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Rheumatic diseases. 1. Differential diagnosis.
In a case of rheumatic disease, the patient's history and a careful physical examination should yield most of the information needed to identify the specific disorder present. A convenient classification is based on four differentiating features: number of joints affected, acuteness or chronicity of disease, absence of joint involvement, and anatomic distribution.
Treatment of total loss of the Achilles tendon by skin flap cover without tendon repair.
We present two cases of conservative treatment of total loss of the Achilles tendon. In our opinion the functional result is acceptable, without tendon grafting. The action of the sural muscles is transmitted through scar underlying the pedicled flaps used to resurface the wounds.
Musculosketal symptoms and non-REM sleep disturbance in patients with "fibrositis syndrome" and healthy subjects.
In sleep studies of (a) patients with the "fibrositis syndrome" and (b) healthy subjects undergoing stage 4 sleep deprivation, we observed in both groups the anomalous presence of alpha-rhythms in the non-rapid-eye-movement (NREM) sleep EEG. This phenomenon has been termed alpha-delta sleep. In the healthy subjects stage 4 deprivation was accompanied by the temporary appearance of muscoloskeletal and mood symptoms comparable to the symptoms seen chronically in the patients. It is suggested that the external arousing stimulus, which induced alpha-delta sleep in the subjects, is paralleled in the patients by an internal arousing mechanism. Such a mechanism, acting in competition with the NREM sleep system, would impair the presumed restorative function of NREM sleep and lead to the development of symptoms. It is proposed that the "fibrositis" symptom complex be considered a "non-restorative sleep syndrome". Evidence froms presented in support of the hypothesis that a disorder of serotonin metabolism serves as a basis for both the EEG sleep disturbance and the symptoms.
Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation.
Two groups of young, healthy, nonathletic volunteers were subjected to selective sleep stage deprivation. Six subjects were deprived of stage 4 sleep and seven subjects of REM sleep. The stage 4 deprived group reported more musculoskeletal symptoms during the deprivation condition than did the REM deprived group. The stage 4 deprived group also showed a significant increase in muscle tenderness between the baseline and deprivation conditions and an altered pattern of overnight change in muscle tenderness in response to deprivation. The REM deprived group did not show either of these changes. These results are discussed in the light of the previously postulated relationship between NREM sleep disturbance and muscoloskeletal pain in patients with so-called "Fibrositis syndrome."
Paternal age effect in fibrodysplasia ossificans progressiva.
Analysis by the method of Smith (1972) of birth order and parental age data collected from 38 of 42 patients with fibrodysplasia ossificans progressive shows a significant paternal age effect. This finding among the sporadically occurring cases would support the proposition that this condition usually arises as a new dominant mutation.
A follow-up study of the use of benoral tablets in non-articular rheumatism.
A multicentric follow-up study was conducted in general practice to assess disease characteristics which determine analgesic needs in non-articular rheumatism. Of 127 patients studied, those with chronic conditions such as brachial fibrositis and tennis elbow with a history extending over more than a month tended to require a longer course of treatment than those whose symptoms related to muscles of the trunk and spine. For most patients a one or two week course of Benoral tablets proved adequate in length and efficacy.
[Proceedings: Comparison of clinical, light and electron microscopic findings in cardiomyopathies].
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[Clinical results of ibuprofen (Brufen) in abarticular rheumatism].
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[Clinical trial of the new percutaneously active antirheumatic etofenamate. Summarising report (author's transl)].
2-(2-Hydroxyethoxy)ethyl-N-(a,a,a-trifluoro-m-tolyl)anthranilate (etofenamate, Rheumon Gel), a percutaneously active antirheumatic containing etofenamate as active principle has been subjected to clinical studies in both hospitalized and out-patients in various types of rheumatic disease. These trials included double-blind studies against placebo gel, controlled comparative studies against two topical commercial products (ointmentI: combination of 2-hydroxyethyl salicylate and p-menthan-3-ol; ointment II: 3,5-dioxo-1,2-diphenyl-4-n-butylpyrazolidine) and open trials for efficacy and tolerance. Of the 760 patients taking part in the trials, 556 were treated with Rheumon Gel.
Left atrial ultrastructure in mitral valvular disease.
Light microscopic and ultrastructural observations were made on left atrial tissues obtained from 14 patients at the time of operation for correction of mitral valvular disease. Cardiac muscle cells varied in size but most frequently were hypertrophied. In fibrotic areas, present in all left atria, the muscle cells tended to be isolated from adjacent cells and exhibited degenerative changes of varying severity. These changes consisted or proliferation of Z-band material and cytoskeletal filaments, myofibrillar loss, proliferation of elements of free and extended junctional sarcoplasmic reticulum, variations in size and number of mitochondria, occurrence of abnormal mitochondria, dissociation of intercellular junctions, formation of spherical microparticles, and accumulation of lysosomal degradation products. Hypertrophy was considered to lead to cellular degeneration, with decrease or loss of contractile function. Atrial fibrillation was associated with severe cellular degeneration. The severity of degeneration was greater in patients with mitral regurgitation, with or without associated mitral stenosis, than in patients with pure mitral stenosis.
[Therapy of painful syndromes with electric stimulation (electroanalgesia)].
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Rheumatoid myopathy.
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[Synthetic ACTH in theumatic diseases: (author's transl)].
44 patients with acute irritations of degenerative articular diseases and 66 patients with soft tissue rheumatism were treated with Synacthen Depot (tetracosactide hexacetate 1 mg/ml). During the first three days of treatment the patients received an average of 2 ampoulbs Synacthen Depot, then treatment was continued at 3-4 day intervals. In the degenerative joint disease group 86.4% and 89.4% in the group with soft tissue rheumatism became free of complaints or improved with the ACTH treatment. Most of the patients with degenerative joint diseases needed a 4 week treatment; 1/3 of the patients with soft tissue rheumatism were already free of complai
Two contributions to understanding of the "fibrositis" syndrome.
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Does allergy play a role in fibrositis?
Twenty patients with active fibrositis and no underlying disease (and with normal electromyographic findings) were evaluated for the possible role of an active allergic process in their conditions. A definite atopic history was obtained in just fewer than 50% of the patients, and an allergic diathesis in slightly more than 50% of the patients' families. Serum immunoglobulin E levels and eosinophil counts for all 20 patients fell within the normal range. Thus the traditional allergic reaction (type I hypersensitivity) would seem unlikely as a mediator of fibrositis.
Long-term follow-up on patients with fibrositis treated with acupuncture.
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