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S Grazio

Publications and source records attributed to S Grazio.

14 recordsLinked to original sources
PubMed2002

Improving risk assessment: hip geometry, bone mineral distribution and bone strength in hip fracture cases and controls. The EPOS study. European Prospective Osteoporosis Study.

Hip geometry and bone mineral density (BMD) have previously been shown to relate independently to hip fracture risk. Our objective was to determine by how much hip geometric data improved the identification of hip fracture. Lunar pencil beam scans of the proximal femur were obtained. Geometric and densitometric values from 800 female controls aged 60 years or more (from population samples which were participants in the European Prospective Osteoporosis Study, EPOS) were compared with data from 68 female hip fracture patients aged over 60 years who were scanned within 4 weeks of a contralateral hip fracture. We used Lunar DPX 'beta' versions of hip strength analysis (HSA) and hip axis length (HAL) applied to DPX(L) data. Compressive stress (Cstress), calculated by the HSA software to occur as a result of a typical fall on the greater trochanter, HAL, body mass index (BMI: weight/(height)2) and age were considered alongside femoral neck BMD (FN-BMD, g/cm2) as potential predictors of fracture. Logistic regression was used to generate predictors of fracture initially from FN-BMD. Next age, Cstress (as the most discriminating HSA-derived parameter), HAL and BMI were added to the model as potentially independent predictors. It was not necessary to include both HAL and Cstress in the logistic models, so the entire data set was examined without excluding the subjects missing HAL measurements. Cstress combined with age and BMI provided significantly better prediction of fracture than FN-BMD used alone as is current practice, judged by comparing areas under receiver operating characteristic (ROC) curves (p<0.001, deLong's test). At a specificity of 80%, sensitivity in identification was improved from 66% to 81%. Identifying women at high risk of hip fracture is thus likely to be substantially enhanced by combining bone density with age, simple anthropometry and data on the structural geometry of the hip. HSA might prove to be a valuable enhancement of DXA densitometry in clinical practice and its use could justify a more proactive approach to identifying women at high risk of hip fracture in the community.

Absorptiometry, Photon↗
PubMed2002

Is the predictive power of previous fractures for new spine and non-spine fractures associated with biochemical evidence of altered bone remodelling? The EPOS study. European Prospective Osteoporosis Study.

BACKGROUND: In the European Prospective Osteoporosis Study (EPOS), a past spine fracture increased risk of an incident fracture 3.6 - 12-fold even after adjusting for BMD. We examined the possibility that biochemical marker levels were associated with this unexplained BMD-independent element of fracture risk. METHODS: Each of 182 cases in EPOS of spine or non-spine fracture that occurred in 3.8 years of follow-up was matched by age, sex and study centre with two randomly assigned never-fractured controls and one case of past fracture. Analytes measured blind were: osteocalcin, bone-specific alkaline phosphatase, total alkaline phosphatase, serum creatinine, calcium, phosphate and albumin, together with the collagen cross-links degradation products serum CTS and urine CTX. Most subjects also had bone density measured by DXA. RESULTS: Cases who had recent fractures did not differ in marker levels from cases who had their last fracture more than 3 years previously. No statistically significant effect of recent fracture was found for any marker except osteocalcin, which was 17.6% lower in recent peripheral cases compared to unfractured controls (p<0.05) and this was independent of BMD. CONCLUSION: Past fracture as a risk indicator for future fracture is not strongly mediated through increased bone turnover.

Aged↗
PubMed2000

Hip geometry, bone mineral distribution, and bone strength in European men and women: the EPOS study.

Hip geometry and bone mineral density (BMD) have been shown previously to relate, independently of each other, to risk of hip fracture. We used Lunar DPX "beta" versions of hip strength analysis (HSA) and hip axis length (HAL) software to analyze scans from ten representative age-stratified population samples in the European Prospective Osteoporosis Study (EPOS). All 1617 subjects were >50 years of age, and 1033 were women. The data were modeled with gender and center as categorical variables. The bone mineral density of the upper half of the femoral neck declined at a faster rate with age than that in the lower half. Femoral neck cross-sectional moment of inertia (CSMI), a measure of resistance to bending, showed no significant age reduction in either gender. However, height and weight effects on CSMI were significantly more beneficial in men than in women (0.002 < p < 0.012) and the weight effect appeared to be mediated by bone mineral content (BMC). Compressive stress (Cstress), defined as the stress in the femoral neck at its weakest cross section arising from a standardized fall, was higher in women. Although Cstress increased with body weight when BMC was held constant, in practice it fell through the association and statistical interaction of rising body weight with rising BMC. HAL, as expected, was strongly positively associated with male gender and also height (p < 0.0001). Hip strength-related indices were markedly center-dependent. Significant differences (p < 0.0001) were noted between the centers for all the variables investigated that related to hip geometry. Adjustment for femoral neck bone mineral content (totBMC) showed these center differences to account for >50% of center variation in hip strength, which remained highly significant (p < 0.0001). We conclude that there are substantial geographical differences in femoral neck geometry as well as in BMD. These geometric variations may contribute to the large variations in hip fracture risk across Europe. The effects of aging on hip strength need to be explored in longitudinal studies.

