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Title: Demyelinating diseases
Title: Diagnostic criteria in multiple sclerosis
Title: Who was the first in Croats to describe a patient with
multiple sclerosis?
Title: Allergy to Synacthen Depot (Tetracosactrin) in Multiple
Sclerosis Patients.
Title: Prevalence of Borrelia burgdorferi antibodies in a high
risk-zone for multiple sclerosis (Gorski kotar, Croatia)
Title: Epidemiological Research on Multiple Sclerosis in Croatia
Title: Multiple sclerosis in Croatia
Title: Some aspects of multiple sclerosis in Gorski kotar,
Croatia. An epidemiological analytic investigation.
Title: Descriptive and Analytical Epidemiologfy of Multiple
Sclerosis in Gorski kotar, Croatia.
Title: Multiple Sclerosis in Gorski kotar, Croatia.
Title:
Title: Significance of porfirin expression in peripheral blood
lymphocytes of multiple sclerosis
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Title: Gorski kotar, Croatia, a high risk area for multiple
sclerosis
Faculty: Medicinski fakultet Sveučilište u Rijeci
Author: MATERLJAN ERIS
Date of defense: 07/15/94
Language: hrvatski
Number of pages: 235
Summary: Objective - To asses the magnitude and the distribution of
multiple sclerosis (MS) in Gorski kotar, Croatia, and outline the
importance of genetic and environmental factors in its pathogenesis.
Design - A list of the potential MS patients was obtained during the
1991-1992 period after careful reviewing of all the sources of medical
records. All the MS patients who fulfilled the diagnostic criteria were
included in the descriptive epidemiological survey. In the additional
analytic approach (case-control study) the native born MS patients from
Gorski kotar were submited to a questionnaire about some characteristics of
early childhood to adolescence and the results were compared with those of
a selected control group.
Setting - All the MS patients born or with the onset of MS in Gorski kotar
were included in the study.
Participants - The ascertaining was defined according to Poser's criteria.
All the potential MS patients were personally examined as well their
medical records. Doubtful cases were submited to additional examinations
(evoked brain potentials, CT, MRI examination, analysis of the
cerebrospinal fluid on intrathecal synthesis of IgG and oligoclonal bands)
The controls were selected at random from the population of this area. To
each MS patient was asigned one or two controls of the same age (difference
no more than two years), sex, birth place and residence during childhood to
adolescence. The controls may have had any other disease except MS,
psychiatric and autoimmune disorders without being excluded.
Results - A total of 139 potential and MS patients were examined. 74 were
accepted as clinically definite or clinically definite laboratory supported
MS. 36 of them were still living in Gorski kotar on prevalence day (March
31, 1991). The overall crude prevalence rate was 117,9/100,000 population.
The prevalence showed an inhomogenous distribution, higher in western Čabar
and Delnice (193.5 and 134.5/100,000 population), and significantly lower
in the eastern Vrbovsko (26.5/100,000 population)(p=0.016). Such a
geographical distribution (west-east) was stable over time. A high
frequency of MS patients was found among the Gorans who emigrated from
Gorski kotar. Sex-specific prevalence rates showed a female preponderance
(148.1 vs 86.6/100,000 population) although not significant (p=0.12).
