Biomedical subjects

H Müller

Publications and source records attributed to H Müller.

At least 73 records · Page 4Linked to original sources

PubMed2001

[Active pre-atrophic autoimmune gastritis. A practice-oriented concept for diagnosis and treatment].

Helicobacter pylori infection sometimes leads to an antigastric autoimmunity that ultimately develops into complete atrophy of the glands of the gastric mucosal glands. It has been found that the "classical" parietal cell antibody positive and H. pylori induced autoimmune gastritis share common aspects of histomorphology, stages, and pathomechanisms. Healing of H. pylori associated active preatrophic autoimmune gastritis by eradication treatment has been confirmed both in case reports and in prospective and retrospective studies. This leads to a general practice-oriented four-step concept for diagnosis and treatment in daily routine: (a) Histological work-up on the basis of: lymphocytic infiltration of the glands of the corpus and fundic mucosa, focal destruction in individual corpus glands, reactive hypertrophy of the parietal cells, and search for H. pylori. (b) Additional serological work-up if histological evidence of H. pylori is lacking: determination of H. pylori and parietal cell antibodies in the serum. (c) Initiation of an established H. pylori eradication therapy if histology and/or serology is positive for H. pylori. (d) Histological and serological follow-up for 9-12 months to monitor the results of treatment.

Autoimmune Diseases↗

PubMed2001

Model for food chain transfer and dose assessment in areas of the Slovak Republic.

The radio-ecological model ECOSYS-87 developed for German ecological conditions, has been adapted to the conditions of two sub-regions in the Slovak Republic. In particular, the selection of plant varieties used for animal feeding, the plants' growing cycles and harvests, the animal feeding practices and the human consumption rates were subjected to adaptation. Measurements of caesium and iodine radioactivity in soil, plants and animal products that have mainly been performed in the vicinity of the Bohunice nuclear power plant after the Chernobyl accident, are compared with the results of the adapted model. Data from various locations with dry, mixed or predominantly wet deposition show in general good agreement.

Animal Feed↗

PubMed2001

The genome segment B encoding the RNA-dependent RNA polymerase protein VP1 of very virulent infectious bursal disease virus (IBDV) is phylogenetically distinct from that of all other IBDV strains.

A full-length cDNA clone of the segment B of the very virulent infectious bursal disease virus (IBDV) strain BD 3/99 was constructed and the full-length nucleotide sequence was established. The nucleotide sequence encoding VP1, an RNA-dependent RNA polymerase, of BD 3/99 was aligned with that of 17 other IBDV strains including six very virulent, three classical virulent, five classical attenuated, one antigenic variant and two serotype 2 strains. The VP1 genes of all very virulent strains were 97.5% to 99.8% identical. With the exception of an atypical Australian strain, 002-73, all of the classical virulent or attenuated and antigenic variant strains were also 97.5% to 100% identical. Serotype 2 strains showed only 4-6% divergence from serotype 1 classical virulent or attenuated strains; in contrast, however, the very virulent strains were 10.5% to 12.5% divergent from the classical virulent or attenuated strains as well as serotype 2 strains. Analysis of the deduced amino acid sequence of VP1 revealed 17 common, including 8 unique amino acid substitutions in the very virulent strains. In the phylogenetic tree the very virulent strains formed a distinct cluster and all other strains including classical virulent, attenuated and antigenic variant strains and even serotype 2 strains were grouped together. It is suggested that the VP1 of very virulent IBDV is phylogenetically distinct from that of all other IBDV strains and probably originated from a hitherto unidentified source.

Amino Acid Sequence↗

PubMed2001

Serum cholesterol predictive equations with special emphasis on trans and saturated fatty acids. an analysis from designed controlled studies.

