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“Rheumatic”,-“gouthy”,-“osteoporotic”-and-“artrosic”-biophysical-

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“Rheumatic”,-“gouthy”,-“osteoporotic”-and-“artrosic”-biophysical- Powered By Docstoc
					              “Rheumatic”, “gouthy”, “osteoporotic” and “artrosic” biophysical-
                               semeiotic Constitutions.

                                                               By Sergio Stagnaro

    (From the book, in advanced preparation: “Semeiotica Biofisica. Microangiologia Clinica”
                          Stagnaro-Neri M. and Stagnaro S., with some modifications).

    Introduction. ................................................................................................................................. 1
    Method. ........................................................................................................................................ 3
    Rheumatic constitution. ............................................................................................................... 4
    Osteoporotic constitution. ............................................................................................................ 4
    Arthrosic constitution. .................................................................................................................. 4
    Gouty constitution. ....................................................................................................................... 4
    Conclusion. .................................................................................................................................. 5
    References. ................................................................................................................................... 6

     Premise.
     In order to understand completely the following topic, it is
advisable to read the preliminary article “Biophysical-Semeiotic
Constitutions”, posted in both the site Metabolic Histangiopathy-
(CAEMH-) (1, 2, 3, 4) (See.         The site HONCode 233736,
www.semeioticabiofisica.it and www.Staibene.it, November 2001.


          Introduction.