According to age mostly of the MS patients were in the 30-34, 40-49 and
55-59 age groups. During the 1971-1991 period the mean annual mortality
rate was 2.2/100,000 population. The mean age of death was 44.8+/-8.9
years. Females died later than males did (46.3+/-9.9 vs 42.3+/-6.9). In the
1946-1987 period 61 inhabitants from Gorski kotar got the MS. The mean
annual incidence for this period was 3.7/100,000 population (5.0/100,000
population in the period 1961-1978). Čabar and Delnice showed significantly
higher rates than Vrbovsko did (5.0 and 4.3 vs 1.2/100,000 population)
(p=0.056). During the same period none of the inhabitants from Severin area
got the MS. The estimated mean annual and age-specific incidence showed for
both sexes the highest rates at 25-29 years of age. On prevalence day the
mean age of the MS patients was 40.6+/-12.5 years, the mean age at onset
24.4+/-9.5 years, and the duration of the disease up to prevalence day
16.0+/-9.0. The sex ratio was 1.8. The initial symptoms were 19.4%
motor-sensitive, 17.9% sensitive, 17.9% motor, 9.0% oculomotor, and 7.5%
cerebellar respectively. On prevalence day the course of the disease was
remittent and/or remittent-progressive in 88.9% of the MS patients, in
11.1% was primary progressive one. The overall lapse from onset to
diagnosis was 5.4 years. Better diagnostic supports shortened this lapse to
less than one year nowadays. 61.1% of the MS patients was heavely disabled,
lightly disabled 38.9%. The analytic epidemiological survey showed the MS
being more frequent among third-born (p=0.046), those having had a higher
economical level familial or personal, particularly among males having had
a past history of trauma (p=0.046), and females born before 1946 having had
a history of tonsillitis at 7-15 years of age (p=0.011). Males who slept
mead or longer and rose later were more frequent MS patients (p=0.007), so
did females who spent a longer time inward (p=0.053). Psychic tension
(p=0.032) and psychic trauma (p=0.036) were a frequent characteristic among
the MS patients of both sexes, so did a past history of retrobulbar optic
neuritis (p=0.011). The MS patients were more frequent with lighter
coloured eyes (p=0.036). A high association was found between MS and trauma
to head, neck or spine (p=0.016) linerly correlated with the severity of
trauma (p=0.003). No association was found with other diseases and/or
disorders. Owners of cats (p=0.038), goats (p=0.025) and birds (p=0.023)
were more frequent an MS patient too.
Conclusions - Gorski kotar is a high risk area for MS in Croatia and
Europe. The MS incidence reveals a very irregular geographical distribution
with different risks in a relative small area. Such an inhomogenous
distribution of MS in Gorski kotar is stable over time. Emigrants from
Gorski kotar take away the risk if they emigrate before adolescence.
Although the characteristics of a putative environmental factor remain
unidentified, facts point to a possible infective, probable viral nature of
MS in this area. Among the factors able to provoke MS, trauma, particularly
traumas of the head, neck or spine seem to be the most consistent. High
incidence of familial MS, some ethnical, phenotypic and genotypic
particularities support the hypothesis of a genetic disposition to this
disease.
Keywords: multiple sclerosi, epidemiology, descriptive, analytic, Croatia
Title:
