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Biomedical subjects

M Schiltenwolf

Publications and source records attributed to M Schiltenwolf.

At least 19 recordsLinked to original sources
PubMed2006

["Are rich people healthier?"--Representative epidemiological data on socioeconomic group-specific disease prevalences among adults in Germany].

BACKGROUND AND OBJECTIVE: The aim of this study was to determine representative nationwide data on differences in the prevalence of specific diseases between socioeconomic groups. METHODS: The "First National Health Survey for the Federal Republic of Germany" was conducted from October 1997 to March 1999 in the form of a standardized cross-sectional questionnaire study. The data were elicited about the 35 most common diseases and socioeconomic status. The net sample was made up of a total of 7125 persons aged 18 to 79. RESULTS: A significantly higher prevalence in subjects of lower socioeconomic status was identified for typical orthopaedic diseases as well as for hypertension, chronic bronchitis, gastric and vascular disease. The most apparent socioeconomic difference to the detriment of socially deprived subjects was identified for addiction disease and diabetes. In contrast, numerous allergic diseases such as food allergies, urticaria, and allergic diseases of the respiratory tract and eyes were approximately twice as common among members of higher socioeconomic groups. Various gastrointestinal and renal diseases (hepatitis, gastritis, pyelonephritis) were also more common in higher socioeconomic groups. These socioeconomic differences were still apparent after adjustment for age and gender. CONCLUSION: This study provides representative socioeconomic group-specific prevalence data on a total of 35 clinical entities for the Federal Republic of Germany. Although the self-reporting involved in large epidemiological studies of this kind is associated with a certain amount of bias, it is nonetheless clear that the frequently cited "socioeconomic gradient", i. e., a higher disease prevalence among lower socioeconomic groups, seems not to apply for numerous disease entities; for which the association seems to be in the opposite direction. This phenomenon requires explanation.

Adult↗
PubMed2006

[Somatoform pain disturbance as the result of trauma].

Orthopedic specialists and emergency surgeons are often confronted with somatoform disorders, which can be the result of traumatization, and they frequently do not recognize this. A combination of pain and several other physical symptoms is typical for somatization, and in these circumstances a psychosocial history should be elicited as a precaution before an elective operation is considered. Recognition of somatization with subsequent referral to more appropriate professional care (e.g., center for multimodal pain therapy, psychosomatic clinic) is crucial. We describe an interesting and instructive case, which it is hoped will help practitioners to recognize such patients and deal with their cases in the correct manner.

Adult↗
PubMed2006

[Multimodal therapy patients with chronic cervical and lumbar pain. Results of a comparative prospective study].

BACKGROUND: Multimodal therapy has been established for patients with chronic low back pain, but studies reporting results in patients with chronic neck pain are rare. METHODS: This prospective clinical study compared the results in 97 patients with chronic cervical pain and 231 patients with chronic lumbar pain after three weeks of multimodal therapy. The following factors were analyzed in both groups at the beginning and after 6 months: ability to work, pain intensity and functional back capacity. RESULTS: Both groups had improved significantly after 6 months in all outcome parameters. Functional back capacity and ability to work at 6 months were not different between the two groups, but pain intensity was significantly lower in patients with low back pain compared to patients with neck pain. CONCLUSION: Multimodal therapy is also an efficient treatment strategy for patients with chronic cervical pain as has already been shown for patients with chronic lumbar pain.

Activities of Daily Living↗
PubMed2005

[Recommendations for expert assessment of tendon injuries].

Expert assessment of tendon injuries depends on differences between private and public insurance providers in the way preexisting conditions have to be taken into account. In most cases degenerative and injury-dependent factors have to be balanced. Common tendon injuries such as Achilles and biceps tendon ruptures as well as rotator cuff tears are discussed.

Diagnosis-Related Groups↗
PubMed2005

[Preaching to the converted: deficits and surpluses in preventative pain therapy in German back care programs].

BACKGROUND: In response to the growing incidence of back pain, increasing emphasis is being placed on individualized preventive measures. The purpose of the present study was to investigate representative data for back pain, participation rates of back care programs, and their correlates in the German general population. METHODS: The first National Health Survey was carried out in the Federal Republic of Germany in the period from October 1997 to March 1999. It comprised a representative, cross-sectional study of the population with a total sample of 6235 participants between the ages of 18 and 79. RESULTS: The 7-day prevalence for back pain in Germany was found to be 36%, and 7% of all Germans had participated in a back care program within the past year. The 1-year participation rate was significantly lower in persons with higher risk for back pain (men, full-time workers, unmarried people, and those with an unhealthy lifestyle). CONCLUSIONS: The user profile for back care programs indicates that genuine needs are not being met and the target group is not being reached. A "preaching to the converted" phenomenon is evident, as indicated by the fact that the user group is made up of individuals who already have a healthy lifestyle and few risks while the population group most likely to develop back pain is significantly less likely to participate in preventive back care programs.

