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Biomedical subjects

W Müller

Publications and source records attributed to W Müller.

At least 1,315 records · Page 73Linked to original sources
PubMedDate not supplied

[Pressure point studies in generalized tendomyopathy (fibromyalgia) (comparison of various methods)].

There are different methods used for examination of tender-point pressure tenderness, which is one of the two most important criteria for diagnosis of generalised tendomypathy (fibromyalgia). When 11 of 18 tender points must be painful under the pressure of 4 kg for fulfilling the criteria of American College of Rheumatology (ACR), we require 12 of 24 points to be tender when pressed with a force less than 2 kg using dolorimeter. We have found that our method have a significantly higher specificity with about the same sensitivity, when compared with by ACR proposed method. Specificity and sensitivity depended on method used for pressure application and not on points examined. In view of our findings, we propose for scientific purposes dolorimetric measurement of pressure tenderness as being more reliable although more time-consuming method.

Adult↗
PubMedDate not supplied

[Blocking of S2 receptors--a new treatment principle in generalized tendomyopathy (fibromyalgia)?].

In a pilot study, the effectiveness of the S2-receptor blocker ketanserin was investigated in patients receiving concurrent physiotherapy for primary fibromyalgia. This combined treatment was compared with physiotherapy alone. In the group treated with ketanserin, a significant reduction in spontaneous pain was observed, and the painfulness of "tender points" also decreased markedly. The patients experienced a significant improvement in the quality of sleep, the feeling of being rested after sleep, and psychological well-being in the evening. Significant improvement was also recorded on the Zerssen Mood Scale and the Erlanger Anxiety Scale. In the group receiving physiotherapy alone, the improvements were far less marked and usually were below the significance level. These results are now being verified in a double-blind, randomized trial.

Dose-Response Relationship, Drug↗
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[Rheumatic manifestations in HIV infection].

The two main rheumatic manifestations of infection by human immunodeficiency virus (HIV) are arthropathies and autoimmune diseases. The pathogenesis of the rheumatic manifestations is currently undefined. Among the different mechanisms implicated, the severe immunosuppression and immunodysregulation, as well as recurrent infections are possible. A direct infection by HIV is another mechanism. The course of some rheumatic diseases may be altered by HIV-infection. Remission of rheumatoid arthritis during the course of HIV-infection is anecdotally reported in the literature, whereas patients with Reiter's syndrome seem to have a severe clinical course.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[Tissue pO2 measurement in taut back musculature (m. erector spinae)].

Measurements with polarographic needle probes in fibromyalgic muscles (mm. erectores spinae) revealed an elevated mean tissue-pO2. The total mean tissue-pO2 in the patient group was significantly higher than that in the control group. Greater pathological tension in fibromyalgic muscles increases the mean tissue-pO2. The distribution of local tissue-pO2 values was normal; there was no evidence of small hypoxic areas in the muscle. The elevated tissue-pO2 in fibromyalgic muscles could either be explained by an increase in local blood flow or by disturbance of oxygen-utilization of the muscle cells. The mean tissue-pO2 in patients treated with NSAD was lower than in patients without this treatment. Myogelosises (i.e., circumscript tautness in muscles, that, contrary to fibromyalgic muscles, do not relax under general anesthesia) showed low tissue-pO2 values and even hypoxia in the core. In myogelosises, pain could be hypoxic in nature. However, in fibromyalgic muscles no evidence for hypoxia or hypoxia-related pain could be found.

Adult↗
PubMedDate not supplied

[Generalized tendomyopathy. I: Clinical aspects, follow-up and differential diagnosis].

