[Results of a multidisciplinary rehabilitation concept in patients with chronic lumbar syndromes]. / Ergebnisse eines multidisziplinären Rehabilitationskonzepts bei Patienten mit chronischen Lumbalsyndromen.

The aim of our pilot study was to evaluate the influence of a multidisciplinary rehabilitation programme on various parameters of pain and function in 88 patients suffering from chronic low back pain caused by disc herniation (46 patients) or after lumbar discectomy (42 patients). We used an exercise-based multidisciplinary programme during a four-week in-patient treatment: active physiotherapy, exercise training and back school, organized in group therapies combined with passive techniques of physiotherapy (heat, massage, electrotherapy, medicated bath) with a daily duration of treatment exceeding three hours. Symptoms and functions improved simultaneously with the reduction of pain. The results of the visual analogue scale improved significantly in both groups (conservatively treated group p < 0.0001, after lumbar discectomy p < 0.005). As for the McGill pain questionnaire, however, only the group with conservatively treated disc herniations changed significantly for the better. We found an improvement in Roland-Morris' disability questionnaire in both groups, which reached statistical significance only in the group after lumbar discectomy. Forward-backward bending (kyphometer measurement as described by Debrunner), ameliorated significantly in both groups. Our results indicate that an exercise based multidisciplinary rehabilitation programme can improve pain and function even in patients suffering from definitely chronic low back pain caused by disc herniation or after lumbar discectomy.

[Results of inpatient postoperative rehabilitation after hip replacement]. / Ergebnisse der stationären postoperativen Rehabilitation nach Hüftgelenkersatz.

The study was performed as a pilot study evaluating the benefit of a 4-week inpatient postoperative rehabilitation programme. We examined 177 patients admitted after total hip replacement. We found statistically significant improvements of joint mobility, muscle power, gait, walking distance and a significant reduction of various pain parameters. The decline in usage of crutches, improvements in the activities of daily living and the positive patients' assessments were of striking evidence. A short time inpatient postoperative rehabilitation programme achieved significant success through an acceptable expenditure of treatment and resulted in substantially increased mobility and autonomy of the patients.

[A rare arthrosis of the metacarpophalangeal joints--a degenerative disease in heavy manual labor]. / Die seltene Arthrose der Metakarpophalangealgelenke--eine degenerative Erkrankung bei manueller Schwerarbeit.

We identified eight patients (10%) suffering from metacarpophalangeal (mcp) osteoarthritis in a group of 81 men doing hard manual labor for more than 10 years. There was no case of mcp osteoarthritis in a group of 65 men which had not performed hard manual labor. The most essential clinical symptom was mild to moderate pain in all cases, followed by deformities, stiffness, reduced subjective grip strength, decreased range of motion, and soft-tissue swelling, listed in order of decreasing frequency. In the first group, we found a higher frequency of other localizations of interphalangeal osteoarthritis. It seems remarkable that in three patients the osteoarthritis of the mcp joints was isolated, without degenerative changes of the other finger-joints. The typical localization of the mcp osteoarthritis was the second and the third fingers, most frequently of the right hand in patients with known right-handedness (but the finding lacks statistical significance). Radial, hook-like osteophytes, and ulnar, blunt-shaped osteophytes were recorded as morphologic characteristics. Extreme stress of the finger joints by intense gripping and handling of heavy tools, and microtrauma caused by vibrating tools are discussed as causative factors.

[Changes in uric acid and blood lipids in patients with asymptomatic hyperuricemia treated with diet therapy in a rehabilitation procedure]. / Veränderungen der Harnsäure und der Blutfette bei Patienten mit asymptomatischer Hyperurikämie unter diätetischer Therapie während eines Rehabilitationsverfahrens.

More than 300 patients with asymptomatic hyperuricaemia had been included in lipometabolic analysis performed before and after 4 weeks of a special low-cholesterol, low-triglyceride and low-purine dietetic regimen. Remarkable in almost the entire hyperuricaemic population (96.7%) had been the presence of serum cholesterol levels of more than 200 mg/dl. Lipoprotein analysis showed that 87% of the patients had increased LDL- and 69% increased VLDL-levels; HDL-levels were pathologically lowered to below 40mg/dl in 41% of the group. After a four-week rehabilitation programme, all lipometabolic parameters and serum urate concentrations were found to have been significantly reduced by the special diet. The results therefore are impressive proof of the major health benefits of purposive nutritional behaviour.

[Hyperlipoproteinemia in primary gout and asymptomatic hyperuricemia]. / Hyperlipoproteinämie bei primärer Gicht und asymptomatischer Hyperurikämie.

