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Biomedical subjects

A Florescu

Publications and source records attributed to A Florescu.

At least 19 recordsLinked to original sources
PubMed2005

Treatment of knee osteoarthritis with pulsed electromagnetic fields: a randomized, double-blind, placebo-controlled study.

OBJECTIVE: The investigation aimed at determining the effectiveness of pulsed electromagnetic fields (PEMF) in the treatment of osteoarthritis (OA) of the knee by conducting a randomized, double-blind, placebo-controlled clinical trial. DESIGN: The trial consisted of 2h daily treatment 5 days per week for 6 weeks in 83 patients with knee OA. Patient evaluations were done at baseline and after 2 and 6 weeks of treatment. A follow-up evaluation was done 6 weeks after treatment. Activities of daily living (ADL), pain and stiffness were evaluated using the Western Ontario and McMaster Universities (WOMAC) questionnaire. RESULTS: Within group analysis revealed a significant improvement in ADL, stiffness and pain in the PEMF-treated group at all evaluations. In the control group there was no effect on ADL after 2 weeks and a weak significance was seen after 6 and 12 weeks. Significant effects were seen on pain at all evaluations and on stiffness after 6 and 12 weeks. Between group analysis did not reveal significant improvements over time. Analysis of ADL score for the PEMF-treated group revealed a significant correlation between less improvement and increasing age. Analysis of patients <65 years using between group analysis revealed a significant improvement for stiffness on treated knee after 2 weeks, but this effect was not observed for ADL and pain. CONCLUSIONS: Applying between group analysis we were unable to demonstrate a beneficial symptomatic effect of PEMF in the treatment of knee OA in all patients. However, in patients <65 years of age there is significant and beneficial effect of treatment related to stiffness.

Activities of Daily Living↗
PubMed2005

[Shoulder function and scores in 180 asymptomatic individuals aged over 75 years].

PURPOSE OF THE STUDY: The purpose of this study was to define the normal shoulder in patients aged over 75 years and to look for correlations between general health, mental status and shoulder function. MATERIALS AND METHODS: Shoulder motion, rotator cuff strength and abnormal movements were evaluated in 180 subjects over 75 without surgical history involving the shoulder. Body mass index (BMI) was determined for each subject. The Simple Shoulder Test (SST) was performed and the Constant and Murley score was calculated for each shoulder. The Beck test was used to assess depression. When joint function was impaired, supplementary x-ray and ultrasound examinations were performed. RESULTS: Asymptomatic pathological features (rotator cuff tears, stiffness, degenerative joint disease) were identified in 56% of the shoulders. Only 44% of the shoulders were free of pathological features. 56.4% of rotator cuff tears were found in the dominant shoulder; 13.9% of subjects had bilateral degenerative joint disease; 23.3% had bilateral stiffness. There were many associated conditions: cardiovascular (33%), pulmonary (28%), gastrointestinal (25.6%), diabetes (12.2%), tumors (10.6%). 18.3% of the subjects were depressive and 14.4% were taking treatment for depression. Shoulder motion and strength were correlated with BMI and nutritional status. Thin subjects (BMI < 20) had more rotator cuff tears. Obese subjects (BMI > 29.9) had more degenerative joint disease and joint stiffness. Demand for treatment and examinations were greater among depressed subjects. DISCUSSION AND CONCLUSION: Shoulder function is compatible with normal lifestyle in subjects over 75, corresponding to their desires and expectations. Shoulder function is correlated with body mass index and mental status. We should carefully assess shoulders in elderly subjects because good shoulder function, even if impaired, is often compatible with moderate stiffness, mild osteoarthritis, and rotator cuff tears, with no particular need for surgery.

Age Factors↗
PubMed2001

Serum levels of parathyroid hormone and markers of bone metabolism in patients with rheumatoid arthritis. Relationship to disease activity and glucocorticoid treatment.

