Biomedical subjects

L Neumann

Publications and source records attributed to L Neumann.

At least 73 records · Page 4Linked to original sources

PubMed1997

Fibromyalgia in hepatitis C virus infection. Another infectious disease relationship.

BACKGROUND: Fibromyalgia syndrome (FS) is a common disorder of diffuse pain in the muscles or joints accompanied by tenderness at specific tender points and a constellation of related symptoms. The potential role of infections in the pathogenesis of FS has only recently been investigated. OBJECTIVES: To evaluate the prevalence of FS and to assess tenderness thresholds in patients infected with hepatitis C virus (HCV). METHODS: The study included 90 patients with HCV, 128 healthy, anti-HCV-negative controls, and 32 patients with non-HCV-related cirrhosis. Tenderness was measured by manual palpation (18 tender points) and with a dolorimeter. Fibromyalgia syndrome was diagnosed according to the 1990 American College of Rheumatology criteria. RESULTS: The diagnosis of FS was established in 14 patients (16%) with HCV, in 1 patient (3%) with non-HCV-related cirrhosis, and in none of the healthy controls (P < .001). Thirteen of the HCV-positive patients with FS were women. The patients with HCV had significantly (P < .01) more tender points (mean [+/- SD] 3.6 +/- 5.3) than the healthy controls (0.1 +/- 0.5) and the patients with non-HCV-related cirrhosis (1.2 +/- 2.7). Specifically, the patients with cirrhosis were most tender on both tenderness measures owing to the high proportion of women in this group. Patients with FS were significantly more tender than those without FS: their dolorimetry thresholds were 2.9 kg vs 6.0 kg (P < .001). CONCLUSIONS: A high prevalence of FS was observed in patients infected with HCV, especially women. Recognizing FS in patients with HCV will prevent misinterpretation of FS symptoms as part of the liver disease and will enable the physician to reassure the patient about these symptoms and to alleviate them.

Adult↗

PubMed1997

The active domain of the herpes simplex virus protein ICP47: a potent inhibitor of the transporter associated with antigen processing.

The herpes simplex virus type 1 (HSV-1) protein ICP47 binds specifically to the transporter associated with antigen processing (TAP), thereby blocking peptide-binding and translocation by TAP and subsequent loading of peptides onto MHC class I molecules in the endoplasmic reticulum. In consequence, HSV-infected cells are masked for immune recognition by cytotoxic T-lymphocytes. To investigate the molecular details of this, so far, unique transporter-inhibitor interaction, the active domain and critical amino acid residues were identified by using short overlapping fragments and systematic deletions of the viral inhibitor. A fragment of 32 amino acid residues, ICP47(3-34), was found to be the minimal region harboring an activity to inhibit peptide-binding to TAP comparable to the action of the full-length protein and therefore representing the active domain. Further N or C-terminal truncations cause an abrupt loss in activity. Within the identified active domain, various mutants and chimeras of ICP47 derived from HSV-1 and HSV-2 helped to identify amino acid residues critical for TAP inhibition. On the basis of these results, therapeutic drugs could be designed that are applicable in treatment of allograft rejection or in novel vaccination strategies against HSV, restoring the ability of the immune system to recognize HSV-infected cells.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

PubMed1997

Structure of the viral TAP-inhibitor ICP47 induced by membrane association.

Herpes simplex virus type I protein ICP47 (IE12) turns off antigen presentation by specifically binding to and blocking the major histocompatibility complex- (MHC-) encoded transporter associated with antigen processing (TAP). Due to the lack of translocated peptides inside the endoplasmic reticulum, MHC class I molecules fail to assemble and therefore MHC-peptide complexes do not reach the cell surface for immune recognition by cytotoxic T-lymphocytes. Here we investigated the structure of ICP47 representing the first natural inhibitor of an ATP-binding-cassette (ABC) transporter identified so far. First, we demonstrate that the N-terminal half of ICP47 is as active in inhibition of human TAP as the full-length protein and therefore serves as an ideal model to investigate structural and functional aspects of the inhibitor. Second, from circular dichroism analysis, the viral inhibitor of TAP appears to be mainly unstructured in aqueous solution. However, in the presence of membrane mimetics or lipid membranes an alpha-helical structure is induced. Third, circular dichroism and fluorescence spectroscopy reveal that membrane adsorption and conformational change of ICP47 are directly dependent on the surface charge density of the lipid membrane. Therefore we conclude that docking to membranes induces a conformational change in ICP47 that may be prerequisite to blocking TAP function.

