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[Chronic pernicious course in multiple sclerosis with involvement of the optic nerves and total spinal sclerosis (diffuse spinal sclerosis) (author's transl)].

Four cases with the clinical diagnosis of chronic MS are presented, which, histologically, show large solitary demyelinated and gliotic areas involving almost the entire spinal cord over 12-25 segments as well as the optic chiasm. The abortive form of the neuromyelitis optical syndrome in MS is discussed. The additional involvement of the cerebral hemispheres suggests that the clinical and histological picture described is related to Schilder's disease.

Adult

Silica-associated systemic sclerosis is clinically, serologically and immunologically indistinguishable from idiopathic systemic sclerosis.

To determine whether the clinical, immunological and serological features of patients with silica-associated systemic sclerosis are different from patients with the 'idiopathic' form of systemic sclerosis (SS) we studied 22 underground coal miners who were exposed to silica dust (SD), 30 mine workers who later developed silicosis (S) and 17 mine workers exposed to silica dust who subsequently developed a systemic sclerosis-like disease (SA-SS). The patients with SA-SS had features clinically indistinguishable from individual patients with SS. They all had Raynaud's phenomenon, 14 had cutaneous sclerosis identical to that seen in acrosclerosis and three had a generalized cutaneous sclerosis. Sixteen patients had bibasilar pulmonary fibrosis, 10 had necrosis of the fingertip pulps, nine had oesophageal involvement and only one patient had renal involvement. Antinuclear antibodies and circulating immune complexes were detected in three and eight patients with SD, 14 and five patients with S and in 16 and nine patients with SA-SS, respectively. Anti-Scl-70 antibody was detected in eight of the 17 patients with SA-SS. Evidence for in vivo endothelial cell damage, as determined by elevated levels of von Willebrand factor, was found in nine patients with SD, 14 patients with S and in 10 patients with SA-SS. Following incubation of the patient's serum with confluent cultures of human umbilical vein endothelial cells there was only a significant reduction in calcium ionophore-induced release of prostacyclin with the serum from SA-SS patients compared to that with control serum (NC). The mean +/- SEM release of 6-keto-PGF1 alpha (the stable metabolite of prostacyclin expressed as ng/10(4) cells) decreased from 2.90 +/- 0.27 to 2.01 +/- 0.33 (SD), 3.34 +/- 0.42 to 1.76 +/- 0.31 (S), 1.98 +/- 0.12 to 0.64 +/- 0.07 (SA-SS) and 2.28 +/- 0.33 to 1.36 +/- 0.21 (NC) with 1 and 20% serum, respectively. This study demonstrates that immune complex and antinuclear antibody formation and in vivo endothelial cell damage occurs following occupational exposure to silica. The patients who subsequently develop a systemic sclerosis-like disease have clinical, immunological and serological features which are indistinguishable from the idiopathic form of the disease although as a group the SA-SS patients have a higher prevalence of pulmonary involvement and the anti-Scl-70 antibody.

6-Ketoprostaglandin F1 alpha

Cellular hypersensitivity in attacks of multiple sclerosis. I. A comparative study of migration inhibitory factor production and lymphoblastic transformation in response to myelin basic protein in multiple sclerosis.

Although cell-mediated hypersensitivity to basic myelin protein has been demonstrated in multiple sclerosis with use of cell migration assays, results with the lymphoblastic transformation technique have been inconclusive. However, prospective studies relating results of lymphoblastic transformation to the clinical course of multiple sclerosis have not been reported. In the present study, both lymphoblastic transformation and migration inhibitory factor assays were used, and results related to the temporal course of multiple sclerosis. Results of the present investigation show that cell-mediated hypersensitivity to myelin basic A1 protein is most significant during exacerbations of multiple sclerosis. Responses obtained employing either the lymphoblastic transformation or migration inhibitory factor assay were equally significant. The results support the hypothesis that a factor suppressing deoxyribonucleic acid synthesis is present in multiple sclerosis and is inhibited by the use of steroids.

Cell Migration Inhibition

Antibody response to arboviruses. Absence of increased response in amyotrophic lateral sclerosis and multiple sclerosis.

Complement fixation and hemagglutination imhibition tests were conducted on the serums of patients with amyotrophic lateral sclerosis and multiple sclerosis using a variety of arboviral antigens. Seventy-eight complement fixation and 15 hemagglutination-inhibition viral antigens were used representing togaviruses, orbiviruses, rhadoviruses, bunyaviruses, arenaviruses, and several ungrouped agents. The serological results did not indicate any relationship between these viruses and either amyotrophic lateral sclerosis or multiple sclerosis.

Amyotrophic Lateral Sclerosis

[Neuroendocrine aspects of the pathogenesis and treatment of disseminated sclerosis and lateral amyotrophic sclerosis].

