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J Valverde

Publications and source records attributed to J Valverde.

At least 19 recordsLinked to original sources
PubMed2006

Erythrocytes dynamic viscoelasticity in beta-thalassaemia minor.

Beta-thalassaemia is a hereditary hemolytic disease, in which each clinic phenotype encompasses a heterogenic group of genetic alterations resulting in beta-globin chain synthesis decrease or absence in red blood cells. Studies on beta-thalassaemia carriers suggest the existence of decreased red cell deformability. The erythrocyte deformability in the blood stream is a well-known fact regarding blood circulation efficiency. Red blood cells may be considered to be viscoelastic and their behavior may be described according to complex viscoelastic parameters when they undergo oscillatory stresses. This dynamic behavior is physiologically important due to the in vivo pulsatile blood flow. The aim of the present work was to evaluate complex erythrocyte viscoelastic parameters in patients suffering from heterozygous beta-thalassaemia in comparison with healthy individuals. Our results reveal that even though thalassaemia erythrocytes show a decreased deformability in the stationary state, in a dynamic state, hemorheological alterations are only evident at low oscillatory frequencies, i.e., at lower frequencies in contrast with the normal heart rate (60 cycles/min = 1 Hz), producing no significant alterations at increased heart rate.

Anemia, Iron-Deficiency↗
PubMed2005

Adsorptive granulocyte/monocyte apheresis for the treatment of refractory rheumatoid arthritis: an open pilot multicentre trial.

OBJECTIVE: To assess the efficacy and safety of adsorptive granulocyte and monocyte apheresis (GCAP) in patients with refractory rheumatoid arthritis (RA). METHODS: Patients with active and refractory RA were treated with weekly GCAP sessions using a column filled with acetate beads (Adacolumn) over five consecutive weeks. Clinical assessments and response to therapy were analysed at weeks 5, 7, 12 and 20 in an open multicentre trial. The primary outcome measure of clinical response was 20% improvement in the American College of Rheumatology criteria (ACR20) at week 20. EULAR (European League Against Rheumatism) response criteria, based on the disease activity score for 28 joints (DAS28) and disability using the Health Assessment Questionnaire (HAQ), were also assessed. RESULTS: Of 27 patients, 81.5% were women with mean disease duration of 14.4 yr. The mean number of previous disease-modifying antirheumatic drugs (DMARDs) was 3.7, and 48.1% of patients had previously failed on biologicals. On an intention-to-treat basis, 40.7% of patients achieved an ACR20 and 44.4% a therapeutic EULAR response at week 20. These percentages were 50 and 54.5% in 22 patients who completed the trial. In the 10 completers who had previously failed on biologicals, an ACR response was achieved in four patients (ACR20, two; ACR50, one; ACR70, one). A significant decrease was recorded in different ACR response components, including the tender joint and swollen joint counts, pain score and patient and physician global disease assessments, as well as the DAS28 index; most of them improved after week 5. ESR and CRP, but not the HAQ score, had decreased significantly at week 20. The treatment was well tolerated and only one serious adverse event related to the study procedure was documented (sepsis due to a catheter infection). CONCLUSIONS: GCAP treatment led to significant clinical improvement in a subset of patients with RA who had failed to respond to DMARDs or biologicals. Further large, placebo-controlled studies are warranted to fully assess the therapeutic value of GCAP for refractory RA.

Adult↗
PubMed2005

Giant cell arteritis and polymyalgia rheumatica: usefulness of vascular magnetic resonance imaging studies in the diagnosis of aortitis.

OBJECTIVES: One of the unresolved challenges posed in giant cell (temporal) arteritis (GCA) is the detection and monitoring of large-artery complications, particularly aortitis. Recent investigations support vascular magnetic resonance imaging (MRI) studies in this issue. We report our preliminary experience with this imaging technique in the study of the aorta and its proximal branches in patients with GCA and/or polymyalgia rheumatica (PMR). METHODS: Between 2000 and 2003, six patients with GCA and/or PMR seen in our department were diagnosed with aortitis using vascular MRI studies. In all cases, the study was performed according to a specifically designed protocol that included MRI and MR angiography (MRA). RESULTS: MRI was a hepful non-invasive method for diagnosis of aortitis in all cases, providing accurate information about its extent. In particular, MRI had a higher ability to detect earlier stages of vasculitis disclosing subclinical aortitis in five of the six patients. The main signs of early vascular inflammation observed were vessel wall thickness and oedema (six cases) and increased mural enhancement on postcontrast T1-weighted images (four cases). MRA disclosed lumen changes (stenosis) in two patients. On follow-up studies, whereas vascular stenosis and vessel wall thickness remained invariable, vascular wall oedema and contrast enhancement improved significantly when disease activity decreased. CONCLUSION: MRI may be a useful technique for diagnosing patients with occult major artery involvement in GCA, whether presenting with classic symptoms of temporal arteritis or PMR. Its utility for monitoring the course of the disease and response to treatment requires further confirmation.

