[Treatment of myofascial lumbar dorsal pain. Effective clinical diagnostics and therapy]. / Die Behandlung myofaszialer lumbaler Rückenschmerzen. Effektive Diagnostik und Therapie.

BACKROUND: Lumbar dorsal pain is a problem that must be taken seriously and is part of many people's everyday lives. Not only does it cause high costs for the health system, it also frequently leads to inability to work. The significance of the myofascial system is still not taken seriously enough in therapy and clinical diagnostics, when treating dorsal pain. In the following article, the effectiveness of specifically targeted therapy for myofascial pain is evaluated. METHODS: Included in the study were 44 patients referred for lumbar dorsal treatment-resistant pain to a practice specializing in pain therapy. Therapy focused on treatment of the affected muscle area with physiotherapy and the additional techniques of infiltrating trigger points, neural therapy, and general relaxation exercises. Medication was optimized according to the specific guidelines for the condition. The effect of therapy was evaluated using the German pain questionnaire (Deutsche Schmerzfragebogen). RESULTS: After the therapy phase, patients had a significantly lower intensity of pain, anxiety, and depression, as well as an increased quality of life. CONCLUSION: The results indicate that targeted treatment of muscles and fascia in patients with chronic back pain can lead to a reduction of pain symptoms. The consideration of the myofascial systems, particularly in relation to nonspecific back pain, could contribute to improving the treatment of pain and contribute to lowering costs.

Argon laser trabeculoplasty in pigmentary glaucoma.

PURPOSE: To evaluate the long-term effect of argon laser trabeculoplasty (ALT) in pigmentary glaucoma. METHODS: The authors retrospectively analyzed results of ALT in 32 eyes of 32 patients with medically uncontrolled pigmentary glaucoma. Data were longitudinally adjusted to normalize the disparity in time of follow-up and evaluated by life-table analysis. RESULTS: Mean age (+/- standard deviation) was 45.1 +/- 13.1 years (range, 23-72 years) (males, 46.3 +/- 13.7 years; females, 42.9 +/- 12.2 years). Mean baseline intraocular pressure (IOP) was 27.8 +/- 5.3 mmHg. Mean follow-up time was 33.0 +/- 5.0 months (range, 1 week [immediate failures] to 96 months). Three eyes were lost to follow-up at 3 months. Eleven eyes required trabeculectomy between 1 week (2 eyes) and 37 months after laser treatment. Life-table analysis indicated a cumulative success for all eyes of 80% at 1 year, 62% at 2 years, and 45% at 6 years. Mean IOP was significantly reduced (P < 0.001; paired Student's t test) for male and female eyes at all intervals calculated. Age was a significant factor in determining time to failure. CONCLUSION: Argon laser trabeculoplasty is effective in pigmentary glaucoma. Younger patients had a greater chance of success than older patients at all intervals. This became highly significant (P < 0.001) after 3 years.

Central visual field, visual acuity, and sudden visual loss after glaucoma surgery.

The relationship between Snellen visual acuity and central visual field loss as determined by the Humphrey 10-degree test was examined in 96 glaucomatous eyes of 79 patients. The severity of the field defect was determined by the number of affected quadrants, defined as a sensitivity loss of at least 10 decibels from normal at the most central point of 1.4-degree eccentricity. The decrease in median acuity was gradual, one-half line per quadrant for one and two affected quadrants, and an additional one and one-half line to two lines for three and four quadrants. Loss of acuity was disproportionate when both temporal quadrants were affected. The major source of error was difficulty with fixation. One type, a prolonged fixation shift, was not related to short-term fixation losses. There was a significant correlation between acuity and foveal threshold over a wide range of both variables. Sudden visual loss from additional optic nerve damage was studied retrospectively in 96 eyes with advanced glaucoma and a central field defect. A frequency of 3% for any loss of visual acuity and a frequency of 1% for a loss to 20/200 or worse were noted. There were no apparent predictive factors.