OBJECTIVE: To evaluate the influence of inflammatory activity and glucocorticoid (GC) treatment on serum parathyroid hormone (s-PTH) and bone metabolism in patients with rheumatoid arthritis (RA). Furthermore, in patients with active RA, to examine the PTH secretion and Ca2+ set point before and after treatment with GC. METHODS: A range of biochemical markers of bone metabolism and calcium homeostasis were measured in 95 patients with definite RA stratified into groups according to disease activity and GC treatment. In a subgroup of 12 patients with active disease, initiating slow-acting-anti-rheumatic-drugs (SAARDs) +/- GC, the PTH secretion and calcium set point were evaluated by use of the Cica clamp technique before and after 1 month of treatment. RESULTS: S-osteocalcin, s-total alkaline phosphatase (s-TAP) and s-carboxyterminal cross-linked telopeptide of type I collagen (s-ICTP) were elevated in all groups. The levels of urine pyridinoline (Pyr) and s-albumin-corrected calcium (s-AlbCorrCa2+) were elevated in patients with active disease and patients treated with GC. S-PTH and s-phosphate were within normal ranges. S-TAP, s-ICTP, Pyr and s-AlbCorrCa2+ correlated positively with indices of disease activity. In the subgroups undergoing the Cica clamp technique, no difference in PTH responsiveness of B-Ca2+ was unveiled. CONCLUSION: Neither active disease nor GC therapy appears to induce secondary hyperparathyroidism, nor is there an alteration in PTH responsiveness of B-Ca2+ in patients with RA. The increased levels of markers of type I collagen metabolism (s-ICTP, Pyr) and s-AlbCorrCa2+ in patients with active disease and patients treated with GC may be a result of increased degradation in synovium, cartilage and bone due to the inflammatory process.

Anti-Inflammatory Agents↗
PubMed1999

Serum YKL-40 concentrations in patients with rheumatoid arthritis: relation to disease activity.

OBJECTIVE: YKL-40, also called human cartilage glycoprotein-39, is secreted by chondrocytes, synovial cells, macrophages and neutrophils. Studies have shown that YKL-40 is an autoantigen in rheumatoid arthritis (RA). We evaluated whether serum YKL-40 was related to disease activity in patients with RA. METHODS: Serum YKL-40 was determined by radioimmunoassay in 156 patients with RA during a 1 yr longitudinal study. RESULTS: Serum YKL-40 was increased in 54% of the patients with clinically active disease. Patients with clinically active disease initially who became inactive after 12 months had a significant decrease in serum YKL-40 (-30%, P < 0.002) and patients who changed from inactive to active disease had an increase in serum YKL-40. Patients who remained active had unchanged serum YKL-40 during the study. Serum YKL-40 decreased rapidly (-24% after 7 days, P < 0.01) during prednisolone therapy, and more slowly in patients treated with methotrexate only (-15% after 60 days, P < 0.01). Patients with early RA (disease duration < 3 yr, n = 50) and a persistently elevated serum YKL-40 were at risk of radiological disease progression as determined by Larsen score. CONCLUSION: Serum YKL-40 varies according to disease activity in RA, but provides in some respect information different from conventional markers. Our previous studies are consistent with a local release of YKL-40 in the arthritic joint followed by a secondary increase in serum YKL-40. YKL-40 may prove to be a new tool for the study of disease activity and pathophysiology of RA.

Adipokines↗
PubMed1999

A randomised trial of differentiated prednisolone treatment in active rheumatoid arthritis. Clinical benefits and skeletal side effects.

