Effect of Avemar--a fermented wheat germ extract--on rheumatoid arthritis. Preliminary data.

OBJECTIVE: To investigate the effect of the fermented wheat germ extract (Avemar)in patients with severe rheumatoid arthritis (RA). METHODS: Fifteen female RA (Steinbrocker II-III) patients, who had unsuccessfully tried two different DMARD treatments, were enrolled in an open-label, 1-year long, pilot clinical study. DMARD and steroid therapies were recorded and continued. All patients received Avemar as additional therapy. For measurement of efficacy the Ritchie Index, the Health Assessment Questionnaire (HAQ) and the assessment of morning stiffness were applied. Patients were evaluated at baseline, 6 and 12 months. For statistical analyses the Wilcoxon test was used. RESULTS: At both 6 and 12 months, Ritchie index, HAQ and morning stiffness showed significant improvements compared with the baseline values. Dosages of steroids could be reduced in about half of the patients. No side effects of Avemar were observed. CONCLUSION: Supplementation of standard therapies with a continuous administration of Avemar is beneficial for RA patients.

Prevalence of obesity in an elderly Hungarian population.

BACKGROUND: There are few cross-sectional population-based studies on obesity in Hungary. Aim of this study was to characterize the prevalence, associated diseases and metabolic laboratory parameters for obesity in men and women in Budapest, Hungary. METHODS: A random sample of 641 persons (307 males and 334 females) aged 50 years and over were recruited from a population register in Budapest. Subjects were interviewed, had height and weight measured in standard fashion. Those who were obese (BMI > 30.0 kg/m2) were matched individually with non-obese subjects. Altogether 101 pairs (48 women and 53 men pairs) were taking part and these subjects had blood taken for amount of serum glucose, lipids and uric acid. RESULTS: The mean age of men and women was 65.0 (SD = 9.1) years and 64.6 (SD = 8.9) years, respectively. The prevalence of obesity was 18.1% in men and 15.4% in women (p < 0.05). In both sexes the mean body mass index was higher at age of 50-64 years than at older ages [in men 27.2 (SD = 3.7) kg/m2 vs. 26.7 (SD = 3.3) kg/ m2, p = 0.286 and in women 26.7 (SD = 4.2) kg/m2 vs. 25.4 (SD = 4.0) kg/m2, p = 0.005]. Body mass index was higher in men than in women at all ages. In the case-control study the mean age of obese and non-obese individuals were 63.1 (SD = 7.8) years and 63.2 (SD = 7.9) years, respectively. Obesity was significantly associated with a history of diabetes mellitus (18 vs. 7%, p < 0.05) and hypertension (48 vs. 28%, p < 0.05). Compared to the non-obese, those who were obese had a higher level of serum uric acid (311 +/- 102 vs. 280 +/- 96 micromol/l, p < 0.05) and triglyceride (2.67 +/- 1.95 vs. 1.86 +/- 0.95 mmol/l, p < 0.05). CONCLUSION: The high prevalence of obesity both in elderly men and women and its strong association with chronic diseases causes economical and social burden for Hungary. Strategies and programs for weight maintenance as well as weight reduction must become a higher public health priority.

Elevated levels of synovial fluid antibodies reactive with the small proteoglycans biglycan and decorin in patients with rheumatoid arthritis or other joint diseases.

OBJECTIVES: To determine whether patients with rheumatoid arthritis (RA) express humoral immunity to the small proteoglycans biglycan and decorin and to compare the response to that of patients suffering from other joint diseases. METHODS: Serum and synovial fluid IgG and IgM antibody levels were determined by enzyme-linked immunosorbent assay. Antibodies to biglycan and decorin as well as to other known and extensively investigated cartilage matrix components such as type II collagen, aggrecan and fibronectin were investigated. Patients suffering from RA, osteoarthritis (OA), psoriatic arthritis and other seronegative spondylarthropathies were included in the study. Correlation between antibody levels and clinical/laboratory parameters was determined. RESULTS: Patients with RA expressed an increased humoral immunity to biglycan, while patients with seronegative spondylarthropathies displayed elevated decorin-specific synovial antibody levels compared with OA patients. CONCLUSION: These results indicate a significantly higher immunity to small proteoglycans in RA and seronegative spondylarthropathies than in OA suggesting a possible involvement in the pathogenesis of inflammatory rheumatic diseases.

Risk factors for diffuse idiopathic skeletal hyperostosis: a case-control study.