ATP-Binding Cassette Transporters↗

PubMed1997

Increased rates of fibromyalgia following cervical spine injury. A controlled study of 161 cases of traumatic injury.

OBJECTIVE: To study the relationship between cervical spine injury and the development of fibromyalgia syndrome (FMS). METHODS: One hundred two patients with neck injury and 59 patients with leg fractures (control group) were assessed for nonarticular tenderness and the presence of FMS. A count of 18 tender points was conducted by thumb palpation; and tenderness thresholds were assessed by dolorimetry at 9 tender sites. All patients were interviewed about the presence and severity of neck and FMS-related symptoms. FMS was diagnosed using the American College of Rheumatology 1990 criteria. Additional questions assessed measures of physical functioning and quality of life (QOL). RESULTS: Although no patient had a chronic pain syndrome prior to the trauma, FMS was diagnosed following injury in 21.6% of those with neck injury versus 1.7% of the control patients with lower extremity fractures (P = 0.001). Almost all symptoms were more common and severe in the group with neck injury. FMS was noted at a mean of 3.2 months (SD 1.1) after the trauma. Neck injury patients with FMS (n = 22) had more tenderness, had more severe and prevalent FMS-related symptoms, and reported lower QOL and more impaired physical functioning than did those without FMS (n = 80). In spite of the injury or the presence of FMS, all patients were employed at the time of examination. Twenty percent of patients with neck injury and 24% of patients with leg fractures filed an insurance claim. Claims were not associated with the presence of FMS, increased FMS symptoms, pain, or impaired functioning. CONCLUSION: FMS was 13 times more frequent following neck injury than following lower extremity injury. All patients continued to be employed, and insurance claims were not increased in patients with FMS.

Adult↗

PubMed1997

Posttraumatic stress disorder, tenderness and fibromyalgia.

The aims of the present study were to inquire into the prevalence of fibromyalgia syndrome, to assess nonarticular tenderness, to measure fibromyalgia syndrome-related symptoms, quality of life, and functional impairment among posttraumatic stress disorder (PTSD) patients as compared with control subjects. Furthermore, the differences between the PTSD patients with and without fibromyalgia syndrome were studied. Twenty-nine PTSD patients and 37 control subjects were assessed as to the diagnosis of fibromyalgia syndrome according to the American College of Rheumatology. Tenderness was assessed manually and with a dolorimeter. Fibromyalgia syndrome-related symptoms, quality of life, physical functioning, PTSD symptomatology, and psychiatric features were assessed by valid and reliable self-report inventories. Results showed that the prevalence of fibromyalgia syndrome in the PTSD group was 21% vs. 0% in the control group. Furthermore, the PTSD group was more tender than the control group. PTSD subjects suffering from fibromyalgia syndrome were more tender, reported more pain, lower quality of life, higher functional impairment and suffered more psychological distress than the PTSD patients not having fibromyalgia syndrome. It is suggested that previous reports on diffuse pain in PTSD in fact described undiagnosed fibromyalgia syndrome. The link between psychological stress and pain syndromes is emphasized.

Activities of Daily Living↗

PubMed1997

Quality of life and physical functioning of relatives of fibromyalgia patients.

OBJECTIVES: The quality of life (QOL) and health status of fibromyalgia syndrome (FS) patients is impaired, and may adversely affect their close relatives. The aim of this study was to assess the QOL and physical functioning of relatives of FS patients. METHODS: A total of 118 relatives (parents, husbands, siblings, and offspring) of 30 FS female patients were evaluated using a QOL scale and the Fibromyalgia Impact Questionnaire (FIQ) and were compared with 124 healthy controls. These measures of functioning and QOL were further studied in relatives with and without FS. RESULTS: Although the QOL of the relatives was better than that of the FS index women, they were significantly less satisfied than the controls with functioning-related aspects, namely work (job or home), independence, and health (P < .05). Relatives with FS (n = 29) and female relatives (n = 40) reported lower QOL than relatives without FS (n = 89) and male relatives (n = 78), respectively. Similarly, physical functioning of relatives, though better than in FS index cases, was significantly worse than in healthy controls. Furthermore, the health status of female relatives and relatives with FS was significantly worse than that of male relatives and relatives without FS, respectively. CONCLUSIONS: The quality of life and physical functioning of relatives of FS patients were found to be impaired, especially in female relatives and those with undiagnosed FS. This finding may be attributed to the psychological distress in families of FS patients and to the high prevalence (25%) of undiagnosed FS among the relatives.