Aged↗
PubMed2003

Characterization of monoclonal antibodies against human red blood group cells antigens by laser backscattering.

A problem in immunohematology is to define the antibody quality which is related to its affinity expressed by the equilibrium constant. The activity of an antibody can be measured by the strength of its interaction, related to the adhesive energy exchanged during RBC agglutination which depends on the antigen-antibody liaison strength. To estimate this adhesive energy, two methods are used in this paper. Firstly, the dissociation behaviour of suspended RBC agglutinates was analysed by laser backscattering intensity (r) in a Couette flow. Backscattered intensity issued from shear-induced mechanical dissociation is recorded and submitted to a numerical process to obtain the energy parameter (ED). Secondly, a modification of this technique is proposed for measuring specific binding energy. Samples were exposed to increasing shear stress, and backscattered intensity was recorded. A constant increase of this intensity with raising shear stress was observed, pointed to a progressive dissociation of RBC agglutinates into smaller ones. Considering that complete dissociation of agglutinates is only approached asymptotically it is assumed that the final break-up of doublets (two-cell agglutinates) is produced at a critical shear stress (tauC) reflecting the work done to breaking-up the molecular bridges between both adjacent cells. This shear stress is defined by the extrapolation of the linear part of the curves [r-log tau] to the backscattered signal (r0) corresponding to the complete dispersion of RBCs. These approaches permit to define the specific surface adhesive energy (Gamma) by using the Derjaguin relation and to assess the functional characterization of specific immunoglobulins. In conclusion, two parameters characterizing monoclonal antibody agglutination properties, ED and Gamma, were estimated by laser backscattering methods, which could be very useful for antibodies quality control.

ABO Blood-Group System↗
PubMed2002

Light and electron microscopic analysis of liver biopsy samples from rheumatoid arthritis patients receiving long-term methotrexate therapy.

OBJECTIVE: We study liver damage in forty-two patients with rheumatoid arthritis (RA) using light (LM) and electron microscopy (EM) and assess histological changes after four years of treatment with methotrexate (MTX). PATIENTS AND METHODS: liver biopsies (LB) were taken before and after four years of treatment. Patients received weekly doses of between 7.5-15 mg of MTX. RESULTS: Fourteen per cent of the baseline LB presented mild perisinusoidal fibrosis (Roenigk IIIA) and the rest a lower Roenigk grade; EM identified an increase in collagen fibers in the Disse spaces in 50% of baseline LB. Neither microscopy technique revealed histological progression in any of the sequential LB. Variables that correlated with histological abnormalities were patient's age, length of evolution of the disease, alcohol consumption and biochemical data (gammaglutamate transferase and albumin); the cumulative dose of MTX was not correlated with worse histological findings. Correlation between the two microscopy techniques was good, though EM was more sensitive than LM for the detection of fibrosis. CONCLUSIONS: RA patients present with liver damage before treatment with MTX. The alterations are mild. At low doses MTX treatment is safe. In addition to the recommendations of the American College of Rheumatology, other factors associated with liver impairment are patient's age and length of evolution of the RA.

Adult↗
PubMed2002

Usefulness of bone densitometry in postmenopausal women with clinically diagnosed vertebral fractures.