More than 800 patients suffering from primary gout or asymptomatic hyperuricemia were examined for the values of total cholesterol and triglycerides and the pattern of lipoproteins. The values for HDL (high-density-lipoprotein = alpha-lipoprotein), LDL (low-density-lipoprotein = beta-lipoprotein) and VLDL (very-low-density-lipoprotein = pre-beta-lipoprotein), found in lipid electrophoresis, were significant abnormal as well in the group of patients with gout (n = 147) as in the group of patients with asymptomatic hyperuricemia (n = 700) versus the healthy controls. It was remarkable, that the values of lipoproteins in asymptomatic hyperuricemia almost were abnormal just as often as in primary gout. Approximately 80% of both groups showed an increased LDL, around 35% a decreased HDL, and an increased VLDL was found in 72% of patients with gout and in 54% of asymptomatic hyperuricemia. Pathological changes of all lipoproteins (HDL, LDL and VLDL) appeared in 23% of patients with gout and in 20% of patients with asymptomatic hyperuricemia. Only 2.7% of patients with gout and 4.8% with hyperuricemia showed a normal lipometabolism.

[Relation of neopterin and beta 2 microglobulin to disease activity in chronic polyarthritis]. / Beziehungen von Neopterin und Beta-2-Mikroglobulin zur Krankheitsaktivität der chronischen Polyarthritis.

The correlations of the serum levels of neopterin and beta-2-microglobulin with the disease activity-measured by a clinical index-were investigated in 41 patients suffering from rheumatoid arthritis. Both parameters correlated significantly with the sum of the used disease activity index. There was a closer correlation between the serum levels of beta-2-microglobulin and the sum of the index and most of the particular parameters of the index than it was seen for the neopterin serum levels.

[Dupuytren's contracture as a concomitant disease in diabetes mellitus]. / Die Dupuytrensche Kontraktur als Begleiterkrankung des Diabetes mellitus.

100 randomized diabetic patients were examined for the occurrence of Dupuytren's palmar contractions and for possible relations to the usual chronic diabetic complications, to metabolic control and to social and environmental factors. The incidence of the Dupuytren's palmar contraction in the total diabetic population was 42%. Contractions were most frequent on the tendons of the third and fourth fingers with a preponderance of the right side. The relative frequency of the Dupuytren's palmar contraction increased with age and the duration of diabetes mellitus. There were no relations to the chronic diabetic complications or the metabolic control. In conclusion Dupuytren's palmar contraction appears to be an age-dependent, but not specifical diabetic process, although it appears to be accelerated by diabetes mellitus.

[Fundamental reflections on patient compliance]. / Grundsätzliche Uberlegungen zur Patientencompliance.

Fundamental reflections on the presuppositions and ethical justifications of measures for improving compliance are presented. The limits and reasons for the responsibility of the physician and the patient and the limits of the measures for improving compliance are discussed.

Serum lipids and lipoproteins in patients with primary gout.

Serum lipid and lipoprotein values of 32 male patients suffering from gout were quantitated and compared with corresponding values of a random control group which did not differ significantly with regard to age, body weight index and socio-economic status. All patients were on therapy with allopurinol which lasted on average for 6 years. The most striking differences between patients and controls were the increased triglyceride and apo B values and the decreased HDL-cholesterol (HDL-C) and HDL-phospholipid (HDL-PL) values in the patient group. The values of total cholesterol, LDL-cholesterol, apo A-I and Lp (a) were not significantly different between patients and controls. The great differences in the ratios of apo B/LDL-C, apo A-I/HDL-C and apo A-I/HDL-PL values suggest that gout is connected with changes in the chemical composition of the major lipoprotein classes. In three normolipemic individuals who were treated for 3 weeks with allopurinol no changes in lipoproteins and apolipoproteins were apparent. The results are discussed in view of the atherosclerosis risk of patients suffering from gout.

[Diabetic osteoarthropathy]. / Die diabetische Osteoarthropathie.

The diabetic osteoarthropathy is an important diabetic complication. There is an obligatory connexion of the diabetic osteoarthropathy with the diabetic neuropathy. It seems to be essential for the diagnosis and treatment to separate the neuropathic and arthropathic lesions from angiopathic changes. It should be paid more attention to the diabetic osteoarthropathy in the treatment and training of diabetic patients suffering from diabetic neuropathy.

[Comparative studies between median blood sugar, hemoglobin A, triglycerides and C-peptide in normal-weight insulin and non-insulin dependent diabetics]. / Vergleichende Untersuchungen zwischen mitttlerem Blutzucker, Hämoglobin A1, Triglyzeriden und C-Peptid bei normalgewichtigen insulin- und nichtinsulinpflichtigen Diabetikern.