Comparative study of neurologic, immunologic, and endocrinologic signs of disseminated sclerosis and lateral amyotrophic sclerosis was carried out by radioimmunoassay, monoclonal antibodies, and microcytotoxic Terasaki's test. The data have shown a tendency to hyperthyroid and hypocorticoid states in 60 percent of lateral amyotrophic sclerosis patients. Fluctuations in hormonal levels of disseminated sclerosis patients were quite the opposite in 37.5 percent of cases. Thyrotropic hormone content was rarely changed (in 20 and 18.75 percent of cases, respectively), this permitting a conclusion on the possibility of an extrahypophyseal (thymic) effect on the thyroid in these conditions and on the advisability of using thyrotropin- and corticotropin-releasing hormones (8-arginine-vasopressin) in combined therapy thereof.

Adult

Linkage investigation of three putative tuberous sclerosis determining loci on chromosomes 9q, 11q, and 12q. The Tuberous Sclerosis Collaborative Group.

Previous linkage studies in tuberous sclerosis have implicated three disease determining loci at 9q, 11q, and 12q. We have collated phenotypic and genotypic data on 1622 members of 128 families with tuberous sclerosis in order to evaluate simultaneously the evidence for these putative loci. Affection status in the family members has been reassessed using uniform diagnostic criteria and genotypic data extensively checked before analysis under alternative models of locus heterogeneity. One tuberous sclerosis determining locus, accounting for approximately 50% of the families studied, has been found to map in the region of D9S10 on 9q34 but no evidence has been found to support the existence of major loci on 11q or 12q. A locus, or loci, elsewhere in the genome is likely to account for tuberous sclerosis in most non-chromosome 9 linked families.

Chromosome Mapping

In vitro cellular responsiveness in multiple sclerosis patients to a viral isolate from multiple sclerosis brain tissue and to other antigens.

The Clausen modification of the leukocyte migration test was used to test patients with multiple sclerosis, normal subjects, and patients with other neurologic diseases for cell-mediated immunity to 6/94 virus (a parainfluenza virus previously isolated from the brain tissue of a multiple sclerosis patient), c-RNA virus isolated from a tumor, and the nonviral antigens Candida and purified protein derivative. Leukocytes of multiple sclerosis patient showed significantly less mean inhibition of migration by the 6/94 virus (but not by the c-RNA virus, purified protein derivative, and Candida) than did the cells of normal controls and patients with other neurologic diseases. The relationship of these findings to previous observations in this area and to the pathogenesis of multiple sclerosis is discussed.

Antigens, Viral

[Pathogenesis of multiple sclerosis. Antibody dependent cytotoxicity of lymphocytes against myelin basic proteins in multiple sclerosis].

In 79 of 100 patients with multiple sclerosis, serum antibodies of the IgG type were demonstrated which render normal lymphocytes cytotoxic against basic protein of myelin. In 11 cerebrospinal fluids which were tested the antibody was also found. The method used was the release of 51Cr from chicken erythrocytes coated with antigen. The antibody-dependent lymphocyte cytotoxicity is related to the degree of activity of the disease and not to the evolution of the disease or its course. As the disease worsens, the frequency of positive reactions is higher than in inactive stages. The immunological reaction is very specific for multiple sclerosis, in patients with other neurological disorders only 5% had positive findings. The antibody-dependent cytotoxicity of lymphocytes against basic protein of myelin may be attributed with a certain diagnostic significance. The reaction seems suitable for the supervision of the course of multiple sclerosis and to check the effect of therapeutic measures. The antibody-dependent lymphocyte cytotoxicity against basic protein of myelin is considered to be significant in the pathogenesis of multiple sclerosis.

Antibody-Dependent Cell Cytotoxicity

Absence of HTLV-I and HTLV-II proviral genome in the brains of patients with multiple sclerosis and amyotrophic lateral sclerosis.

Previous studies have failed to provide serological evidence to incriminate a retroviral infection in the cause of multiple sclerosis. Gene amplification techniques have also failed to identify retroviral footprints in DNA from peripheral blood leukocytes. Here we provide evidence that proviral DNA of HTLV-I and HTLV-II is not found in the central nervous system tissues of patients with multiple sclerosis, patients with amyotrophic lateral sclerosis and controls.

Amyotrophic Lateral Sclerosis

[Thymus-dependent lymphocytes in multiple sclerosis and amyotrophic lateral sclerosis].

A study of the rosetteforming possibilities of T-lymphocytes in the peripheral blood of patients with disseminated sclerosis and lateral amyotrophical sclerosis detected a significant deficit of a subpopulation of T-cells, which form the most active rosettes of the morula type. Besides, in patients with disseminated sclerosis the relative amount of rosetteforming lymphocytes in the peripheral blood is significantly lower.

Adolescent

Electroencephalographic studies in multiple sclerosis. Specific changes in benign multiple sclerosis.

