feature of the spondylarthropathies. This article intends to clarify the clinical and histological differentiation between Sweet's syndrome, psoriatic skin lesions and erythema nodosum for the rheumatologist and stresses that these conditions must each be treated in a completely different manner.

Acute Disease↗
PubMedDate not supplied

Objectively measured sperm motility and sperm head morphometry in boars (Sus scrofa): relation to fertility and seminal plasma growth factors.

This study was conducted to investigate the relationships between results of computer-assisted semen analysis (spermatozoal motility and sperm head morphometry) and fertility of boars. In addition, concentrations of insulin-like growth factor (IGF)-I and IGF-II in seminal plasma were determined. The nonreturn rate (NRR) and the number of live-born piglets were compatible with the requirements of artificial insemination for all boars included in this study. Semen samples of 12 boars (Pietrain; 3 ejaculates each) were evaluated for spermatozoal motility and sperm head dimensions using computer-assisted methods. Native semen samples were centrifuged, and seminal plasma was frozen at -20 degrees C until assayed for IGF-I and IGF-II by specific radioimmunoassays. Spermatozoa of boars with a higher NRR (>86%) had a significantly slower average velocity of motile spermatozoa when compared with that of boars with an NRR below 86%. High-fertility boars (NRR > 86%) had significantly smaller sperm heads than did boars with an NRR below 86%, and their sperm heads were less elongated. Substantial concentrations of IGF-I (8.4-22.2 ng/mL) and IGF-II (12.1-19.8 ng/mL) could be measured in porcine seminal plasma; however, there was no correlation between IGF levels and semen parameters or individual fertility.

Animals↗
PubMedDate not supplied

Co-occurrence of spondyloarthropathy and connective tissue disease: development of Sjögren's syndrome and mixed connective tissue disease (MCTD) in a patient with ankylosing spondylitis.

Spondylarthropathies (SpA) and connective tissue diseases (CTD) are clinically distinct entities which, at first glance, seem to have little in common. However, a link between SpA and CTD has recently been suggested by a study in which a higher prevalence of Sjögren's syndrome (SS) and sicca symptoms was reported in patients with ankylosing spondylitis (AS) and undifferentiated SpA (1). Another link between SpA and CTD is a possible side effect of a DMARD widely used to treat SpA: sulfasalazine (SAS). SAS was reported to induce antinuclear antibodies (ANA) and systemic lupus erythematosus (SLE)-like syndromes such as drug-induced lupus. This report describes a 54-year-old white male, HLA B27-positive AS patient with some syndesmophytes who, after 15 years of disease, developed SS with salivary gland involvement, Raynaud's syndrome and anti-Ro antibodies. Then, 20 years after the onset of AS, he became acutely ill, suffering severe myositis and myocarditis along with swollen hands and highly elevated autoantibody titers recognizing UIRNP; his condition was interpreted as mixed connective tissue disease (MCTD). The patient had been treated with SAS and azathioprine (AZA) alone several times during the last years because he had not tolerated other DMARDs. A combination of both drugs had been prescribed 3 weeks before a severe flair because of progredient high disease activity with painful peripheral arthritis of the MCP and PIP joints which, however, had not shown radiographic erosions. We describe the rare development of MCTD in an AS patient and report, for the first time, the onset of MCTD potentially triggered by sulfasalazine.

Humans↗
PubMedDate not supplied

Ankylosing spondylitis--cardiac manifestations.

There is a definite association of heart disease with ankylosing spondylitis (AS). The magnitude of this relationship is less clear. Three types of inflammatory affections can be differentiated: 1. aortitis and aortic insufficiency with the possible necessity of cardiac surgery, 2. conduction disturbances of the atrioventricular node with a probable subsequent indication for a pacemaker and 3. myocardial involvement with a possible compromise of left ventricular function. There seems to be an HLA B27-associated cardiac syndrome consisting of aortic root disease and conduction abnormalities. Patients can be recognized at pre-clinical stages. Prospective studies have not been performed. HLA B27-related heart disease does not seem to be associated with increased mortality.

Aortic Diseases↗
PubMedDate not supplied

Mortality, course of disease and prognosis of patients with ankylosing spondylitis.

Patients with ankylosing spondylitis (AS) have about a 50% increased risk of mortality on the basis of the limited amount of data available. There is some evidence that the progression of disease is strongest in the first 10 years of disease but it is also clear that the disease keeps on being active for further decades. The overall burden of disease is similar to rheumatoid arthritis but the overall disease duration of AS is longer. Prognostic factors have also not been studied extensively in AS but it seems clear that early hip involvement indicates a worse outcome. The same is true for early limitation of spinal mobility, laboratory evidence of ongoing disease activity (ESR, hypergammaglobulinemia), peripheral arthritis and dactylitis. The significance of organ involvement for the prognosis, especially in the kidney in the form of amyloidosis, and in the heart and lungs, is less clear. Radiation therapy of the spine, which had been performed quite extensively in former decades, has been associated with a mean radiation dose of about double that of atomic bomb survivors and an increased risk of leukemia and mortality. This therapy has been largely abandoned nowadays. Elder rheumatologists report however that the clinical improvement of irradiated patients has been partly impressive.

Hip Joint↗
PubMedDate not supplied

Immunological basis for the use of TNFalpha-blocking agents in ankylosing spondylitis and immunological changes during treatment.

TNFalpha is expressed in high amounts at the site of inflammation in ankylosing spondylitis, which provided the basis to initiate treatment studies with TNF-blocking agents. We could show that the immunological effects of infliximab and etanercept differ in patients with AS, although the clinical effect was similarly good. While infliximab induced a downregulation of the production of the T-helper 1-cytokines IFNgamma and TNFalpha, etanercept treatment triggered rather an upregulation of these cytokines secreted by T cells after in vitro stimulation.