Early and late phases of ocular anaphylaxis in actively immunized guinea pigs.

A model of ocular anaphylaxis with distinct early- and late-phase components was studied in actively immunized guinea pigs. Twenty guinea pigs were injected with dinitrophenylated (DNP) bovine gamma globulin emulsified in Freund's complete adjuvant and challenged topically with di-DNP-lysine. Clinical signs were monitored over a 48 h period. An early-phase reaction (EPR) characterized by conjunctival edema, conjunctival erythema, lid swelling, and lid redness was observed. This reaction peaked at 0.5 h after challenge and subsided to a low point at 3-4 h. Subsequently, a second episode of lid swelling and lid redness was observed at 4-8 h. All animals in both groups exhibited an EPR. In addition, 75% of the animals underwent an EPR and an LPR. No animals exhibited an isolated LPR. Of the animals that underwent a dual response, 47% were biphasic, 6% were prolonged and 47% were multiphasic. The development of an active model of ocular anaphylaxis exhibiting both EPR and LPR components will enable studies of mechanisms which regulate the frequency and magnitude of these ocular allergic responses.

Effect of topical dexamethasone on the ocular allergic reaction in passively sensitized guinea pigs.

We examined the effect of extended topical pretreatment with dexamethasone (Dex) on the ocular allergic response in passively sensitized guinea pigs. The passive IgG1 antibody dependent guinea pig model used in these studies demonstrates both early- and late-phase ocular anaphylactic reactions. Fourteen hours prior to challenge with the hapten di-DNP-lysine, three groups of guinea pigs were sensitized subconjunctivally with antiserum rich in IgG1 anti-DNP antibodies in both eyes (group 1, n = 11) or in one eye (group 2, n = 9; group 3, n = 10). The contralateral eyes of animals in groups 2 and 3 received normal guinea pig serum. At 1-hour intervals, beginning 6 h prior to challenge, guinea pigs in group 1 received 0.1% Dex in 0.5% hydroxymethylcellulose (MC) topically in one eye and 0.5% MC in their other eye. Animals in group 2 were treated on the same schedule with 0.5% MC only in both eyes. Animals in group 3 were not pretreated. Conjunctival edema, conjunctival erythema, periorbital swelling, and lid erythema were scored independently in the upper and lower lids of both eyes of all animals for 10 h. Comparisons between the scores of Dex-pretreated eyes in group 1 and MC-pretreated eyes in group 2 or untreated eyes in group 3 revealed no significant differences in any clinical sign at 0.5 h (early-phase reaction). However, these comparisons demonstrated significant reductions in all four clinical signs in animals of groups 1 from 1 to 8 h and marked reduction or complete absence of signs from 6 to 10 h (late-phase reaction).(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of abnormal von Willebrand factor by endothelial cells from a patient with type IIA von Willebrand disease.

Studies were conducted to characterize the biosynthesis of von Willebrand factor (vWf) by cultured endothelial cells (EC) derived from the umbilical vein of a patient with type IIA von Willebrand disease. The patient's EC, compared with those from normal individuals, produced vWf that had decreased amounts of large multimers and an increase in rapidly migrating satellite species, features characteristic of plasma vWf from patients with type IIA von Willebrand disease. The type IIA EC did produce a full spectrum of vWf multimers in both cell lysates and postculture medium, although the relative amounts of the largest species were decreased. The large multimers were degraded in conjunction with the appearance of rapidly migrating satellites that contained approximately equal to 170-kDa proteolytic fragments, suggesting that this patient's functional defect is due to abnormal proteolysis and not to a primary failure of vWf subunit oligomerization. Moreover, the observed degradation appears to result from an abnormal vWf molecule and not elevated protease levels. These results suggest that this patient's von Willebrand disease phenotype is caused by increased proteolytic sensitivity of his vWf protein.