The effects of dietary trans fatty acids on serum total and low density lipoprotein (LDL) cholesterol have been evaluated by incorporating trans fatty acids into predictive equations and comparing their effects with the effects of the individual saturated fatty acids 12:0, 14:0, and 16:0. Trans fatty acids from partially hydrogenated soybean oil (TRANS V) and fish oil (TRANS F) were included in previously published equations by constrained regression analysis, allowing slight adjustments of existing coefficients. Prior knowledge about the signs and ordering of the regression coefficients was explicitly incorporated into the regression modeling by adding lower and upper bounds to the coefficients. The amounts of oleic acid (18:1) and polyunsaturated fatty acids (18:2, 18:3) were not sufficiently varied in the studies, and the respective regression coefficients were therefore set equal to those found by Yu et al. [Yu, S., Derr, J., Etherton, T.D., and Kris-Etherton, P.M. (1995) Plasma Cholesterol-Predictive Equations Demonstrate That Stearic Acid Is Neutral and Monounsaturated Fatty Acids Are Hypocholesterolemic, Am. J. Clin. Nutr. 61, 1129-1139]. Stearic acid (18:0), considered to be neutral, was not included in the equations. The regression analyses were based on results from four controlled dietary studies with a total of 95 participants and including 10 diets differing in fatty acid composition and with 30-38% of energy (E%) as fat. The analyses resulted in the following equations, where the change in cholesterol is expressed in mmol/L and the change in intake of fatty acids is expressed in E%: delta Total cholesterol = 0.01 delta(12:0) + 0.12 delta(14:0) + 0.057 delta(16:0) + 0.039 delta(TRANS F) + 0.031 delta(TRANS V) - 0.0044 delta(18:1) - 0.017 delta(18:2, 18:3) and deltaLDL cholesterol = 0.01 delta(12:0) + 0.071 delta(14:0) + 0.047 delta(16:0) + 0.043 delta(TRANS F) + 0.025 delta(TRANS V) - 0.0044 delta(18:1) - 0.017 delta(18:2, 18:3). The regression analyses confirm previous findings that 14:0 is the most hypercholesterolemic fatty acid and indicate that trans fatty acids are less hypercholesterolemic than the saturated fatty acids 14:0 and 16:0. TRANS F may be slightly more hypercholesterolemic than TRANS V or there may be other hypercholesterolemic fatty acids in partially hydrogenated fish oil than those included in the equations. The test set used for validation consisted of 22 data points from seven recently published dietary studies. The equation for total cholesterol showed good prediction ability with a correlation coefficient of 0.981 between observed and predicted values. The equation has been used by the Norwegian food industry in reformulating margarines into more healthful products with reduced content of cholesterol-raising fatty acids.

Adult↗

PubMed2001

Meningitis in a girl with recurrent otitis media caused by Streptococcus pyogenes--otitis media has to be treated appropriately.

Streptococcus pyogenes rarely causes meningitis. A recent increase in the incidence and severity of diseases due to S. pyogenes has been observed worldwide, without an apparent increase in the incidence of S. pyogenes meningitis. However, more recently severe and fulminant cases of S. pyogenes meningitis have been reported in the literature. This case report emphasizes the fact that S. pyogenes can cause meningitis with severe clinical sequelae such as hygromas and right-sided third cranial nerve palsy. Most importantly, it is concluded that recurrent otitis media has to be treated carefully following appropriate identification of the causing organism in order to prevent severe clinical courses of streptococcal infections.

Adrenal Cortex Hormones↗

PubMed2001

Partially hydrogenated soybean oil reduces postprandial t-PA activity compared with palm oil.

The effects of dietary trans fatty acids on fasting and diurnal variation in hemostatic variables are not known. This study compares the effects of three diets with three different margarines, one based on palm oil (PALM-diet), one based on partially hydrogenated soybean oil (PHSO, TRANS-diet) and one with a high content of polyunsaturated fatty acids (PUFA-diet) on diurnal postprandial hemostatic variables. A strictly controlled dietary Latin square study was performed and nine young female participants consumed each of the diets for 17 days in a random order. The sum of the cholesterol-increasing fatty acids (C12:0, C14:0, C16:0) was 36.3% of total fatty acids in the PALM-diet, the same as the sum of saturated-(C12:0, C14:0, C16:0) (12.5%) and trans fatty acids (23.1%) in the TRANS-diet. The sum of C12:0, C14:0 and C16:0 was 20.7% in the PUFA-diet. The amount of fat made up 30-31% of energy in all diets. Nine participants completed the study. The diurnal postprandial state level of tissue plasminogen activator (t-PA) activity was significantly decreased on the TRANS-diet compared with the PALM-diet. t-PA activity was also decreased on the PUFA-diet compared with PALM-diet but the difference was below statistical significance (P=0.07, Bonferonni adjusted). There were no significant differences in either fasting levels or in circadian variation of t-PA antigen, PAI-1 activity, PAI-antigen, factor VII coagulant activity or fibrinogen between the three diets. Our results indicate that dietary trans fatty acids from PHSO has an unfavourable effect on postprandial t-PA activity and thus possibly on the fibrinolytic system compared with palm oil.

