New model for the induction of osteoblastic bone metastases in rat.

BACKGROUND: We have investigated different models for osteoblastic lesions. Currently, there are two models using MatLyLu R-3327prostate cancer cells: tumor cell application in the left heart ventricle and intravenous application with concomitant transient surgical clamping of the lower caval vein. MATERIALS AND METHODS: Thirty male Copenhagen rats (age 9+/-2 months, mean weight 323+/-21 g) were each injected with 200,000 R-3327 prostate cancer cells. In 10 rats the left ventricle route was used (group 1), in an other 10 rats the intravenous route (group 2), while in the third group of 10 rats a new model of a direct intra-osseous route was applied (group 3). Additionally, a control group of 5 rats underwent the same procedure as in group 3, but only saline without tumor cells was administered. A 99mTc-HMDP bone scan and histological examination of bone and lung were performed for follow-up. RESULTS: In the bone scan, bone lesions could be not visualized in groups 1 and 2, but in group 3 osteoblastic lesions were observed in both femora in 9 out of 10 rats. Upon histological examination, there were lung metastases in animals from groups 1 and 2, but not in group 3. Clinical signs for bone metastases in the lumbar spine (motor disablement of the hind legs) were found in groups 1 and 2. CONCLUSION: The intra-osseous administration of MatLyLu R-3327 prostate cancer cells represents a useful and effective model for osteoblastic bone lesion, and allows further autoradiographic evaluation of bone uptake using bone-seeking radiopharmaceuticals.

[Interdisciplinary quality circle for osteoporosis. First results from the Regional Advisory Board for Osteoporosis for Saxony-Thuringia]. / Interdisziplinäre Qualitätszirkel für Osteoporose. Erste Erfahrungen aus dem Regionalen Expertenkreis Osteoporose von Sachsen-Thüringen.

The Regional Advisory Board Osteoporosis (REKO) for Saxony-Thuringia has established interdisciplinary quality circles in different districts with the goal to standardize the diagnosis of osteoporosis. Therefore, they developed a standardized program for general practitioners, gynecologists, internists and orthopedics. The documentation sheet covers 5 areas: Identification of the anamnestic osteoporosis risk with 7 standardized questions: If the patient reaches 3 or more out of 13 possible points, we assume he is at risk. 3 out of 5 clinical symptoms, 3 out of 6 x-ray symptoms and osteoporosis typical results of the bone density measurement in combination with the anamnesis give us a scale which allows us to classify each symptom for diagnostic purpose. The differential diagnostic laboratory program includes: Blood sedimentation rate, calcium, alkaline phosphatase, creatine, TSH basal and 25 OH vitamin D3 in the serum. To check effectiveness of the antiresorptive therapy, bone specific resorption markers are sometimes usable. The program will be implemented this year in all quality circles, evaluated and then defined in its final form. Among the participants of the quality circles, the program is already usable and offers a reliable basis for the therapy.

[Therapy of osteoporosis]. / Therapie der Osteoporose.

The different possibilities of the therapy are discussed. Most importantly, calcium should be supplemented prophylactically in sufficient doses (1-1.5 g/d). Vit. D may be added in the elderly patient. In the pre- and postmenopause, an estrogen/gestagen administration is indicated. Estrogen is also the treatment of the first choice in the therapy of the manifest osteoporosis. Calcitonin, which has an analgetic effect as well, is currently recommended as an inhibitor of bone absorption. Starting with daily injections of 100 IU of calcitonin followed by 50 IU injections three times a week improve feeling and condition of the patient. Bisphosphonates, which have excellent effects on bone absorption, are not yet permitted for the osteoporosis therapy. Vit. D metabolites (alfacalcidol) have a particular beneficial effect on the osteoporosis induced by glucocorticoids. Sodium fluoride and monofluorophosphate are the only substances available that lead to a real bone build on. About 0.5 mg/kg body weight of fluoride should be administered. 30% of the patients do not respond to this treatment and side effects have to be observed. Growth hormone and parathormon may be useful drugs in the future. The drug treatment of osteoporosis has to be accompanied by a proper pain therapy as well as a physiotherapeutic, orthopedic and psychososical care.

