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Biomedical subjects

H Menninger

Publications and source records attributed to H Menninger.

50 records · Page 3Linked to original sources
PubMed1977

[The diagnosis of soft tissue alterations of the knee by means of xeroradiography (author's transl)].

Xeroradiography is a useful screening-method for the evaluation of soft tissue alterations in the region of the poplitea. It proves that recognition of Baker's cysts, aneurysms, and even tumours is possible due to morphological criteria which allow for differentiation to a degree. The conformation of a lesion by means of arthrography or angiography is not to be dispensed with, but xeroradiography permits the objective demonstration of a clinically uncertain alteration. This method has demonstrated its usefulness especially for the rheumatologist in the evaluation of Baker's cysts.

Humans↗
PubMed1976

Purification and some properties of a neutral protease from human leukocyte granules and its comparison with pancreatic elastase.

1. A cationic protease has been purified from the granule fraction of blood-donor leukocytes by a preparative method including precipitation by acetone and chromatography on Bio-Gel A 1.5 m, CM-Sephadex C-50 and Sephadex G-G-75. 2. The pH optimum against denatured bovine hemoglobin is 7.4. Gel chromatography indicated a molecular weight close to 23 000. 3. This neutral protease (EC 3.4.-.-) is able to split the synthetic esters Z-Ala-NPh and AcAla3OMe, its activity on the former substrate being 2.2 times greater than that of pancreatic elastase, on the latter the same. It differs crucially from pancreatic elastase in having small elastinolytic activity. 4. In cationic disk electrophoresis, neutral protease resolves into three protein bands with lower mobility than lysozyme: all bands exhibit esterolytic activity against 2-acetoxy-3-naphthoic acid o-toluidide, strongly suggesting that they represent isoenzymes. 5. The enzyme is completely inhibited by iPr2P-F, partially so by soybean trypsin inhibitor and Trasylol. Cysteine, EDTA and TosLysCH2Cl have no effect. 6. During chromatography on CM-Sephadex C-50 a more positively charged enzyme(s) was identified. This had hemoglobinolytic activity at pH 7.4 but only a small esterolytic effect on Z-Ala-NPh; it showed only traces of activity against AcAla3OMe.

Cytoplasmic Granules↗
PubMedDate not supplied

[Combination therapy with remission-inducing drugs in chronic polyarthritis: 1996 update].

Therapy of rheumatoid arthritis with a combination of several disease-modifying drugs aims to better control of the disease than achievable by monotherapy. Subsequent to a paper written two years ago, this publication reviews studies dealing with combination therapy issued mainly in 1995 and 1996. Most studies deal with MTX as one of the partners. Beneficial results were reported for the combination of methotrexate with antimalarials, cyclosporine or sulfasalazine. The triple combination of methotrexate with hydroxychloroquine and azathioprine is especially promising although the studies presented up to now are still insufficient for its final assessment, due to methodologic problems. Similarly, the value of the combination of sulfasalazine with injectable gold, of sulfasalazine with methotrexate and hydroxychloroquine, or of methotrexate with injectable gold is still uncertain.

Antirheumatic Agents↗
PubMedDate not supplied

Effect of antirheumatic drugs on neutral protease from human leucocyte granules.

The inhibitory effect of 38 antirheumatic and other agents on purified neutral protease from human polymorphonuclear leucocytes has been studied by determining the decrease in enzyme activity on Z-Ala-NPH as substrate. Analgesics, salicylates, cytostatic agents and steroids, as well as D-penicillamine, colchicine, allopurinol, chlorzoxazone and chlorpromazine, either had no effect on neutral protease or inhibited it only to a very small extent. Typical antirheumatic agents like gold and pyrazolone derivatives suppressed the activity of the enzyme at a concentration of 10(-5)M. The two sulphonated polysaccharides Arteparon and pentosan polysulphate (SP 54) were the most potent inhibitors of neutral protease (inhibition down to 10(-8)M). Increasing concentrations of various inorganic salts gradually suppressed the effect of some otherwise effective drugs on neutral protease. The drugs were completely ineffective at a salt concentration of 0.5 M. At physiological concentrations, however, this effect was insignificant. Inhibition of neutral protease may be one way in which some antirheumatic drugs exert a therapeutic effect in rheumatic diseases.

Anti-Inflammatory Agents↗
PubMedDate not supplied

[Data of two years of the comparative study methotrexate/aurothiomalate in 102 patients].