Generalized tendomyopathy (GTM), or fibromyalgia, is a disorder characterized by diffuse pain in the musculoskeletal apparatus which usually begins at a single site, e.g., as low-back pain or cervical syndrome, and develops into generalized pain over months or years. It is accompanied by increased tenderness at characteristic tender points, although the pain threshold on the whole is reduced. In addition to the main symptoms (pain in the musculoskeletal system, tenderness at the tender points), autonomic and functional symptoms are almost invariably present and are often accompanied by pathological psychological findings such as neuroses and depression. To date, no reliable laboratory parameters or pathognomonic histological findings have been identified. The disorder affects primarily women, beginning around the age of 35 and reaching its peak during or after the menopause. It also affects young people and those over age 60, although it is much less common in these cases. Secondary forms are observed particularly in rheumatoid arthritis. The differential diagnosis must first distinguish primary GTM from the secondary forms. There must also be further differentiation between internal and psychiatric disorders and primary GTM. This can be achieved in many cases by careful clinical diagnosis, although a more complete examination is sometimes required.

Diagnosis, Differential↗
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[Generalized tendomyopathy. II: Pathogenesis and therapy].

Many factors are known to play a role in the pathogenesis of generalized tendomyopathy (GTM), or fibromyalgia. While the secondary forms develop along with known diseases, particularly rheumatoid arthritis, the cause of primary GTM is often not well understood. The fact that this disorder usually appears first at a single site, e.g., as low-back pain or cervical syndrome in which poor posture or malformation of the spine can be observed, gives rise to the theory that local changes in the spine or the joints are particular underlying causes of the initial manifestation. As the disorder becomes generalized, however, psychological causes predominate. Psychosocial factors in particular seem to further the process of generalization. Therapy can take many forms. Above all, it calls for an understanding attitude on the part of the managing physician and, whenever, possible, elimination of likely causal factors. Analgesics and antiinflammatories are often inadequate; antidepressants and neuroleptics provide more effective relief. Moreover, intensive physiotherapy and psychotherapy are necessary. GTM in many cases is resistant to treatment despite intensive management, although it often subsides naturally after age 60. Recognizing GTM is of great importance in order to initiate appropriate treatment promptly, avoid incorrect diagnoses and their consequences, e.g., repeat surgery, and to prevent premature disability.

Fibromyalgia↗
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[Soluble interleukin 2 receptor (sIL-2R) in chronic polyarthritis].

An ELISA was used to measure soluble interleukin-2 receptor (sIL-2R) in the sera and synovial fluid (SF) of patients with rheumatoid arthritis (RA). Patients with seropositive, as well as seronegative RA had raised levels of sIL-2R in serum and SF compared to patients with osteoarthritis and sex-age matched healthy subjects. According to literature, sIL-2R levels in the sera of RA-patients may be a useful marker of disease activity. Increased sIL-2R levels in SF show new aspects in pathophysiology of RA.

Adult↗
PubMedDate not supplied

[Epidemiologic responsibilities of the public health service].

Public Health Service (PHS) needs an epidemiological approach to execute and implement its widespread tasks, as laid down by law. Data collection and transfer is strictly limited by law; PHS has usually to refer to its own (current) data, collected and used primarily for individual applications and therefore of limited epidemiologic use. The legal basis for epidemiologic work in the field of PHS is interpreted, the restrictions by data protection are shown, the limited use of the present current data basis is discussed. Finally, the role of PHS as part of the local administration is justified as well as its importance for community based health reports and health planning.

Communicable Disease Control↗
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[Initial clinical experiences in the treatment of chronic polyarthritis with a new monokine release inhibitor].

