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Biomedical subjects

M Felder

Publications and source records attributed to M Felder.

At least 37 records · Page 2Linked to original sources

[Problems with bone densitometry].

Today, bone density can be measured by different technical methods which show variations in terms of reproducibility, accuracy and sensibility. A crucial parameter is the reproducibility, which differs considerably from method to method. With densitometric methods it is possible not only to evaluate patients at risk getting an osteoporosis but also to establish an individual prophylaxis and therapy by means of highly precise quantitative methods, based on the parameters 'bone density' and 'loss of bone density'. A high bone turnover leads to fast bone loss and, vice versa, fast bone loss, measured by densitometry, is correlated with high bone turnover in postmenopausal women. This allows to establish an individual therapy with antiresorption resp. bone-stimulating agents and the knowledge about a tailored, individual treatment increases patients' compliance and reduces the rate of 'non-responders'.

Aged↗

[Osteoporosis therapy, current status].

Treatment of osteoporosis includes various possibilities with drugs. Furthermore, approaches with physiotherapy and adequate diet are also important. As to drugs substances like calcium, estrogens, bisphosphonates, calcitonin, fluoride and vitamin D have to be mentioned. Anabolic steroids have some beneficial effects on bone, but there are problems with side effects. Strontium and ibriflavone show interesting potentials, but they need to be studied in more detail.

Aged↗

Efficacy and safety of radiation synovectomy with Yttrium-90: a retrospective long-term analysis of 164 applications in 82 patients.

In this long term retrospective study of radiation synovectomy with Yttrium-90 (Y90), we evaluated the results of 164 applications in 82 patients with RA, OA with synovitis, ankylosing spondylitis and psoriatic arthritis. Radiation synovectomy with Y90 has an overall success rate of approximately 50% and is therefore an effective alternative to surgical synovectomy in chronic synovitis which fails to respond to conservative treatment. Elbow and knee responded significantly better than shoulder and ankle joints. Patients with radiological stages from 0 to 2 showed a significantly better success rate than those with stage 3 changes. In responders, repeat therapy for recurrence of symptoms or treatment of a symptomatic corresponding symmetrical joint is advisable. Repeat therapy in a previous non-responder is associated with an unacceptably high failure rate. Therefore, when a joint fails to respond after 6 months, arthroscopy should be performed to evaluate further treatment procedures. A successful result was found in only 11 of 25 joints treated with arthroscopic synovectomy followed by radiation synovectomy within 2 weeks, indicating no benefit of this combination.

Adult↗

An ethics committee for a HMO an oxymoron? Certainly not!

In developing a plan-wide ethics committee for a health maintenance organization (HMO), one will inevitably be faced with the numerous differences between a HMO and any other health care facility. These differences offer advantages and disadvantages with regard to the formation of an ethics committee and strongly influence the logistics and functions of such a committee. Managed health care is a new arena for an ethics committee, one in which the role of an ethics committee is beginning to unfold.

Ethics Committees↗

[Drug therapy of ankylosing spondylitis].

Ankylosing spondylitis has to be treated with NSAID's in order to influence the inflammatory process and thus reducing pain and slowing down the stiffening of the vertebral column. For this purpose, apart from the NSAID's Sulphasalazine is used. As a symptomatic treatment of pain and muscle spasm simple analgesics and muscle relaxants can be used. In peripheral arthritis a local treatment with intraarticular steroids can be useful, and sometimes a radiosynoviorthesis can stop the inflammation for a longer period. In case of osteoporotic fractures prescription of calcitonin may be considered.

Adrenal Cortex Hormones↗

Bone loss in patients with rheumatoid arthritis--effect of steroids measured by low dose quantitative computed tomography.

For 2 years bone density changes in patients with rheumatoid arthritis were monitored to determine the effect of low dose corticosteroid treatment. Sixteen perimenopausal females were studied. Of these nine were treated with 5 to 20 mg prednisone per day and seven had no steroids. The differential effects on trabecular bone density and on cortical bone in the radius and the tibia were examined with high precision peripheral quantitative computed tomography (QCT). Steroid therapy did not influence cortical bone loss and had only a minor influence on trabecular bone density. Of greater importance was the influence of estrogen depletion. Corticosteroids and estrogen depletion, however, cannot explain fully the yearly loss of 5.7% in the trabecular and 4% in the cortical bone of the radius.