Adult↗

PubMed2001

Ultrasonographic detection of asymptomatic endometrial cancer in postmenopausal patients offers no prognostic advantage over symptomatic disease discovered by uterine bleeding.

The aim of this study was to investigate whether endometrial carcinoma (EC) screening by transvaginal sonography (TVS) has a prognostic advantage over symptomatic EC. In a retrospective study, 190 postmenopausal patients with symptomatic EC and 123 asymptomatic patients with suspicious endometrium detected by TVS were analysed regarding clinical, socio-economic and histopathological findings. Total bleeding time and the International Federation of Gynecology and Obstetrics (FIGO) tumour stage were evaluated with respect to their effect on survival. In 123 asymptomatic patients with suspicious endometrium, 16 (13%) EC, 61 (50%) polyps, 21 (17%) hyperplasias, 23 (19%) atrophias, 1 (0.8%) myoma and 1 (0.8%) metastasis were found. TVS findings in asymptomatic patients resulted in unnecessary operations, which were associated with considerable costs totalling at least 116256. Compared with screened asymptomatic patients, symptomatic patients were significantly (P<0.05) older, more frequently obese, and hypertensive, had a larger proportion of cases living in rural areas and visited their gynaecologists rarely. The bleeding time of symptomatic patients strongly correlated with the tumour stage (P<0.0001). Depending on the bleeding time, the 5-year disease-free survival and overall survival rates were 77% and 86% (no bleeding), 83% and 98% (<8 weeks), 74% and 90% (8-16 weeks), and 62% and 69% (>16 weeks), respectively. The corresponding tumour stage-related data for disease-free and overall survival were 100% (Ia; both rates), 87% and 95% (Ib), 66% and 93% (Ic), 63% and 78% (II) and 36% (III/IV; both rates), respectively. Postmenopausal vaginal bleeding represents an early symptom of EC, but it is not always perceived as problematic by the patients. There is no prognostic advantage for screened compared with symptomatic patients, who had bleeding of shorter than 8 weeks. Moreover, patients who are at a high risk for EC tend to avoid TVS screening. Finally, endometrial screening often results in unnecessary operations, which are associated with increased morbidity and costs.

Aged↗

PubMed2001

[Agranulocytosis in a child with schizophrenia treated with clozapine--clinical findings and therapy, a case report].

OBJECTIVES: The indication of clozapine therapy is governed by special guidelines due to a 1%-3% risk of clozapine-induced agranulocytosis. Up to now there has never been a report of such a case in a child with schizophrenia. The case report presented here is concerned with the clinical features and the treatment of clozapine-induced agranulocytosis in childhood schizophrenia. METHODS: It deals with the treatment of a 12-yearold boy with a schizophrenic psychosis. The psychotic symptoms before treatment and during inpatient treatment are described. The procedures for the diagnosis and treatment of the clozapine-induced agranulocytosis are presented. RESULTS: Clozapine medication may induce agranulocytosis in the treatment of a child with a schizophrenic psychosis. The highly specific guidelines governing its use must be followed as well in the treatment of very early onset schizophrenia. An agranulocytosis may result following 15 weeks of clozapine medication. The treatment with granulocyte colony-stimulating factor seems to support normalization of the blood picture.

Agranulocytosis↗

PubMed2001

[Wellness holidays--wholesome wish or one-sided reality].

The term wellness is widely used in European tourism. The principal observations regarding the wellness industry concern an expanding supply of and an insufficiently researched demand for wellness programs. The quality dimension of wellness services is increasingly becoming the decisive competitive factor. For this reason quality management plays an important role. Market research shows that average 3- to 5-star hotels provide fairly comprehensive wellness facilities. Wellness hotels should therefore specialize in health information, individual care and a wide range of cultural and relaxation programs. Although the same hotel can host cure and wellness guests at the same time, these two segments have to be considered separately when deciding on the marketing strategy. We therefore assume that wellness is pursued solely by 'healthy' people, the prime aim being prevention. 'Normal cure guests' aim to heal their illness.

Balneology↗

PubMed2001

Apaf-1 is a transcriptional target for E2F and p53.