Faculty: Medicinski fakultet Sveučilište u Rijeci
Date of defense: 09/28/95
Language: hrvatski
Number of pages: 76
Summary: Objective: to analyzea role of physical trauma in the
occurence and evolution of multiples clerosis (MS). Design: retrospective
epidemiological case-control study. Setting: MS patients born or suffering
from MS in the counties: Primorsko-goranska, Istarska and Ličko-senjska,
high risk areas for MS in Croatia. Subjects: the study included 132 MS
patients, clinically definite and laboratory supported definite cases of MS
(Poser's crteria). The control group consisted of the population from the
same area chosen at random (one control subject per any MS patient), of the
same sex, similair age, and same place of birth and residence. The controls
could suffer from any other disease except MS and other known immunological
and mental disease. None of the participants was subject of civilian or
criminal charges at a Court of Law. Methods: the subjects having suffered
from an injury provided information on the injured parts, as well as the
strenght and cause of the injury. The data were mostly provided in the
participant's homes and rathe rarely in hospital. In the evaluation of
results an odds ratio (OR) was assessed. The differences were tested using
the hi square test, the determination of the 95% confidence interval for
OR, and the Fisher's exact probability test. The Mantel-Haenszel's
stratification test and linear trend test were applied. results: there were
132 MS patients (sex ratio F/M 1:1,8) and the corresponding control group.
The average age of MS patients was 45.49+/-14.42 years. The mean age of
onset was 27.96+/-8.82 years. 7 patients were injured during the disease
and 46 before its onset. All the registered injuries were statistically
significant more frequent in MS patients than in the control group (females
p=0.01, males p=0.0018, both sexes p=0,000045; head injuries in females
p=0.004, polytrauma in males p=0.013). The causes of the injuries were
statistically significant only for the falls in MS patients (p=0.04). The
interval between physical trauma and the onset of MS in both the sexses was
11.56+/-10.6 years for all the injuries. The polytrauma reduced
significantly this period (8.71+/-8.18 years). Severe trauma strongly
hurried the onsed of initial signs and symptoms of the disease. Traffic
accidents most significantly reduced the period from trauma to the onset of
the disease (5.75+/-5.67 years, p=0.023). In all the cases the severity of
injuries, particularly those of the head in MS male patients, regardin the
cause showed a statistically significant increase from a small degree to a
high one. The injuries occurring during the disease in three female MS
patients, caused worsening of the disease in only one or two days ofter
their occurrence. Conclusions: the results of this research suggest that
physical injuries can be an important environmental factor in the
occurrence of MS. Physical injuries of the central nervous system (head and
spine), especially if being severe, could start or worsen the process of
primary demyelination in the predisposed individuals.
Keywords: multiple sclerosis, epidemiology, injuries
Title:
Faculty: Medicinski fakultet Sveučilište u Rijeci
Date of defense: 05/24/91
Language: hrvatski
Number of pages: 68
Summary: By reason of its frequent appearance, severity and
consequences,multiple sclerosis (MS) is a disease which has a special
positionamong human demyelinisation diseases. Since this is an
autoimmunedisease which appears in young adults and therefore in women
ofreproductive age, the intention of our work was to examinate thevalues of
some immunological parameters among pregnant women withMS. The following
parameters were quantified: a) lymphocytesubpopulations by the rosette
techniques; b) levels of IgG, IgMand IgA in the serum; c) reactivity of
lymphocyte to policlonalmitogens.
The analyses of lymphocyte subpopulations show significantlylower levels
primarily of active lymphocytes, but also of total Tlymphocytes during the
second and the third trimesters ofpregnancy as well as during the
postapartal perio. In MS aptientswhich suffered from a relapse of the
disease during pregnancy,values of active T lymphocytes were significantly
lower ascompared to values in pregnant women with a stable phase of
thedisease.
In the experimental part of our investigations, we observed theclinical
course of the disease (EAE) in pregnant femalessensitized during
gestational period of 21 days. The clinicalcourse of the disease was of a
significantly higher intensity andduration after birth. In the group of
rats sensitized during thesecond week of gestation this was the period of
relapse, but inthe group of rats senzitized during the third gestational
weekthis was the period of acute phase.
In DA rats, whose mother was sensitized during the second week ofgestation,
we observed the monophasic type of EAE after activeinduction of the
disease. The same type of EAE we obtained inrats sensitized with purified
myelin basic protein as apposed tothe chronic relapsing form of EAE in rats
sensitized withhomogenate of white matter of CNS.
With histological analyses of CNS tissue we demonstratedperivascular
infiltrates with mononuclear-macrophages cells. Thenumber of infiltrates
was different in each particular ratsacrified in the same period of the
disease. The number ofinfiltrates differed even in the same anima depending
on the siteof sectio, showing an ascendent course of the disease.
