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Biomedical subjects

E Havrdová

Publications and source records attributed to E Havrdová.

13 recordsLinked to original sources
PubMed2005

[Uvetitis and multiple sclerosis].

AIM: To evaluate the type of uveitis, the time of the duration between the first ocular signs and establishing of the diagnosis of multiple sclerosis (MS), effect of the treatment, and the final visual acuity (VA). METHODS: In a retrospective study, medical records of 41 patients (82 eyes) from the total of 1267 patients with uveitis treated at the Center for uveitis diagnosis and treatment at the Department of Ophthalmology of the Faculty Hospital and 1st Medical faculty, Charles University in Prague, Czech republic, during the period 1986-2003 were evaluated. The cohort consisted of 32 females and 9 males, mean age of 27 years (8-46 years). The mean follow-up period was 8 years (1-17 years). RESULTS: The cohort consisted of 41 patients (82 eyes), 32 females and 9 males. The mean age at the beginning of the uveitis was 27 years, at the time of the diagnosis of the MS 29.5 years. In 19 patients the starting of the uveitis preceded the manifestation of the systemic disease. In 23 patients, the uveitis was the first manifestation of MS. The most common type of uveitis in patients with MS was the intermediate uveitis (IMU) and vasculitis of retinal vessels. In 82% of patients, we were able during the follow-up period to stabilize the VA, or even to improve it. The systemic immunosuppressive treatment was necessary in 83 % of patients. SUMMARY: The MS was the second most common systemic disease in uveitis patients. It is necessary to follow-up young patients with unclear etiology of IMU or vasculitis, because the systemic disease may develop even few years after the first sings of uveitis. The collaboration between the neurologist and the ophthalmologist is of a great importance.

Adolescent↗
PubMed2005

[Future possibilities of the multiple sclerosis treatment].

Multiple sclerosis is an autoimmune disease of the central nervous system. Pathogenetic mechanisms involve inflammation and neurodegeneration leading to myelin sheaths destruction and irreversible nerve fibre loss. At present mainly the inflammatory part can be influenced and undoubtedly only the earliest beginning of the treatment can effectively postpone irreversible disability. High-dose corticosteroids remain the "gold standard" in MS attack treatment. Interferon beta and glatiramer acetate represent disease modifying drugs. Both of these medicaments decrease the number of attacks for about 30 %, however each patient responds differently. In many cases new attacks appear and it is necessary to intensify the treatment--to add immunosuppresives, to use combinations of steroid and cytostatic treatment. Intravenous immunoglobulins represent second line treatment. In the case of rapid disease progression immunoablation and stem cells transplantation is available. From recently tested drugs the most successful was the monoclonal antibody natalizumab. Unfortunately because of serious adverse effects in patients treated by combination of interferon beta + natalizumab, the application has been stopped. Monoclonal antibody against inteleukin 12 and chemokine receptor CCR2, cytostatics fumarate, laquinimod and cladribine are also tested in the clinical studies. DNA vaccination represents revolutionary opportunity of inducing tolerance against myelin autoantigens.

Humans↗
PubMed2005

Advanced glycoxidation end products in patients with multiple sclerosis.

Advanced glycoxidation end products (AGEs) play an important role in the pathogenesis of neurodegenerations and we studied if AGEs could represent a useful marker in patients with multiple sclerosis (MS). AGE-products were assessed in cerebrospinal fluid (CSF) and serum of 31 patients with MS and 8 controls. We did not find any statistically significant differences in patients with MS and controls either in CSF or in serum. We have observed a significant association between pentosidine and total AGEs as well as a relationship of both to the protein content in CSF in MS patients. Despite of the involvement of both oxidative stress and RAGE (receptor for AGEs) in the pathogenesis of MS and its experimental model, neither pentosidine nor total AGE were shown as useful markers in this indication. Other compounds and ligands of RAGE are probably of higher significance in MS.

Adult↗
PubMed2003

[Multiple sclerosis and magnetic resonance].

