[Stress-related alteration of urine compositions: idiopathic CaOx stone formers, patients with chronic inflammatory bowel disease (CIBD) and healthy controls]. / Stressbedingte Alteration der Harnzusammensetzungen : Untersuchung von idiopathischen CaOx-Steinbildnern, Patienten mit chronisch entzündlicher Darmerkrankung und gesunden Probanden.

BACKGROUND: Increased emotional stress in everyday life influences the way of living and metabolism of people living in developed countries. Contemporaneously, the incidence and prevalence of urolithiasis rises. Does a pathogenetically relevant relationship exist between chronic stress burden and permanently altered urinary composition? PATIENTS AND METHODS: The influence of chronic stress burden on urine composition and risk of urinary calcium oxalate (CaOx) stone formation was, for the first time, comprehensively investigated in 29 healthy controls (CG), 29 idiopathic CaOx stone formers (SF) and 28 patients suffering from chronic inflammatory bowel disease (CIBD). After 4 days with standardized nutrition, 24-h urine was collected. Extensive urinalysis was performed and APCaOx index calculated. Evaluation of subjective stress level was carried out by using the standardized and well-established questionnaire Trierer Inventar zur Beurteilung von chronischem Stress (TICS). The concentration values of the urinary parameters as well as the APCaOx values were linearly correlated with the stress scores obtained from the different items of the TICS. A significance level p≤0.05 was considered to indicate statistical significance. RESULTS: The mean APCaOx indices amounted to 0.8±0.3 in CG, 1.2±0.7 in SF and 1.9±1.2 in CIBD. The increased APCaOx in SF mainly results from relatively increased Ca and oxalate excretions, whereas in CIBD this also results from reduced urinary excretions of citrate and Mg as well as reduced 24-h urinary volumes. The calculation of linear correlation coefficients between a TICS stress dimension and a concentration value of a urinary parameter or APCaOx results in r values not exceeding 0.600. However, some of these correlations are statistically highly significant. In SF only one combination with Ca was observed, while in CIBD in contrast a number of combinations, in particular including Na, was obtained. In CG direct statistical relationships between stress burden and citrate as well as Mg exist. In this group, increased stress burden is associated with increased inhibitory potential to prevent CaOx stone formation. CONCLUSION: In the investigated study groups, differently complex relationships between amount of stress burden and risk of CaOx stone formation were observed, however, without obvious physicochemical principle(s). In some individuals, stress can be associated with a significantly stress-related alteration of urinary composition towards increased CaOx stone formation risk. The results obtained from the CIBD group allow for the first time a conclusive link between emotional stress and inflammatory activity on the one hand and inflammatory activity and metabolic risk constellation of CaOx stone formation on the other hand.

[Influence of acupuncture on postoperative pain, nausea and vomiting after visceral surgery : a prospective, randomized comparative study of metamizole and standard treatment]. / Einfluss von Akupunktur auf postoperative Schmerzen, Ubelkeit und Erbrechen nach viszeralen Eingriffen : Eine prospektive, randomisierte Vergleichsstudie mit Metamizol und Standardbehandlung.

BACKGROUND: The objective of this study was to assess repeated needle acupuncture in the treatment of postoperative pain and nausea after visceral surgery. MATERIAL AND METHODS: Sixty-six patients undergoing visceral surgery (hysterectomy, cholecystectomy) were randomly assigned to group A (three sessions of needle acupuncture, n=21), group M (3x1000 mg metamizole, n=20), or group K (control, n=25). All patients received patient-controlled analgesia (PCA) using piritramide. To adjust for nonspecific effects due to physician-patient interaction during acupuncture sessions in group A, patients in groups M and K also received three standardized visits. Primary outcome parameters were defined as pain intensity, analgesic consumption, and frequency of nausea and vomiting in a period up to the morning of the second postoperative day. RESULTS: Patients in group A reported significant less pain, nausea, and vomiting compared to patients in group K. Mean cumulative piritramide consumption was significantly lower in group A (25.0 mg) than in group M (34.5 mg) and group K (55.2 mg). CONCLUSION: Repeated needle acupuncture may be effective in postoperative pain relief and the treatment of nausea and vomiting in the postoperative period. These effects seem not to be due solely to interaction between the acupuncturist and the patient.

[Physiotherapeutic and rehabilitation therapy for ankylosing spondylitis. Status quo and are they still necessary in the age of anti-cytokine therapy?]. / Physikalisch-therapeutische und rehabilitative Massnahmen bei der ankylosierenden Spondylitis. Status quo und was spricht im Zeitalter der Anti-Zytokin-Therapie noch dafür?