OBJECTIVES: To study benefits and skeletal side effects of carefully monitored prednisolone treatment in patients with active rheumatoid arthritis. METHODS: One hundred and two patients with active rheumatoid arthritis were randomly allocated to treatment with disease modifying anti-inflammatory drug (DMARD) alone or DMARD and prednisolone in a one year follow up study. Prednisolone was given in a dose regimen adapted to the disease activity of the individual patient. The mean dose was 6 mg and the mean cumulated dose was 2160 mg. Patients were followed up with disease activity parameters, radiograph of the hands (Larsen score), and bone mineral density (BMD) of the lumbar spine, distal forearm and hand. At one year 26 patients had withdrawn from the investigation leaving 76 patients for evaluation. RESULTS: The results showed that disease activity in the prednisolone treated group was reduced within two weeks. In the DMARD alone group disease activity was gradually reduced over months. At six months there was no difference between the groups as evaluated by an improvement score using a number of ACR criteria. Prednisolone in the present set up was not able to protect significantly against radiological disease progression, although there was a trend towards less progression in Larsen score in the prednisolone group, a matter that was further underlined in an intention to treat analysis. BMD data revealed a significant reduction in spinal BMD in the prednisolone group, whereas prednisolone seemed to have a protective effect against bone loss in the hand and distal forearm. CONCLUSIONS: This study does not allow any firm conclusions for or against the treatment of rheumatoid arthritis with prednisolone. The data suggest that the beneficial effects of prednisolone are not as clear cut in established rheumatoid arthritis as in early disease. Furthermore the data indicate that treatment in the chosen relatively low dose does not provide sufficient control of disease. On the other hand the spinal bone loss observed in the prednisolone group does invite considerations about using higher doses.

Adult↗
PubMed1996

Bone loss in rheumatoid arthritis. Influence of disease activity, duration of the disease, functional capacity, and corticosteroid treatment.

Axial and appendicular bone mass were studied in 95 patients with rheumatoid arthritis. The aims were to quantify bone mineral density (BMD) and to evaluate the importance of disease activity, duration of disease, functional capacity, and corticosteroid treatment for bone loss in patients with rheumatoid arthritis. The BMD in the lumbar spine (BMDSPINE) did not differ from age-matched healthy controls, but distal forearm BMD (BMDARM) and metacarpal BMD (BMDMCB) were significantly lower in the patients (p < 0.01 and p < 0.001, respectively). Neither BMDSPINE nor BMDMCB were related to the disease activity at the time of investigation. By contrast, BMDARM was decreased in patients with active disease. BMD in any of the three measured locations was not directly correlated to duration of the disease. However, the bone mass in the appendicular skeleton was already decreased within the first two years after the start of the disease. The overall functional capacity in terms of physical activity increased BMD in the axial skeleton. The local functional capacity in terms of grip strength was positively related to BMD in the appendicular skeleton. Patients with severe functional impairment had the lowest BMDARM. The decreased BMD in patients with rheumatoid arthritis seems primarily to be caused by an impaired physical activity which may be related to disease activity. Corticosteroids did not decrease BMD in neither the axial nor the appendicular skeleton. The antiinflammatory effect of steroids lead to clinical improvement, which may counteract the expected negative effect of these drugs on bone in rheumatoid arthritis.

Absorptiometry, Photon↗
PubMed1995

Cytokine autoantibodies in rheumatoid arthritis.

Sera from 42 patients with rheumatoid arthritis (RA) and 40 healthy controls (HC) were examined for cytokine autoantibodies (CK-aAb) by accurate and sensitive radioimmunoassays. The prevalences of detectable CK-aAb in RA (HC) were: aAb-IL-1 alpha = 36% (38%); aAb-IL-6 = 29% (13%), p = 0.06; aAb-IL-8 = 0% (0%); aAb-IFN alpha = 12% (3%), p = 0.11. The levels of the individual CK-aAb did not correlate, and there were no correlations between CK-aAb levels and clinical or laboratory variables. CK-aAb levels remained constant in 8 RA patients tested over a period of 6 months. With regard to alterations in aAb-IL-1 alpha levels, 4/11 HC were consistently positive over 18-36 months; 2/11 converted and became highly positive. The levels of aAb-IFN alpha and aAb-IL-6, but not aAb-IL-1 alpha, tended to be increased in RA patients; aAb-IL-8 were undetectable in both RA and HC.

Adult↗
PubMed1982

Peripheral neuropathy with a syndrome of continuous motor unit activity.

