[Anticoagulative therapy and antiphospholipid syndrome].
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Anticoagulants↗
Biomedical subjects
Z Fojtík
Publications and source records attributed to Z Fojtík.
[18F-FDG PET in the diagnosis of large vessel vasculitis].
INTRODUCTION: Positron emission tomography (PET) is a non-invasive diagnostic method which shows the bio-distribution of positron emitter labelled radiopharmaceuticals in the body. Due to the fact that not only timorous, but in certain conditions also some inflammatory cells may exhibit increased accumulation of 18F-FDG, 18F-FDG PET can be used in the diagnosis of both tumours and certain types of inflammations. OBJECTIVE: The objective of the study is to asses the benefits of 18F-FDG PET in the patients examined for symptoms of fever of uncertain origin whose results suggested the possibility of large vessel vasculitis. SAMPLE AND METHODS: In the years 2003 and 2004, the positron emission tomography centre at Masaryk Oncological Institute in Brno examined 35 patients in order to establish the cause of febrilia using 18F-FDG PET. The suspicion of large vessel vasculitis was based on the detection of high accumulation of radiopharmaceuticals in large vessels walls (in the aorta and the larger outgoing branches). The patients underwent a further standard imaging test to diagnose large vessel vasculitis as follows: CT angiography (CTA) in 4 patients, MR angiography (MRA) in 3 patients and duplex ultrasonography (USG) in 7 patients. A definitive diagnosis of primary autoimmunity of large vessel vasculitis was counter checked histologically or based on a therapeutic test by means of the effect of corticotherapy in immunosuppressive doses. RESULTS: Positive PET findings were recorded in 23 out of 35 patients (65.7%). 11 out of 23 PET positive patients (47.8% of PET positive persons and 31.4% of all patients with febrilia) were suspected to have active large vessel vasculitis based on PET examination. In 10 of the 11 patients, it was possible to perform additional examinations necessary to confirm the diagnosis: a histological test of arteria temporalis in one case, and a therapeutic test using corticotherapy in all 10 cases. Large vessel vasculitis was confirmed in all 10 individuals (2 men and 8 women aged 53-66, median age of 62 years). None of the CTA, MRA or USG examinations in any of the cases detected direct or clear signs ofvasculitis, but 3 CTA and 1 MRA examinations could be considered abnormal. The detection of temporal (giant cell) arteritis based on excision of arteria temporalis superficialis points to the limits of PET examination which is unable to assess veins with a diameter of less than 5 mm. On the other hand, it documents the possibility of extra-cranial damage being proved in this diagnosis with the use PET. In seven of the ten cases, a control PET scan was done during corticotherapy. It showed a drop in the accumulation of radiopharmaceuticals, and therefore a drop in the inflammatory metabolic activity on the walls of the large vessels, which was in line with the drop in the laboratory parameters of the inflammation (FW, CRP). CONCLUSION: Positron emission tomography using 18F-FDG can be used to detect active large vessel vasculitis in patients examined for symptoms of fever of uncertain origin. Apparently, PET can detect cases of large vessel vasculitis where other imaging methods have failed and can be also used to follow the development of vasculitis activity during therapy.
Adolescent↗
[Incidence of selected antiphospholipid antibodies in a group of patients with systemic lupus erythematosus].
Antiphospholipid antibodies (APLA) present very heterogeneous groups of antibodies which can significantly and in various ways influence processes on different levels of coagulation cascade. Their presence can be accompanied with repetitive venous and arterial thromboses, recurrent loses of foetus, and thrombocytopenia. Incidence of these thrombotic disorders was monitored in a group of 46 patients with systemic lupus erythematodes (SLE). Positive lupus anticoagulant (LA), antiphospholipid antibodies complex, and thrombocyte counts were assessed. Thrombotic disorders were assessed in a retrospective analysis. In the LA+ group 62% of patients had history of venous thromboses, 31% had history of arterial thromboses, and 18% had history of spontaneous abortions. In a group without positive LA 18% of venous thromboses (p = 0.0006) and 6% of arterial thromboses (p = 0.03) were indicated. In the assessment of spontaneous abortions no statistically significant difference was found. An average value of thrombocytes in LA+ group was 152 +/- 66 x 10(5)/l, in LA- group 223 +/- 86 x 10(5)/l, which is statistically significant difference (p < 0.05). In the assessment of thrombotic disorders in a group with combination LA+ and APA+ statistical significance was indicated only in venous thromboses (p = 0.004). We can state from the results that in thrombotic disorders which can be seen in the framework of systemic tissue disorders positive LA and APA and a range of other factors such as activity of a basic disease, associated diseases, and treatment which can aggravate thrombotic disorders of individual patients can participate.
Abortion, Spontaneous↗
[The significance of antiphospholipid antibodies].
Antiphospholipid antibodies (APLA) present very heterogeneous groups of antibodies which can significantly influence processes on different levels of coagulation cascade depending on effects of phospholipid surfaces on blood coagulation. This usually leads to a particular level of thrombophylia. Clinical syndrome accompanying positive APLA, such as antiphospholipid syndrome, was defined by clinical and laboratory symptoms. This clinical syndrome can be a primary syndrome, if other disorders with ability to induce generation of antibodies can be excluded, or a secondary syndrome. The most often in cases of systemic tissue disease. APLA can be divided according to the presence of lupus anticoagulant and anticardiolipin antibodies. According to a definition lupus anticoagulants are antibodies able to inhibit and prolong in vitro one or more blood clotting processes dependent on phospholipid surfaces. Anticardiolipin antibodies are antibodies measured by ELISA method with cardiolipin used as an antibody. Findings show that some APLA are directed against proteins bound to phospholipid surfaces. Main cofactor proteins include beta 2-GPI and prothrombin. Because of their heterogeneous specificity, APLA are directed against negative phospholipids or proteins bound to phospholipid surfaces and have important pathophysiology role in development of antiphospholipid syndrome.