Adult↗
PubMed2005

Pain and high sensitivity C reactive protein in patients with chronic low back pain and acute sciatic pain.

BACKGROUND: The severity of pain from musculoskeletal disorders might be associated with high sensitivity C reactive protein (hsCRP), a sensitive marker of low grade systemic inflammation. OBJECTIVE: To study the association between pain as assessed by a visual analogue scale (VAS) and hsCRP in patients with chronic low back pain and acute sciatic pain. METHODS: Information on pain severity, determinants of hsCRP, and hsCRP values were obtained prospectively at up to 10 time points during six months in 72 consecutive patients (mean age 43.3 years; 59.7% female): 41 with chronic low back pain and 31 with acute sciatic pain. The association between severity of pain and raised (highest quartile) hsCRP values at any time point was estimated by multivariable logistic regression using generalised estimating equations to adjust odds ratios (OR) and their confidence intervals (CI) for intraindividual dependence of measurements. RESULTS: Mean intensity of pain (VAS 0-10) at baseline was 4.9 and 5.5 in patients with chronic low back and acute sciatic pain, respectively. Highest v lowest tertile of average intensity of pain during the last 24 hours was associated with increased hsCRP levels among patients with acute sciatic pain (adjusted OR = 3.4 (95% CI, 1.1 to 10), but not in patients with chronic low back pain (adjusted OR = 0.87 (0.25 to 3.0)). CONCLUSIONS: Mean intensity of pain during the previous 24 hours as assessed by VAS was independently associated with high levels of hsCRP in patients with acute sciatic pain but not in those with chronic low back pain.

Acute Disease↗
PubMed2004

[Chronic musculoskeletal pain--aspects for assessment in private disability compensation (I)].

Pain is the most frequent symptom of diseases of the musculoskeletal system. Moreover pain is the most frequent complaint in applications for governmental or private disability compensation. Since pain remains a subjective sensory perception, it is the task of assessment to prove all the proband's information for consistency. Both multidimensionality of chronic pain and a high impact of psychosomatic comorbidity imply that not only orthopaedic and traumatologic but as well psychosomatic competence for legal assessment is required.

Chronic Disease↗
PubMed2004

[The Explanatory Model-Interview in the diagnosis of orthopaedic pain patients].

AIM: This study aims to clarify weather the Explanatory Model Interview (EMIC, Weiss, 1997) can detect differences between pain patients with somatoform disorders and pain patients without any psychiatric disorder. We consider the importance of psychological symptom reporting, somatic illness attribution and the subjective experience of exhaustion. METHODS: The (EMIC) and the Structured Clinical Interview for DSM-IV (SKID) were administered to 87 in-patients recruited from the pain therapy ward of the Orthopaedic Clinic in Heidelberg, Germany. The analysis of the EMIC strongly reflects interactional factors and the subjective importance for the patients. RESULTS: Patients with somatoform disorders reported more psychological distress than patients without psychiatric disorder, especially after inquiry. Physical exhaustion was clearly more important in the symptom attribution of somatic pain patients, but an exclusive somatic illness attribution did not appear more often in this group of patients. CONCLUSIONS: Most pain patients with somatoform disorders report psychological distress when they are encouraged. In spite of this emotional strain, most of the pain patients with somatoform disorders attribute their pain complaints to somatic causes. The conspicuous importance of exhaustion in the attribution of patients with somatoform disorders confirms clinical observations and requires further research.

Adult↗
PubMed2004

[Limited efficacy of opioids in chronic musculoskeletal pain].

After excluding malignant disease in 21 patients with unremitting strong pain of the musculoskeletal system despite long-term opioid medication, the opioids were withdrawn to search for reasons of the limited effectiveness of the opioids. The opioid withdrawal was integrated in multimodal pain coping therapy. Besides the somatic diagnoses, pain-relevant psychosomatic diagnoses were evaluated with the structured clinical interview for DSM-IV (SCID). At the time of admission and discharge pain medication, physical functions, mood, and pain intensity were recorded. In the SCID interview, all patients were diagnosed with a relevant comorbid psychiatric condition (pain disorder, anxiety, depression). Despite reduction of the opioid medication, there was no increase of pain, but an improvement of the physical functions. In patients with chronic pain of the musculoskeletal system and limited effectiveness of opioid medication, psychosomatic comorbidities should be evaluated. Instead of continued and increased opioid medication, pain coping strategies and opioid withdrawal should be tested.