Molecular cloning of the human gene for von Willebrand factor and identification of the transcription initiation site.

A series of overlapping cosmid genomic clones have been isolated that contain the entire coding unit of the human gene for von Willebrand factor (vWf), a major component of the hemostatic system. The cloned segments span approximately 175 kilobases of human DNA sequence, and hybridization analysis suggests that the vWf coding unit is approximately 150 kilobases in length. Within one of these clones, the vWf transcription initiation site has been mapped and a portion of the vWf promoter region has been sequenced, revealing a typical "TATA box," a downstream "CCAAT box," and a perfect downstream repeat of the 8 base pairs containing the transcription start site. Sequencing of a segment of another genomic clone has revealed the vWf translation termination codon. Where tested, comparative restriction analysis of cloned and chromosomal DNA segments strongly suggests that no major alterations occurred during cloning and that there is only one complete copy of the vWf gene in the human haploid genome. Similar analyses of DNA from vWf-producing endothelial cells and nonexpressing leukocytes suggest that vWf gene expression is not accompanied by gross genomic rearrangements. In addition, there is significant homology of C-terminal coding sequences among the vWf genes of several vertebrate species.

Human megakaryocytes. IV. Growth and characterization of clonable megakaryocyte progenitors in agar.

Human megakaryocyte progenitors were cloned in semisolid agar from unfractionated bone marrow cells and recognized by their capability of producing discrete megakaryocyte colonies. Megakaryocyte colonies were identified in situ by immunofluorescence, using antibodies against platelet glycoproteins Ib, IIb, and IIIa, as well as von Willebrand factor (vWf), which are regarded as distinct protein markers for the megakaryocyte-platelet lineage. Megakaryocyte colonies typically contained 20-50 cells arranged in compact configurations, with high nuclear-cytoplasmic ratios, diameters between 10 and 14 micron, and round, oval, or indented nuclei. Colony numbers peaked at days 6 and 7, with a mean of 17.9 megakaryocyte colonies (range, 8-33) per 2 X 10(5) unseparated marrow cells. The in vitro growth characteristics and kinetics of megakaryocytes grown in agar are different from those described for the plasma clot and methylcellulose systems, which suggests selection of distinct progenitor subsets. Consequently, this assay may be a useful complement to other approaches in characterizing the megakaryocyte progenitor population.

Triple procedure of extracapsular cataract surgery, posterior chamber lens implantation, and glaucoma filter.

A triple procedure consisting of extracapsular cataract surgery, posterior chamber intraocular lens implantation, and glaucoma filtering operation was performed in 30 eyes of 28 patients. The follow-up time was six to 24 months, with a median of 11 months. Group I consisted of 21 eyes with advanced glaucoma and poor to marginal pressure control. After surgery, the pressure was less than or equal to 21 mm Hg in 62% but 86% still required medication. This intraocular pressure control is worse than that reported by others. Group II consisted of nine eyes with a functioning filtering bleb before surgery. The incision was made through the filtering bleb in order to facilitate the cataract surgery. A new filtering procedure was performed adjacent to the original one. There was loss of control in a significant number of eyes but, with rare exception, no better or worse than that reported with other approaches. In pseudophakia there is a poor correlation between pressure control and a visible bleb. The visual results for both groups were good, with 73% obtaining 20/40 or better visual acuity.

Platelet glycoproteins IIb and IIIa associated with blood monocytes are derived from platelets.