UNLABELLED: 102 patients (pat.) with active erosive rheumatoid arthritis (RA) with a median disease duration of only 14 months without malalignment or deformities entered a randomized study to compare the effects of 15 mg methotrexate (MTX) and 50 mg gold sodium thiomalate (GST) administered intramuscularly once a week. The study was double blind during the first year and open during the second year. Clinical and laboratory evaluations were made every three months. X-rays of hands, wrists and forefeet in standard a.p.-projection were taken at month 0, 6, 12 and 24. 32 joints were evaluated according to Larsen. 17/52 (MTX) and 21/50 (GST) patients were withdrawn for several reasons. Withdrawals for toxicity were significantly more frequent in the GST group. 35 patients in the MTX group and 26 patients in the GST group were evaluated for efficacy. All clinical parameters, ESR and CRP improved by more than 50% in both groups without significant intergroup difference. The greatest improvement was seen already after six months. An > 50% improvement occurred in 57% of pat. in both groups. The Larsen score (sum of the Larsen grades of 32 joints) deteriorated significantly in both groups during the first six months (MTX = 3.0, GST = +4.3), it remained stable thereafter in the MTX group and decreased in the gold group. The number of erosive joints increased significantly in both groups during the first six months. This increase was slowed down after six months in the MTX group, in the gold group a decrease was seen indicating a healing of erosions. All differences between the groups were not significant, however. CONCLUSION: While tolerability was better with MTX, both drugs were similarly effective in the treatment of RA and slowed down radiologic progression.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[Pathogenesis of tendon-/muscle pain with special reference to posture--a concept related contribution to the understanding of generalized tendomyopathy].

Tendomyopathies (TM) comprise two subgroups. Both are caused by the irritation of nociceptors (IN). Type I results from IN within muscles and tendons with the consequence of local pain, whereas type II refers to TM occurring at a site distant from IN anywhere in the body. Such TM-type II are understood to serve for the protection of the organism from further IN and depend on the regulatoric role of the central nervous system ("reflectoric TM"). Reflectoric shoulder pain emerging from arthritis in carpal joints (Hiemeyer et al.: Z. Rheumatol. 48, 1989, 139-143) is quoted as an example of such "regulatoric pain". Abnormal spinal posture (ASP) is believed to cause IN at various sites of the sceletomotoric system with the consequence of localized or generalized fibromyalgic syndromes (FS) of the type II subgroup. Now clinical signs of TM such as pain during motion, compression or stretching as well as muscular stiffness and fatigue are characteristic for so called primary FS; in addition, the majority of such patients exhibits ASP, especially increased thoracospinal kyphosis (Hiemeyer et al.: Akt. Rheumatol. 14, 1989, 193-201). For these reasons we arrive at the conclusion that ASP is a disposing factor for the development of FS. Therefore FS should not be called primary unless spinal posture has not been examined thoroughly. As a result of this concept we consider control of spinal posture by physiotherapy as an essential part in the causal treatment of FS.

Fibromyalgia↗
PubMedDate not supplied

[Detritus synovitis in chronic polyarthritis: a clinical and operation histologic evaluation].

In rheumatoid arthritis (RA) joint inflammation is due to two processes: 1) the underlying inflammatory process (UIP) characterized by a lymphoplasmacellular infiltration of the synovial tissue, as well as pannus formation, and 2) the detritogenic synovitis (DS), a synovial response to articular wear products from cartilage and bone (detritus) that induces a preferentially fibrinous inflammation. In order to estimate the role of DS in the clinical presentation of such joints, 40 patients with RA undergoing knee-joint surgery on 48 occasions were evaluated for clinical parameters, radiological stage (Larsen), and histopathological characteristics of UIP and DS. The clinical parameters were comparable in knee joints with predominantly UIP or DS. However, DS was regularly seen in knees with advanced destruction according to Larsen's stages 4 to 5, while UIP occurres in joints even without radiological damage. In conclusion, it is assumed that the poor response of patients with advanced RA to so-called long-term drug therapy may be in part explained by the modifying influence of joint detritus on the underlying "rheumatoid" inflammatory process.

Aged↗
PubMedDate not supplied

[Assessment of the functional origin of shoulder pain in chronic polyarthritis by diagnostic local anesthesia of inflamed distal joints. A pilot study].

We examined 40 patients with rheumatoid arthritis suffering from painful shoulder. While the shoulder itself was not treated, Mepivacain was injected into an arthritic joint of wrist or elbow. In 36 out of 40 patients we achieved full or partial improvement of pain and movement of the shoulder. We conclude that pain in the shoulder of these patients was caused by a regulatory mechanism, triggered by nociceptors in an arthritic distal joint in order to protect this damaged structure. The therapeutic consequence implies treatment of the distal joint rather than treatment of the painful shoulder itself.