In our study the glycosylated haemoglobin was positively correlated with the mean bloodglucose concentration and the levels of serum triglycerides and proved to be a valuable parameter, which completes the hitherto existing possibilities of diabetes control. The difference of the levels of serum triglycerides and C-peptide between non-insulin-dependent and insulin-dependent diabetics, with the same quality of the levels of HbA 1 and mean bloodglucose, give us a help to decide, which therapeutic way would be the best in the introduction respectively correction of the treatment of the elderly diabetic patients.

[Nature and extent of self medication with so-called "home remedies" in patients with rheumatic diseases]. / Art und Ausmass der Selbstmedikation mit sogenannten "Hausmitteln" bei Patienten mit rheumatischen Erkrankungen.

272 patients with various rheumatic disorders were interviewed on the basis of a 28 points questionnaire concerning a possible self-medication with non prescribed remedies. A total of 272 patients (78%) had taken various non prescribed remedies and additionally 56 patients had kept self-made dietary restrictions. The parameters favouring an increased rate of self-medication were: female sex, increased age and a prolonged duration of the disease. However, the type of the rheumatic disorder did not play any significant role. The possible reasons of this high degree of self-medication with non prescribed remedies are discussed and improved patient-information by the physician is postulated.

[Occurrence of malignant non-Hodgkin lymphoma after long-term azathioprine therapy of chronic polyarthritis]. / Auftreten eines malignen Non-Hodgkin-Lymphomes nach Azathioprin-Langzeittherapie einer chronischen Polyarthritis.

The case is presented of a female patient with rheumatoid arthritis, in whom a malignant non-Hodgkin lymphoma developed following long-term treatment with azathioprine. The possibility of an increased incidence of malignant lymphomas in immunological disorders, including rheumatoid arthritis, is discussed, as is the question of the extent to which azathioprine therapy might be involved in this. Some pathogenetic mechanisms of the development of malignant lymphomas are also considered.

[Diffusive interstitial pulmonary fibrosis in chronic polyarthritis]. / Die diffuse interstitielle Lungenfibrose bei chronischer Polyarthritis.

Among 167 in-patients with rheumatoid arthritis, 7 cases (4,2%) of diffuse interstitial pulmonary fibrosis of variable degree were revealed by chest X-ray examination. There was a predominance of the advanced functional classes according to Steinbrocker (where the duration of the disease was approximately the same as in patients without pulmonary fibrosis). There were higher 1-hour erythrocyte sedimentation rates and gamma-globulin valves and lower levels of hemoglobin and hematocrit in the patients with diffuse interstitial pulmonary fibrosis than in those without pulmonary changes. The etiological and pathogenetic aspects of several theories are discussed. The therapeutic possibilities are described and the importance of penicillamine therapy is emphasized.

[A clinical trial of sulindac in osteoarthrosis]. / Sulindac: Klinische Prüfung bei Arthrosen.

45 patients wih degenerative joint diseases (osteoarthrosis of the hip or knee, Heberden's nodes) were treated for 5 weeks in an open controlled trial with Sulindac, a new nonsteroidal antirheumatic drug (300-400 mg daily). The effectiveness of the drug was evaluated by the following criteria: changes of pain intensity with active movements, pain at rest, night pain, duration of morning stiffness and limitation of movement. Analysis of the global data showed in 64,4% excellent results. In 9.9% the results were good, in 17,8% moderate and there was no response in 6.6%. Other side effects (epigastric pain 8,9%, dizziness 2,2%) were not serious and reversible during the treatment with Sulindac.

[Viscosity of synovial fluid and possible artificial lubricants (author's transl)]. / Das rheologisch Verhalten von Synovialflüssigkeiten und möglichen Ersatzlösungen.

The viscosity of "normal" post mortem synovial fluid, and synovial fluid samples of knee joints affected by various joint diseases (inflammatory and non inflammatory) was investigated and compared with flow curves of Hyaluronic acid and Polyacrylamide solutions. The viscoelastic behaviours of synovial fluid seems to be of great importance for the lubrication mechanism of the joints. Differing results of the viscoelastic properties could be determined in different joint diseases. As a result of these changes the lubrication mechanism is impaired and this leads to cartilage wear. Solutions of Polyacrylamide and Hyaluronic acid have been investigated as model-substances, the former showing rheological properties similar to normal synovial fluid. Their application as an artificial lubricant has been investigated.