Multiple sclerosis is a demyelinating process presently referred to autoimmune diseases. Its diagnostics is based on clinical examination and paraclinical tests (magnetic resonance, examination of CSF and evoked potentials recording). Magnetic resonance (MR) has the highest significance, both for the diagnostics and for the monitoring of the course of disease and results of treatment. Results of magnetic resonance are not specific for the multiple sclerosis and therefore for the reliable diagnosis the McDonadl's criteria have to be fulfilled. It appears that magnetic resonance is more sensitive to progression of disease than the clinical examination. Monitoring of the course of disease requires new techniques of MR imaging. Automatic, software assisted determination of plaque volumes in T2 and T1 weighted images--so called "lesion load", is checked during the patient's treatment. Assessment of brain volume determines progression of atrophy. The aim of all the new methods of MR imaging is to search for a reliable technique of the disease monitoring and namely for the prediction of disease progression.

Brain↗
PubMed2000

[Hematopoietic stem cell transplantation in autoimmune diseases in rheumatology practice].

Autoimmune diseases (AID) result from the impairment of the effector and/or recognition phase of the immune response. The autoimmune process plays a crucial role in the pathogenesis of the systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), and their treatment is therefore largely based on immunosuppression. However, some patients do not respond to its standard doses. The disease becomes intractable with the survival rate comparable to that of some haematological malignancies, or patients become soon handicapped with very poor quality of life, depending on continual administration of high doses of steroids. The new hope for those patients becomes therapy with high dose myelo- and immuno-ablative chemotherapy with autologous hematopoietic progenitor cell support (PBPC). Tens of patients with intractable forms of AID were transplanted in the pilot clinical studies with promising results. The most frequent indications included: SLE, SSc, and RA. Final conclusion of the therapeutic effects will be drawn from the analysis of larger trails.

Arthritis, Rheumatoid↗
PubMed2000

[Immunoablation and hematopoietic stem cell transplantation in the treatment of multiple sclerosis].

High dose chemotherapy with autologous hematopoietic cell support is a standard approach in the management of selected hematological malignancies. Autoimmune diseases which do not respond to conventional immunosuppression might benefit from high dose immunoablative chemotherapy. The transplantation of hematopoietic cells is necessary after the high dose chemotherapy to restore bone marrow function. The immune system undergoes a new ontogeny which can result in the development of tolerance. Multiple sclerosis (MS) has so far been the most common indication for this kind of treatment. Experience with preclinical studies on murine experimental allergic encephalomyelitis (EAE), as well as the course of MS following bone marrow transplantation for coincidental malignancy in humans formed the basis of the first clinical studies involving high dose chemotherapy and autologous hematopoietic support. Results of the first studies confirm that the method is feasible in patients with MS, and that the effect is very promising. Nonetheless, more consistent results vis a vis the therapeutic effect should emanate from upcoming studies.

Hematopoietic Stem Cell Transplantation↗
PubMed2000

Occurrence of IgA and IgG autoantibodies to calreticulin in coeliac disease and various autoimmune diseases.

Calreticulin (CRT), a high-affintiy calcium binding protein and chaperone, was recently identified as one of the targets of autoantibodies in coeliac disease. We evaluated the level of IgA and IgG antibodies to CRT in sera from patients with coeliac disease and various autoimmune diseases. The level of antibodies to gliadin (shown previously to cross-react with CTR), isolated enterocytes and tissue transglutaminase were determined for comparison. The mean level of IgA antibodies to CRT was significantly higher (P< 0.001) in sera from coeliac patients with active disease (139.9+/-11.2 AU/+/-SE) than in healthy controls (20.9+/-1.7 AU). In sera of patients with systemic lupus erythematosus (SLE), insulin dependent diabetes mellitus (IDDM), multiple sclerosis (MS) and autoimmune thyroiditis (AT) or inflammatory bowel disease (IBD) the mean level (25.8+/-3.7 to 38.1+/-5.6 AU) did not exceed the cut-off value. A low level of these antibodies, however, was detected in some sera of patients with MS and IBD. The level of IgG anti-CRT antibodies was increased in coeliac patients (mean 125.4+/-8.0 AU, P< 0.001) when compared to that in healthy controls (33.9+/-2.3 AU). The IgG anti-CRT antibodies were also detected in about 30% of SLE patients sera (54.1+/-3.6 AU, P< 0.001), but the mean level reached only half that detected in coeliac patients.

Adolescent↗
PubMed2000

High-dose immunosuppressive therapy with PBPC support in the treatment of poor risk multiple sclerosis.