Abortion, Spontaneous↗
[Bisphosphonates, their mechanism of action and properties useful in the therapy of metabolic bone diseases].
Bisphosphonates are a group of chemical substances which have been used in medicine for thirty years in the treatment of skeletal diseases and disorders of calcium metabolism. Bisphosphonates are derived from pyrophosphate by substitution of an O atom for a C atom. This structure makes possible a number of variants by changing the side-chains of the C atom. The basic P-C-P bond is very thermostabile and completely resistant to enzymatic hydrolysis. The basic biological property of bisphosphonates is inhibition of bone resorption but has not been completely elucidated so far. The prerequisite is the inhibitory action of bisphosphonates on osteoclast activity. The latter are inhibited only when they are in contact with bone surfaces which contain bisphosphonates. Another possible mechanism of action of bisphosphonates is their action on osteoblasts: osteoblasts produce local growth factors which inhibit osteoclasts and thus osteoresorption is inhibited. So far it is not exactly known whether the direct effect on osteoclasts, the indirect effect via osteoblasts or a combination of both are the most important effect of bisphosphonates on the resorption of bone.
Bone Diseases, Metabolic↗
[Bisphosphonates in the treatment of osteoporosis].
Bisphosphonates are chemical substances which are used in medicine for the diagnosis of bone diseases, for the treatment of bone metastases of various tumours and in recent years also for the treatment of osteoporosis, in particular postmenopausal or corticoid induced osteoporosis. The administration of biphosphonates is based on the idea that ideal treatment of an enhanced bone turnover is creation of a greater bone mass by de novo bone formation with concurrent inhibition of bone absorption (possibility of dismantling the remodelling cycle). This idea of the action of biphosphonates is based on the finding that they reduce the absorption activity of osteoclasts or enhance the osteoforming activity of osteoblasts. Biphosphonates thus create a positive balance of the remodelling cycle, i.e. they increase the density of bone mass and reduce the frequency of fractures. In the submitted paper the authors present a summary of results and possible use of these biphosphonate groups which were used in the treatment of involutional or corticoid induced osteoporosis.
Diphosphonates↗
[Osteoporosis. 1].
This article reviews the available data considering the question of pathogenesis and diagnostic of osteoporosis. Low bone mass can occur because there is insufficient bone deposited in the skeleton during growth, modelling, or because bone tissue is subsequently lost, remodelling. Peak bone mass is largely under genetic control, adequate nutrition during growth. Bone loss results from disturbance of bone remodelling, a continuous preventive maintenance programme in the adult skeleton. Bone remodelling is a quantum phenomenon that occurs in discrete units in four phases. Calciotropic hormones modulate the bone-cell production rate of cytokines and growth factors. Cytokines also locally mediate the effects of several hormones on bone cells. Disruption of the remodelling cycle at one of several points will lead to bone loss. Osteoporosis is a disease characterised by low bone mass per unit volume, microarchitectural deterioration of bone tissue leading to enhance bone fragility, and a consequent increase in fracture risk.
Humans↗
[Osteoporosis. 2].
Drug used to treatment osteoporosis can be grouped in two main categories: those that decrease bone resorption and those that increase bone formation. Long-term estrogen therapy as antiresorptive drugs are most effective when bone turnover is increased at time of menopause. Further antiresorptive drugs include oral calcium, calcitonin, bisphosphonates. Drugs that act by increasing bone formation produce an increase in bone mass, these agents are good candidates for the treatment of osteoporosis. Intermittent slow-release sodium fluoride administered for osteoporotic patients inhibits new vertebral fractures, increases the mean spinal bone mass and is safe to use. Calcium supplementation, and vitamin D supplementation have a beneficial effect in retardation of bone loss with very good tolerance. As to new preparations, the most promising ones seem to be drugs, which act on the level of cytokines and growth local factors in bone. In the conclusion authors present therapeutic possibility of postmenopausal women, the most risk group of osteoporotic patients.
Female↗
[Antiphospholipid syndrome].
Antiphospholipid syndrome (APS), first described and termed in the early 1980's, is defined by its clinical and laboratory signs. If other disorders inducing antibody production are excluded, APS may be considered a primary disease. Or it can be a secondary condition that is usually seen in systemic diseases of connective tissues. The main concept of APS is based on strong association between its clinical and laboratory manifestations and patient's medical history. Clinical signs include recurrent arterial and venous thrombosis or repeated fetal losses; laboratory criteria involve lupus anticoagulant (LA) syndrome or medium and high titres of anticardiolipin (aCL) antibodies. Thus defined, APS represents the most common form of acquired thrombophilic conditions while the basic concept lies in strong association between specific clinical manifestations and repeated detection of LA or aCL. Antiphospholipid antibodies (LA and aCL) are extremely heterogeneous antibody groups whose effect on processes at different levels of coagulation cascade varies. Their effect can be analogical to the action of phospholipid surfaces at various points of blood coagulation. This process usually results in development of a certain degree of thrombophilia. Present level of understanding of APS indicates that characteristics of clinical signs and detection and evaluation of antiphospholipid antibodies have not been definitely established yet and are to be specified with the help of molecular geneticists, immunologists, biochemists, hematologists and rheumatologists.
Antiphospholipid Syndrome↗