[Are inpatient rehabilitation or ambulatory physical therapy of patients with musculoskeletal problems effective and are patients referred to proper treatment?]. / Sind stationäre Rehabilitation oder ambulante Physiotherapie bei Patienten mit muskuloskelettalen Problemen wirkungsvoll und landen Patienten auf dem richtigen Behandlungspfad?

The aim of the present study was to investigate the effectiveness of an inpatient rehabilitation program and outpatient physiotherapy, respectively. Moreover, we wanted to know whether the referral to these two treatment paths was appropriate with regard to the patient's initial health status. According to the referring physician's indication patients with health problems in the cervical, lumbar spine, arm or leg were treated by an inpatient rehabilitation program or by outpatient physiotherapy. These two consecutively recruited patient cohorts were then compared. Those patients treated by the inpatient rehabilitation program differed from the outpatient group with regard to the initial health status and to age. Patients with musculoskeletal problems, who underwent an inpatient rehabilitation program, showed a significantly worse health and functional status than the outpatient group. Therefore, it can be concluded that the indication towards inpatient rehabilitation or outpatient physiotherapy was correctly given by the referring physicians. Patients treated by outpatient physiotherapy did also show a reduced health and functional status in comparison to the average population. Both types of treatment led to statistically significant and clinically relevant improvement of both the health and functional status in all patient groups.

The effect of amlodipine and enalapril on blood pressure and neurohumoral activation in hypertensive patients with Ribbing's disease (multiple epiphysal dystrophy).

BACKGROUND: In patients with Ribbing's disease (RD)--a form of multiple epiphysal dystrophy--hypertension is frequent, often severe, and accompanied by a relevant cardiac dysfunction. HYPOTHESIS: This study was undertaken to evaluate the contribution of the calcium antagonist amlodipine and of the angiotensin-converting-enzyme inhibitor enalapril to blood pressure regulation by studying their effect on neurohormonal activation. METHODS: Fifty hypertensive patients with RD were studied. After a placebo run-in period of 4 to 6 weeks, patients were randomly assigned to receive either amlodipine (10 mg once daily) or enalapril (20 mg once daily) for 6 months. RESULTS: Both drugs significantly lowered blood pressure. Enalapril did not result in activation of the sympathetic system (as determined by measurement of the plasma norepinephrine level). On the other hand, the hypotensive effect of amlodipine occurred with an increase in heart rate and in the levels of plasma norepinephrine and angiotensin II. CONCLUSION: It is unclear whether amlodipine may reduce cardiac dysfunction in patients with RD.

Magnesium depletion in patients on long-term chlorthalidone therapy for essential hypertension.

Sixty patients were treated for 1 year for essential uncomplicated hypertension, 30 with beta-blockers alone (BB) and 30 with BB and chlorthalidone (CTD). BB did not affect serum K+ or Mg++. In the BB-group there was a statistically significant trend towards retention of Mg++ in a loading test, but the effect was clinically marginal. BB + CTD reduced serum K+ and Mg++ and caused significant Mg++ depletion, as shown by the Mg++ loading test. All the effects were highly significant and were clinically important. The metabolic perturbations due to CTD are potentially dangerous and make this drug unattractive as 'first choice' treatment for hypertension.

Epidemiological study in Switzerland.

A study group of originally 623 employed women of Northwestern Switzerland who were aged 30 to 49 yr and showing objective evidence of intake of phenacetin-containing analgesics, and a control group of 621 comparable women showing no such intake, were examined in 1968 and followed-up five times from 1969 to 1975 for laboratory evidence of urorenal disorders. Mortality was higher in the study group, with 21 deaths, compared to the control group, with 5 deaths, and was higher than expected in a comparative population in Switzerland (P less than or equal to 0.05). In both study and control groups, morbidity was low. There was no difference between the study and control groups with respect to subsequent proteinuria and hematuria. The seven-year incidence of low urine specific gravity after overnight thirsting was higher in the study group than in the control group (2.9% vs. 1.0%), and the incidence of raised serum creatinine was also significantly higher in the study group (2.9% vs. 0%). However, when the study group was further subdivided into a subgroup showing evidence of high intake of phenacetin-containing analgesics and one showing low-intake, only the high-intake subgroup had an incidence of raised serum creatinine concentrations (5.3%), significantly higher than the control group (0%), whereas the low-intake subgroup had an incidence (0.4%) similar to the control group. Also the high-intake subgroup showed significantly higher rates of bacteriuria than the controls (P less than or equal to 0.004).