Analgesics, Opioid↗
PubMed2003

[Possible conservative treatment methods for patients with spinal claudication].

The success of multimodal therapy for patients with symptoms of spinal canal stenosis lasting >6 months was investigated in a prospective study. Clinical (age, weight, height) and morphological data were collected for 36 patients (21 women and 15 men) with an average age of 67 years. The extent of narrowing in the spinal space (diameter of the dural sac <100 mm(2)) was measured by magnetic resonance imaging at segments L1-S1. Impairments in daily activities were assessed by questionnaire before a 3-week multimodal treatment regimen and 3 weeks and 6 months thereafter. In addition, depression status and walking distance on a treadmill were evaluated. Of the 180 segments examined, 124 evidenced a diameter of the dural sac of <100 mm(2). The average functional capacity improved with treatment from 46.7 to 53.5 (p<0.001) and the average depression status decreased from 13.5 to 11 (p>0.05). The average walking distance was 373 m before treatment and 565 m after treatment (p<0.001). Short-term improvement of the walking distance was achieved with the conservative treatment implemented. Medium- and long-term results remain unclear. Predictors for treatment success (age, sex, BMI, functional capacity, walking ability before treatment) could not be found. No scientific evidence can be gleaned from the literature in this regard so that further prospective studies should be performed.

Aged↗
PubMed2000

Epidural corticosteroid injection in the conservative management of sciatica.

In this prospective randomized clinical trial, the results of epidural corticosteroid injections were evaluated in patients with lumbosciatic pain caused by herniated nucleus pulposus. Thirty-six patients with radicular lumbosciatic pain and positive straight leg raising test because of confirmed prolapsed intervertebral lumbar discs were randomized into two groups with (17 patients) and without (19 patients) epidural corticosteroid injection. Members of the treatment groups received three injections of 100 mg methylprednisolone in 10 mL bupivacaine 0.25% each. Additional therapy was standardized and identical in both groups. Followup examinations were performed at 2 weeks, 6 weeks, and 6 months. The examinations included pain level (visual analogue scale), straight leg raising test, and functional status (Hannover Functional Ability Questionnaire). At 2 weeks, patients receiving methylprednisolone injection showed a significant improvement in straight leg raising test results compared with patients in the control group. Results were better in the methylprednisolone group, although not statistically significant for pain relief and mobility. At 6 weeks and 6 months, pain relief, improvement of straight leg raising, and improvement of functional status showed no statistical significance. Epidural corticosteroid injections can be recommended as additional therapy only in the acute phase of the conservative management of lumbosciatic pain.

Adult↗
PubMed1999

The risk of paraplegia through medical treatment.

In the Orthopedic University Hospital of Heidelberg (section Orthopedics II, treatment and rehabilitation of paraplegics), 21 patients with iatrogenic paraplegia were treated between 1968 and 1991. Paraplegia occurred in nine cases after procedures close to the spinal cord. In 12 cases paraplegia complicated medical treatment. Procedures close to the spinal cord, such as laminectomy, vertebrotomy, spondylodesis, and peridural anaesthesia, involve the risk of mechanical damage to the spinal cord, the level of paraplegia depends on the area of treatment. Any previous damage to the spinal cord increases the risk of paraplegic complications. The main risks in procedures distant from the spinal cord, such as vascular surgery, angiography, radiotherapy, bronchial artery embolisation, and umbilical artery injection, are disturbances of the blood supply or toxic mechanisms. The ischaemic genesis of spinal cord damage is obvious in the case of vessel ligatures or cross-clamping of the aorta with resulting hypotonic discirculation. In radiomyelopathy as well, the damage to the spinal vessels outweighs the direct neuronal damage. Corresponding to the vascular cause, lesions are more likely to occur at the level of borderlines of blood supply in the middle thoracic cord or in the area of a non-anastomosed great radicular artery in the lumbar spinal cord. Knowledge of the consequences and side effects of medical treatment is imperative. Knowing about the risk of a paraplegic lesion, we need a strict indication for diagnostic and therapeutic interventions. Due to progress in science some of the reasons of iatrogenic paraplegia have become manageable. Especially in radiotherapy, vascular surgery and angiography the risk of neurological complications has been lowered.