EEG changes were analysed in a group of 260 patients with definite multiple sclerosis, 156 women and 104 men, average age 38.8, at different stages of the disease. Among 103 patients with an evolution up to 5 years, 34% had significantly abnormal EEG'S while in 157 patients with an evolution from 5 to 45 years abnormal records were obtained in 47.8%. The larger group showed EEG differences between benign (66 patients), malignant (23 patients) and moderate courses (68 patients) patients. The frequency of abnormal and doubtful EEGs was highest in the benign group (80.4%) and largest in the malignant group (24.1%). The main characteristic in malignant multiple sclerosis in the steadily progressive stage was a flat EEG. There was also a significant correlation between a flat EEG and intellectual deficit. In benign multiple sclerosis the dominant activities were slow (6-10 c/sec) and high voltage (80-180 muV) alpha-theta rhythms spreading all over the cortex, usually associated with "centrencephalic" discharges. A self-limiting effect of lesions around the 3rd ventricle on auto-agressive immunological processes is proposed.

Adult

Aberrant CSF protein fractions found by electrofocusing in multiple sclerosis. A study of 26 cases with clinically verified or probable multiple sclerosis and 2 cases with optic neuritis.

The CSF gamma-globulin patterns found by electrofocusing in multiple sclerosis can be classified into five (a-e) mean patterns, where the individual bands lie very close together. However, in some patients with verified or probable multiple sclerosis conspicuous bands are found. The electrofocusing patterns from 28 such cases were compared with those reported by Kjellin and Vesterberg and with 20 cases of verified multiple sclerosis collected by chance. Differences were found with regard to the frequency of the different mean patterns, the occurrence of a double fraction in region '5', a single fraction in region '7' and a highly alkaline fraction. The electrofocusing findings have been compared with the clinical data of the 28 patients. There seems to be some correlation between the patterns of conspicuous bands and the duration and course of the disorder as well as probable sites of the CNS lesions. No indication was found, that either a high CSF gamma-globulin value and/or in a high degree of barrier damage was a prerequisite for the occurrence of conspicuous bands in the CSF gamma-globulin region. The aberrant electrofocusing patterns might be genetically determined or caused by some unusual agents (possible viral) or autoimmune reactions, modified by other than gentically divergent factors.

Cerebrospinal Fluid Proteins

[The pathogenesis of multiple sclerosis. Cytotoxic antibodies against myelin sheath tissue in multiple sclerosis].

Cytotoxic antibodies to myelin can be demonstrated by the method of 51Cr-release from chick erythrocytes coated with myelin basic protein. The cytotoxic antibody is inactivated by heating to 56 degrees C and needs complement in order to exert its action. The antibody was determined as IgM and IgG. It has relative specifity and shows cross-reaction with other basic proteins. The cytotoxic antibody was found in only 8% of healthy persons. Patients with multiple sclerosis were positive in 87% of the cases and in acute cases in 94%. In other neurological diseases cytotoxic antibody was present in 64%. The occurrence of cytotoxic antibody to myelin protein is not specific for a particular neurological disorder, especially not for multiple sclerosis. Cytotoxic antibodies arise as a secondary phenomenon, they are not the cause of the disease involved. They appear to be suitable, however, to determine, in association with cellular immunological reactions against myelin which may be regarded as the "primary" immunological processes, the demyelination process in the multiple sclerosis focus.

Antibody Specificity

Jejunal immunopathology in amyotrophic lateral sclerosis and multiple sclerosis. Identification of viral antigens by immunofluorescence.

Jejunal mucosa from 7 patients with amyotrophic lateral sclerosis (A.L.S.), 20 newly reported patients with multiple sclerosis (M.S.), and 35 control patients without either disease was studied by immunofluorescence. An immune reaction was present in all A.L.S. specimens and consisted of altered ratios of immunoglobulin-labelled cells in the lamina propria, complement-labelled cells in the same location, and, in some, immunoglobulin and complement deposits in the epithelial basement membrane. Poliovirus antigen was detected in 4 cases, and in 1 of the these cases measles antigen was also present. A fifth specimen showed large amounts of herpesvirus antigen. In 2 cases studied at necropsy, both viral infection and immunological change was confined to the proximal jejunum. Measles antigen was identified in every case of M.S., and in biopsy specimens from 16 of the 20 M.S. patients immunological reactions similar to those seen in A.L.S. were present. With 2 exceptions, the controls did not show these changes in the jejunal mucosa. The exceptions were a patient with Friedreich's ataxia, who had an increase of IgG-labelled cells and some complement-bearing cells in the lamina propria, and a patient diagnosed as having non-tropical sprue, in whom large quantities of herpes antigen were seen.

Amyotrophic Lateral Sclerosis

Effect of birthplace on the development of amyotrophic lateral sclerosis and multiple sclerosis. A study among Finnish war evacuees.