[Pyrithyldione excretion in the urine. Methods and results from various collectives]. / Pyrithyldionausscheidung im Urin Methodik und Resultate aus verschiedenen Kollektiven

A simple thinlayer chromatographic method for the detection of pyrithyldion in 5 ml of urine per analysis is described. Sensitivity (0.01 mug of pyrithyldion) and specificity (reaction still positive 5-6 days after injection of 50 mg of pyrithyldion) of the method are considered acceptable. The duration of elimination for pyrithyldion is relatively long (5-6 days). Epidemiological investigations were conducted in two different patient groups to analyze spontaneously voided urine samples. The incidence of positive urine samples in 204 ambulatory internal medicine patients was only 0.5% for pyrithyldion and N-acetyl-p-amino-phenol (the main metabolite of phenacetin). In contrast, the incidence in a specially selected group of 600 working women with regular intake of analgesics was much higher (between 17.7% and 28%) in the period 1969 to 1972.

[Social histories of female abusers of phenacetin-containing analgesics]. / Sozialanamnestische Erhebungen bei Frauen mit Abusus phenazetinhaltiger Analgetika

The abuse of analgesics is common in the Swiss population. In a field study social und psychological investigations with 600 women ingesting analgesics and 600 women not taking analgesics are made. In a preliminary interpretation of 80 interviews the women ingesting analgesics differ only in a few points from the control group: 1. In the study group a greater number women has children, however on the average a lower number than the control group 2. The children of the women ingesting analgesics are more often taken care of outside their own home. 3. As an overwhelming event in life the loss of one or both parents was often mentioned. 4. Questions asked with regard to depressive symptoms were similar for both groups.

[Trends in urinary analgesic excretion in a cohort observed from 1968 to 1975]. / Trendentwicklung der Ausscheidung von Analgetika im Urin beim gleichen Kollektiv 1968-1975

From 1968 to 1972 and in 1975 (provisional results) urine samples collected on three days per year were examined by photometer for N-acetyl-p-aminophenol (=NAPAP, main metabolite of phenacetin) and for salicylates in the same population. It consists of 1200 women born from 1918 to 1937 whose majority works in 80 enterprises of Northwestern Switzerland. In 1968 half of the women showed regular intake of phenacetin containing analgesics (=study group) in contrast to the other half that did not (=control group). Excretion of salicylates was no criterion for grouping. Between 1968 and 1972 the total of women positive for NAPAP in urine decreased from 50% to 35%. The decrease concerns almost exclusively women positive for NAPAP on one or two days, whereas the number of women positive on all three days remained stable. At the same time the total number of women positive for salicylates decreased too. Possible reasons for the decreasing tendency of analgesics intake are mentioned. The much more frequent excretion of salicylates in the study group in contrast to the controls is probably due to the intake of combined analgesics. The provisional results of 1975 are in accordance to those observed previously.

Relation between regular intake of phenacetin-containing analgesics and laboratory evidence for urorenal disorders in a working female population of Switzerland.

A study group of 623 employed Swiss women aged 30-49 years showing objective evidence of intake of phenacetin-containing analgesics, and a control group of 621 comparable women showing no such intake, were observed for 4 years (1969-72) for laboratory evidence of urorenal disorders. In both study and control groups morbidity was low. There was no difference between the study and control groups with respect to subsequent proteinuria, bacteriuria, and haematuria. The 4-year incidence of low urine specific gravity after overhight thirsting was significantly higher in the study group than in the control group (3-8% v. 0-8%) and the incidence of raised serum-creatinine was also significantly higher in the study group (2-9% v. 0-4%). However, when the study group was further subdivided into a sub-group showing evidence of high intake of phenacetincontaining analgesics and one showing low intake, only the high-intake subgroup had an incidence of raised serum-creatinine (5-4%) significantly higher than the control group (0-4%), whereas the low-intake subgroup had an incidence (0-4%) similar to the control group.