A meta-analysis of the effectiveness of mud-bath therapy on knee osteoarthritis.

OBJECTIVE: Osteoarthritis (OA) results from loss of cartilage in-tegrity in association with changes to the structure of the entire joint. Treatment of OA is based on different pharmaceutical and no phar-maceutical approaches and the latter include the use of spa-therapy. The biological effects of mud-bath therapy are mainly secondary to heat stimulation and to physic-chemical properties of mineral waters and mud-packs. Mud-bath therapy likely exerts its effects modulating several cytokines and other molecules involved in inflammation and cartilage degradation. Our aim was to perform an updated meta-analysis of the effectiveness of the mud-bath therapy on knee osteoarthritis and briefly to discuss the mechanisms of action of this treatment. MATERIALS AND METHODS: A MEDLINE on PubMed for articles on knee OA and spa therapy published from 1995 through up to April 2019 was performed. Then, we checked the Cochrane Central Register of Controlled Trials to find additional references included up to April 2019. Articles were included if in accordance with the eligibility cri-teria. Sample size and effect sizes were processed with the MedCalc software package. RESULTS: Twenty one studies met the inclusion criteria and were included in meta-analysis. We examined WOMAC Index and VAS pain. We found significant improvements in function scores and painful symptoms after mud-bath therapy in patients with knee joint osteoarthritis. CONCLUSIONS: Spa therapy is a non-drug treatment modalities, non invasive, complication-free, and cost-effective alternative modality for the conservative treatment of knee osteoarthritis. It cannot substitute for conventional therapy but can integrated or alternated to it. Treatment with mud-bath therapy may relieve pain, stiffness and improve functio-nal status in patients with knee OA.

Prevention and treatment of nephrolithiasis: a review on the role of spa therapy.

The prevalence and incidence of nephrolithiasis is reported to be increasing across the world. It is a disease of increased urinary concentration of stone-forming salts. The physicochemical mechanism of stone formation includes precipitation, homogenous/heterogeneous nucleation, growth, aggregation and concretion of various modulators in urine. Necessary condition to develop stones is urinary supersaturation, due to reduced urinary volume or to an excesses solutes. Fluid intake is the main determinant of urine volume. Urine dilution can significantly decrease both the crystallization rate of the urinary salts and the aggregation of the crystals. A correct fluid intake can act on different effects: urinary tract washing, urinary volume increasing and dilution of solutes. In addition mineral waters have other particular features: greater diuretic effect, more important urinary dilution with solutes and microbial concentration reduction, urinary pH changes, superior washout effect due to mechanical effects and ureteral contractions. Adequate water intake is the most important conservative strategy in urolithiasis prevention; particularly hydropinotherapy with oligomineral water should be considered as an important instrument to prevent stones in subjects predisposed to the disease (family members of people suffering from kidney stones), to reduce relapses, and can help to eliminate residual fragments also after extracorporeal shock wave lithotripsy. It is recommended a management with increased mineral water intake to promote urine volume of at least 2.5L each day to prevent stone formation. Obviously water intake shall be varied in relation to the presence of contraindications or any diseases.

[Ethics in clinical practice and in health care]. / L'etica nella pratica clinica e nell'assistenza sanitaria.

The clinical ethics is the identification, analysis and solution of moral problems that can arise during the care of a patient. Given that when dealing with ethical issues in health care some risks will be encountered (talking about ethics in general, or as a problem overlapped with others in this area, or by delegation to legislative determinations) in the text certain important aspects of the topic are examined. First of all ethics as human quality of the relationship between people for the common good, especially in health services where there are serious problems like the life and the health. It is also necessary a "humanizing relationship" between those who work in these services in order to achieve quality and efficiency in this business. It is important a proper training of health professionals, especially doctors, so that they can identify the real needs and means of intervention. It is also important that scientific research must respect fundamental ethical assumptions. In conclusion, ethics in health care is not a simple matter of "cookbook" rules, but involves the responsibility and consciousness of individual operators.

The therapeutic activity of sulphate-bicarbonate-calcium-magnesiac mineral water in the functional disorders of the biliary tract.