Aged↗
PubMedDate not supplied

[Immune complexes: mediators for the formation of inflammatory granulation tissue? Immunohistologic studies of the hyaline articular cartilage in chronic polyarthritis].

Previous reports describe the presence of immunoglobulins and complement components within rheumatoid articular cartilage, thereby suggesting an effect of immune complexes on the formation of pannus. This hypothesis is reinvestigated in this paper. As confirmed in our work, the superficial layer of rheumatoid hyaline cartilage may fulfill the immunohistological criteria for the presence of immune complexes. In osteoarthritis, however, a noninflammatory disease not mediated by immunologic mechanisms, similar results can be obtained. The presence of immune-proteins within hyaline cartilage therefore requires a cautious interpretation. Hyaline cartilage in rheumatoid arthritis is replaced by granulation tissue growing not only at its surface (pannus), but also in subchondral bone. We therefore also thoroughly investigated deep layers of hyaline cartilage in the vicinity of such subchondral tissue, but could not obtain any evidence for the presence of immune complexes therein. The growth of subchondral granulation tissue and the accumulation of PMN in the region of its junction with hyaline cartilage therefore appear to be independent of immune complexes within rheumatoid hyaline cartilage. It is suggested on the basis of these data that immune complexes possibly present in hyaline cartilage do not play an essential role in the formation of granulation tissue replacing cartilage in rheumatoid arthritis. It is, however, not entirely excluded that during advanced stages of rheumatic cartilage degradation immune complexes are formed within the matrix or carried into it from the extra-cartilaginous environment, and that they may then contribute to further cartilage destruction by enzyme release during phagocytic processes.

Antigen-Antibody Complex↗
PubMedDate not supplied

Granulocyte elastase at the site of cartilage erosion by rheumatoid synovial tissue.

Elastase, an enzyme in the azurophilic granules of polymorphonuclear cells (PMN), is like other granular PMN proteases characterized by its degradative activity at physiological pH towards native macromolecules as shown in a serum free medium. Joint tissue specimen obtained during elective surgery in cases of various rheumatic conditions were examined in order to elucidate the role of this enzyme during joint cartilage destruction. An indirect immunofluorescence microscopic technique utilizing a rabbit immunoglobulin G preparation raised against purified elastase was used for this purpose. Immunoreactive elastase was seen bound to cells which were recognized as PMN by their nuclear characteristics and staining in a histochemical reaction with naphtol AS-D chloroacetate. PMN were encountered more or less often in the pannus but clearly accumulated in a significant amount at the pannus-cartilage junction in one case of rheumatic monarthritis and three out of four cases with rheumatoid arthritis. This finding shows that PMN--contrary to other descriptions--belong to the morphologic characteristics of inflammatory rheumatic conditions and directly supports the hypothesis that PMN enzymes play an active role in rheumatoid cartilage destruction.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[Radiologic healing phenomena in chronic polyarthritis treated with methotrexate or sodium aurothiomalate].

PROBLEM: Do radiographs of hands and forefeet obtained from patients with rheumatoid arthritis present with healing phenomena? What is their importance relative to progressive changes? METHODS: Dorsopalmar/-plantar radiographs of hands and forefeet of 43 patients with early rheumatoid arthritis (median disease duration 1.7 years, anatomical Steinbrocker's age < or = 2, patients selected from a prospective study, treatment with methotrexate vs gold-sodiumthiomalate) were obtained at months 0, 6, 12, 24 and 36. Radiographs were evaluated without knowing the mode of treatment at 34 sites according to their time sequence for the following variables: a modified Larsen index, numbers of erosive and of radiologically active joints, and the numbers of joints being improved vs. deteriorated in relation to the preceding x-ray. RESULTS: The radiologic progression could be measured by both a score derived from the modified Larsen index as well as by the numbers of erosive joints with the result of an increasingly crescent, but flattening curve. The number of erosive joints was more sensitive to progression than the score derived from Larsen index. The number of joints deteriorating, compared with the preceding x-ray, decreased from month 6 to month 36 from 16.1% to 7.1% resp. At the same time, 90% of patients increasingly developed radiologic improvement in 2.9% zu 9.3% of joints, including diminution in size and recortication of erosions and particular cysts with a "filling in" by trabecular bone and recovery of a bony outline. There were no relevant differences between therapy groups. CONCLUSIONS: Progression in early rheumatoid arthritis is best measured by the number of joints with erosions. Reparative signs show up with increasing frequency during the course of the disease. After 3 years of treatment the numbers of joints exhibiting improvement predominate those with deterioration. The data support the concept of early aggressive therapy of rheumatoid arthritis and suggest the inclusion of reparative phenomena into the criteria for improvement of this disease.

Antirheumatic Agents↗