Biomedical subjects
Publications and source records attributed to U Schlumpf.
Aims, methods and effects of physiotherapy in treatment of patients suffering from ankylosing spondylitis are represented by a review. For a thorough understanding of therapeutic approaches pathology and pathogenesis are outlined in the introduction. The principles mainly of a regular active exercise programme are emphasized and explained.
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A tight but painless soft-tissue swelling in the left parasternal region, with chronic cough and lumbo-ischial pain becoming progressively more severe over several months, occurred in a 27-year-old man. The chest X-ray film was normal, radiography of the iliosacral joints revealed right-sided sacroiliitis. In the further course of the illness night sweat, nightly fever up to 38 degrees C and weight loss of 7 kg in two months, as well as severe treatment-resistant earache developed. When hospitalized, another chest X-ray film showed disseminated small nodular foci pointing to tuberculosis. Sputum and irrigation fluid from the right middle-ear contained Mycobacterium tuberculosis. Biopsy material from the parasternal tumour and middle-ear mucosa contained caseous granulomas, confirming the diagnosis of tuberculous sacroiliitis as part of multi-organ tuberculosis. Tuberculostatic treatment--400 mg isoniazid, 600 mg rifampicin, and 1,500 mg pyrazinamide daily (the latter discontinued after 8 weeks)--normalized the appearance in the chest X-ray film. The patient returned to his home in Holland and, four years later, reported that he was free of any symptoms, even during sport activity.
The inflammatory stage of osteoarthritis when secondary synovitis contributes to the characteristic clinical presentation is first explained. During episodes of acute synovitis nonsteroidal antiinflammatory drugs may be particularly beneficial. Guidelines for a prescribing policy are given in which a safety first approach is adopted. Propionic acid derivatives or newer drugs with similar properties are proposed as initial therapy to control symptoms of osteoarthritis. Special problems of patients at risk (ulcer patients, renal insufficiency, heart failure) are considered.
Previous history, clinical findings, course and therapeutic outcome in 149 elderly patients with lumbar disk hernia were analyzed and compared with younger adult patients. 21% of all patients with lumbar disk hernia undergoing surgical treatment, and 25% under conservative treatment, were aged over 60 years. In these patients no history of low back pain is present in one third, the course is prolonged and motor deficits are more often encountered. Concomitant osseous narrowing (spinal stenosis, narrowed recessus lateralis) were present in 72% of this elderly group. Surgical complications are increased (34%) and are due to age-related diseases. Functional results are excellent after both conservative treatment and surgical therapy.
Analyses of C3 split products with C3d specificity (C3dg) were performed in 157 synovial fluids (SF) of 129 patients with various known joint diseases. Considerable overlap between all inflammatory infectious, and crystal induced disease categories confines the value of such measurements as a diagnostic guide to only a few clinical situations. In seronegative as well as in seropositive rheumatoid arthritis no correlation between SF C3d levels and erythrocyte sedimentation rate could be found.
To determine the clinical significance of the Raji cell radioimmunoassay as a laboratory marker of activity, four patients with systemic lupus erythematosus (SLE) were followed for a period of 30 to 90 months. These sequential analyses did not show a correlation between circulating immune complexes, determined by Raji cell radioimmunoassay, and signs and symptoms in these lupus patients over a period of several years. We believe that the Raji cell test offers no advantage over other well known immunologic parameters used in SLE (antibodies to native DNA, complement factors C3 and C4 or CH50). In the management of SLE patients, laboratory data should not serve as a key by which to adjust treatment with prednisone or immunosuppressive drugs; clinical data are of outstanding importance in this respect.
Two patients are described with parcellar algodystrophy, a special form of algodystrophy. Bone biopsy in one patient revealed increased bone resorption and irregular new bone formation. Parcellar algodystrophy is characterized by the very localized pathological changes in the region of a joint. Only a small area of demineralization may be visible on X-ray. Skeletal scintigraphy shows hyperfixation of technetium-99m already in an early stage. Although the inflammatory signs are clinically impressive, the ESR may be normal. History may reveal previous involved joints. Parcellar algodystrophy normally runs a benign course. The difficulty of correct diagnosis is discussed. The changes are compared to those of partial algodystrophy and algodystrophy with no radiological abnormality throughout the course of the disease.