Adolescent↗
PubMed1999

[Aspects of conservative sciatic pain therapy].

Successful multimodal conservative treatment of sciatic pain will prevent unfavorable results of life discectomy and accelerates the natural course. In assessment of modalities of conservative treatment of sciatic pain, somatic and psychosomatic aspects have to be considered. Severe neurological deficits caused by lumbar disc herniation have to be treated surgically. Conservative treatment of sciatic pain follows the etiopathogenetic hypothesis of a centrally triggered and radicularly terminated inflammation; it reflects the biopsychosocial paradigm. Inflammatory alterations in the disc and psychosocial peculiarities of the patients prove this disease model. Conservative treatment of sciatic pain does not determine its, but works by the combined operation of different but etiopathogenetic or scientifically efficient means. Somatic therapy aims at blocking the inflammatory cascade by peridural and systemic antiphlogistic drugs, sufficiently applied analgesics and temporally limited bedrest. Physiotherapy and sports therapy for remobilization will follow. Psychosomatic therapy works through relaxation, support and interpretation. Physiotherapy, relaxation and verbal intervention work prophylactically, too. The patient-doctor relationship plays a crucial role in conservative treatment of sciatic pain.

Combined Modality Therapy↗
PubMed1998

[A new classification of semilunar bone necrosis].

The currently accepted classifications of Kienböck's disease by Decoulx and coworkers (1957) as well as Lichtman and coworkers (1977) resp. Lichtman and Degnan (1993) do not take into account early changes in MRI or changes in carpal architecture. A recent publication by Lichtman and Ross (1994) did not solve the problems of precisely describing the disease. This necessitates a new, reliable classification based on the true nature course of the disease. In a prospective study with 49 patients and in a retrospective review of 125 cases of lunate necroses, the regular natural course of the disease was analysed. It begins with normal X-ray appearance but a typical extinguished T1-signal in MRI; a fracture line is part of the later course and not seen in the beginning. Later, collapse of the lunate and the carpus can be observed. A new classification based on the natural course of the disease is proposed. This classification divides the natural course of Kienböck's disease into four stages, subdividing stage I, II and III by A and B. The disease commences with pathology only detectable by MRI (extinguished signal in T1-weighted sequence-stage I A), followed by first changes in the X-ray (condensation or mosaic-like appearance), while the outer form remains preserved (stage I B); the disease proceeds with partial deformation of the lunate with proximal or radial indentation (stage II A), later with a fracture line, while the lunate index of Ståhl remains normal (stage II B); the collapse of the lunate follows, and Ståhl's lunate index becomes pathologic (stage III A); the subsequent collapse of the carpus is characterized by a pathologic Youm-index (stage III B); Kienböck's disease, finally, leads to arthrosis of the wrist.

Follow-Up Studies↗
PubMed1997

[Late results of surgical treatment of acute and chronic instability of the ulnar collateral ligaments].

A total of 113 patients with acute and chronic instability of the ulnar collateral ligament metacarpal phalangeal (MP) joint of the thumb were treated surgically between 1980 and 1985; 82 patients were followed up after a mean period of 10 years. Of 59 patients with acute injuries, 52 were painfree with full stability of the MP joint; 23 patients with chronic instability and tendon grafting also showed restoration of stability. Nevertheless, the range of motion was reduced severely and opposition of the thumb was impaired. The results of follow-up reveal that acute reattachment of the injured ulnar collateral ligament is more effective.

Adult↗
PubMed1997

No indications for percutaneous lumbar discectomy?

A questionnaire was used to assess the outcome of automated percutaneous lumbar discectomy (APLD), to correlate patients' data and to identify criteria for pain relief and patient satisfaction. Two hundred and thirty eight patients were operated on by APLD between 1988 and 1990. The questionnaire returned by 182 patients (76.4%) was suitable for evaluation. The mean follow-up was 2.5 years. Overall, 60% reported pain relief and 52% were satisfied with APLD. Conventional operations were carried out subsequently on 45 patients (25%). Bivariate and multivariate analyses were done for preoperative (age, gender, neurological deficit, Lasegue's sign, sports activity), perioperative (weight of disc material removed, level of APLD) and post-operative (conventional nucleotomy, change in condition, pain relief, satisfaction, sports activity, return to work, compensation claims) parameters. The only significant parameters for improvement in condition and pain relief was age, where patients younger than 41 do better. Risk factors for reoperation were a positive Lasegue's sign and over 41 years of age. Patient satisfaction was significantly higher for patients without sensory deficit preoperatively.

Adolescent↗