After World War II the southeastern part of Finland was ceded to the Soviet Union and its entire population evacuated to other areas of the country. The prevalences of amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) were studied among the evacuees and compared to the corresponding data among the nonevacuated population. The prevalence of ALS among the war evacuees was two times higher than among the nonevacuated population (18.0 and 8.8 per 100,000, respectively). The prevalence of MS among the evacuees was only half of that found among the nonevacuated population, 38.3 and 73.0 per 100,000, respectively. The findings for ALS indicate that birthplace may have an effect on the later development of the disease and that there may have existed some environmental factor(s) which have made the evacuees more liable to contract the disease later in their lives. The low figure of MS for evacuees supports our previous results of an uneven geographic distribution of MS in Finland with the high-risk areas in the western and southwestern parts of the country. No accumulation of MS was found among the evacuees living in the high-risk areas.

Amyotrophic Lateral Sclerosis

[Serum antibodies to cytoplasmic antigens of the human brain in patients with multiple sclerosis and amyotropic lateral sclerosis].

In order to eliminate antibodies to water soluble proteins of the human brain which were preliminary divided into 10 fractions of DEAE-cellulose, the authors studied the serum of 30 patients with disseminated sclerosis and 30 patients with lateral amyotrophical sclerosis and determined their antithymic serum activity. The antibides were detected only to protein fractions 1,2 and 10. There was a tendency towards a more frequent detection of antibodies with an increase of the severity of the disease. It was not possible to determine antibodies with an increase of the severity of the disease. It was not possible to determine any correlation between the amount of antibodies and such clinical indices as the degree of severity, duration, form of the disorder, age and sex of the patients. The cytotoxic index of the patients was significantly higher than that in normals. The authors also found a correlation between the antibodies in the serum cytoplasmatic brain proteins and antithymic activity of the same sera.

Adolescent

Efficacy and toxicity of cyclosporine in chronic progressive multiple sclerosis: a randomized, double-blinded, placebo-controlled clinical trial. The Multiple Sclerosis Study Group.

Patients with clinically definite multiple sclerosis, mild to moderately severe neurological disability (entry score on the Expanded Disability Status Scale (EDSS) between 3.0 and 7.0), and a progressive course defined by an increase in the EDSS of between 1 and 3 grades in the year prior to entry were randomized to receive either cyclosporine (n = 273) or placebo (n = 274) in a 2-year, double-blinded, multicenter trial. Treatment groups at entry proved balanced for age, gender, duration of illness, and neurological disability. Cyclosporine dosage was adjusted for toxicity and a median trough whole-blood level was maintained between 310 and 430 ng/ml. The mean increase in EDSS score was 0.39 +/- 1.07 grades for cyclosporine-treated patients and 0.65 +/- 1.08 grades for placebo-treated patients from entry until the time of early withdrawal or completion of the study (p = 0.002). Of three primary efficacy criteria, cyclosporine delayed the time to becoming wheelchair bound (p = 0.038; relative risk, 0.765), but statistically significant effects were not observed for "time to sustained progression" or on a composite score of "activities of daily living." Active treatment did have a favorable effect on several secondary measures of disease outcome. A large and differential withdrawal rate (44% for cyclosporine-treated patients, 32% for placebo-treated patients) complicated the analysis but did not appear to explain the observed effect of cyclosporine in delaying disease progression. Multivariate analysis did not show institutional effects but did demonstrate substantial effects of baseline neurological disability on outcome. Nephrotoxicity and hypertension were common troublesome toxicities and accounted for most of the excess loss of patients in the cyclosporine arm of the study. Thus, chronic cyclosporine therapy was associated with a statistically significant but clinically modest delay of progression of disability in a group of patients with multiple sclerosis selected for moderately severe and progressive disease. Close supervision by physicians familiar with cyclosporine is mandatory to minimize known adverse effects, particularly nephrotoxicity, when considering the use of this immunosuppressant.

Adult

Biochemical findings in multiple sclerosis IV. Isoelectric focusing of the CSF gamma globulins in multiple sclerosis (262 cases) and other neurological diseases (272 cases).

Despite enormous efforts to find a specific laboratory test for multiple sclerosis, agar gel electrophoresis of the CSF proteins has remained the next to the best one. This study presents evidence that thin layer polyacrylamide isoelectric focusing of the CSF gamma globulins is by far superior for this purpose. In effect, about 91% of the 262 multiple sclerosis patients studied had oligoclonal fractions present in the very alkaline region of the pH gradient. Of the same group of patients only 65% did show pathological results when studied by agar gel electrophoresis. Of the 272 CSF samples from patients suffering from other neurological diseases, only about 7% showed the presence of oligoclonal bands in the same region of the pH gradient, when submitted to isoelectric focusing.

Adolescent