Platelet glycoprotein IIb/IIIa (GP IIb/IIIa), the receptor complex for fibrinogen, has been regarded as a megakaryocyte/platelet lineage-restricted antigen. Recently, however, it has been reported that GP IIb/IIIa is expressed in blood monocytes. Studies were performed to establish the origin and immunological characteristics of monocyte-associated glycoproteins IIb and IIIa (GPs IIb and IIIa). Preparations of blood monocytes containing varying platelet-monocyte ratios were metabolically labeled with [35S]methionine with the expectation that any newly synthesized GPs IIb and IIIa would be monocyte-derived, since platelets have only rudimentary protein synthetic apparatuses. Analyses of sodium dodecyl sulfate (SDS) gels of homogenates of cell preparations containing from 200 to 5:1 platelet-monocyte ratios revealed that unlabeled GPs IIb and IIIa were readily immunoisolated using protein A-Sepharose immunobeads. However, fluorographic analyses of the same cell preparations pulse-labeled with [35S]methionine failed to demonstrate synthesis of GP IIb or IIIa. Additionally, no GP IIb or IIIa was detected when immunoisolation was carried out in pure preparations of monocytes containing less than 1:100 platelet-monocyte ratios and SDS acrylamide gels were stained by the sensitive silver stain method. Furthermore, heterologous polyspecific antisera and two monoclonal antibody preparations against GPs IIb and IIIa, which bound to platelets, failed to bind to monocyte membranes. Thus, evidence was presented that indicated that monocytes do not synthesize platelet GPs IIb and IIIa and that detection of these molecules in blood monocyte preparations reflects platelet contamination.

Dark- and light-adapted visual evoked cortical potentials in retinitis pigmentosa.

Fifty patients with all genetic types of retinitis pigmentosa (RP) were tested with the visually evoked cortical potential (VECP) by full-field flashes of blue and red light in the dark-adapted state and white light flashes in the light-adapted state. VECPs were recorded in all but one of these patients, even those with only a few degrees of central visual field remaining. In a subgroup of patients the absence of the VECP to blue light, dark-adapted, was correlated with a final dark-adapted threshold at or above cone threshold. These observations suggest that the VECP may be a useful objective method of assessment of patients with RP especially patients without detectable ERGs.

Human megakaryocytes. V. Changes in the phenotypic profile of differentiating megakaryocytes.

Human megakaryocytes were studied for phenotypic changes occurring throughout differentiation using a panel of monoclonal antibodies raised against marrow megakaryocytes and blood platelets. 11 monoclonal antibody preparations were selected for restricted specificity against megakaryocytes and/or platelets after screening by immunofluorescence, complement-mediated cytolysis, and solid phase enzyme-linked immunosorbent assay. The expression of the cellular epitopes recognized by these reagents enabled the identification of three levels of megakaryocyte maturation characterized by distinct immunologic phenotypes. Based upon their reactivities against megakaryocytic cells at different ontogenetic levels, monoclonal antibodies were operationally categorized into three groups. Group A consisted of six different monoclonal antibodies that recognized antigens on the colony-forming unit-megakaryocyte (CFU-Mk), in vitro grown colony megakaryocytes, and early immature marrow megakaryocytes, only, and did not detect their respective epitopes on either mature megakaryocytes or platelets. A monoclonal antibody categorized in group B detected a cell antigen expressed by megakaryocytic cells at all maturational levels, but which is lost or suppressed during terminal differentiation and is not expressed on blood platelets. Group C included four different monoclonal antibodies raised against platelets that recognized antigenic determinants expressed on the CFU-Mk, colony megakaryocytes, early and mature megakaryocytes, and platelets. Three group C monoclonal antibodies (PC-1, PC-3, and PC-4) were specific for platelet glycoprotein IIb/IIIa. Additionally, group C monoclonal antibody PC-2 was unique in that it showed partial reactivity against the clonable progenitor for the erythroid series (BFU-E). Recognition of discrete phenotypic changes in differentiating megakaryocytes will enable multiparameter analyses of these cells as well as the study of factors regulating the dynamics of megakaryocytopoiesis in health and disease.

Glaucoma filtering surgery: factors that determine pressure control.