OBJECTIVE: Diffuse idiopathic skeletal hyperostosis (DISH) is a skeletal disease characterized by ligamentous ossification of the anterolateral side of the spine. The aim of this study was to characterize risk factors associated with DISH. METHODS: Subjects were recruited for participation in a screening survey of vertebral osteoporosis. The cases were 69 men and 62 women with DISH and the controls were 69 men and 62 women with spondylosis over the age of 50 yr. Cases and controls were matched for age and sex. Radiographs were taken according to a standardized protocol and DISH was classified using the Resnick criteria. Laboratory parameters and an interviewer-administered questionnaire were used to obtain data about exposure. RESULTS: The mean ages of the populations with DISH and spondylosis were 65.2+/-8.8 and 65.0+/-9.1 yr respectively. Compared with controls, patients with DISH had a greater body mass index (27.8 vs 26.0 kg/m(2), P<0.05) and a higher serum level of uric acid (308 vs 288 micromol/l, P<0.05) and were more likely to have had diabetes mellitus (19.8 vs 9.1%, P<0.05). CONCLUSION: DISH is clearly a distinct disorder with risk factors that distinguish it from other spinal degenerative diseases.

A model for the long-term planning of physician workforce in Hungary.

A computer programme for the long term (25 years) projection of the physician workforce was developed. The input variables were the admittance rate of the medical schools and the unemployment rate of the active physicians, the output variables were the number of active physicians. The age and sex structure, the retirement age were taken into account. Different scenarios were made to compare the impact of the output of medical faculties and the unemployment rate of doctors on the number of active of the physicians in five years intervals for a twenty-five years period. The input of the young graduates varied between 800-600/year, the unemployment rate between 4.5% and nil. At end of the 25 years projection period the reduction of physicians was between 9.6 and 25.0%. The aim was to find a professionally acceptable, socially tolerable and politically eligible optimal relationship among the three variables.

[Cognitive enhancement effect of piracetam in patients with mild cognitive impairment and dementia]. / A piracetam tünetjavító hatása enyhe kognitív zavar és demencia tünetcsoportjában szenvedó betegeken.

Effectiveness and tolerability of two piracetam-containing drugs were compared in the frame of an open, multicentre, Phase-IV, prospective study with group and self control carried out in 9 Hungarian centres in 1998. Patients with cognitive decline from Alzheimer's disease and/or cerebrovascular origin have received the drug, in the first 4 weeks in 4800, later 2400 mg daily doses. One hundred four patients finished the study. No relevant difference with statistically significant degree was registered between the two groups. Based on this fact in this study data of the 104 patients were examined together. Authors examined two problems. The first: on which cognitive function is more effective the drug. Five factors of the modified Mini-Mental State Examination were separated and compared. Nearly all of them significantly increased especially the factors of memory, and concentration-psychomotor speed. The second examined field: are there certain subgroups with prognostic value about the effectiveness of piracetam treatment. Neither the duration of the illness, nor etiologic diagnosis, severity of cognitive decline, or former treatment with piracetam did influence significantly the efficacy. In case of depressive symptoms such connection was established: the more pronounced the severity of these symptoms the higher improvement can be expected in cognitive functions. This was also stressed by the logistic regression analysis. Authors described an original evaluation method of the trail-making test, which could widen the application of this popular test in psychopharmacologic studies. Final conclusions: the cognitive enhancer effect of piracetam appeared in a few weeks. This treatment could be effective even in Alzheimer's disease, in case of more pronounced cognitive decline, longer duration of the illness, and in case of former piracetam treatment as well. The degree of cognitive improvement was most pronounced in patients with comorbid depressive symptoms.

[Caudal epidural injection in the management of lumbosacral nerve pain syndromes]. / Caudalis epiduralis injekció az akut lumbosacralis gyöki fájdalomszindrómák kezelésében.