Antibodies, Monoclonal↗
PubMedDate not supplied

Infliximab in the treatment of active and severe ankylosing spondylitis.

For treatment of the spondylarthropathies (SpA), of which ankylosing spondylitis (AS) is the prototype, there is no effective disease modifying treatment available. In contrast to rheumatoid arthritis (RA), few studies have been performed on the treatment of patients with AS with disease modifying antirheumatic drugs, none of which have proved clearly effective in axial disease. Many patients with AS carry a heavy burden of disease and AS itself is responsible for direct and indirect socioeconomic costs. To find an effective treatment for severe ankylosing spondylitis is therefore thought to be an unmet medical need. In the last four years several pilot studies and recently a few randomised controlled trials have raised good evidence that TNFalpha blockade is very effective in AS and other SpA. Disease activity, function and quality of life improved upon treatment with TNFalpha blockers. Thus, biologicals seem to represent a major breakthrough in the treatment of AS and other SpA. Side effects similar to those observed in RA treatment occur. But there is furthermore a need for safety data for long-term treatment with biologicals over several years. In the light of the high costs and the unknown long-term side effects, a definition for patients who might be candidates for such a treatment is needed. This article gives detailed information about current experience with the new treatment options in active and severe AS with anti-TNFalpha therapy.

Antibodies, Monoclonal↗
PubMedDate not supplied

Side effects of anti-TNF therapy: current knowledge.

The development of the anti-TNF therapies is a milestone in the therapy of rheumatic diseases. As in all new treatment opportunities it is of concern whether all potential undesired side effects have been evaluated within the clinical trials which have lead to approval of the drugs. Postmarketing experience and pharmacovigilance programs are necessary to determine the overall safety profile of the new agents. From the clinical trials and the practical experience of the first years we know that side effects have occurred in patients treated with anti-TNF agents. Sufficient knowledge about these partly specific side effects is critical for rheumatologists who treat their patients with these very effective biologic drugs.

Antibodies, Monoclonal↗
PubMedDate not supplied

Bisphosphonates--targeting bone in the treatment of spondyloarthritis.

The increased prevalence of osteoporosis and recognition of the importance of subchondral bone marrow inflammation in ankylosing spondylitis, together with in vitro and animal model data indicating that bisphosphonates may possess anti-inflammatory properties, constitute a theoretical rationale for their evaluation in this disease. Open evaluation of intravenous pamidronate in some but not all studies has demonstrated efficacy whilst controlled evaluation of a monthly regime has shown that therapy is efficacious in about 60% of patients, although effects are delayed, treatment being necessary for at least 6 months.

Anti-Inflammatory Agents↗
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Use of contrast enhanced magnetic resonance imaging to detect spinal inflammation in patients with spondyloarthritides.

Inflammation of spinal structures is a characteristic feature of the spondyloarthritides (SpA). The term SpA covers patients with inflammatory back pain and/or peripheral arthritis who can be further categorized. Ankylosing spondylitis (AS), the prototype of the SpA, the most frequent inflammatory spinal disease in adults, usually starts in the sacroiliac joints. Pathologic spinal changes occurring in AS are spondylitis, spondylodiscitis and inflammation and ankylosis also at other sites in the axial skeleton. In the later stages of AS such changes can be well recognized by spinal x-rays. In the early disease stages it has been more difficult to analyze the exact anatomic localization of spinal inflammation to date, because conventional imaging systems have only a limited capacity to demonstrate such changes early. There is some evidence that magnetic resonance imaging (MRI) with fat saturation and contrast enhanced MRI are useful to visualize early and late inflammatory changes in the sacroiliac joints. In this paper we report that MRI is also useful to localize the site of inflammation to distinct regions of the spine in AS and other SpA.

Adult↗
PubMedDate not supplied

Imaging and scoring in ankylosing spondylitis.

Ankylosing spondylitis (AS), the prototype of the spondyloarthritides (SpA), is a disease subset but also a possible outcome of the SpA. Early diagnosis of sacroiliitis, the most frequent clinical symptom often accompanied by inflammatory back pain, and other inflammatory lesions of the spine such as spondylitis and spondylodiscitis, can be visualized early by magnetic resonance imaging (MRI). Chronic changes such as syndesmophytes are well detected by conventional x-rays of the spine, mostly lateral, in the lumbar spine also a.p. Active spinal inflammation can be demonstrated by MRI by using either the fat saturating STIR technique or by application of the contrast agent gadolinium-DTPA. This is especially useful in early and active disease, in young women and in children, and for the differential diagnosis of septic sacroilitis. Because of the efficacy of the novel biologic agents directed against TNFalpha such as infliximab and etanercept in SpA there is a need for spinal imaging techniques that are more sensitive than conventional x-rays. The available scoring tools are limited in their sensitivity to change. Novel approaches using MRI have been recently proposed.

Disease Progression↗
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Assessment of ankylosing spondylitis.

Outcome measures for the assessment of patients with ankylosing spondylitis (AS) have been the subject of considerable research in the last decade, largely through the contributions of the ASessments in Ankylosing Spondylitis (ASAS) International Working Group. This review focuses on the measurement of disease activity, physical function and structural damage in AS, both in daily patient care and to measure treatment response in clinical trials. The ASAS Core Sets for assessment in AS are an important tool to guide disease monitoring, and the domains they contain are discussed, along with other possible concepts important to patient care, including imaging and health-related quality of life. In clinical trials, the assessment of disease response to therapy using the ASAS Response Criteria is a valuable means of determining treatment efficacy and allows comparison of response across trials and interventions.

Clinical Trials as Topic↗