Adolescent↗

PubMed1997

Awareness of diagnostic and clinical features of fibromyalgia among family physicians.

OBJECTIVES: The aim was to assess the awareness and knowledge of family physicians about diagnostic and clinical features of fibromyalgia syndrome (FS), and to evaluate the contribution of rheumatology education to the improvement of this knowledge. METHODS: A detailed questionnaire on FS was completed by 172 family physicians. A composite score, based on five items, was constructed to quantitatively assess knowledge of FS (maximum score of 5). A comparison was made between physicians exposed to extensive education on FS (in Beer Sheva medical centre) and physicians without such exposure (in other centres). RESULTS: Ninety-six per cent of the physicians claimed to be familiar with FS. They recognized most of the FS-related symptoms, but had limited knowledge of the diagnostic criteria, treatment modalities and prognosis. Only 55% knew that FS is associated with widespread pain and 25% were familiar with the point count criterion. Physicians trained in Beer Sheva scored significantly higher than those trained elsewhere: 3.0 +/- 1.2 versus 2.4 +/- 1.2, respectively (P = 0.006), and their knowledge of FS treatment was significantly better. CONCLUSION: Family physicians in Israel are quite unfamiliar with the diagnostic criteria of FS, though educational exposure improves their awareness and knowledge.

Adult↗

PubMed1997

Hepatitis C virus infection and extrahepatic malignancies.

An association between chronic hepatitis C (HCV) infection and non-Hodgkin's lymphoma has been reported. We carried out this study to evaluate the possibility of an association between HCV infection and other extrahepatic malignancies. The medical records of 103 unselected, consecutively chosen, anti HCV-positive and 105 hepatitis B surface antigen (HBsAg)-positive patients attending the liver clinic or hospitalized in the Department of Medicine were reviewed. Patients in whom anti-HCV positivity was detected after the malignancy was diagnosed were excluded. Malignancy rates in the general Israeli population were obtained from the Israeli cancer registry. The ages of anti-HCV-positive and HBsAg-positive patients were 54 +/- 16 (+/-SD) (range, 15-84) and 45 +/- 12 (range, 20-78) years, respectively; the male/female ratios were 50/53 and 73/32, respectively. Extrahepatic malignancies were found in 15 (14.6%) of the anti-HCV and in three (2.9%) of the HBsAg-positive patients. Thirteen of the malignancies were found among the 60 anti-HCV-positive patients aged > or =55 years old. Only one malignancy was found among the 28 HBsAg-positive patients of the same age group (p < 0.01). The rate of extrahepatic malignancies in these HCV-infected patients was significantly higher (p < 0.01) than expected in the general population. An association between HCV infection and extrahepatic malignancy may exist, but further prospective studies, including a large number of patients with HCV infection, will be necessary to define this observation.

Adolescent↗

PubMed1997

Hepatitis B and C viruses serology in patients with SLE.

Sera of 95 patients with SLE were tested for the presence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C antibodies. The results show that HBsAg was not detected in the sera of all of the SLE patients. Only one patient was confirmed to have anti-HCV antibodies, suggesting that chronic infection with hepatitis B and C is not increased in patients with SLE compared with the general population.

Adolescent↗

PubMed1997

Fibromyalgia syndrome (FM) and nonarticular tenderness in relatives of patients with FM.

OBJECTIVE: To determine the prevalence of fibromyalgia (FM) and to assess nonarticular tenderness in relatives of patients with FM. METHODS: Thirty female patients with FM randomly chosen from 117 of their close relatives (parents, brothers, sisters, children, husbands) were assessed for nonarticular tenderness. A count of 18 tender points was conducted by thumb palpation, and tenderness thresholds were assessed by dolorimetry at 9 tender sites. FM was diagnosed according to the 1990 American College of Rheumatology criteria. RESULTS: The prevalence of FM among blood relatives of patients with FM was 26%, and among their husbands 19%. FM prevalence in male relatives was 14%, and in female relatives 41%. The mean tender point counts of male and female young relatives was significantly higher than that of controls: 6.1 vs 0.2 (p < 0.01), and 4.4 vs 0.4 (p < 0.01) respectively. Similarly, adult relatives had considerably higher mean tender point counts than controls: 4.0 vs 0.04 (p < 0.01) and 10.3 vs 0.28 (p < 0.01) respectively, for males and females. CONCLUSION: Relatives of patients with FM have a higher prevalence of FM and are more tender than the general population, as recently reported and shown in a healthy control group. This finding can be attributed to genetic and environmental factors.