[Experiences with sodium fluoride in the treatment of osteoporosis]. / Erfahrungen mit Natriumfluorid in der Behandlung der Osteoporose

In 10 patients with primary and 13 patients with glucocorticoid osteoporosis a NaF-therapy with an average daily dose of 80 mg was carried out in a period of 1/2 to 4 1/2 years. 22 patients spoke about an improvement of the complaints. Radiologically an osteogenesis could be proved in 19 patients. Dose and duration of the therapy as well as eventual additional treatments, frequency and severity of the side-effects are discussed and the indication for a NaF-medication are elaborated.

[Significance of occupational, health and life satisfaction in coping with rheumatic complaints]. / Bedeutung von Arbeits-, Gesundheits- und Lebenszufriedenheit im Bewältigungsporzess rheumatischer Beschwerden.

In a pilot study with a prospective study design we analyzed the interaction between disease modifying drugs and coping styles. We examined 45 inpatients with definite or classical rheumatoid arthritis at the beginning of disease modifying drug treatment and eight months later. In this paper we evaluate the role of health satisfaction in relation to an effective therapy. The results of the discriminant analyses between sufficient and non-sufficient persons show that a differential discrimination can be achieved with psychosocial variables, for example diseasecompetency and self-mobility. Finally, our results show that a disease modifying drug treatment in rheumatic diseases must be completed with psychosocial treatments.

[Psycho-rheumatic problems in patients with soft tissue rheumatism]. / Psychorheumatische Probleme bei Patienten mit Weichteilrheumatismus.

Patients with non-articular rheumatism syndrome demand a multidimensional judgment and an interdisciplinary care in a biopsychosocial understanding of the disease. In the psychosomatic consideration factors from the person-environment interaction of the patient gains increasedly importance. Thereby the communication of pain in the doctor-patient relationship and the valuation of pain in the family play a particular role. These regions of psychorheumatological problems are shown and discussed.

[Evaluation of the clinical severity in occlusion of the superficial femoral artery]. / Zur Beurteilung des klinischen Schweregrades bei Berschlüssen der A. femoralis superficialis.

The judgment of the efficiency of the collateral circulation is of decisive importance for the estimation of the clinical degree of severity and thus also for the indication to angiosurgical measures. Since also angiographically only an indirect evidence concerning the collateral circulation can be given, the angiological findings of 18 patients with unilateral or bilateral occlusion of the superficial femoral artery (n = 25 lower extremities) were evaluated. On the basis of the measuring values received with the help of the phebembraxis plethysmography 3 degrees of severity may be differed which essentially correspond to clinical stage: 1. good collateral circulation (data in ml/100 ml tissue min: ff above 5 ml, pf above 15 ml, pf-time below 30 s 2. moderate collateral circulation: ff below 5 ml, pf below 15 ml, pf-time 30-60 s 3. bad collateral circulation: ff below 5 ml, pf below 10 ml, pf-time above 60 s. Of the measuring sizes (ff, pf, pf-time) the pf-time proved to be the most reliable parameter. On the basis of these results the phlebembraxis plethysmography is a valuble supplementation in the preoperative vascular diagnostics.

Progression of joint damage in early active severe rheumatoid arthritis during 18 months of treatment: comparison of low-dose cyclosporin and parenteral gold.

OBJECTIVE: This study compared the progression of joint damage in patients with early active severe rheumatoid arthritis (RA) treated with cyclosporin or parenteral gold. METHODS: In this open, randomized, multicentre study with a blinded radiological endpoint, 375 patients who had suffered from active severe RA for <3 yr were randomized to be treated for 18 months with low-dose cyclosporin or parenteral gold. The groups were stratified with regard to corticosteroid use. Primary efficacy variables were numbers of erosions, erosion score and the Larsen-Dale joint damage score. RESULTS: Joint damage progressed at similar rates in both treatment arms. In both groups, patients receiving corticosteroids had less X-ray progression. Rheumatoid factor positivity, high swollen joint count, high erythrocyte sedimentation rate and pre-existing X-ray abnormalities predicted progression of joint damage. Although numbers of serious adverse events were similar, more gold patients (n = 65) than cyclosporin patients (n = 45) withdrew from study medication because of adverse events. CONCLUSION: Cyclosporin was comparable to parenteral gold in retarding progression of joint damage and was better tolerated in terms of adherence to therapy. The open label design should be kept in mind when assessing this difference.