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Biomedical subjects

E Genth

Publications and source records attributed to E Genth.

90 records · Page 5Linked to original sources
PubMedDate not supplied

[Diffuse fasciitis after Borrelia infection--a case report].

Diffuse fasciitis (DF) [diffuse fasciitis with eosinophilia-Shulman's syndrome] has occasionally been linked to a precedent infection with Borrelia burgdorferi. Here, we report on another case of DF in a 25 year old male, in whom Borrelia burgdorferi infection as possible inciting agent could be identified based on the patient's history and laboratory data. Efforts to microscopically demonstrate spirochetes or to amplify Borrelia-DNA by nested PCR in lesional tissue failed after antibiotic treatment had already been initiated. Although only a few cases of Borrelia associated diffuse fasciitis have been reported in the literature, the link between typical signs and symptoms as well as laboratory findings of Borrelia infection and the onset of diffuse fasciitis, starting at the primary site of EM, provide indirect evidence for a causative role of Borrelia burgdorferi as a potential infectious agent for DF.

Adult↗
PubMedDate not supplied

[Eosinophilia-myalgia syndrome with fasciitis and interstitial myositis after L-tryptophan administration].

We describe a 53-year-old women with eosinophilia-myalgia syndrome who suddenly developed severe persistent myalgias of her arms, legs, back, and shoulder after a 5-month period of daily L-tryptophan ingestion, associated with fever, progressive stenocardia and left-sided congestive heart failure. Laboratory tests showed a leukocytosis of 11.2/nl with 3.14/nl eosinophils and an elevated erythrocyte sedimentation rate. There was a marked, predominantly proximal sclerosis of her arms, legs and trunk with a brownish discoloration. The skin of her arms and legs appeared dimpled (peau d'orange). Findings of the electrophysiological examinations were consistent with sensory neuropathy and myositis. Remarkable fasciitis and interstitial myositis were present in a biopsy specimen (from skin to muscle) taken from her thigh. However, eosinophilic infiltrates were rare. Angiography revealed an apical obstructive cardiomyopathy. In this paper, we describe the clinical findings, the course over 2 years, as well as the therapeutic management. Furthermore, the most important differential diagnoses are discussed and the literature is reviewed with special attention given to more recent pathogenic insights into this newly recognized multisystem disease.

Biopsy↗
PubMedDate not supplied

HLA-B27-positive oligarthritis.

68 cases with polyarthritis were selected from 406 HLA B 27 positive patients with various rheumatic diseases excluding ankylosing spondylitis (AS) or Reiter's disease. 23 fulfilled at least 5 criteria of the ARA for the diagnosis of rheumatoid arthritis (RA). 5 suffered from polyarthritis and psoriasis. The remaining 40 patients expressed an asymmetric oligarthritis especially of the lower limbs (knee, ankle) affecting predominantly young adult men. Sacroiliitis was observed in 10 cases. Joint erosions, rheumatoid factors and visceral manifestations were uncommon. The arthritic pattern of B 27 positive oligarthritis differed clearly from rheumatoid arthritis (n = 34) and psoriatic arthritis (n = 15), but was similar to peripheral joint involvement in AS (n = 32) except for the higher incidence of coxitis in AS. HLA typing is helpful not only in the early diagnosis of AS but also in the differential diagnosis of unclassifiable polyarthritis.

Adult↗
PubMedDate not supplied

[Responsibilities and goals of a rehabilitation clinical in the present and future].

Rehabilitation its an important part of the management of patients with chronic rheumatic diseases and it aims to improve or supervene physical or psycho-social disability and handicap. With regard to the fluctuating course of chronic inflammatory rheumatic diseases, a universal concept of rehabilitation always includes the curative aspect of treatment. Based on the legal and organizational premises for rehabilitation, the problems of access, usage, management and of continuous treatment are critically reviewed. The important tasks in rehabilitation of patients with rheumatic diseases by rehabilitation clinics are education and informing of patients about their disease, including the outcome, possible treatments, self management and coping strategies as well as functional therapy of disorders of the locomotor system. In addition, the adaptation of medical and physical treatment, advice and help with regard to work and occupation, and planning of continuing rehabilitative interventions are important activities of rehabilitation clinics. In the future, an improved integration of rehabilitation within concepts of medical and social support, progress in quality of structuring and processing activities in rehabilitation clinics, and the expansion of ambulant rehabilitation to facilitate continuous support has to promoted.

Activities of Daily Living↗
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[Diagnostic significance of scleroderma and myositis-associated autoantibodies].