OBJECTIVE: To analyse whether bone mineral density (BMD) assessment is required in postmenopausal women presenting with low trauma vertebral fracture. METHODS: Women with vertebral fracture diagnosed over a 10 year period were recruited from our database. The following were excluded: (a) patients with high energy trauma; (b) patients with malignancies; (c) patients with a metabolic bone disease other than osteoporosis. All postmenopausal women were included in whom BMD had been evaluated at both the lumbar spine and femoral neck by dual energy x ray absorptiometry during the six months after the diagnosis. Patients with a potential cause of osteoporosis other than age and menopause were not considered. A total of 215 patients were identified. RESULTS: The mean (SD) age of the patients was 65.9 (6.9) years. BMD at the lumbar spine was 0.725 (0.128) g/cm(2) and the T score was -2.94 (1.22); BMD at the femoral neck was 0.598 (0.095) g/cm(2) and the T score was -2.22 (0.89). The BMD of the patients was significantly lower than that of the general population at both the lumbar spine and femoral neck. When the lowest value of the two analysed zones was considered, six patients (3%) showed a normal BMD, 51 (23.5%) osteopenia, and 158 (73.5%) osteoporosis. The prevalence of osteoporosis at the femoral neck increased with age; it was 25% in patients under 60, 35% in patients aged 60-70, and 60% in patients over 70. CONCLUSION: These results indicate that bone densitometry is not required in postmenopausal women with clinically diagnosed vertebral fractures if it is performed only to confirm the existence of a low BMD.

Absorptiometry, Photon↗
PubMed2001

A comparative study of computed digital absorptiometry and conventional dual-energy X-ray absorptiometry in postmenopausal women.

The aim of the study was to evaluate whether computed digital absorptiometry (CDA) of the hand might be a useful screening technique for identifying patients with postmenopausal osteoporosis and to compare the results of CDA with those of dual-energy X-ray absorptiometry (DXA) of the lumbar spine and femoral neck. We studied 230 postmenopausal women (mean age 58.4 + 7.9 years). For CDA, bone mineral density (BMD) was measured with an AccuDEXA Schick densitometer in the third middle phalanx of the nondominant hand. For DXA, BMD of the lumbar spine and upper femur was assessed using a DXA Hologic QDR-1000 densitometer. We did a comparative analysis (ANOVA) and linear correlation tests. Sensitivity and specificity of CDA and receiver operating characteristic (ROC) curves for the diagnosis of osteoporosis were calculated. The mean BMD with CDA was 0.445 +/- 0.084 (T-score: -1.27 +/- 1.29). The mean BMD (g/cm2) with DXA at the lumbar spine was 0.877 +/- 0.166 (T-score: -1.52 +/- 1.59) and 0.708 +/- 0.127 at the femoral neck (T-score: -1.12 +/- 1.25). BMD at the lumbar spine and femoral neck correlated positively with CDA of the hand (r = 0.66 and r = 0.65 respectively, p<0.001). When using as cut-off a T-score of -2.5, according to WHO criteria, 76 women (33%) had osteoporosis of the lumbar spine and/or femoral neck with DXA and 42 (18%) with CDA (p<0.001). The kappa score for osteoporosis was 0.33 for CDA versus spinal DXA and 0.35 for CDA versus femoral DXA. With the cut-off level used, sensitivity and specificity of CDA in detecting osteoporosis at the lumbar spine were 0.39 and 0.90, respectively; sensitivity and specificity of CDA in identifying osteoporosis at the femoral neck were 0.58 and 0.87, respectively. The positive predictive value of CDA for osteoporosis was 69% and the negative predictive value was 75%. The area under the ROC curve for osteoporosis was 0.822 +/- 0.028. We conclude that: (a) CDA assessment has a moderate correlation with BMD measured by DXA at the lumbar spine and femoral neck; (b) CDA has a low sensitivity for the diagnosis of osteoporosis compared with spinal and femoral DXA; and (c) predictive values for osteoporosis at both the lumbar spine and femoral neck are acceptable.

Absorptiometry, Photon↗
PubMed2001

Nutritional status in patients with rheumatoid arthritis.

BACKGROUND: Some chronic diseases have been associated to an impairment of nutritional status. OBJECTIVE: To analyze nutritional status and its relation to dietary intake, disease activity and treatment in rheumatoid arthritis. PATIENTS AND METHODS: We have included 93 patients (43 men and 50 women) and 93 age- and sex-matched healthy controls. The assessment of nutritional status included anthropometric (body mass index, tricipital skin fold and midarm muscular circumference) and biochemical (serum albumin, prealbumin and retinol binding protein) parameters. Dietary intake was calculated from a food frequency questionnaire. As a measure of disease activity, we used the Health Assessment Questionnaire, Ritchie index, tender and swollen joint count and C-reactive protein. Statistical analysis was performed in the whole series and in every functional class. RESULTS: In the whole series, midarm muscular circumference and serum albumin were significantly lower in patients than in controls. All anthropometric parameters and serum albumin were significantly lower in patients in functional class IV than in their respective controls. The dietary intake of energy, carbohydrates, vegetal proteins and lipids was higher in patients than in controls. Midarm muscular circumference and serum albumin had a significant inverse relation with disease activity parameters; body mass index, midarm muscular circumference and serum albumin correlated inversely with the cumulative dose of glucocorticoids. CONCLUSIONS: Patients with rheumatoid arthritis in functional class IV have an impairment of nutritional status without a deficient dietary intake. The differences found in other functional classes are explained by rheumatoid arthritis itself. Nutritional parameters are related to disease activity and glucocorticoid treatment.