Cytokines such as Interleukin-1 (IL-1) are important modulators of the cell-mediated immune response and play a paramount role in inflammatory autoimmune disease. We report on preliminary clinical experiences with a new, tricyclic substance [( 10-Methoxy-4H-benzo[4,5]cyclo-hepta-[1,2-b]thiophene-4- ylidene]acetic acid, MW 284), which inhibits the release of interleukin-1 alpha and -beta from cultured murine macrophages or human mononuclear cells. The study included 12 patients (rheumatoid arthritis, n = 9; hemochromatotic arthropathy, n = 1; psoriatic arthropathy, n = 1; seronegative spondylarthropathy, n = 1). Eight patients were treated for a total of 8 weeks, receiving a median dose of 800 mg/d of the substance. Due to significant clinical benefits, two patients continued for a total of six months. Administration of the drug was discontinued in two patients because of severe urticaria and lack of compliance, respectively. Four out of 10 patients showed clinical improvement according to Ritchie-Index, pain score, ESR and CRP. Side effects were diffuse gastrointestinal symptoms (4/12), temporary impairment of liver function (4/12) and allergic skin reactions (3/12).

Anti-Inflammatory Agents, Non-Steroidal↗
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[Localized pressure pain in the diagnosis of generalized tendomyopathy (fibromyalgia)].

56 tender points were examined in 100 patients and 50 age- and sex-matched healthy volunteers using a dolorimeter. 24 of the 56 points were especially selected according to ability of discrimination, best possible distribution on the body, and easy localization. All 56 points as well as the 24 specially selected points were examined as to their sensitivity and specificity in the diagnosis of generalized tendomyopathy. The sensitivity and the specificity for both point-combinations were acceptable. The sensitivity and specificity of the 24 points were superior to the 56 points in the case of discrimination ability. A 100% sensitivity and specificity could not, however, be achieved. It remains to be considered if functional and vegetative symptoms must still be used to support the diagnosis of generalized tendomyopathy (fibromyalgia).

Female↗
PubMedDate not supplied

[Hyaluronic acid and N-terminal procollagen-III-peptide in the urine in inflammatory and degenerative joint diseases].

In a cross-sectional study of 130 patients (main diagnosis: rheumatoid arthritis, n = 41, osteoarthritis, n = 39; ankylosing spondylitis, n = 28) we measured the concentrations of hyaluronan (HA) and the N-terminal propeptide of type-III collagen (NP III P) in urine and evaluated the relationship with their serum levels. Increased HA levels in serum correlated with increased urinary excretion (r = 0.69 for patients with active rheumatoid arthritis). Only patients with rheumatoid arthritis showed significantly elevated HA concentrations in urine (mean = 1,493 micrograms/mmol creatinine). Because of relatively wide fluctuations in urinary HA in normals (mean = 944, standard deviation 818 micrograms/mmol creatinine) and only modest differences between groups, the diagnostic accuracy of urinary HA measurements is inferior to serum determinations. NP III P showed no significant differences between patients and controls (means 10.5 to 15 micrograms/mmol creatinine). Obviously, renal excretion is of minor importance in the metabolism of HA and NP III P. The possible diagnostic usefulness of determinations of these parameters in serum is not enhanced by measurements in urine.

Adolescent↗
PubMedDate not supplied

[Effect of 5-aminosalicylic acid as a constituent of sulfasalazine in the treatment of chronic polyarthritis].

Sulphasalazine, a combination of sulphapyridine and 5-aminosalicylic acid, has recently been shown to be an effective second line agent in the treatment of rheumatoid arthritis. 20 patients were treated for 12 weeks either with sulphasalazine or 5-aminosalicylic acid (5-ASA) to investigate whether 5-ASA is the active moiety. In a second investigation the analgesic effect of 5-ASA was studied. 5-ASA showed no second line effect and no analgesic effect. Sulphapyridine therefore appears to be the active moiety.

Adult↗
PubMedDate not supplied

[Measuring pressure pain of tendons and muscles in healthy probands and patients with generalized tendomyopathy (fibromyalgia syndrome)].

A newly developed dolorimeter was tested by repeated measurements in 25 healthy volunteers to demonstrate its reliability. Repeated measurements at 12 different points demonstrated good correlation. Measurements at these points gave a highly significant difference between 100 patients with generalized tendomyopathy (fibrositis-syndrome/fibromyalgia) and a group of 50 age- and sex-matched healthy volunteers.

Female↗