Age Factors↗
PubMed2000

Radiological changes of the symphysis in ankylosing spondylitis.

PURPOSE: To evaluate the symphyseal changes in patients with ankylosing spondylitis. MATERIAL AND METHODS: Radiological-morphological changes of the symphysis were studied in 68 patients (66 men, 2 women) with ankylosing spondylitis whose age ranged from 21 to 75 years. The duration of the disease was from 2 to 50 years. RESULTS AND CONCLUSION: Changes in the symphysis were found in 16 patients (23.5%) and were less prominent than findings in the sacroiliac joints. We classified these changes into four stages: minimal changes, apparent destruction, reparation and ankylosis. The third and the fourth stages of the changes in the symphsis were found more frequently in patients who suffered from the disease for more than 15 years. Radiological evaluation of symphyseal changes can be helpful in the evaluation of disease progression as well as in establishing a differential diagnosis.

Adult↗
PubMed1998

[Occurrence of subcutaneous rheumatoid nodules in patients with rheumatoid arthritis in Croatia].

The subcutaneous rheumatoid nodules (RN) have been recognized by the American Rheumatism Association, both in 1958 and in 1987, as one of the diagnostic criteria (ARA criteria) among other rheumatoid arthritis (RA) symptoms. The aim of this research has been both to provide the incidence of occurrence of RN in patients with RA in Croatia and to determine its significance in making the RA diagnose. The test group comprised 233 patients (182 women and 51 men) with RA, their average age being 48.3 years in the range of 18 to 77. Both the anamnesis and the clinical examination have determined the occurrence of RN in 54 (23.2%) of 233 patients. The range of occurrences was more evident in men (31.4%) than in women (20.8%), though this difference was statistically irrelevant. The most common localization of benign rheumatoid nodules was the exterior side of elbow and PIP hand joints. The obtained results prove that the incidence of RN in our tested patients with RA can be compared with those of the earlier researches done in Croatia (18.1% Jajić, Vlak; 20-25% Jajić), as well as with those obtained in the western European countries (20% Doherty, George; 25% Ziff; 20-25% Miehle; 21% Wolf et al.).

Adolescent↗
PubMed1997

[Work capacity evaluation in patients with ankylosing spondylitis].

The aim of the study was to establish the employment and working ability for patients with ankylosing spondylitis. The study was performed using a questionnaire mailed to 185 patients with verified diagnosis of ankylosing spondylitis who were treated at the Department of Rheumatology of the University Hospital "Sestre milosrdnice" in Zagreb in the last 5 years. The questionnaire included a few categories of questions and here we analysed those referring the working abilities. The answers were obtained from 92 patients. We took in account the data for 79 patients who fall into the age group of working population (men to 65 yrs, women to 60 yrs.). In that group there were 50 men and 29 women. Twenty-six patients have a full time job, 7 patients have a part-time job, one changed the job and 45 of them are retired. The difference of working abilities was observed regarding to the physical requirement for the job (P < 0.05) and the duration of the disease (P < 0.05). Among the patients who are retired majority stated that ankylosing spondylitis was the cause of their retirement. As for the patients who still work (N = 34), 14 of them were not on sick-leave the last year at all, 2 of them were absent up to one week, 10 patients were absent from 1 to 4 weeks, 3 patients were on sick-leave from 1 to 3 months, and 5 of them more than 3 months. Statistically significant difference was observed in sick-leave rate regarding to the physical requirements for the job (P < 0.01), but not regarding to the duration of the disease (P > 0.05). The results of our study suggest that ankylosing spondylitis reduce the working ability especially for patients who have a hard job. There is an imperative to maintain the working abilities of patients with ankylosing spondylitis as long as possible.

Aged↗
PubMed1997

[Clinical features of ankylosing spondylitis--epidemiologic study].

The aim of the study was to establish some clinical features of ankylosing spondylitis in an epidemiological study using a mailed questionnaire. The questionnaire was sent to 185 patients with ankylosing spondylitis who were treated at the Department for Physical Medicine, Rehabilitation and Rheumatology. The answers were obtained from 92 patients (49.7%). In the studied cohort there were 60 men and 32 women. The average age of all patients were 51.6 +/- 11.8 yrs. In most of the patients (69 or 75%) the duration of ankylosing spondylitis is more than 15 years. The diagnosis of ankylosing spondylitis was established on average 6.5 years after the beginning of symptoms. Patients suffering from ankylosing spondylitis more than 15 years reported that the worst period of the disease was the starting 10 years. The main symptoms of the disease are stiffness and pain. The aggravation of pain occurs with enhanced physical activity as well as with prolonged rest--Painful swelling of one or more joints of 3 weeks duration had 63.7%, and more than 3 weeks duration 40.7% patients. There was no difference in occurrence of painful swelling extravertebral joints regarding to duration of the disease (P > 0.05). The most often affected joints were hips and shoulders. Eyes inflammation was reported by 63 patients, and unspecified enterocolitis had 16 patients.