Adolescent↗

PubMed1997

Elevated levels of hyaluronic acid in the sera of women with fibromyalgia.

OBJECTIVE: To evaluate serum levels of hyaluronic acid (HA) in patients with fibromyalgia (FM). METHODS: HA serum levels were evaluated by a radiometric assay in 42 women with FM (ACR criteria), 27 female patients with rheumatoid arthritis (RA) and 36 healthy female controls matched for age. RESULTS: HA serum levels (mean microg/l +/- SEM) were 41 +/- 8.7 in healthy controls; 113 +/- 15.9 in RA: and 420 +/- 26 in FM. CONCLUSION: HA serum levels in women with FM were significantly elevated compared to healthy controls and patients with RA. This observation suggests that FM is associated with a biochemical abnormality and that serum HA could be a laboratory marker for its diagnosis.

Adult↗

PubMed1996

[Long-term results after Charnley hip replacement].

We made a prospective study of 241 Charnley total hip replacements performed between 1968 and 1974. In 1990 we reviewed 92 patients with 103 hips or 96% of surviving hips at a mean follow-up of 17.6 years (15 to 20.6). The clinical results were excellent with Charnley scores of four or more for pain in 95% of the cases, for function in 73% and for movement in 93%. Of the whole series, 8.3% had been revised and Kaplan Meier survival analysis showed a probability of revision at 20 years of 10.7%. No significant difference concerning the results was found between young patients operated between the ages of 34 to 55, and older patients operated between the ages of 56 to 79 years. These results are similar to those from the few other series with extended follow-up and make it difficult to justify the present widespread use of uncemented hip prostheses.

Adult↗

PubMed1996

A new observation of two cases of acrofacial dysostosis type Genée-Wiedemann in a family--remarks on the mode of inheritance: report on two sibs.

We report on a Yugoslavian sibpair with postaxial acrofacial dysostosis type Genée-Wiedemann with some novel signs which broaden the spectrum of this syndrome. The manifestations of the present cases are compared with those of the previously described patients. Life expectancy, change of symptoms over time, and the mode of inheritance are discussed.

Abnormalities, Multiple↗

PubMed1996

Penicillin prophylaxis in complicated wounds of hands and feet: a randomized, double-blind trial.

The purpose of the study was to examine the effect of prophylactic penicillin treatment on the infection rate in patients with traumatic wounds of hands or feet with underlying lesions of bone, tendon or joint. A total of 599 patients were randomized to double-blind treatment with either (A) one injection of penicillin G, (B) penicillin V tablets for 6 days or (C) no antibiotic treatment. In group A the infection rate was 4.9 per cent, in group B 6.7 per cent and in group C 10.2 per cent. The difference between the infection rates in group A and C was 5.3 per cent with a 95 per cent confidence interval (CI) from 0.1 to 10.4 per cent (P = 0.046). Correction for an interim analysis and subgroup analyses increases this P value to 0.096. The difference between the infection rates in group B and C was 3.6 per cent (95 per cent CI from -1.9 to 8.9, P = 0.20). Patients in group B had gastrointestinal complaints five times as often as patients in group A and C. Prophylactic tablets for 6 days require patients' co-operation while an injection ensures that the prophylaxis is given. We therefore conclude that a single prophylactic injection of two million units of penicillin G is advisable for patients with these injuries.

Adolescent↗

PubMed1996

Familial aggregation in the fibromyalgia syndrome.