BACKGROUND AND AIM: Functional disorders of the biliary tract involve gallbladder and sphincter of Oddi and cause pain and/or digestive troubles. In this context, in addition to pharmacological treatments, an important role is played by the use of sodium-sulphate and sulphate-bicarbonate mineral waters that, because of their composition into ions macro and trace elements, can stimulate the release or modulate the activity of some neurohumoral regulators of the digestive process. We want to do a study on the effects of hydropinotherapy with a sulphate-bicarbonate-calcium-magnesium mineral water in patients suffering from pain and other symptoms caused by biliary dyskinesias, biliary sand (without gallstones), or following a cholecystectomy (post-cholecystectomy syndromes). MATERIALS AND METHODS: We enrolled 43 patients suffering from those affections; all the patients did two cycles in one year of hydropinotherapy with Acqua Santa at Italy's Chianciano Spa; 20 of these patients did a third cycle of hydropinotherapy in the second year of the study. At the end of the second and of the third cycle we compared the frequency of eleven main symptoms in both groups and we also performed an longitudinal-observational study on the frequency of those symptoms before the beginning of the first cycle of the therapy and at the end of the second and of the third cycle. Statistical analyses were based on the use of Pearson's χ2 test. RESULTS: The frequency of the symptoms observed at the end of second and third cicle of hydropinotherapy was significantly lower than that considered before starting therapy. The differences were statistically significant. CONCLUSIONS: The results of our research regarding the hydropinotherapy by sulphate-bicarbonate-calcium-magnesium mineral water show a significant improvement of symptoms in patients suffering from disturbances of biliary tract.

[The possible uses of balneotherapy in treating chronic venous insufficiency of lower limbs]. / Possibilità della balneoterapia termale nell'insufficienza venosa cronica degli arti inferiori.

The Chronic Venous Insufficiency (CVI) of inferior limbs is a widespread disease, with an increasing incidence as a consequence of longer life expectance, life-style, obesity, smoking, use of drugs as oestrogens and progestins and working conditions. Medical therapy is still lacking for evidence of efficacy, and compression therapy is useful only in preventing a worsening of this condition. Surgical treatment is the only radical therapy effective for the advanced phases of the disease. In this context spa balneotherapy can be considered as a possible chance to improve some subjective and objective symptoms of CVI of inferior limbs, and to prevent worsening of this condition. The authors performed a review of the relevant scientific literature concerning the treatment of CVI of inferior limbs with mineral water balneotherapy, in order to evaluate its effects on objective and subjective symptoms and its effectiveness to prevent further worsening. We searched the PubMed/Medline, Cochrane Library, Embase, Web of Science databases for articles published between 1990 and 2011 on this topic. To this end, the authors selected few clinical-controlled and case-controlled studies; patients affected from CVI of inferior limbs were treated with balneotherapy at health spas with sulphureous, sulphate, salsojodic or salsobromojodic mineral waters. Baths in mineral waters were often associated with idromassotherapy and vascular pathway. Effects of spa balneotherapy are related to some aspecific properties, like hydrostatic pressure, osmotic pressure and water temperature, partly related with specific chemico-physical properties of the adopted mineral water. The controlled clinical studies on spa therapy showed significant improvement of subjective (such as itch, paresthesias, pain, heaviness) and objective symptoms (namely edema and skin discromias). These studies suggest that spa balneotherapy may give a good chance of secondary prevention and effective therapy of CVI of inferior limbs, but also that it needs of other clinical controlled trials.

[SPA treatments of diseases pertaining to internal medicine]. / I mezzi di cura termale nella terapia di malattie di competenza internistica.

Authors resume the therapeutic employment of mineral waters, muds and baths in internistic syndromes or diseases. Mineral waters are used in the therapy of functional dyspepsia, gastro-oesophageal reflux, chronic primary stipsis, irritable bowel, biliary dyskinesias, mainly hypokinetic gallbladder and Oddi's sphincter, spasm, postcolecystectomy syndrome. The therapeutic effects of mineral waters are determined by their anion and cation content, the presence of undissociated salts and also by the presence of oligoelements. Additionally, the effects of a mineral waters are connected with physical constants: osmotic pressure and temperature. Many researches showed activity of the mineral waters on intestinal autonomic nerves and plexus (CIA), motility, exocrine, endocrine and paracrine digestive secretions and therapeutic properties belonging to evidence based medicine. Mud and bath therapy are effective in treatment of osteoarthritis. During and after mud-therapy effects on diencephalic-pituitary-adrenal axis were displayed, producing increase of endogenous opioids and cortisol. Clinical controlled trials showed significant improvement of symptoms as pain and stiffness. Inhalant therapy by sulphureous and salsojodic mineral waters improve symptoms as cough and escreate and functional indices as FEV1 in chronic obstructive pulmonary disease. The oligomineral waters are very useful in the treatment and secondary prevention of urolithiasis and of relapses of urinary stones after spontaneous expulsion, surgical treatment, stones removal by percutaneous or uretheroendoscopic treatment and lithotrypsia. Patients must drink at least 2L every day, substantially for ever. Chloruratesodic and bicarbonate mineral waters show improvement in disorders of lipidic and urate metabolism.