Factors that determine pressure control after filtering surgery were studied in 194 eyes of 158 patients in a retrospective study. Emphasis was placed on the cumulative probability method of Kaplan and Meier and multiple regression analysis. Aphakia and the presence of a surgical bleb were the most important factors. Age and type of surgical procedure were next. Race and race-sex interaction were the least important. The above factors accounted for only 6% to 16% of the total variance. The difference between eyes of the same patient was less than that between paired eyes of different patients but the former was surprisingly high. In the selected group of successful cases without medication the postoperative pressure was independent of the baseline pressure and choice of surgical procedure.

Human megakaryocytes. III. Characterization in myeloproliferative disorders.

Abnormal proliferation of the megakaryocytic line was observed in the marrow tissue from patients with myeloproliferative disorders. Megakaryocytes were identified by immunofluorescence using distinct platelet protein markers. Plasma factor VIII antigen (factor VIII:AGN) and platelet glycoproteins IIb and IIIa were detected in normal mature and early megakaryocytes, as well as in a morphologically heterogeneous population of low density marrow cells regarded as atypical megakaryocytes. Atypical megakaryocytes were defined as oval/round 14-35-micron diameter blast-like mononuclear/multinucleated cells bearing platelet protein markers with distinct morphological features, including cytoplasmic vacuolation, variable nuclear/cytoplasmic ratios, and variable cytoplasmic granulation. Atypical megakaryocytes were observed in most chronic myelogenous leukemia (CML) patients and in two patients with polycythemia vera, representing between 60 and 1,840 cells/10(4) cells (less than 1.050 g Percoll/cu cm). No atypical megakaryocytes were found in (a) 20 normal controls, (b) two patients with essential thrombocythemia, (c) a patient with thrombocytosis secondary to acute bleeding, and (d) in two patients with CML. Atypical megakaryocytes appear to represent a single-cell population, as demonstrated by a series of double immunofluorescence assays using combinations of five different antiplatelet protein sera. There was a statistically significant correlation between the frequency of atypical megakaryocytes and the presence of immature forms of myeloid cells in blood. Analyses of Fc IgG receptors conducted with two different immunofluorescence systems have demonstrated that phenotypic similarities existed between atypical megakaryocytes and myeloproliferative platelet proteins and differentiation markers on megakaryocytes are useful in elucidating the pathophysiologic alterations occurring in the megakaryocytic compartment in patients with myeloproliferative disorders.

Glaucoma filtering surgery factors that determine pressure control.

Factors that determine pressure control after filtering surgery were studied in 194 eyes of 158 patients in a retrospective study. Emphasis was placed on the cumulative probability method of Kaplan and Meier and multiple regression analysis. Aphakic and the presence of a surgical bleb were the most important factors. Age and type of surgical procedure were next. Race and race-sex interaction were the least important factors. The above factors accounted for only 6% to 16% of the total variance. The difference between eyes of the same patient was less than that between paired eyes of different patients but the former was surprisingly high. In the selected group of successful cases without medication the postoperative pressure was independent of the baseline pressure and choice of surgical procedure.

Some cardiovascular effects of noise.

We recently reported that exposure to moderately high noise levels for 9 months produced sustained blood pressure elevations in rhesus monkeys (M. mulatta) without impairing their auditory sensitivity (Peterson et al, Science, 1981, 211, 143Off). In the present study, a continuation and elaboration of the earlier work, 4 chair-restrained monkeys (M. fascicularis) were studied concurrently. After 3 mo of low-noise conditions, 2 experimental Ss were exposed to a realistic noise sequence [Leq24: 85 db(A)], 24 hrs per day for about 6 mo. Compared to control animals who remained under low-noise conditions throughout the experiment, the noise-exposed Ss again exhibited a substantial increase in blood pressure, and also manifested orderly changes in the diurnal rhythm of heart rate, blood pressure, and "pauses" in cardiac rhythm. Our results conflict in detail with certain findings from earlier epidemiological studies, possibly because of differences in the species used, experimental design, or sampling strategies. The desirability of undertaking long-term prospective studies in this area is discussed.