         In the 1980s, at a large number of national and world conferences and congresses, we have
illustrated basal concepts of the diverse biophysical-semeiotic constitutions by means of a slide,
which shows a tree, whose roots and trunk represents analogously the Congenital Acidosic
Enzyme-Metabolic Histangiopathy- (CAEMH-) (1, 2, 3, 4) (See. The site HONCode 233736,
www.semeioticabiofisica.it), while numerous branches represent metabolic-endocrine diseases,
arterial hypertension, gall-bladder and kidney stones, malignancies, a.s.o.
         Understandably, we did not then collect the necessary biophysical semeiotic knowledges,
unavoidable in suggesting the current theory of different constitution.
         In fact, Biophysical Semeiotics and Clinical Microangiology originated subsequently, in
1990 year, and then slowly developed on.
         It is easy to underline the “link”, genetic in nature, between the most serious human
diseases, but it is really difficult to illustrate “briefly” the differences in genome-dipendent
manifestations on clinical-microcirculatory dimension, which can be then observed and described
properly by biophysical-semeiotic words.
         Consequently, we have to go on clearly from the logical view-point, describing without
opposing each other, but getting over them aiming to a superior synthesis, general concepts and
particular aspects at the base of our interpretation of microangiological or biophysical-semeiotic
constitution (i.e., the heredity, clinically speaking).
         It is a matter of fact that not “all” women, CAEM- positive, in an age mainly between 20
and 55 year, involved by flu virosis, are then suffering from Polymyalgya Rheumatic Acute
Benigne “Variant” (PRABV), we described previously (5, 6, 7), which has common characteristics
as well as clearcut differences with the classic polymyalgya rheumatica. In other words, in a group
of patients, positive for CAEM-, comparable as far as sex (femile sex is generally involved), age,
and undergoing disease (flu) are concerned, there is a sub-group, fortunately limited, predisposed
to PRABV and/or other connectivitis.
        At this point, it is necessary to remember that, due to the fact that patients involved by
autoimmune disorders, in which is present, although modified, anti-bodies synthesis syndrome,
oncological terrain is mainly absent (See the site, http://digilande.it/Piazzetta.sfera.net,
www.katamed.it, the Page Semeiotica biofisica, and www.Staibeneit.it, November 2001).
        Thus, it has to be investigated the difference, molecular-biological in nature, genetically
directed, that surely exists between the two sub-groups of women (or men, although with less
occurence, as written above), only apparently equal, in order to reach hopfully the rheumatic
constitution.
        In addition, the likelihood of such condition is suggested by the presence of some rheumatic
disorders in the same family and by frequent association of several rheumatic manifestations in a
single individual (CREST). On the contrary, all these diseases are toally absent in other people,
components of defined falmily groups, comparable with the formers as fa as life envinromental,
culture, sex, and social condition are concerned.
        As we refer later, the clinical-miroangiological manifestation of “rheumatic” genotype is
like rheumatic histangiopathy, although of smaller intensity.
        At this moment, it has to remember and underline a really interesting datum, which
corroborates the scientific truth of biophysical-semeiotic theory, at the base of rheumatic
constitution: in classic rheumatic polymyalgya exclusively rhyzomelic joints, i.e. the same joints
involved by connectivitis, present the characteristic microvascular alterations, which bring about
autoimmune biophysical semeiotic signs (LAS, local autoimmune syndrome, See on the above-cited
site), while all other joints – never diseased – show a physiological tissue-microvascular system.
        Moreover, women at “real” risk of PRABV or recovered from this disease from years or
decades by now, present characteristic biophysical semeiotic signs of the rheumatic constitution,
whose seriousness is decreasing, starting from great central rhyzomelic joints as fa as those
peripheral; small joints are not involved in PRABV. This clinical evidence corroborates the
scientific value of our theory, discussed in this article, i.e. rheumatic constitution.
        Really, it underlines the general validity of our original interpretation of the initial intuition,
i.e. the contemporary microangiological manifestation, that can be assessed at the bed-side in a
“quantitative” manner, of genetic information, even if altered in different way, notoriously until
now evaluated exclusively by means of parenchymal modifications and, more precisely, of the
genome itself.
        A further clinical evidence, which supports our biophysical semeiotic theory, is represented
by particular microvessels of abdominal adipose tissue in individual at “real” risk for dyslipidaemia,
as well as in dyslipidaemic patients, and in individual at the moment healthy, but who over the last
years presented high cholesterol blood concentration, total and/or LDL, and/or triglicerydes.
        In a long well established bed-side experience, we have observed that in “all” such
individuals, without any exeption (the statement “all” from the epistemological view-point, is very
abounding in informazion and scientific value, because it may be easily falsified), since birth-day is
always present characteristic Endoarterial Blocking Devices (EBD) alterations, i.e. opening
duration, evaluated as duration of middle ureteral reflex during “mean-intense”stimulation of
related trigger-points is < 20 sec. (NN = 20 sec.) and closure duration or duration of reflex
disappearance is > 6 sec. (NN = 6 sec.).(For learning this evaluation method See: Technical Page,
n° 5 in this site).
        From hemoreological and microcirculatory point of view, these modifications of both
function and structure of EBD, parallell the blod-flow lowering in capillary bed, during rest as well
as activation of Microcirculatory Functional Reserve (MFR), e.g. during the work of related
parenchyma. In fact, contemporaneously is present the microcirculatory activation, dyssociated,
type II. (See the site www.semeioticabiofisica.it/microangiologia).
        The involvement of haemoderivative structures, and particularly the almost ubiquitous EBD,
plays a primary role in allowing easily bed-side diagnosis of the hereditary microcirculatory
alterations (i.e. genetically directed), in day-to-day practice: for instance, in individuals in the first
two decades of life, utilizing the useful tool of biophysical-semeiotic preconditioning (See later),
whose use is easy and rapid, permits doctor to recognize altered genetic information in organs,
tissues, and even in small areas, as the limited zone of a breast quadrant at “real” risk of cancer.
        Actually, preconditioning result is related to the structural-functional conditioned of local
tissue-microvessel-units, and particularly to local Microcirculatory Functional Reserve (MFR) as
well as microcirculatory activation, since it reveals the functional-anatomical impairment of a part
of these microvessels, indicating erroneous genetic information, which modifies in different degree
physiological MRF activation caused by preconditioning, whose result is therefore pathological.
        For example, in case of gouthy constitution, which can evolve in gouty metabolic
syndrome or clinical disease, the biophisical-semeiotic preconditioning of helix (digital pressure
between two fingers upon the helix bended into itself and “basal” evaluation of latency time (lt) of
helix-gastric aspecifix or -caecal reflex (Fig. 1) (NN = 10 sec.), and subsequently by a second
evaluation, applied after 5 sec. intervall exactly from the first) results pathological, although with
different intensity, in relation to the risk itself or the disease seriousness, after its onset, of course: in
healthy, at basal line parameters values – in practice, lt = 10 sec. – ameliorate clearly (lt  12 sec.),
while in “gouthy” risk either persists unchanged (< 10) or worsens, in relation to the seriousness of
underlying disorder.
        A further example: the preconditioning, although limited in a breast area at “real” risk of
cancer, shows a pathological result, which appears to be related to the seriousness of the risk itself:
lt does not change or becomes shorter, i.e. lt > 9,5 sec. (physiological basal value = 9,5 sec.) after
cancer onset: oncological terrain and, respectively, “quantifiable” real risk of breast cancer or in
situ cancer (See : “Oncological Terrain” in the abobe-referred site and in www.Staibene.it,
November 2001)


Method.