The effect of epidural steroid injections was assessed in 39 patients with lumbar nerve root compression syndromes in a double-blind controlled trial, the patients were allocated at random to 3 groups. In group A (n = 13) the patients received a caudal epidural injection of 1 ml (7 mg) bethametason (Diprophos) in 10 ml normal saline and 20 ml local anesthetic (Lignocaine 1%). The second group B (n = 13) received a caudal epidural injection of 20 ml local anaesthetic (Lignocaine 1%) and 10 ml normal saline. The third group C (n = 13) received a superficial injection of 1 ml (7 mg) bethametason around of the sacral hiatus. All injections were performed by the same experienced anaesthesiologist. An independent physician, who was not aware which type of injection had been given, carried out the clinical measurements and the evaluation. Taking of analgesic drug Tramadol was permitted. The symptoms were assessed by visual analogue scale (VAS 100 mm), lumbar flexion (Schober and finger-floor distance), the angle of raised leg sign (RLS degrees), and by complete neurological examination, the investigation was made 5 times (1 hour, 24 hours, 48 hours, 1 week, and 4 weeks after epidural injections). The results between 0-1 week and 0-4 week were statistically analysed by Student-, Wilcoxon-, and Mann-Whitney test and analysis of variance (ANOVA). The mean VAS values decreased in time in all patient groups. There was no difference between the three treatment groups either after one or after 4 weeks by ANOVA. The mobility of the lumbar spine improved in all patient groups, but there was no significant difference between the three treatment groups. The raised led sign--values improved in all patient groups. There was a significant difference between the three treatment groups by ANOVA after one week, due to the difference between group A and C. After four weeks there was no significant difference. No major complications or side effects were seen in our trial. The raised leg sign due to epidural steroid injection showed better results in comparison to steroid injection around of the sacral hiatus were seen.

Prognostic value of simple exercise test parameters in patients with dilated cardiomyopathy.

The prognostic value of maximal exercise capacity as well as that of the simple exercise systolic blood pressure and heart rate variables were evaluated in 50 patients with dilated cardiomyopathy. Patients were treated beside digitalis and/or diuretics with vasodilators aggressively. Exercise was performed on an upright bicycle ergometer. Continuous, multistage, symptom limited, maximal tests were carried out. Patients were followed up for 23.5 +/- 15.2 months. Both one-way and multivariate analyses of data showed, that not only the maximal exercise capacity related significantly to the survival, but the several simple systolic blood pressure and heart rate variables (their values at peak exercise and their increase during the test) did so as well. Considering parameters separately, maximal exercise capacity was found the strongest predictor of survival, though the power of the calculated rate-pressure product at peak exercise, that of the systolic blood pressure at peak exercise as well as that of the increase in heart rate during the test proved nearly as strong as the maximal exercise capacity did. Anyway, the multivariate analysis showed that the former parameters were dependent on maximal exercise capacity. Some parameters with individual prognostic value proved independent from each other. Combined consideration of the systolic blood pressure at peak exercise and the increase of heart rate during exercise resulted in the highest predictive power which exceeded even the power of maximal exercise capacity.(ABSTRACT TRUNCATED AT 250 WORDS)

[Quality control of radiographic imaging of the lumbar spine]. / Az ágyéki gerinc röntgenfelvételek leletezésének minöségi ellenörzése.

The qualitative control of the roentgenographic findings was performed independently by the assessment of five x-ray specialists on 40 two-directional lumbosacral roentgenograms. The findings were based on questioners including all details and a table of the internationally used "Radiological Diagnosis". In earlier publications the anatomical and structural changes were considered the risk factors of the waist. (Osteoporosis, changes in the position of the vertebral body, change in the shape of the spine, restriction of the intervertebral cleft and deformation of the small articulations). The views of the research workers were compared by means of statistical analysis. Compared with other authors the methods of these findings are in agreement with the international norms. These findings drew attention to the necessity of an objective assessment of the subjective findings.

Absolute alkaline phosphatase positive and negative neutrophil counts in chronic granulocytic leukemia.

Absolute counts for the alkaline phosphatase positive (AP+) fraction of potentially AP+ neutrophils were measured cytochemically during the course of chronic granulocytic leukaemia (CGL), from the clinical onset of the disease. In a previous study of different kinds of severe granulocytopenia, the AP positivity of circulating neutrophils appeared to indicate a kinetic parameter. Early release of mature, non-stored bone marrow granulocytes apparently furnished more AP+ neutrophils, whereas release of stored cells furnished more AP- cells. If we consider enzyme activity to indicate a kinetic parameter, its differential diagnostic usefulness would be less than generally supposed. One hundred and forty eight determinations in 74 CGL patients showed that low AP values are valid for CGL statistically, especially between the 2nd to 5th years of clinical disease, but normal or higher counts of circulating AP+ fraction of mature neutrophils could be found in one fourth of advanced cases (blastic metamorphosis excluded), and even more (17/37) in the earliest period of the CGL process. A similar tendency appears to be detectable in the absolute counts for circulating AP- cells.