Sulphate-bicarbonate mineral waters in the treatment of biliary and digestive tract diseases.

The authors point out the therapeutic properties of sulphate-bicarbonate mineral waters. After summarizing the general mechanism of action of mineral waters, the main indications of such waters in thermal treatment are examined including: biliary sand, biliary dyskinesia, functional dyspepsia, irritable colon, chronic primitive constipation. The dysfunctions of biliary and digestive tracts are growing, mainly in the affluent world, because of the increase for stress, dietary habits, modern life style. Now they affect from 2,4% of general population to 7% of men and 20% of women, according to different studies. Mineral waters can improve symptoms and care some physiopathological underlying mechanisms. Authors stress the efficacy of sulphate-bicarbonate mineral waters in the therapy of biliary dyskinesias, namely gallbladder hypokinesia and Oddi's sphincter spasm, caused by their content in SO4 = anion and Mg++ cation and related effects on paracrine-endocrine gastrointestinal system. In addition, they report the effects of sulphate-bicarbonate mineral waters in the lithogenic bile (sand bile), because of their diluting and washing activity. Among the sulphate-bicarbonate mineral waters, the Authors outline the well-documented therapeutic activity of Acqua Santa and Fucoli of Chianciano Terme. Acqua Santa has stimulating effect on cholecystis's motility, as proved by controlled clinical trials. Finally, the therapeutic use of sulphate-bicarbonate mineral water is discussed in functional dyspepsia, chronic primitive constipation and irritable bowel syndrome.

[Spa therapy in osteoarthritis: experience in Cervia]. / La terapia termale nell'osteoartrosi: esperienza di Cervia.

AIMS: Mud-bath treatment has a relevant therapeutic activity in reducing symptoms and disabilities in rheumatic diseases, as studies on inflammation process and clinical symptomatology have shown. Objective of this study is to evaluate the efficacy of mud therapy by natural limans of Cervia on clinical parameters in patients with lumbar spine osteoarthrosis (OA). MATERIALS AND METHODS: 30 patients (20 females and 10 males) suffering from lumbar OA, diagnosed by clinical symptoms and X-Ray findings (osteophytosis, morphological changes of vertrebral somes, tightness of intervertebral spaces, alterated lumbar physiologic lordosis) were studied. All patients were examined first when recruited (T0) and after two weeks of therapy (T1). Interviews were submitted in order to estimate functional restrictions and pain. Statistical analysis was performed via t test for paired data. RESULTS: On the basis of the statistical analysis a very significant difference was demonstrated between the average values of the tests before and after the treatment. These results confirm the improvement of the symptoms concerning the pain, the articular functionality and the quality of life. CONCLUSIONS: The results of the study demonstrate the efficacy of the mud-bath treatment with natural limans of Cervia on the patients affected by lumbar spine osteoarthrosis (OA).

[Efficacy of mud-bath therapy with Mineral Water from the Sillene spring at Italy's Chianciano Spa for osteoarthritis of the knee: a clinical statistical study]. / Effcacia della fangobalneoterapia con Acqua Minerale Sillene (Terme di Chianciano, Italia) nell'osteoartrosi del ginocchio: uno studio clinico-statistico.

AIMS: Many previous researches showed clinical benefits, effects on inflammatory mediators and pain, immune system, hormones and on the diencephalic-pituitary-adrenal axis. Our study evalues the efficacy of mud-bath therapy with mineral water from the Sillene Spring at Italy's Chianciano Spa in patients with osteoarthritis of the knee. MATERIALS AND METHODS: In study we compared: physical examination of the knee joint, visual analogue scale (VAS) assessment of pain, and Lequesne Algo-functional Index. Tests were performed in 61 patients divided into 2 groups. The group A underwent three full cycles of mud-bath therapy over 1 year's time, the group B did not. An observational longitudinal study was also conducted on the patients of group A, before and after completion of the treatment protocol. Statistical analyses were based on use of Pearson's chi² test, Student's t tests for paired and unpaired data. RESULTS: The percentage of patients with no symptoms or mild symptoms was higher in group A than in group B (differences were highly significant); the mean value of VAS and the overall Lequesne indexes mean score reported in group A was significantly lower than that reported in group B. The same we observed comparing the clinical conditions of group A patients before and after mud-bath therapy. No adverse effects were observed in any of the patients in group A. CONCLUSIONS: The mud-bath therapy at Chianciano Spa significantly improves the clinical conditions of patients with knee osteoarthritis and significantly reduces the frequency and severity of symptoms and the disability they cause.

[The historical-scientific foundations of thalassotherapy: state of the art]. / Le basi storico-scientifiche della talassoterapia: stato dell'arte.