Ankylosing spondylitis (AS) is one of the most common chronic inflammatory rheumatic diseases characterized by erosions and bone proliferation with consecutive morphologic and functional deficits. Physiotherapeutic and rehabilitation measures are often necessary for AS patients for their whole life. In recent years, biologicals have substantially improved the outcome in AS patients, but their positive influence on vertebral and joint functions still requires differential indicative physiotherapeutic strategies and rehabilitation, in most cases in combination with effective analgesic and anti-inflammatory medication. Although physical therapy and rehabilitation have not been investigated in large controlled trials, they are essential for the multimodal therapeutic concept of AS.

[Physiotherapy strategies in osteoporosis--recommendations for daily practice]. / Differenzialindikative physikalische Therapiestrategien der Osteoporose--Empfehlungen für den Praxisalltag.

Physiotherapy in osteoporosis essentially takes the form of stimulatory therapy tailored to the findings and the pathomechanism. The choice of therapy and its dosage depend on the desired result (prevention, cure, rehabilitation). Physical therapy applied in osteoporosis includes electrical, thermic (hydrothermic, high frequency thermic, light thermic) and mechanical (massage, physiotherapy) stimuli, which can be applied regionally, locally or hoistically. To be efficient, a pain therapy requires that the various painful states be differentiated between: whereas, for example, in the case of acute pain physiotherapy fulfils the function of immediate therapy (normally rest and "mild" cold applications), in chronic pain it has to fulfil the function of an adaptive performance therapy of neuronal structures (formative-adaptive physiotherapy, thermic therapy improving trophism, direct current, transcutaneous electric nerve stimulation/TENS). It is necessary and extremely important forday-to-day clinical practice that physiotherapy strategies that are tailored to each patient's needs and also economically justifiable be implemented. The article isintended to contribute to this.

Exercises and physiotherapeutic strategies for preventing and treating osteoporosis.

For the treatment of osteoporosis, appropiate physiotherapy needs to use the given or remaining abilities of a patient to modulate and optimize the biological functions and structures (bone, muscle) in an adaptive, stimulating and regenerating sense. In addition physiotherapy can set serial physical stimuli to minimize pain perception by bio-psychosocial effects. Physiotherapy for osteoporosis has to be seen equivalent to pharmacotherapy with respect to prevention, cure and rehabilitation. In general, 2 different aims for effective treatment can be defined: 1. Aims that can be achieved solely with physical therapy, such as structural improvement of the existing and pharmacologically increased bone mass, slowdown of round-back formation and fall prophylaxis. 2. Aims that can be mainly achieved with physiotherapy and pharmacotherapy, such as increase of bone density and differentiated amelioration of pain. This article summarises the current knowledge on exercise and physiotherapy in preventing and treating osteoporosis, and focuses specifically on the diagnostic-orientated stimulating preventative, curative and/or rehabilitative effects, in which the choice of the individual regimen and the dosage need to be optimized for every patient individually.

Current knowledge about physiotherapeutic strategies in osteoporosis prevention and treatment.

In treating patients with osteoporosis, one option in physiotherapy is to comply with given physical norms by using physical stimuli to influence biological functions and structures (bone, muscle) for adaptation, stimulation, and regeneration. Serial physical stimuli can also be used for interventions and actions to minimise pain perception by means of biopsychosocial influence. In osteoporosis, physiotherapy has to be rated on a par with pharmacotherapy with respect to prevention, cure, and rehabilitation. Generally, two different aims can be defined: (1) those which can be achieved with physical therapy alone, such as structural improvement of the existing and pharmacologically increased bone tissue, slowing down of round-back formation, and fall prophylaxis and (2) those which can be achieved with physiotherapy and pharmacotherapy, such as effective pain relief and increased bone density. Regulation and normalisation of physical capacities with an aim towards maintenance and economisation of functions and improvement in abilities call for a skillful and case-specific use of physiotherapy.

Acquired nevoid telangiectasia.

BACKGROUND: Acquired nevoid telangiectasia (ANT) is a segmental dilatation of papillary plexus vessels. OBJECTIVE: In the present study, the frequency of ANT and its associations with collagen vascular and spinal disease have been investigated. METHODS: 188 unselected patients, seen at an interdisciplinary dermatorheumatologic outpatient clinic, were clinically examined for the presence of ANT and possible associations to preexisting disease. RESULTS: ANT was seen in 17% of patients, all females. The mean age of ANT patients was 57.5 +/- 8.2 years. Most common diseases were lupus erythematosus and scleroderma. Twenty-four of them suffered from generalized fibromyalgia, 8 had spondylitis deformans, 1 suffered from thoracal syringomyelia and 1 had a spine trauma. Two types of ANT have been seen: the cervicothoracal transition type and the lumbosacral transition type. CONCLUSIONS: ANT is not uncommon among patients attending a dermatorheumatologic outpatient clinic. ANT indicates spinal or neuromuscular complaints, but is not related to collagen vascular disease itself.