Age Distribution↗
PubMed2001

Value of clinical factors in selecting postmenopausal women with rheumatoid arthritis for bone densitometry.

OBJECTIVE: Criteria to decide which patients with rheumatoid arthritis (RA) should be examined by dual energy x ray absorptiometry (DXA) are currently not available. The rheumatologists from Amsterdam have proposed preliminary criteria based on clinical risk factors (age, disease activity, and functional status). These criteria are preliminary and not widely accepted but might be helpful in practice. The value of the proposal in a group of Spanish postmenopausal women with RA is analysed. METHODS: DXA (lumbar spine and femoral neck) was performed in 128 patients recruited from a clinical setting, and the proposed criteria were applied. T and Z scores were established for a Spanish reference population. RESULTS: The mean (SD) age of the patients was 61.3 (10.7) and mean duration of the postmenopausal period 14.5 (10.1) years. Mean duration of RA was 13.7 (7.7) years. Mean C reactive protein was 22 (21) mg/l; mean erythrocyte sedimentation rate 26 (18) mm/1st h; and mean Health Assessment Questionnaire score 1.25 (0.79). Ninety (70%) patients fulfilled the proposed criteria. Their sensitivity for the diagnosis of osteoporosis (T score < or =-2.5 SD) was 86% and their specificity, 43%. Positive predictive value was 54% and negative predictive value, 79%. CONCLUSIONS: The proposed criteria seem a good screening method for the selection of those patients with RA whose bone mineral density should be assessed as the sensitivity and negative predictive value are acceptable.

Absorptiometry, Photon↗
PubMed2001

Complete heart block in an adult with systemic lupus erythematosus and recent onset of hydroxychloroquine therapy.

Complete heart block (CHB) is a rare complication of systemic lupus erythematosus (SLE), mainly seen during an acute flare-up of the disease or after high-dose long-term treatment with antimalarial drugs, although anti-Ro and anti-RNP antibodies have also been implied by some authors. A 40-y-old woman developed CHB in the context of an acute flare-up of SLE, first diagnosed three years ago, having recently commenced hydroxychloroquine (HCQ) treatment. Anti-Ro and anti-RNP antibodies were also positive. No features of myocarditis were found. A temporary pacemaker was required and complete resolution was achieved on steroid therapy with withdrawal of antimalarial therapy. The characteristics of previous cases are well publicised and discussion focuses on the possible aetiology and pathogenesis of the present case.

Adolescent↗
PubMed2001

Osteoporotic vertebral fracture in clinical practice. 669 Patients diagnosed over a 10 year period.

OBJECTIVE: Few data are available on clinically diagnosed vertebral fracture. Information about osteoporotic vertebral fracture has mainly been obtained via inferences from epidemiological studies of vertebral deformity. We evaluated the characteristics of patients with osteoporotic vertebral fracture diagnosed in a rheumatology department over a 10 year period. METHODS: Patients with back pain and vertebral fracture diagnosed between January 1990 and December 1999 were recruited from our data base. Patients with high energy trauma, malignancies, and metabolic bone diseases other than osteoporosis were excluded. These variables were analyzed: sex, age at diagnosis, type of osteoporosis (primary vs secondary), number of fractures at diagnosis (single vs multiple), and percentage of admissions and length of stay. RESULTS: Of the 669 patients, 534 (80%) were women and 135 (20%) were men. Age at diagnosis ranged from 30 to 91 yrs, mean 67.1 +/- 9.1. Secondary osteoporosis was diagnosed in 177 (26%) patients and the frequency was significantly higher in men than women (55% vs 19%; p < 0.001); the most common associations for secondary osteoporosis were oral corticosteroids, chronic obstructive airway disease, and rheumatoid arthritis. At diagnosis, half of the patients presented with multiple fractures. One hundred twenty (18%) patients were admitted; length of stay ranged from 5 to 56 days, mean 15.9 +/- 7.7. The frequency of admissions was higher in men than women (27% vs 16%; p < 0.001), higher in patients with secondary osteoporosis than in those with primary osteoporosis (33% vs 12%; p < 0.001), and higher in patients with multiple fractures than in those with single fractures (27% vs 8%; p < 0.001). CONCLUSION: Characteristics of patients recruited from a clinical setting differ significantly from those of subjects included in the epidemiological studies. In a rheumatology practice, frequency of secondary osteoporosis, mainly associated with corticosteroid treatment, is notably high. Admission is by no means a rare event.