The authors studied the familial occurrence of fibromyalgia (FMS) to determine a possible role of genetic and familial factors in this syndrome. Fifty-eight offspring aged 5 to 46 years (35 males and 23 females) from 20 complete nuclear families ascertained through affected mothers with FMS were clinically evaluated for FMS according to the ACR 1990 diagnostic criteria. FMS symptoms, quality of life, physical functioning, and dolorimetry thresholds were assessed in all subjects. Sixteen offspring (28%) were found to have FMS. The M/F ratio among the affected was 0.8 compared with 1.5 in the whole study group. Offspring with and without FMS did not differ on anxiety, depression, global well-being, quality of life, and physical functioning. A high prevalence of FMS was observed among offspring of FMS mothers. Because psychological and familial factors were not different in children with and without FMS, the high familial occurrence of this syndrome may be attributable to genetic factors.

Adolescent↗

PubMed1996

The effects of replacing beta-blockers with an angiotensin converting enzyme inhibitor on the quality of life of hypertensive patients.

The aim was to evaluate the effects of a change of treatment from beta-blocker to captopril on the quality of life of hypertensive patients. One hundred forty-nine mild to moderate hypertensive patients who were being treated with beta-blockers were randomly assigned to receive captopril (12.5 to 50 mg twice daily), or to continue on beta-blocker treatment (atenolol: 25 to 100 mg once daily [n = 121], or propranolol, 10 to 80 mg twice daily [n = 12]). When required, 25 mg hydrochlorothiazide was added in each group. The patients were followed over periods ranging from 6 to 12 months. Blood pressure, treatment side effects, and quality of life were monitored. Blood pressure was equally well managed in both groups, though a lower level of treatment was required in the captopril group. The captopril treated patients exhibited favorable changes in several aspects of quality of life: sleep-related, gastrointestinal, and physical activity-related symptoms improved from baseline to end of follow-up. Drowsiness and the ability to concentrate significantly improved in the captopril group only (P <.01). Change in treatment from beta-blocker to captopril resulted in equally well controlled blood pressure on a lower drug dose. Moreover, the change to captopril had a positive impact on the quality of life.

Adrenergic beta-Antagonists↗

PubMed1996

Total hip arthroplasty with the Charnley prosthesis in patients fifty-five years old and less. Fifteen to twenty-one-year results.

Data on 240 primary Charnley total hip arthroplasties, performed in 211 patients from October 1968 to July 1974, were recorded prospectively. Fifty-two prostheses were implanted in forty-six patients who were thirty-four to fifty-five years old, and 188 prostheses were implanted in 165 patients who were more than fifty-five years old. The results for the younger patients were compared with those for the older patients. Twenty hips were revised over-all, and all five of the infections and four of the five fractures of the femoral stem that occurred in this group were in the older patients. However, the rate of aseptic loosening was similar for the two age-groups (three of the hips in the younger patients and five in the older patients). The probability of revision after twenty years for the two groups, as determined with Kaplan-Meier analysis, was 11.7 per cent for the younger patients and 10.7 per cent for the older patients. There was no significant difference between the two groups with regard to either the number of revisions or the percentage of patients who had radiographic signs of loosening. The median Charnley hip scores during the course of the study were also similar for the two groups. We recommend that Charnley low-friction arthroplasty be used even in younger patients, as the long-term results were excellent and were comparable with those in the elderly age-group.

Adult↗

PubMed1996

Wobble board training after partial sprains of the lateral ligaments of the ankle: a prospective randomized study.

Ankle sprains are often complicated by functional instability and repeated sprains. Rehabilitation with wobble boards in patients with functional instability has been tested, and significant improvement has been found compared to no training. The aim of this study was to investigate whether the number of patients with residual symptoms following ankle sprains could be reduced by training on a wobble board during 12-week recovery period. In addition, the influence of training in the time course reduction of edema was investigated. We performed a prospective study including 61 patients, all active in sports for more than 2 hours a week with primary ankle sprains. The effect of a 12-week training program with wobble board was compared with no training. Forty-eight patients completed the study. In the follow-up period (mean X = 230 days), we found significantly fewer recurrent sprains, and significantly fewer patients in the training group had functional instability of the ankle compared with the no training group. There were no differences in the two groups in the time which elapsed before patients were painless at walking, during running, or at sports. Volumetric measurements revealed no difference in the speed of reduction of hematoma and edema of the ankle and foot between the two groups. We conclude that training on a wobble board early after primary stage 2 ankle sprains is effective in reducing residual symptoms following this lesion and that training does not seem to affect the time course reduction in edema.

Adult↗