Keywords: Multiple sclerosis, pregnancy, experimental allergic encephalomyelitis
Title:
Faculty: Medicinski fakultet Sveučilište u Rijeci
Date of defense: 07/17/92
Language: hrvatski
Number of pages: 121
Summary: Infectious and non-infectious inflammatory diseases of the
central nervous system (CNS) are result of two entirely different
patophysiological processes. However, what they do have in common is the
fact that all inflammatory changes occuring in them are related to the
integrity and/or permability of the blood-brain barrier (BBB). The main
function of the barrier is to mantain homeostasis of the nervous tissue and
to protect it from various lesions. In our study we compared the values of
different laboratory parameters used in the assessment of BBB impairment
and the reaction of the CNS tissue to inflammatory process: concentration
of total proteins, albumins and particular IgG fractions in cerebrospinal
fluid; albumin quotient, IgG index and total daily synthesis of IgG, and
the level and nature of pleocytosis. The patients (97) were divided in
three groups: patients with infectious dieases of CNS; patients with
multiple sclerosis (MS) and patients with non-infectious/non-inflammatory
disturbance of CNS (31). Among the parameters, albumin quotient was found
to be the most suitable parameter for identification of BBB impairment. In
bacterial infections of CNS impairment was established in all patients, it
occurred on the first day of disease onset, was generally severe, and the
normalisation depended on adequate therapy. Converselly, in viral
infections of CNS the integrity of BBB was maintained in the majority of
patient (58.8%), the impairment was mild, and the normalisation fast and
spontaneous. Similarly, in most patients with MS (67,5), the BBB was
undamaged or only slightly impaired, but without any relation to the
activity of the disease. In parasite infestations no impairment of the BBB
was established. Local immunological reactivity of the CNS tissue was
assessed via intrathecal synthesis of immunoglobuline; it was most
prominent among the MS patients (75%), which confirms the immunological
nature of the disease, but was also significant in viral infections (47%).
In addition, our results showed that measurement of intrathecal synthesis
of IgG can be of prognostical significance in neuroboreliosis and
neurocysticercosis.
Keywords: infectious diseases, multiple sclerosis, blood-brain barrier
Title:
Faculty: Medicinski fakultet Sveučilište u Rijeci
Date of defense: 04/15/94
Language: hrvatski
Number of pages: 61
Summary: Experimental allergical encephalomyelitis could be provoked
by hepatitis B virus (HBV) according to some experimental sudies. In
patients with clinically definite and laboratory supported definite MS, the
condition of hepatitis B markers has been analysed using the "case-control"
method of analytic epidemiology. 50 MS patients have been selected at
random from the Croatiam MS association Registry. The control group
consisted of 150 healthy persons of the same age, sex and residence. All of
them were screened for hepatitis B markers. The MS patients varied from
controls in major possibility of being innoculated with hepatitis B virus
(stomatological interventions p=0.04, and number of hospitalisations,
p=0.0001). The percentage of MS patients after innaparent hepatitis B
infection and the chronic carriers of hepatitis B surface antigen (HBsAg)
was almost the same in MS patients and in the control group. Almost the
same number of chronic carriers of HBsAg in MS patients and controls was
quite an unexpected result. In immunosupressed patients the number of
chronic carriers of HBsAg is increased.
Keywords: hepatitis B, multiple sclerosis
Title:
Faculty: Medicinski fakultet Sveučilište u Rijeci
Date of defense: 02/20/95
Language: hrvatski
Number of pages: 116
Summary: Introduction: the past studies proved that multiple
sclerosis (MS) is a disease of an exogenous origin and expressed in
genetically predetermined individuals in contact with yet unidentified
cause. Objective: to analyze HLA antigens in the native population of MS
patients in Gorski kotar, Croatia, a high risk area for this disease.
Methods and perticipants: the MS patients were selected with the
application of the Poser's diagnostic criteria for MS. The control group
consisted of unrelated natives of Gorski kotar chosen at random who were
not hosts of hereditary degenerative diseases. The HLA-A, HLA-B, HLA-C and
HLA-D antigens were analyzed using the Terasaky's microlymphocytotoxicity
method. Statistics: the distribution of HLA antigens was tested with
relative risk test (RR) and with the analysis of etiologic (EF) and
preventive (PF) factor. Statistical significance was determined with chi
square test (x2). Results: the population of Gorski kotar was found to
differe from the white race sample in the following antigens: B5
(x2=19.37), B8 (x2=4.14), B12 (x2=6.98), B14 (x2=3.93). The native MS
patients from Gorski kotar differe from the control group only in the
antigen DR2 (x2=6.34). This MS patients showed an increased RR for the
antigens A1 (RR 2.39), B7 (RR 2.25), DR2 (RR 3.04) and DR9 (RR 6.0). The
highest value of EF was found for the antigen DR2 (EF 0.34) and the highest
value of PF was found for the antigen A10 (PF 0.11). The haplotype HLA A3,
B7 and DRŽ was found to be more frequent in the MS patients but with no
statistical significance. The research confirmed that the native population
of Gorski kotar with the HLA antigens DR2 had an increased risk to get MS
Keywords: multiple sclerosis, HLA antigens, Croatia
Title:
Faculty: Medicinski fakultet Sveučilište u Rijeci
Mentor: SEPČIĆ JURAJ
Date of defense: 05/24/91
Number of pages: 68
Author: Barac-Latas mr.sc. Vesna
Degree level: M.A.