A chronic alcoholic who had also been submitted to partial gastrectomy developed a syndrome of continuous motor unit activity responsive to phenytoin therapy. There were signs of minimal distal sensorimotor polyneuropathy. Symptoms of the syndrome of continuous motor unit activity were fasciculation, muscle stiffness, myokymia, impaired muscular relaxation and percussion myotonia. Electromyography at rest showed fasciculation, doublets, triplets, multiplets, trains of repetitive discharges and myotonic discharges. Trousseau's and Chvostek's signs were absent. No abnormality of serum potassium, calcium, magnesium, creatine kinase, alkaline phosphatase, arterial blood gases and pH were demonstrated, but the serum Vitamin B12 level was reduced. The electrophysiological findings and muscle biopsy were compatible with a mixed sensorimotor polyneuropathy. Tests of neuromuscular transmission showed a significant decrement in the amplitude of the evoked muscle action potential in the abductor digiti minimi on repetitive nerve stimulation. These findings suggest that hyperexcitability and hyperactivity of the peripheral motor axons underlie the syndrome of continuous motor unit activity in the present case.

Alcoholism↗
PubMed1980

Clinical and electrophysiological studies of carbon disulphide polyneuropathy.

A clinical and electrophological study was performed on 30 patients with chronic carbon disulphide poisoning. Although the measurements of motor conduction velocity and of terminal latency were within the normal range in the subclinical stage, estimation of nerve excitability threshold showed distal motor hypoexcitability, thus proving a very effective means for the early detection of carbon disulphide polyneuropathy. The distal muscle fatigue found in 35% of patients was confirmed by the decrement (more than 10%) in the amplitude of muscle evoked potentials in the abductor digiti minimi muscle in response to repetitive stimulation of the ulnar nerve. Association of the above findings with the significant electrophysiological changes, viz., decrease in the amplitude of sensory evoked potentials on stimulation of the digital fibres, mild slowing of sensory conduction velocity in the peripheral nerves, and decrease in the amplitude of evoked potentials in the distal muscles, suggest that the carbon disulphide polyneuropathy would be underlain by a primary distal axonopathy.

Adult↗
PubMed1980

Clinical and electrophysiological study of neuropathy after organophosphorus compounds poisoning.

Clinical and electrophysiological examinations were performed on 12 patients with toxic neuropathy following accidental ingestion of alcohol polluted by triorthocresyl phosphate (TOCP). Concurrent PNS and CNS lesions were found in all patients. Two to three months after ingestion, five of them showed prevalent signs of mixed, sensorimotor polyneuropathy, especially motor and distal, and the electrophysiological data pointed to the mixed process of axonal degeneration and secondary demyelination. In two of these five patients in whom examinations were repeated 13 years after TOCP ingestion, there was a marked clinical and electrophysiological improvement of signs of PNS lesions. Improvement of signs of CNS lesions was very poor even after 13 years. Signs of CNS lesions prevailed in the remaining seven patients. The clinical picture resembled that in amyotrophic lateral sclerosis and the electrophysiological data suggested a neuronal and axonal degeneration. Apart from the 12 cases of TOCP neuropathy, we also studied two cases of poisoning with organophosphorus insecticides, Dipterex and Divipan, in which a pure motor form of neuropathy was found.

Adult↗
PubMed1978

Electroneurographic evidence of polyneuropathy in chronic liver disease.

An electroneurographic study performed on the peripheral nerves of 25 patients with severe cirrhosis following viral hepatitis showed slight slowing (P greater than 0.05) of motor conduction velocity (CV) and significant diminution (P less than 0.001) of sensory CV and mixed sensorimotor-evoked potentials, associated with a significant decrease in the amplitude of sensory evoked potentials. The slowing was about equal in the distal (digital) and in the proximal segments of the same nerve. A mixed axonal degeneration and segmental demyelination is presumed to explain these findings. The CV measurements proved helpful for an early diagnosis of hepatic polyneuropathy showing subjective symptoms in the subclinical stage.

Chronic Disease↗