        In healthy, in supine position and psycho-physically relexed, digital pressure on the
sinovium, i.e., digital stimulation of sinovium trigger-points (in practice, cutaneous projection area
of a small and/or great joint) brings about gastric aspecific reflex (Fig.1) after an age-dependent lt.
of 8-10 sec., reflex duration > 3 < 4 sec. and disappearance duration > 3 < 4 , which parallels
fractal dimension (fD = 3, 81), when it is evaluated in a sophysticated way (9, 10, 11, 12, 13, 14,
15, 16, 17, 18). (For further technical information: See Technical Page n° 5 in the site)




                                                       Fig: 1
      Figure indicates clearly the location of bell-piece of stethoscope and lines, on which digital
  percussion must be applied, directly and gently, in order to perform correctly the auscultatory
    percussion of stomach (in practice, it is sufficient to out-line a small tract of gastric great
                                             curvature).


Rheumatic constitution.

        On the contrary, in individuals with rheumatic constitution lt. results is < 10 sec., in
relation to risk seriousness, and gastric aspecific reflex - gastric aspecific-rheumatic reflex - is
followed characteristically by tonic Gastric Contraction (tGC) after lt 2  6 sec., once more
inversely related to he seriouness of underlying disorder or “real” rheumatic risk.
        In a long experience, really interesting proved to be the dorsal hand skin-gastric aspecific
reflex, pathological, i.e. absent in healthy at least for 10 sec., as regards the “quantitative”
assessment of rheumatic risk: cutaneous, prolonged pinching of dorsal hand skin provokes gastric
aspecific reflex after lt.  6 sec., followed typically by tGC: lt. value is inversely related to risk
intensity. This interesting reflex, rapidly and easily to observe, has been posted on the sites:
Piazzetta, Cose Serie, Professione Medica and in Medscape, Forum Discussion.


Osteoporotic constitution.

        In case of osteoporotic constitution, mean-intense digital pressure, applied upon
lumbar vertebrae spine (or whatever other bone, of course) brings about gastric aspecific reflex after
lt.  10 sec. (NN = 10 sec.), which increases after a time (tl2)  10 sec. (NN = 10 sec.).


Arthrosic constitution.

        In the arthrosic constitution gastric aspecific-rheumatic reflex behaviour (digital
mean-intense pressure on the sinovium) is characterized by lt. < 10 sec., i.e. normal value, and never
is followed. by tGC.


Gouty constitution.

        Finally, doctor can in the easiest way recognize the gouty constitution by means of
helix-gastric aspecific reflex: in healthy, mean-intense digital pressure on the helix (between two
fingers), bent in itself, causes the reflex after lt. of 10 sec. (lt. > 10 indicates a “lower” uric acid
blood concentration).
        On the contrary, the “real” risk for gout is characterized by a lt. < 10 sec., as always in
relation to the seriousness of the risk itself.
        Moreover, we remember the important diagnostic role played by sinovium preconditioning
in “quantitative” evaluation of all biophysical-semeiotic “rheumatic” constitution as well as the
precise assessment of sinovium EBD, always altered from both functional and structural view-
point, as illustrated above.
        To an accurate evaluation of these and all other constitutions, based upon the precise
assessment of clinical microangiological results, evaluated soth at rest – basal line – and by means
of dynamic tests, doctor’s knowledge of Biophysical Semeiotics must be steady.
Conclusion.

        From the above remarks, shortly referred, appears plain the importance of these biophysical
semeiotics signs and preconditioning also in the differential diagnosis at the bed-side.
        For instance, from the differential diagnosis point of view, in case of a patient who presents
with arthralgias, it is no necessary for him to undergo expensive examinations, useful in recognizing
a connectivitis, when the rheumatic constitution is absent.
         Clearly, as reader easily understands, examples are very numerous, considering, in addition,
that there is a large variety of biophysical semeiotic signs, both specific and aspecific, as RESH
(19), LAS (20), Acute Phase Proteins (See Appendicitis in the cited site, and in the Page Semeiotica
Biofisica in www.katamed.it , and in http://digilander.it/Piazzetta.sfera.net, Cose Serie, Professione
Medica).
        As regards the influence of these data on clinical resarch, it is enough to remember that we
are now able to compare, fortunately, two groups of individuals identical not only as fas as race,
sex, age social conditions, diet etymologically speaking, a.s.o. are concerned.
        In fact, the use of a drug in preventing a disease can be fortunately evaluated in objective
manner, as individuals, who undergo the treatment, are all at “real” risk of the disease.
        On the contrary, we are not allowed to conclude that the preventive treatment showed
positive results in a statistically significant way, if we do not know the precise percentage of
subjects at “real” risk in the two groups we studied, a part from the great number of trials.
                In our opinion, to consider perfectly comparable two groups, due to the really large
number of evaluated individuals, indicates exclusively the “false” conscience of researchers: we
like compare “a few” subjects, but involved by “real” and clinically quantifiable risk and hopefully
of identical seriousness in relation to a well defined disorder, as one of us wrote in BMJ.com
(“There is a fundamental bias in all clinical researches”, 14 May 2001).
References.