Title: Gorski kotar, Croatia, a multiple sclerosis high risk
area.
Faculty: Medicinski fakultet Sveučilište u Rijeci
Mentor: SEPČIĆ JURAJ
Date of defense: 07/15/94
Number of pages: 235
Author: Materljan Eris
Degree level: Ph.D.
Title:
Faculty: Medicinski fakultet Sveučilište u Rijeci
Mentor: SEPČIĆ JURAJ
Date of defense: 09/28/95
Number of pages: 76
Author: Rudež dr.sc. Josip
Degree level: Ph.D.
Title:
Faculty: Medicinski fakultet Sveučilište u Rijeci
Mentor: SEPČIĆ JURAJ
Date of defense: 07/17/92
Number of pages: 121
Author: Poljak mr.sc. Ivica
Degree level: M.A.
Title:
Faculty: Medicinski fakultet Sveučilište u Rijeci
Mentor: SEPČIĆ JURAJ
Date of defense: 04/15/94
Number of pages: 61
Author: Šantić mr.sc. Veljko
Degree level: M.A.
Title:
Faculty: Medicinski fakultet Sveučilište u Rijeci
Mentor: SEPČIĆ JURAJ
Date of defense: 02/20/95
Number of pages: 116
Author: Strenja-Linić mr.sc. Ines
Degree level: M.A.
Title:
Faculty: Medicinski fakultet Sveučilište u Rijeci
Mentor: MATERLJAN ERIS
Date of defense: 04/16/95
Number of pages: 47
Author: Muškardin dipl.med.sestra. Marčela
Degree level: D.A.
Title:
Faculty: Medicinski fakultet Sveučilište u Rijeci
Mentor: SEPČIĆ JURAJ
Date of defense: 03/10/94
Number of pages: 36
Author: Ivančić dr.med. Suzy
Degree level: D.A.
Title:
Faculty: Medicinski fakultet Sveučilište u Rijeci
Mentor: SEPČIĆ JURAJ
Date of defense: 04/10/94
Number of pages: 40
Author: Wahid dr.med. Mohamed Jehade
Degree level: D.A.
Title:
Faculty: Medicinski fakultet Sveučilište u Rijeci
Mentor: SEPČIĆ JURAJ
Date of defense: 07/17/94
Number of pages: 29
Author: Dragaš dr.med. Nataša
Degree level: D.A.
Title:
Faculty: Medicinski fakultet Sveučilište u Rijeci
Mentor: SEPČIĆ JURAJ
Date of defense: 04/07/95
Number of pages: 42
Author: Antončić dr.med. Željka
Degree level: D.A.
Title:
Title:
Title:
Title:
Institution: Hrvatsko neurološko društvo
Year: 1995
Title:
Institution: Hrvatsko društvo za multiplu sklerozu - Rijeka
Year: 1994
Title:
Institution: Hrvatsko društvo za multiplu sklerozu - Delnice
Year: 1994
Title:
Institution: The 2nd Alghero Workshop on Multiple Sclerosis Epidemiology
Year: 1995
Title:
Institution: Hrvatsko društvo za multiplu sklerozu - Zagreb
Year: 1994
Title:
Institution: Hrvatska akademija medicinskih znanosti
Year: 1995
Title:
Title:
Title:
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