Female↗
PubMed1996

Geometric measurements of the proximal femur in UK women: secular increase between the late 1950s and early 1990s.

The aim of this study was to determine whether hip axis or femoral length has increased in women in the United Kingdom between the late 1950s and early 1990s. Such an observation would be of interest as it might explain the rise in age-specific incidence of hip fracture observed during these years. We studied two sets of antero-posterior pelvic radiographs of women aged 55-69 years taken during the course of population-based studies in the UK, one in 1958-60 and the other in 1989-91. One observer (S.G.) recorded the following measurements at the right hip: hip axis length (HAL), femoral length (FL) and femoral width (FW). Two summary ratios, HAL/FW and FL/FW were calculated to allow for differences in radiographic technique. HAL, FL and FW were greater in the 1989-91 films compared with those taken in 1958-60. Both HAL and FL expressed as a ratio to FW were also greater in the later films. FL/FW increased by 4.5% (p < 0.05); HAL/FW increased by 2.3%, though this was not statistically significant. We conclude that there has been a small apparent change in geometric measurements of the hip during the past 36 years. Cautious extrapolation suggests that such a change may explain up to one third of the increase in incidence of hip fracture observed during this period.

Age Factors↗
PubMed1995

[The mode of onset of rheumatoid arthritis and seasonal variations].

The aim of the study was to establish age and sex distribution, seasonal variations, and mode, of onset in a sample of patients with rheumatoid arthritis. One hundred eighty nine patients (146 women and 43 men), whose age ranged from 18 to 77 yrs. (mean age 49.1, SD 12.93) were included in the survey. In majority of patients the disease started between 31-50 years, whereas in the age group from 21-30 it occurred more frequent in women, and in the age group from 51-60 in men. The onset of rheumatoid arthritis was in almost equal proportions acute or insidious, regardless sex. No difference was found concerning onset of the disease and seasonal variations. However there was a statistically significant correlation between mode of the onset and seasonal variations (P < 0.05). Rheumatoid arthritis started abruptly more often in springtime, and more insidiously in autumn, whereas in summer and winter there was an equal number of patients with acute or insidious onset of the disease.

Adolescent↗
PubMed1995

[Chloroquine in the treatment of psoriatic arthritis].

In 30 patients (20 males and 10 females) wih psoriatic arthritis chloroquine was administered in a dosage of 250 mg daily per os. After 12 months of monitoring decreased number of swollen and painfully tender joints were found as well as shortening in duration of morning stiffness. As for laboratory parameters lowering of the average values of ESR and alpha-2 globulins were found whilst there were no changes of ceruloplasmin, haptoglobin and CRP. Worsening of skin lesions was observed in only 2 patients (6.5%). These results suggest that synthetic antimalarials (chloroquine) can be successfully used in the treatment of psoriatic arthritis with special care.

Adult↗
PubMedDate not supplied

Reactivation of primary hypertrophic osteoarthropathy by bronchogenic carcinoma.

This paper reports 2 cases of primary hypertrophic osteoarthopathy (PHO) which evolved into secondary hypertrophic osteoarthopathy (SHO) under the influence of bronchogenic carcinoma. The patients had a clinical picture of primary hypertrophic osteoarthropathy but without any signs of disease activity until in the last several months when a malignant bronchopulmonary condition developed. This activated all the symptoms: joint swelling; enlarged fingers and distal forearms and legs; moist palms and soles; unpleasant odour of perspiration; and deeper folds of the forehead and nasolabial furrow. A bone scan showed increased accumulation of the radioisotope in specific regions of the skeleton. To our knowledge, no similar cases have been described in the literature.

Carcinoma, Bronchogenic↗
PubMedDate not supplied

Immunohistochemical detection of TGF-alpha, EGF-R, c-erbB-2, c-H-ras, c-myc, estrogen and progesterone in benign and malignant human breast lesions: a concomitant expression.

The expression of transforming growth factor-alpha (TGF-alpha), epidermal growth factor receptor (EGF-R) and oncogenes c-erbB-2, c-H-ras, c-myc, as well as estrogen (ER) and progesterone (PR) receptors were studied immunohistochemically in the tissue of 21 benign and 58 malignant human breast lesions. Twenty nine (50%) of 58 carcinomas were positive for EGF-R and c-erbB-2 product, 55 (94.8%) for c-myc product, 9 (15.5%) for c-H-ras product and 17 (29%) for TGF-alpha. Eighteen of 58 (31%) carcinomas were estrogen receptor positive and 22 (38%) were positive for progesterone receptor. No correlation was found between expression of each investigated parameter and the clinical stage or degree of histological differentiation of the carcinomas. However, a significant positive correlation was observed between lymph node involvement and c-erbB-2 and EGF-R/c-erbB-2 positive tumors. A strong correlation was also observed between high levels of EGF-R and low levels of estrogen receptor. In 15 of 17 cases we found simultaneous expression of EGF-R and TGF-alpha. We also found interesting patterns in concomitant expression of the investigated parameters suggesting a possible cascade of events that occur in breast cancer cells.

Breast Diseases↗