Loss of function of the retinoblastoma protein, pRB, leads to lack of differentiation, hyperproliferation and apoptosis. Inactivation of pRB results in deregulated E2F activity, which in turn induces entry to S-phase and apoptosis. Induction of apoptosis by either the loss of pRB or the deregulation of E2F activity occurs via both p53-dependent and p53-independent mechanisms. The mechanism by which E2F induces apoptosis is still unclear. Here we show that E2F1 directly regulates the expression of Apaf-1, the gene for apoptosis protease-activating factor 1. These results provide a direct link between the deregulation of the pRB pathway and apoptosis. Furthermore, because the pRB pathway is functionally inactivated in most cancers, the identification of Apaf-1 as a transcriptional target for E2F might explain the increased sensitivity of tumour cells to chemotherapy. We also show that, independently of the pRB pathway, Apaf-1 is a direct transcriptional target of p53, suggesting that p53 might sensitize cells to apoptosis by increasing Apaf-1 levels.

Animals↗

PubMed2001

E2F1-mediated transcriptional inhibition of the plasminogen activator inhibitor type 1 gene.

Gene expression of the plasminogen activation system is cell-cycle dependent. Previously, we showed that ectopic expression of E2F1 repressed the plasminogen activator inhibitor type 1 (PAI-1) promoter in a manner dependent on the presence of DNA-binding and transactivation domains of E2F1 but independent of binding to pocket-binding proteins, suggesting a novel mechanism for E2F-mediated negative gene regulation [Koziczak, M., Krek, W. & Nagamine, Y. (2000) Mol. Cell. Biol. 20, 2014-2022]. However, it remains to be seen whether endogenous E2F can exert a similar effect. We report here that down-regulation of PAI-1 gene expression correlates with an increase in endogenous E2F activity. When cells were treated with a cdk2/4-specific inhibitor, which maintains E2F in an inactive state, the decline of serum-induced PAI-1 mRNA levels was suppressed. In mutant U2OS cells expressing a temperature-sensitive retinoblastoma protein (pRB), a shift to a permissive temperature induced PAI-1 mRNA expression. In U2OS cells stably expressing an E2F1-estrogen receptor chimeric protein that could be activated by tamoxifen, PAI-1 gene transcription was markedly reduced by tamoxifen even in the presence of cycloheximide. These results all indicate that endogenous E2F can directly repress the PAI-1 gene. DNase I hypersensitive-site analysis of the PAI-1 promoter suggested the involvement of conformation changes in chromatin structure of the PAI-1 promoter. 5' deletion analysis of the PAI-1 promoter showed that multiple sites were responsible for the E2F negative regulation, some of which were promoter dependent. Interestingly, one of these sites is a p53-binding element.

Animals↗

PubMed2001

Molecular and antigenic characterization of Bangladeshi isolates of infectious bursal disease virus demonstrate their similarities with recent European, Asian and African very virulent strains.

Three isolates of infectious bursal disease virus (IBDV), obtained from chickens in Bangladesh in 1999 and designated as BD 1/99, BD 2/99 and BD 3/99, were characterized. In an antigen capture enzyme-linked immunosorbent assay using a panel of VP2-specific neutralizing monoclonal antibodies (mAb), all three isolates showed a mAb-binding profile similar to that of very virulent IBDV (vvIBDV) strains. In contrast to the classical virulent strains, they did not react with mAb 3 and mAb 4. Molecular characterization was performed by direct sequencing of a 677-base pair cDNA corresponding to the VP2 variable domain of the polyprotein gene, synthesized by a reverse transcription-polymerase chain reaction. In comparison to the classical virulent strains, the Bangladeshi isolates were found to have five amino acid substitutions in this region. Four of these changes, Pro222Ala, Val256Ile, Leu294Ile and Asn299Ser, were also observed in other vvIBDV strains. The fifth substitution, Glu300Ala, was similar to that in some African strains of IBDV. The results support the observation that antigenically and genetically similar vvIBDV strains, first observed in Europe in the late 1980s, have spread to most parts of the world in a short period of time.

Africa↗

PubMed2001

Serological status for Chlamydophila psittaci, Newcastle disease virus, avian polyoma virus, and Pacheco disease virus in scarlet macaws (Ara macao) kept in captivity in Costa Rica.