  1) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica condizione necessaria
      non sufficiente della oncogenesi. XI Congr. Naz. Soc. It. di Microangiologia e
      Microcircolaz. Abstracts, pg 38, 28 Settembre-1 Ottobre, 1983, Bellagio.
  2) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica. X Congr. Naz. Soc. It.
      di Microangiologia e Microcircolazione. Atti, 61. 6-7 Novembre, 1981, Siena.
  3) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica. Una Patologia
      Mitocondriale Ignorata. Gazz Med. It. – Arch. Sci. Med. 144, 423, 1985 (Infotrieve).
  4) Stagnaro S., Diet and Risk of Type 2 Diabetes. N Engl J Med. 2002 Jan 24;346(4):297-
      298. letter [PubMed –indexed for MEDLINE].
  5) Stagnaro S., Auscultatory Percussion of Rheumatic Diseases. X European Congress of
      Rheumatology. Moscow. 26 June-July, 1983, Proceedings, pg 175.
  6) Stagnaro S., Auscultatory Percussion Therapeutic Monitoring and Cerebral Dominance in
      Rheumatology. 2nd World Congress of Inflammation, Antirheumatics, analgesics,
      immunomodulators. Abstracts, A. Book 1, pg. 116, March 19-22, 1986, Montecarlo.
  7) Stagnaro S., Polimialgia Reumatica Acuta Benigna Variante. Clin. Ter. 118, 193, 1986
      (Pub-Med indexed for Medline).
  8) Stagnaro-Neri M., Stagnaro S., Cancro della mammella: prevenzione primaria e diagnosi
      precoce con la percussione ascoltata. Gazz. Med. It. – Arch. Sc. Med. 152, 447, 1993.
  9) Stagnaro-Neri M., Moscatelli G. Stagnaro S., Biophysical Semeiotics: deterministic
      Chaos and biological Systems. Gazz. Med. It. Arch. Sc. Med. 155, 125, 1996.
  10) Stagnaro-Neri M., Stagnaro S., Aneurisma Aortico Addominale: una Diagnosi clinica con
      la Semeiotica Biofisica. Acta Cardiol. Medit. 14, 17, 1986.
  11) Stagnaro-Neri M., Stagnaro S., Deterministic Chaos, Preconditioning and Myocardial
      Oxygenation evaluated clinically with the aid of Biophysical Semeiotics in the Diagnosis of
      ischaemic Heart Disease even silent. Acta Med. Medit. 13, 109, 1997.
  12) Stagnaro-Neri M., Stagnaro S., Microangiologia clinica della ipertrofia prostatica benigna.
      Ruolo patogenetico delle modificazioni del sistema microlovascolotessutale valutate con la
      Semeiotica Biofisica. Acta Cardiol. Medit. 14, 21, 1986.
  13) Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica del torace, della circolazione ematica
      e dell’anticorpopoiesi acuta e cronica. Acta Med. Medit. 13, 25, 1997.
  14) Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica: la manovra di Ferrero-Marigo nella
      diagnosi clinica della iperinsulinemia-insulino resistenza. Acta Med. Medit. 13, 125, 1997.
  15) Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica: valutazione clinica del picco precoce
      della secrezione insulinica di base e dopo stimolazione tiroidea, surrenalica, con glucagone
      endogeno e dopo attivazione del sistema renina-angiotesina circolante e tessutale – Acta
      Med. Medit. 13, 99, 1997.
  16) Stagnaro-Neri M., Stagnaro S., Semeiotica biofisica: Valutazione quantitativa del rischio
      oncologico, Il Medico delle Ferrovie, n. 2/3, 63-64, 1996.
  17) Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica: valutazione clinica del picco
      precoce della secrezione insulinica di base e dopo stimolazione tiroidea, surrenalica, con
      glucagone endogeno e dopo attivazione del sistema renina-angiotesina circolante e tessutale
      – Acta Med. Medit. 13, 99, 1997.
  18) Stagnaro-Neri M., Stagnaro S., Diagnosi Clinica Precoce dell’Osteoporosi con la
      Percussione Ascoltata. Clin.Ter. 137, 21-27 Pub-Med indexed for MEDLINE 1991.
  19) Stagnaro S., Sindrome percusso-ascoltatoria di Iperfunzione del Sistema Reticolo-
      Istiocitario. Min. Med. 74, 479, 1983 (Pub-Med indexed for Medline).
  20) Stagnaro S., Sindrome percusso-ascoltatoria autoimmune. Gazz. Med. It. 142, 555, 1983.

				
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