Throughout the ages the interest in the use of sea water in medicine has fluctuated from century to century and from nation to nation. In this paper, the historical development of sea medicine from the ancient Egyptians until the 20th century is given. The medical world has viewed it with different opinions, from very enthusiastic to extremely critical, and from beneficial to harmful. In the last decades, thalassotherapy is receiving renewed attention from many medical specialties and health tourists. The aim of this review is that of offer an update on the real therapeutic possibility of the thalassotherapy. However, the exact therapeutic potential of thalassotherapy still remains largely unknown. Better and more profound scientific evidence for its efficacy is therefore warranted, in particular for its effects on the musculoskeletal system and skin. The main researches belong to the activity of thalassotherapy and the clinic outcomes, namely in osteoarthritis patients, were referred.

[Recent trends in the therapy of hepatitis C]. / Recenti orientamenti di terapia dell'epatite C.

The treatment of HCV correlated hepatitis is an important argument, because of the great incidence and prevalence of this disease. At the end of the Eighties, the IFN was the first substance used for HCV correlated hepatitis therapy. The IFN monotherapy with a dose of 3-6 MU for 6-12 months eradicates the infection in the 15% of cases, and cause an histological temporary improvement in a variable number of patients that keep the infection. In the following years, the research on evaluation of the efficacy of the recombinant interferons or interferons made with genetics engineering (IFN alpha 2a, IFN alpha 2b and IFN Consensus) has given results comparable with the results obtained with IFN alpha. Later, it started the experimentations with IFN associated to other substances, for example IFN-ribavirin combination therapy. The treatment IFN-Ribavirin eradicates the infection in 30% of the patients with the genotype 1b and in 60% with the genotype 2 or 3, while this treatment is less efficacious in the patients with the genotype 4. Recently, it started to use the PEG IFN. The pegylation is the combination of a polietylen-glicole molecule with the IFN molecule, so as to prolong its half-life and reduce the dose only one a week, with reduction of the collateral effects. Some studies has shown that the use of PEG-IFN in monotherapy could help the patients with advanced liver complaint. Successive studies are directed to show the efficacy of the PEG-IFN and ribavirin combination therapy. Recent researches put in evidence new substances, that could represent the future for HCV correlated hepatitis therapy. Between these substances we have to highlight the interleukin, the inhibitors of the viral multiplication and the inhibitors of IMPDH (Inosine monophosphate dehydrogenase). At the beginning of 2002 has made the improvement of HCV vaccine known. Actually, in the USA there are in progress human experimentations, and the production of gamma-globuline, that could be effective to prevent the infection.

[Meta-analytical study of gastrointestinal stromal tumors (GIST)]. / Studio metanalitico dei tumori stromali gastrointestinali (GIST).

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasms of the gut wall. GIST have still today controversial aspects of their histogenesis that are reflected on the classification, clinical behaviour and prognosis. The authors analyzed 14 studies observed between 2000 and 2001; also the tumors early classified as leiomyomas, leiomyosarcomas and schwannomas were included in these studies because, on the basis of immunohistochemical analysis, their cells were c-Kit positive. The GIST occurred in 728 patients with the age range of 12 days-96 years with a male predominance (59.3%). The most common symptoms were abdominal pain (25.4%) and gastrointestinal bleeding (23.4%). CT scan was the most important diagnostic technique. Surgery was the only useful treatment; in this study completeness of resection predicted for longer survival. Overall survival was between 21.4% and 88.8%; the percentage of deaths was between 11.1% and 78.5%. Distant metastases, localised in liver and lungs, and locoregional recurrences developed in a percentage between 9% and 68%.

[Hepatocarcinoma: epidemiologic and clinical evaluation of 90 patients]. / L'epatocarcinoma: valutazione epidemiologica e clinica di 90 pazienti.

PURPOSE: The aim of the study was to improve the knowledge of epidemiology and clinic of primitive HCC. PATIENTS AND METHODS: Ninety consecutive HCC patients, attending the Medical Therapy Dpt. of Rome University "La Sapienza" were examined: diagnosis of HCC was based on histologic data in 71; in the others the diagnosis derived from ultrasonographics, RMN, TC data. RESULTS AND CONCLUSIONS: Show M/F ratio 3.7/1; in 87% HCC is associated to liver cirrhosis (HCC/CEA); the cumulative presence of HBV and HCV is 75.6%: HCV alone 33.4%, resulting the major risk factor for HCC; patients with associated alcoholism, HBV and/or HCV show evidence of earlier appearance of HCC. Significant higher presence of HBsAg is recorded in HCC without surrounding liver cirrhosis compared to HCC/CE. The cumulative survival rate of treated patients is higher compared with non treated, irrespectively to kind of therapy. The HCC/CE+ patients have significant greater presence of elevated levels of alpha-FP and portal thrombosis compared to a randomized group of patients with liver cirrhosis only. At the end we outline that over 10% of HCC has none note risk factor for hepatic diseases.

