[Basic abdominal ultrasound diagnosis course. The normal spleen].
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Diagnosis, Differential↗
Biomedical subjects
H Kellner
Publications and source records attributed to H Kellner.
[Lymphocytapheresis in the treatment of chronic polyarthritis. Effect on clinical and laboratory chemical parameters and lymphocyte function].
Ten patients with rheumatoid arthritis (RA) were treated by lymphocytapheresis. Only patients with severe disease (Steinbrocker classification III/IV, at least two disease-modifying drugs previously unsuccessful, present treatment insufficient) were selected, concomitant treatment was standardized (NSAID and/or low-dose steroids in a fixed dose, administered constantly for 6 weeks). Using an IBM cell-separator, apheresis was administered three times per week for 2 weeks with continuation only in the case of improvement. Lymphocyte elimination rate was 10(9)-10(10) per apheresis in all cases. Only three patients showed significant clinical improvement (evaluated by the Ritchie Index, grip strength and morning stiffness), little (5 patients) or nor (2 patients) change was registered in the other cases. No side effects occurred during treatment. Standard laboratory parameters (including rheumatoid factor, circulating IC) showed no correlations with the course or success of treatment. Interestingly, all therapy responders showed a markedly depressed lymphocyte proliferative capability (LPC, tested with tetanus toxoid/streptodornase as antigens) compared to the non-responders before apheresis, with complete reversal to normal LPC during treatment. Lymphocytapheresis might be a promising additional treatment in a minority of RA patients characterized by a certain form of lymphocyte dysfunction. Markers to preselect such a subgroup are still to be found.
Arthritis, Rheumatoid↗
[Ultrasonic diagnosis of inflammatory rheumatic diseases].
During the last two decades, sonography has become more and more important in the diagnosis of rheumatic diseases. With the development of high-frequency realtime transducers, detailed images of the musculoskeletal system can be provided. Furthermore, sonography or echocardiography is able to detect systemic manifestations of connective tissue diseases. Compared to plain films, which mainly evaluate bony lesions of inflammatory joint diseases, sonography is used to assess non-bony abnormalities (synovial membrane, cartilage, menisci, tendons) and synovial space. Pannus and effusion as indicators of inflammatory rheumatic disease can easily be examined by sonography. However, sonographic findings in rheumatic diseases are mostly nonspecific and can rarely be used to distinguish between different diagnoses, which is sometimes possible using plain x-rays (i.e., pencil-in-cup). Sonography has proven to be a meaningful diagnostic tool in evaluating tumors in subcutaneous tissue or muscles. The diagnostic results of musculoskeletal sonography are today compared to those obtained by computed tomography (CT) and magnetic resonance imaging (MRI). Although musculoskeletal MRI can visualize bony and non-bony structures at the same time, sonography is still of particular interest in the diagnosis of rheumatic diseases, because it is a noninvasive, widely available, relatively inexpensive imaging modality which can be rapidly performed and repeated.
Arthritis, Rheumatoid↗
Rapidly progressive seronegative spondylarthropathy with atlantodental subluxation in a patient with moderately advanced HIV infection.
It has been suggested that the immunosuppressed state associated with HIV infection may influence the clinical course of rheumatic diseases. We describe the case of a patient with moderately advanced HIV infection who developed a psoriatic rash and a rapidly progressive spondylarthropathy of the cervical spine with atlantodental subluxation requiring spondylodesis. This case supports the hypothesis that HIV infection may be associated with uncommon manifestations and a rapidly progressive course refractory to medical therapy in patients with spondylarthropathy.
Adult↗