Adrenal Cortex Hormones↗
PubMed2000

[Study of bone mineral density in postmenopausal women with rheumatoid arthritis treated with low dose glucocorticoids].

BACKGROUND: To study bone mineral density (BMD) in a group of postmenopausal women with rheumatoid arthritis (RA) treated with low doses of corticosteroids. PATIENTS AND METHODS: One hundred and eleven patients were included. Mean age (SD) was 63.8 (8.8) years, mean duration of postmenopausal period was 16.4 (10.1) years and the mean disease duration was 12.5 (8.2) years. RESULTS: A significant reduction of lumbar BMD (p < 0.05) and femoral BMD (p < 0.0001) was observed. The prevalence of osteoporosis was of 47%. CONCLUSIONS: The study supports, in the Spanish population, that postmenopausal women with RA treated with low doses of corticosteroids, have low BMD. We consider that the prevalence of osteoporosis in these patients is high.

Anti-Inflammatory Agents↗
PubMed2000

Pyarthrosis in patients with rheumatoid arthritis: a detailed analysis of 10 cases and literature review.

OBJECTIVES: 1) To analyze the clinical features and outcome of patients with rheumatoid arthritis and pyarthrosis seen in a rheumatology department during a 9-year period; 2) To review the available literature about this association in the last decade. METHODS: From the database of our department, we collected all hospitalized cases of infectious arthritis in native joints between January 1990 and December 1998. In 10 cases (27%), pyarthrosis occurred in patients with rheumatoid arthritis. A detailed analysis of each patient was performed. The literature was reviewed by using MEDLINE from 1990 to 1999. RESULTS: The mean age of patients was 63.2 years; six were female. Most patients had long-standing disease and poor functional class, and all received glucocorticoid treatment. Mean diagnostic delay was 7.3 days. Causative organisms were Staphylococcus aureus (4 cases), gram-negative bacilli (3 cases), anaerobic bacteria (2 cases), and Streptococcus pneumoniae (n = 1). Two patients died. In all but two patients who survived, joint function worsened. CONCLUSIONS: Rheumatoid arthritis is a relevant host-related risk factor for septic arthritis. Pyarthrosis in these patients is associated with considerable morbidity and mortality.

Aged↗
PubMed2000

[Abnormal glycosylation of soluble ABH antigens in tumors of the urinary tract].

OBJECTIVE: To determine the secretor expression in patients with bladder cancer, adenoma of the prostate and normal subjects. METHODS: The secretor character was determined in saliva of normal subjects (n = 40), patients with bladder cancer (n = 61) and adenoma of the prostate (n = 44) by the technique of hemoagglutination inhibition. RESULTS: 80% of the normal subjects were found to be secretors, which is in agreement with the data reported in the literature. Only 23 (37.71%) of the patients with bladder cancer were secretors and 24 (54.54%) of the patients with prostate adenoma expressed the secretor gene. CONCLUSIONS: The expression of soluble antigens decreased in patients with bladder cancer or prostate adenoma in comparison to the normal subjects. Deletion of ABH antigens in the membrane of tumor cells has been reported in other studies. This lack of expression results from a genetic alteration in the clones involved in tumor pathology. The decrease in soluble antigens in the patient groups analyzed might be due to the same mechanism of genetic alteration that could involve non tumor tissues. Most of the cancers in humans originate in epithelial cells and the changes in blood group antigens constitute an important aspect in tumor immunology.

ABO Blood-Group System↗
PubMed2000

Evaluation of red blood cell aggregation in diabetes by computerized image analysis.