The early development of bilateral osteonecrosis of the femoral head after high doses of steroids in two young patients suffering from chorioretinitis is described. Steroids were given orally and by parabulbar injections. Consecutive avascular necrosis of the femoral head was treated in both cases by flexion osteotomy combined with cancellous bone grafting of the lesion. In one case a pedunculate bone graft was inserted. Early treatment requires early diagnosis and a high index of suspicion in the affected patient, and seems crucial in respect to prognosis. Conventional X-rays of the affected hips, combined with skeletal scintigraphy in the early stage, appear to be simple and useful diagnostic tools.
The influence of diclofenac sodium (Voltaren) on glucose metabolism was investigated in a group of 13 maturity onset diabetics treated by a standard diet alone. A second group of 14 patients with maturity onset diabetes well controlled by a standard diet and tolbutamide (Rastinon) was examined for a possible drug interaction. Determinations of capillary blood glucose as well as assessments of urine sugar by Clinitest and 24-hour urine glucose determinations were regularly done before and during treatment with diclofenac sodium. The results of this study show no alteration of glucose metabolism. These laboratory data suggest that there is no clinically relevant interaction between diclofenac sodium and tolbutamide. Neither the blood glucose profiles of the individual patients nor those of the two above-mentioned groups showed any alterations of blood glucose concentration. Diclofenac sodium, a non-steroidal antirheumatic drug, may be recommended in the treatment of rheumatic diseases in diabetics. Indomethacin, naproxen, sulindac, diftalon and diclofenac are more recently developed antirheumatic drugs which have been specially tested in diabetics.
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Seven cases with the syndrome of thalassemia minor and pauciarticular, non-erosive, seronegative arthritis are described. Other known causes of seronegative arthritis had been excluded. There was a predilection for middlesized joints such as ankles, wrists and elbows. Usually the synovitis was asymmetrical from onset, with one to eight joints affected. Finger or toe joint were usually spared. Extraarticular synovitis such as tenosynovitis or bursitis were not observed, nor were nodules, signs of vasculitis or visceral involvement. The course of this arthritis showed chronicity and mild, persistent, non-erosive synovitis without joint effusions. X-ray revealed juxtaarticular osteoporosis of the affected joints, characterized by a diminution of the number of trabeculae (hypertrophic atrophy) combined with broadening of the singular trabeculae; this picture is typical of hemoglobinopathies. - Computed tomography showed a probable slight deficit of bone mineralization. Laboratory investigations including ESR, routine immunological tests, blood chemistry, and HLA-tissue typing were all normal. - The combination of this peculiar arthropathy with thalassemia minor would appear to be worthy of note and requires a further search among the forms of arthritis of unknown origin.
Non-suppressible insulin-like activity (NSILA) is a term used for a variety of substances in serum, excluding insulin, which promote glucose uptake of adipose tissue and diaphragm in vitro. NSILA-S is a peptide with a molecular weight of 7000 which is soluble in acid ethanol and which has been purified on a large scale from human serum. This study describes a simple chromatographic one step procedure by which NSILA-S can be extracted and quantitatively measured in individual sera. Using Sephadex G-75 equilibrated with 1 M acetic acid, NSILA-S was detected only in one peak containing small molecular peptides. NSILA-S obtained with this one step chromatographic procedure exerted all the effects of purified NSILA-S including sulphation activity on the rat cartilage. All chromatographic fractions with NSILA-S also had sulphation activity. Both, NSILA-S and sulphation activity were increased in acromegalics and decreased in pituitary dwarfs. It is suggested that one molecule in serum is responsible for both activities which are, at least in part, under the control of growth hormone.
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Intravenous pulse methylprednisolone of 1000 mg was compared with 250 mg in patients suffering from rheumatoid arthritis. In this prospective open trial no difference could be observed regarding the number of heavily involved joints, morning stiffness, or blood sedimentation rate 2 weeks and 2 months after use of highdose or intermediate dose intravenous methylprednisolone. Medium remission duration was 6 weeks (2-24 weeks). Side effects occurred only rarely; they were transitory and harmless.