From 1998 to 1999, a total of 128 blood samples were collected from scarlet macaws (Ara macao), kept in captivity in 11 different aviaries located in six provinces of Costa Rica. The sera were examined for antibodies directed against Chlamydophila psittaci, Newcastle disease virus (NDV), avian polyoma virus (APV), and Pacheco disease virus (PDV). Testing by enzyme-linked immunosorbent assay (ELISA), showed 16 (12.39%) of the samples (n = 129) exhibited antibodies directed against C. psittaci. Employing haemagglutination inhibition tests for NDV antibodies, all of the samples were found to be negative. The prevalence of antibodies specific for APV was tested with a blocking ELISA and serum neutralization tests (SNT) and 12 of 128 samples (9.37%) were found to be positive with both tests. In SNT, two out of 128 samples (1.56%) were positive for PDV. This is the first description of the serological status in scarlet macaws in captivity in Costa Rica. The study demonstrates the absence of NDV antibodies in the birds investigated on one hand, but also indicates a health hazard for numerous avian species due to the risk of infections with C. psittaci, APV or PDV.

Animals↗

PubMed2001

Regional plus systemic chemotherapy: an effective treatment in recurrent non-small cell lung cancer.

AIMS: This study was undertaken to determine the activity and toxicity of regional chemotherapy using an isolated thoracic perfusion (ITP) technique as second-line treatment for patients with advanced and recurrent non-small cell lung cancer (NSCLC). METHODS: Eighteen patients with relapsed NSCLC confined to the thoracic region entered the study and received regional chemotherapy using ITP plus low-dose systemic chemotherapy. All 18 patients had been pre-treated with some form of chemotherapy, surgery and/or radiotherapy. The cytostatic regimen had two components: (1) ITP using mitomycin 10 mg/m(2), navelbine 25 mg/m(2)and cisplatin 30 mg/m(2)on day 1; (2) systemic chemotherapy with 5-fluorouracil 250 mg/m(2)and cisplatin 20 mg/m(2)given as a continuous infusion over 24 h on days 1-4. RESULTS: All 18 patients were assessable for toxicity, tumour response and survival. There were 10/18 responses (CR 0; PR 10): a response rate of 56%. Side-effects were transient and acceptable. No treatment-related death occurred. Median survival was 21 months and the 1-year survival rate was 75%. CONCLUSIONS: Regional chemotherapy using ITP plus low-dose systemic chemotherapy is effective in recurrent advanced NSCLC, with an encouraging survival outcome.

Adult↗

PubMed2001

Intra-arterial infusion of 5-fluorouracil plus granulocyte-macrophage colony-stimulating factor (GM-CSF) and chemoembolization with melphalan in the treatment of disseminated colorectal liver metastases.

AIMS: We compared two prospective trials of intra-arterial cytokine/chemotherapeutic infusion plus chemoembolization in the treatment of inoperable colorectal liver metastases. MATERIALS AND METHODS: One hundred and three patients with disseminated inoperable colorectal liver metastases received intra-arterial chemotherapy with 5-FU and granulocyte-macrophage colony-stimulating factor (GM-CSF) plus chemoembolization via an angiographically positioned hepatic artery catheter. Two different regimens were used in two consecutive studies. Group A: short-term i.a. infusion of 550 mg/m(2)5-FU (days 1-4) plus 80 microg/m(2)GM-CSF (day 1+2) combined with chemoembolization with 25 mg/m(2)melphalan plus Lipiodol and Gelfoam (day 5). Group B: continuous circadian intra-arterially administered 1400 mg/m(2)5-FU infusion plus 60 mg/m(2)i.v. leucovorin and 80 microg/m(2)GM-CSF (day 1+2) combined with chemoembolization with 25 mg/m(2)melphalan plus Lipiodol and Gelfoam (day 3). RESULTS: One hundred and three patients (62 male/41 female) with a median age of 59.9 and a median Karnofsky index of 88.5 were treated with 447 cycles of immuno-chemoembolization (group A 299, group B 148 cycles). Fifty-seven percent of these patients had received prior systemic chemotherapy. Side-effects were seen in all patients, mainly upper abdominal pain lasting 1-4 days and grade 1 or 2 vomiting. Systemic side-effects were mild and transient with a very low rate of leukopenia. Using World Health Organization response criteria, the following responses could be demonstrated: group A: CR 2.7%, PR 32.4%, MR 21.6%, SD 12.7%, NR 16.2%; group B: CR 1.0%, PR 42.4%, MR 24.2%, SD 18.2%, NR 12.1%. Time to progression was 7 as compared to 8 months. Median survival was 17 months in group A, whereas it has not been reached after 28 months (P=0.0095) in group B. There was no statistically significant difference between chemo-naive patients and patients who had received prior systemic therapy. CONCLUSION: Immuno-chemoembolization combined with 2-day circadian administration of 5-FU is an effective tool in the treatment of disseminated colorectal liver metastases. This regimen is also effective as second-line treatment.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2001

Improvement in the quality of the endoscopic/bioptic diagnosis of gastric ulcers between 1990 and 1997--an analysis of 1,658 patients.