[Effects of Kneippism, a standardized complex therapy, on pain, quality of life and use of medicines: cohort study with a one-year follow-up]. / Auswirkungen der Kneipp-Kur, einer standardisierten Komplextherapie, auf schmerz, Lebensqualität und medikamentenverbrauch: kohortenstudie mit 1-jahres-follow-up.

BACKGROUND: Inpatient as well as outpatient cure in a spa environment with commonly 3- to 4-week duration features a combination of different treatments customized according to the needs of the individual patient. The physiological rationale and the mode of action are widely accepted. However, firm quantitative evidence of the clinical effectiveness is incomplete. OBJECTIVE: To document the effects of a well standardized complex therapeutic regimen (Kneippism) on pain, quality of life, and drug consumption during therapy and with 1-year follow up. STUDY DESIGN: Prospective cohort study with assessments at the beginning, during, and at the end of treatment and with follow-up investigations 3, 6, and 12 months thereafter. SETTING: Four spa clinics in Bad Wörishofen, Southern Bavaria. PATIENTS: 363 patients (248 outpatients, mean duration of therapy 23.3 days, and 115 inpatients, mean duration of therapy 27.4 days), one half between 40 and 60 years old above 60 years of age, predominantly suffering from musculoskeletal and/or cardiovascular diseases. INTERVENTION: Custom-tailored combination of therapies comprising of hydro-, kinesi-, and phytotherapy, dietetics, 'ordnungstherapie', and continued disease-specific standard treatment, if necessary. MAIN OUTCOME MEASURE: Pain, patients' self-rating, (IRES questionnaire), medication. RESULTS: The monitored dimensions of pain improved significantly during treatment and remained at that level essentially for the complete follow up interval. The same was true for various dimensions of reported subjective complaints as well as for drug consumption. CONCLUSION: When estimating the clinical relevance of a complex therapeutic regimen such as a cure of 3- to 4-week duration, the question of the impact of the specific effect of single components is secondary to the question of the overall relevance of that therapeutic concept. The findings of this study point at potential long-term effects of at least 1-year duration.

[Progressive systemic sclerosis - treatment results of extracorporeal photopheresis]. / Progressive systemische Sklerodermie. Behandlungsergebnisse unter extrakorporale Photopherese.

The treatment of progressive systemic sclerosis (PSS) is still unsatisfactory. We report on clinical, laboratory and immunological findings in 26 patients with PSS (6 males, 20 women) treated with extracorporeal photopheresis (ECP) for 8 cycles in a nonrandomized, uncontrolled study. ECP was performed on two consecutive days once a month. 8-methoxypsoralen concentrations in plasma and buffy coat were monitored by HPLC. We performed a standardized examination programme and determined parameters of inflammation and immune function. Global assessment revealed a partial remission in 18 patients, a stable disease in 8 patients and a slight progression in one patient. In the peripheral blood count a significant increase of CD3-positive NK cells was noted (p=0.03) although the leukocyte count decreased from 2,255 to 1,156 cells/microl. There was a non-significant decrease of elastase (102. 9 vs. 90.4 ng/ml), sulfidoleukotriens (2,255.4 vs. 1,688.9 pg/ml), ICAM-1 (301.9 vs. 276.6 ng/ml), soluble IL-2 receptor (609.0 vs. 422. 3 U/ml), and IL-10 (164.7 vs. 138.7 pg/ml). IL-6 and IL-8 did not show significant changes. The ECP treatment of patients with PSS shows immunomodulatory effects changing levels of pro-inflammatory and cytokine substances. Even after 8 cycles partial remission or stable disease is seen in patients as shown by global assessment and certain clinical symptoms. On the other hand, sufficient data on the long-term outcome are still missing.

[Nail changes in rheumatic disease]. / Nagelveränderungen bei rheumatischen Erkrankungen.

Clinically the nail organ ist easy to investigate. When estimating dermato-rheumatological diseases, knowledge of important associated nail symptoms is extremely helpful. In some diseases like osteoarthropathia psoriatica and special variants, Reiter's syndrome and connective tissue disease, typical or even characteristic symptoms can be found. In other disorders like rheumatoid arthritis, goal and systemic vasculitis, associated nail disorders are not uncommon, but of less diagnostic specificity. We review data from the literature and from our dermato-rheumatological outpatient clinic.