Adult↗

[Assessment of the course of chronic polyarthritis].

In the following review the classical clinical and radiological parameters of rheumatoid arthritis are discussed. In our own study we made a prospective follow up of 29 patients with rheumatoid arthritis (104 years of disease) comparing the clinical and laboratory data with the radiological findings. Finally we investigated in another population with rheumatoid arthritis (315 patients) the question of quality of life using a structured questionnaire.

Arthritis, Rheumatoid↗

Effect of salmon calcitonin on the infiltration of T lymphocytes in a synovium-like membrane of a rat inflammatory model.

The effect of salmon calcitonin (SCT) on the number of T lymphocytes accumulating in air pouch lining membranes produced on the back of Wistar rats was studied. SCT was given from day 0 through day seven following the air cavitation by daily injections of 2.5-20 micrograms/kg directly into the air cavity. Compared with saline controls, treatment with SCT caused a clear reduction in percentage of T lymphocytes, T helper cells and T non-helper subset in the synovial-like air pouch lining as revealed by FITC-labeled monoclonal antibodies and quantified by flow cytophotometric measurements. This effect may be due to a reduction in local vascular permeability caused by SCT.

Air↗

Impaired mitogen-induced interferon-gamma production in rheumatoid arthritis and related diseases.

Peripheral blood lymphocytes from patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), progressive systemic sclerosis (PSS), Reiter's disease, osteoarthritis, and from healthy volunteers were investigated for interferon-gamma (IFN-gamma) production after mitogen activation. Phytohaemagglutinin stimulation revealed an impaired IFN-gamma production in RA, SLE, and PSS but normal levels in Reiter's disease and osteoarthritis. In RA this deficiency was also seen after pokeweed mitogen, OKT3, and concanavalin A activation. No major differences were found in interleukin 2 (IL-2) production and cell proliferation. The IL-2 receptor expression was reduced on stimulated RA lymphocytes. The deficient IFN-gamma production was compensated in RA by co-stimulation of PHA or OKT3 with phorbol myristic acetate (PMA). In addition, the combination of the calcium ionophore A 23187 and PMA induced a strong IFN-gamma secretion in all patient groups and in the controls.

Adolescent↗

Quantitative computed tomography of the rheumatic knee.

A good noninvasive means to quantitate the extent and course of bone loss in rheumatoid arthritis (RA) is currently not available. We report on ways of assessing arthritic bone changes by means of quantitative computed tomography (QCT). The visualization of lesions and the quantitation of bone density diminutions are based on a stack of forty thin computed tomograms and 3D reconstructions. A pilot study shows that QCT may be a useful tool in the noninvasive assessment of the progression of RA and that it may help to evaluate the efficacy of therapeutic procedures.

Adult↗

Food allergy in patients with rheumatoid arthritis.

Three hundred patients of the Swiss Rheumatoid Arthritis Patient Union were asked by questionnaire whether they had any adverse reaction from food. Of the 159 replies 52 gave a positive history. Thirty-five patients could be further evaluated. Six patients, who gave the most typical history of allergy, were investigated clinically, with laboratory tests and technetium-scintigramme after food challenge. There was no sign of an immunologic reaction in any of the measured parameters. The other patients were interviewed a second time with an extensive allergological questionnaire. None of the food intolerances could be substantiated.

Antigen-Antibody Complex↗

[Vasculitic polyneuropathy as a complication in chronic polyarthritis].

Polyneuropathy due to vasculitis in connection with rheumatoid arthritis is a rare complication of the disease. Special investigations can help us to distinguish between a peripheral sensory-neuropathy with a good prognosis, the neuropathy of the autonomous nervous system and the severe form of mononeuritis multiplex. The bad prognosis of this form is due to the diffuse vasculitis of internal organs. We describe 5 patients with rheumatoid arthritis and different forms of vasculitis. The differential diagnosis, therapy and prognosis are described in detail.

Aged↗