BACKGROUND: Helicobacter pylori research has greatly improved the diagnosis and treatment of gastric ulcer. The aim of the present study was to investigate the question whether the new perceptions had been incorporated into the daily diagnostic routine of the nineteen-nineties. PATIENTS AND METHODS: Analysis of the biopsy material at the institute of Pathology of the Klinikum Bayreuth obtained from 1,658 patients with gastric ulcers in the months of January and February 1990 (n = 506), 1992 (n = 525), 1994 (n = 532), 1995 (n = 432) and 1997 (n = 400) with the aim of determining the quality of the endoscopic assessment of biological significance, and the number of biopsy specimens obtained from the ulcer, as well as the number of additional biopsies taken from the antrum and corpus. RESULTS: 1,436 (88.9%) of the endoscopically diagnosed ulcers proved to be histologically benign and 222 (11.1%) malignant, of which 192 (86.5%) were carcinomas, 24 (10.8%) MALT lymphomas, 2 (0.9%) sarcomas, and 4 (1.8%) ulcerated metastases. The percentage of false-negative endoscopic assessments of biological significance was 1.8%, that of the false-positive assessments 4.1%, that is, both very low figures. In the case of endoscopically suspicious findings, the histological examination revealed an ulcerated malignant tumor in almost 30% of the cases. The average number of biopsies harvested from the ulcer increased from 5.9 in 1990 to 7.1 in 1997. The frequency of biopsies obtained additionally from antrum and corpus rose statistically significantly from 14.1% of the cases in 1990 to 43.0% in 1997. CONCLUSION: During the course of the nineteen-nineties, the quality of the endoscopic/bioptic diagnosis improved noticeably. In terms of the number of biopsy specimens obtained from the ulcer to identify its biological significance, and the number of additional biopsies from antrum and corpus to identify underlying diseases, there is, however, still room for improvement.

Adolescent↗

PubMed2001

[Interobserver variability in CT of oro- and hypopharyngeal carcinomas].

PURPOSE: To evaluate the inter- and intraobserver reproducibilities of computed tomography (CT) in patients with oro- and hypopharyngeal carcinomas. METHODS: Two independent readers interpreted the CT images of 41 patients with hypopharyngeal carcinomas, 45 patients with oropharyngeal carcinomas, and 23 patients without a tumor. All relevant subregional anatomic structures were evaluated for the presence of tumor infiltration. Statistical analysis was done by using Cohen's kappa and the Wilcoxon test; subregional prevalences, sensitivities, and specificities were also determined. RESULTS: Mostly, especially for clinically relevant subregions, moderate and substantial inter- and intraobserver reproducibilities were determined (range of the determined kappa values: 0.25-1.00). The kappa values of the intraobserver reproducibilities of both readers were not significantly different (P = 0.20). The kappa values of the intraobserver reproducibilities were in almost all the cases higher than the respective kappa values of the interobserver reproducibility. CONCLUSION: CT of oro- and hypopharyngeal carcinomas can be interpreted with clinically acceptable variability. A higher agreement can be achieved if repeated interpretation is done by a single person.

Adult↗

PubMed2001

Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review.

Clinical experience suggests that fasting followed by vegetarian diet may help patients with rheumatoid arthritis (RA). We reviewed the available scientific evidence, because patients frequently ask for dietary advice, and exclusive pharmacological treatment of RA is often not satisfying. Fasting studies in RA were searched in MEDLINE and by checking references in relevant reports. The results of the controlled studies which reported follow-up data for at least three months after fasting were quantitatively pooled. Thirty-one reports of fasting studies in patients with RA were found. Only four controlled studies investigated the effects of fasting and subsequent diets for at least three months. The pooling of these studies showed a statistically and clinically significant beneficial long-term effect. Thus, available evidence suggests that fasting followed by vegetarian diets might be useful in the treatment of RA. More randomised long-term studies are needed to confirm this view by methodologically convincing data.

Arthritis, Rheumatoid↗