Red blood cell (RBC) aggregation has been widely studied and its importance is well established in the rheology of microcirculation. RBC aggregation is a major factor responsible for the flow properties of blood. Increased RBC aggregation has been observed in several pathological states. Therefore, the measurement of erythrocyte aggregation is rheologically important for quantifying flow abnormality in pathological conditions. Normal RBC under low flow or at rest form rouleaux aggregates, while abnormal RBC aggregation may lead to the formation of irregular aggregate structures, which may be induced by cell-associated factors (reduced membrane sialic acid levels) but also by extracellular factors. The main objective of the present investigation was to study RBC aggregate morphology in diabetic patients, using direct microscopic observation and numerical processing of recorded digitized images. Blood samples were obtained from 20 diabetic patients and from 15 normal control subjects. The aggregate morphology was quantified by the so-called Aggregate Shape Parameter (ASP) defined as the ratio of the aggregate projected area to its square perimeter. ASP appeared significantly higher (p < 10(-5)) in diabetic patients (0.65 +/- 0.18) than in normal controls (0.28 +/- 0.15). This rheo-optical method based on the theoretical model for rouleaux aggregates provides a useful reference for measuring deviations of RBC aggregate morphology. Increased aggregation of RBC resulting from a decreased sialylation of glycophorins may be an important factor in the development of vascular diseases and in the microcirculation impairment.

Adult↗
PubMed2000

[Deletion of ABH antigens in urine sediment cells from patients with prostatic adenoma].

OBJECTIVE: This study was conducted to analyze ABH antigenic expression in urinary sediment of patients with benign prostatic hyperplasia (BPH) before and after deobstructive surgery. METHODS/RESULTS: The agglutination inhibition technique was utilized to determine the ABH antigenic expression in urinary sediments of 30 healthy subjects and 34 patients with BPH. The presence of neoplastic cells was also determined in urinary sediments of the patients by Papanicolaou's stain. These studies were performed before and 12 months after surgery. Membrane antigen expression was found in 100% of the healthy subjects and in only 50% of the patients with BPH before surgery. Only 25 patients returned for control evaluation after surgery. Of these, 17 were positive and of the remaining 8 patients who were negative preoperatively, only one continued to be negative. Urine cytology demonstrated progression to malignancy in this patient. CONCLUSIONS: Determination of ABH antigenic expression appears to be able to identify premalignant conditions and could be a useful complementary diagnostic method to cytology.

ABO Blood-Group System↗
PubMed1999

Löfgren's syndrome revisited: a study of 186 patients.

PURPOSE: To evaluate the clinical features, the results of noninvasive tests and biopsies, and the outcome of patients with Löfgren's syndrome. SUBJECTS AND METHODS: Patients diagnosed as having Löfgren's syndrome at a university hospital in Barcelona, Spain, from 1974 to 1996, were prospectively followed. Löfgren's syndrome was defined as the association of erythema nodosum or periarticular ankle inflammation with unilateral or bilateral hilar or right paratracheal lymphadenopathy. RESULTS: Löfgren's syndrome was diagnosed in 186 patients. The mean age was 37 +/- 11 years, and 157 (85%) were women. In 91 patients (49%), symptoms started during the spring (P < 0.0001). Erythema nodosum, periarticular ankle inflammation, or both were present at onset in 173 patients (93%). At the time of diagnosis, 161 patients (87%) had no respiratory symptoms; 151 (81%) had stage I abnormalities on chest radiograph, 29 (16%) stage II, and 6 (3%) stage 0. Five percent of patients had decreased forced vital capacity, and 15% had decreased carbon monoxide diffusing capacity. Extrathoracic involvement was infrequent. Serum angiotensin-converting enzyme levels were increased in 50% of patients. Gallium-67 scans showed hilar uptake in all the studied patients, but it yielded useful additional diagnostic information only in those with normal chest radiographs or with unilateral hilar lymphadenopathy. The diagnosis was proven with biopsy results in 63% of patients. None of the patients without histologic confirmation were subsequently found to have a diagnosis other than sarcoidosis. In the 133 patients who were followed for a mean of almost 5 years, 11 (8%) continued to have active disease, and 8 (6%) had several recurrences between 18 months and 20 years after a complete resolution. A normal serum angiotensin-converting enzyme level at diagnosis was associated with disease resolution without recurrence. CONCLUSION: Löfgren's syndrome is usually a self-limiting form of sarcoidosis. Histologic confirmation is not necessary in typical cases. In a small number of patients, the disease may remain active or recur long after its onset, although usually with mild organ dysfunction.

Adolescent↗