In more than 95% of patients with systemic sclerosis and in about 60% of patients suffering from idiopathic inflammatory myopathies autoantibodies directed at different nuclear or cytoplasmic antigens can be detected with different methods. Scleroderma-associated autoantibodies can be visualized as antinuclear antibodies (ANA) by immunofluorescence assays using cultured monolayer cells. In case of a negative ANA result the diagnosis of systemic sclerosis is unlikely. In individual patients the different autoantibodies (against DNA topoisomerase I (Scl-70), centromeric antigens, fibrillarin, To (Th), RNA polymerases, NOR-90, U1-nRNP, PM-Scl, Ku) are mutually exclusive. They can be detected early in the course of diseases, most often are persistent, and are closely associated with immunogenetic markers. They are characteristic for distinct subsets of patients homogeneous in clinical manifestations as well as in disease outcome. Myositis-associated autoantibodies are directed to nuclear (about 60% of myositis patients; PM-Scl, Mi-2) or cytoplasmic antigens (about 35-40%; Jo-1 and other aminoacyl-tRNA-synthetases, signal recognition particle (SRP), KJ and others) and likewise are related to distinct clinical, prognostic, and immunogenetic traits leading to the description of characteristic antibody-based syndromes. Based on published results and on our own investigations, the diagnostic potential of scleroderma- and myositis-associated antibodies is evaluated and a new classification of systematic myositic and sclerodermatous disease is proposed.

Antibodies, Antinuclear↗
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[Crystal-induced arthropathies].

The formation and deposition of crystals in articular tissues increases with growing age. As a consequence crystal-induced or crystal-associated arthritides or arthropathies can be observed particularly in the elderly where these disorders comprise a considerable part of inflammatory joint diseases. Gout, induced by monosodiumrate crystals mostly presents as acute monarthritis, less frequently as a chronic polyarthritis. Calciumpyrophosphate deposition may induce acute pseudo-gout, rheumatoid-arthritis-like (pseudo-rheumatoid) arthritis and a variety of other clinical syndromes. Basic calciumphosphate crystals may be associated with acute and chronic recurrent or destructive arthropathies. The detection of crystals in joint fluids by polarized microscopy as well as typical X-ray-findings allow to make a diagnosis in the context of characteristic clinical features. In addition to the antiinflammatory treatment it is important to detect and treat underlying metabolic disorders.

Arthritis, Gouty↗
PubMedDate not supplied

[Fibromyalgia and Sjögren syndrome--clinical and methodological aspects].

The prevalence of fibromyalgia in primary (n = 18) or secondary (n = 20) Sjögren's syndrome was examined. In all patients with Sjögren's syndrome as well as in 31 fibromyalgia patients and 20 healthy individuals measurements of pressure pain threshold were done by palpation and dolorimetry. Widespread pain, functional complaints, as well as depression were determined by a questionnaire. The results show a high frequency of fibromyalgia in the group of patients with pSS (44%), 72% of pSS patients reported widespread pain. Only 5% of the sSS patients fulfilled the ACR criteria for fibromyalgia and 40% of this group reported on widespread pain. Dolorimetry measures at tender or control points revealed that the pressure pain threshold was significantly reduced in all patient groups with healthy controls. There were only small differences between the clinical groups. Within the different groups examined there was a close correlation between dolorimetric threshold at tender and control points. In contrast to self-estimated widespread pain the pressure pain threshold was not closely related to functional complaints in the patient groups. The prevalence of depression was increased in both pSS and FM patients, in contrast to the other groups. The results suggest to include Sjögren's syndrome into the differential diagnosis of FM. The dolorimetric results were interpreted as an argument against the actual tenderpoint concept. They support the view that patients with FM rather represent an arbitrary coincidence of widespread pain and elevated tenderness on pressure.

Adult↗
PubMedDate not supplied

[Decrease of mitogen stimulation of lymphocytes in rheumatoid arthritis].

Peripheral blood lymphocytes of 51 patients with rheumatoid arthritis and of 14 healthy blood donors were cultivated in autologous and homologous normal pool-serum and stimulated with phytohemagglutinin (PHA-P), concanavalin A (Con A) and pokeweed mitogen (PMW) in different doses. In autologous as well as in homologous pool-serum the 3H-thymidine uptake of stimulated lymphocytes from patients with rheumatoid arthritis was significantly depressed independent of the mitogen concentration used. Serum from patients with rheumatoid arthritis depressed the activation of blood donor lymphocytes by Con A and PWM. The depression of lymphocyte activation was not related to the presence of rheumatoid factors in the serum, the severity of the disease and the anti-rheumatic therapy.

Arthritis, Rheumatoid↗
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[Nosologic criteria in rheumatology].

Nosologic criteria are important tools for diagnosis and categorization of rheumatic diseases, disease status and outcome. They have been developed predominantly for phenomenologic syndromes (of unknown etiology) and are standards of the scientific communication as well as necessary instruments for the selection of patient groups for investigations in different fields of rheumatology (epidemiology, etiology, pathogenesis, clinical rheumatology, diagnostics, therapy). Diagnostic criteria help to identify disease in individual patients. Classification criteria separate patients with a particular disease from patients without the disease and are useful to select and describe patient groups. Status indices assess disease activity and actual damage according to reversible or irreversible features respectively. Prognostic criteria differentiate patients with probably favorable or severe disease course or outcome, and outcome criteria are designed to assess the overall impact of a disease as dependent variables for clinical studies. This review describes the different types and purposes of nosological criteria in different rheumatic diseases as well as their problems. Some aspects of the actually used criteria especially from the "Diagnostic and Therapeutic Criteria Committee" of the American College of Rheumatology are critically commented.

Arthritis, Rheumatoid↗