High-dose immunoablative chemotherapy with autologous haematopoietic cell support might be beneficial in the treatment of intractable forms of MS. We mobilised PBPC in 11 patients with secondary progressive MS and finally eight patients were grafted after high-dose BEAM chemotherapy with either in vitro or in vivo T cell depletion. Median EDSS and SNRS scores at the time of inclusion were 6.5 (6.5-7.5) and 56 (44-65), respectively. PBPC mobilisation was safe with no serious adverse effects, and without significant aggravation of disability. One patient improved significantly (by 1.0 point on EDSS) after the mobilisation. Two mobilisation failures were observed. No life-threatening events occurred during the transplantation. All grafted patients, except one, at least stabilised their disability status. One patient improved significantly (by 1.5 points on EDSS), two patients improved slightly (by 0.5 points on EDSS), one patient worsened by 1.0 point on the EDSS in 10 months. Improvement occurred with a delay of 2-4 months. Median EDSS and SNRS of grafted patients at the last follow up were 6.5 (5.5-8.5) and 64 (39-73), respectively with median follow-up of 8.5 months. Further follow-up is needed to determine the disease course after complete immune reconstitution. Bone Marrow Transplantation (2000) 25, 525-531.

Adolescent↗
PubMed1999

Huntington's disease: the relationship between clinical signs, CAG repeats and the atrophy of the caudate nucleus in CT scans.

We compared clinical data from 45 patients with Huntington's Disease (HD) with CAG triplet repeats and the planimetric measurement of the caudate nucleus head area (CNHA) in CT scans. The mean age of patients was 50.4 yrs (SD +/- 10.2), the mean duration of HD 7.4 yrs (4.6), the mean age at the onset of HD 43.1 yrs (11.1). HD started with motor symptoms in 28 patients, with psychiatric symptoms in 14 patients, the history was unknown in 3 patients. The paternal transmission was observed in 29 patients, the maternal one in 12 patients, unknown in 4 patients. The mean number of CAG repeats was 46.6 (6.1). The mean CNHA was 0.4 cm2 (0.1). We found statistically significant reversed correlation between CAG repeats and the age at the onset of HD (p < 0.0001, r -0.6). The earlier onset of HD in patients with the paternal transmission compared to the maternal one was found statistically significant (p < 0.05). This phenomenon was not related to the larger number of CAG triplets in patients with the paternal transmission. No differences either of the age at the onset of HD or numbers of CAG repeats were found between subgroups of HD patients starting with motor or psychiatric symptoms. We also observed the significant reversed correlation between the duration of HD and CNHA measurement (p < 0.001, r -0.5). Even in the earliest stage of HD patients showed the marked atrophy of CNHA.

Atrophy↗
PubMed1996

[The CT image of atrophy of the head of the caudate nucleus in Huntington's chorea].

BACKGROUND: The aim of the study was to measure, using computed tomography (CT), the head of caudate nucleus in Huntington's disease (HD) and in controls in order to verify, whether differences in results have a diagnostic value. METHODS AND RESULTS: We measured using CT (orbitomeatal line, 5 mm slices), the head of caudate nucleus are a (HCNA), bifrontal distance (BFD: maximum distance between frontal horns of lateral ventricles), bicaudate distance (BCD: minimum distance between heads of caudate nuclei) and calculated an index (BCD/BFD) in 12 HD patients (mean age 44.6 yrs (SD: 8.8), mean duration of HD 3.6 yrs (2.5), and in 18 age matched healthy controls. We found in HD patients mean HCNA 0.40 cm2 (SD: 0.12) (min. 0.14 cm2, max. 0.55 cm2), in controls 1.20 (0.1) (1.06, 1.45). Mean BFD in HD patients was 3.99 cm (0.37), (3.31, 4.48) and in controls 3.55 (0.45) (2.84, 4.76). Mean BCD in HD patients was 2.74 cm (0.44) (2.06, 3.44) and in controls 1.55 (0.50) (0.79, 2.70) and mean BCD/BFD index in HD patients 0.68 (0.06) (0.59,0.77), and in controls 0.43 (0.10) (0.25, 0.59). The group statistics revealed the significant difference between HD patients and controls: HCNA (p < 0.0001), BFD (p < 0.01), BCD (p < 0.0001) and BCD/BFD index (p < 0.0001). When dealing with individual values, only HCNA shows no overlapping of values between HD patients and controls. CONCLUSIONS: CT linear measurement of HCNA is a simple and specific tool for the diagnosis of HD.

Adult↗