Successful treatment of a morbidly obese and growth-retarded adolescent with Williams-Beuren Syndrome by combining the medication of growth hormone and sibutramine.

A 16-year-old male adolescent diagnosed to have the Williams-Beuren syndrome was referred to our obesity outpatient clinic, due to his morbid obesity (body mass index 39.2 kilograms per square metre) and gluttony. After several unsuccessful dietary treatments, we started therapy with sibutramine. As growth hormone (GH) deficiency was diagnosed by an additional GH-stimulation test, we commenced with a GH-treatment. This well-tolerated combination therapy led to a remarkable weight loss of 10 kg and a growth-rate acceleration of 3.7 cm/year. Nine months after stopping the treatment with sibutramine, a partial weight gain was noticed. This case report justifies further research work on a combination therapy with sibutramine and GH for similar cases.

Low-fat, high-carbohydrate (low-glycaemic index) diet induces weight loss and preserves lean body mass in obese healthy subjects: results of a 24-week study.

BACKGROUND: The traditional treatment for obesity which is based on a reduced caloric diet has only been partially successful. Contributing factors are not only a poor long-term dietary adherence but also a significant loss of lean body mass and subsequent reduction in energy expenditure. Both low-fat, high-carbohydrate diets and diets using low-glycaemic index (GI) foods are capable of inducing modest weight loss without specific caloric restriction. The purpose of this study was to investigate the feasibility and medium-term effect of a low-fat diet with high (low GI) carbohydrates on weight loss, body composition changes and dietary compliance. METHODS: Obese patients were recruited from two obesity outpatient clinics. Subjects were given advise by a dietician, then they attended biweekly for 1-hour group meetings. Bodyweight and body composition were measured at baseline and after 24 weeks. RESULTS: One hundred and nine (91%) patients completed the study; after 24 weeks the average weight loss was 8.9 kg (98.6 vs. 89.7 kg; p < or = 0.0001). There was a significant 15% decrease in fat mass (42.5 vs. 36.4 kg; p < or = 0.0001) and a decrease in lean body mass of 5% (56.1 vs. 53.3 kg; p < or = 0.0001). DISCUSSION: In this 6-month study, a low-fat, low-GI diet led to a significant reduction of fat mass; adherence to the diet was very good. Our results suggest that such a diet is feasible and should be evaluated in randomized controlled trials.

Clinical quality management in rheumatoid arthritis: putting theory into practice. Swiss Clinical Quality Management in Rheumatoid Arthritis.

Clinical quality management (CQM) in rheumatoid arthritis (RA) aims to reduce inflammatory activity and pain in the short term, and damage, and consequently disability, in the long term. Within CQM as used in Switzerland rheumatologists are provided with a measurement feedback system with which they can regularly follow their patients. Inflammatory activity is measured with the Disease Activity Score (DAS28) and the Rheumatoid Arthritis Disease Activity Index questionnaire (RADAI), damage with an X-ray score and disability with the Stanford Health Assessment Questionnaire (HAQ). Feedback is used to optimize therapy, which in the short term allows the activity of the inflammatory process to be adjusted or 'titrated'. In the long term, the therapy result for the individual patient is monitored by the course of disability and damage. In this paper we present a series of cases to illustrate the usefulness of the CQM system in the management of individual RA patients. CQM in RA may be helpful when making decisions about adjustment of treatment, and to document and communicate these decisions based on quantitative data.

[Diclofenac/orphenadrine infusion therapy in patients with active arthrosis]. / Diclofenac/Orphenadrin-Infusionstherapie bei Patienten mit aktivierten Arthrosen.

This study investigated the efficacy and safety of a diclofenac/orphenadrin infusion in 21 female and 1 male patients with clinically and radiologically diagnosed inflammatory osteoarthritis of the big joints, especially the knee and hip joints. The patients received 1 infusion per day over 2 h for 10 days. Efficacy and safety were assessed by measuring the subjective pain intensity at rest and during exercise on a visual analogue scale and on an ordinal rating scale before and after every infusion. The patients were interviewed daily for possible side effects. After the 10-days treatment course a 5% reduction of pain at rest and a 37.5% reduction of pain during exercise was observed. Subjective pain intensity was reduced by an average of 32.5%. In most cases relief was noticeable after the 4th infusion. 9 patients rated the medication safety as "very good", 11 patients as "good". A total of 12 patients reported mainly mild side effects such as vertigo, dry mouth, and temporarily reduced visual acuity. Based on its rapid onset of action and its efficacy, it can be stated that the investigated diclofenac/orphenadrin infusion is a valuable extension of the therapeutic methods in patients with inflammatory osteoarthritis.

[Possible diagnostic error of "Bechterew disease"]. / Mögliche Fehldiagnose "Morbus Bechterew".

A 41-year old caucasian male presented with limited range of motion of the entire spine and myogenous intermittent claudication. He was referred with the diagnosis "ankylosing spondylitis". The clinical picture mimicked ankylosing spondylitis, but there were no corresponding radiological abnormalities despite a 13-year history of his disease. Laboratory values showed markedly elevated levels of muscle enzymes. The diagnosis of rigid spine syndrome, a subtype of muscular dystrophy, was made from the clinical picture a normal EMG and degenerative changes on a biopsy from the muscle trapezius. We would like to draw attention to this rare cause of back pain.