[Massive polycystic liver disease with rapid evolution: report of a case]. / La policistosi epatica massiva a rapida evolutività: presentazione di un caso clinico.

We report a case of massive polycystic liver associated to polycystic kidney disease. In a 47-year-old woman we observed liver cysts without hepatic impairment and with only a mild renal involvement.

[Polymyalgia rheumatica associated with myelodysplasia]. / Polimialgia reumatica associata a mielodisplasia.

In this paper we describe a patient, female 76 years aged, who showed typical symptomatic, haematologic and instrumental findings of polymyalgia rheumatica. The patient also showed myelodysplastic syndrome and peripheral signs of vasculitis, which some authors refer in association with PMR. The improvement obtained with steroidal therapy confirmed the clinical picture of case.

[Maxillofacial-dental anomalies in cleidocranial dysostosis]. / Anomalie dento-maxillo-facciali nella disostosi cleido-cranica.

The authors evaluated the dento-maxillofacial anomalies in cleido-cranial dysplasia; the use of a removable orthodontic appliance can solve orthodontic problems particularly the deficiency of anchorage.

[Evaluation of exocrine pancreatic insufficiency in cirrhotic patients,using the fecal chymotrypsin test]. / Valutazione dell'insufficienza pancreatica esocrina nei cirrotici con il test della chimotripsina fecale.

In spite of having been the object of a number of studies, the association of morphologic and functional alterations of the pancreas with liver cirrhosis is as yet controversial. Therefore, the authors have studied exocrine pancreatic function in 40 patients: 8 with alcoholic cirrhosis, 18 with non-alcoholic cirrhosis, and 14 without evidence of hepatobiliary and pancreatic pathology. Pancreatic function was studied by the fecal chymotrypsin test which is sufficiently sensitive and specific and has been preferred in view of its practicability and non-invasiveness. Analysis of the results showed pathologic values to be significantly more frequent in subjects with alcoholic cirrhosis (50%, p < 0.05) compared to non-alcoholic cirrhotics (11.11%) and to controls (7.2%). These findings go to show that pancreatic exocrine deficit is frequently associated with alcoholic cirrhosis, thus confirming what has already been known about the pathogenetic role of alcohol which is apt to provoke both hepatic and pancreatic damage. Finally, it should be pointed out that pancreatic exocrine deficit is a purely functional alteration without clinical manifestations.

The prevalence of gallstones in patients suffering from liver cirrhosis: a clinico-statistical study of 350 patients.

The overall prevalence according to sex and to age group of biliary calculosis was assessed in 350 patients with liver cirrhosis: data were compared with homogeneous findings in the general population of the GREPCO study. Cholelithiasis was found to be significantly more frequent in cirrhotics, and the pattern was confirmed when data were analyzed according to sex; a significantly higher percentage was found in cirrhotics of the 40-49 and 60-69 age groups. Among cirrhotics with gallstones, alcoholics represented a smaller percentage compared to non-lithiasic cirrhotics. The incidence of complications such as digestive hemorrhage, coma, and hepato-renal syndrome, was equal in cirrhotics with and without biliary calculosis, or, as far as coma was concerned, even lower among the former. A fatal outcome was less frequent in cirrhotic patients with than in those without cholelithiasis. Our results go to show that biliary calculosis does not aggravate the course of liver cirrhosis.

[A case of intestinal giardiasis associated with immunoglobulin deficiency and intestinal lymph node hyperplasia]. / Su di un caso di giardiasi intestinale associata a deficit immunoglobulinico e iperplasia nodulare linfatica intestinale.

The authors recall the main etiopathogenetic, immunological and clinical features of Giardiasis; they report on a patient suffering from intestinal Giardiasis associated with immunoglobulin deficiency and nodular lymphatic hyperplasia of the gut. They report the results of medical therapy.

[Hydrological therapy of renal lithiasis]. / Terapia idrologica della litiasi renale.

The spa treatment most widely used in the management of renal calculosis is the drinking of a certain amount of mineral water under certain predetermined conditions of temperature, time and rhythm. These treatments are always indicated unless there are obstacles to the passage of urine or general contraindications. Chances for success are increased if the diagnosis is exact and the stone has been located. The results obtained by various authors are reported and their statistical validity is discussed. Favorable effects consist in: increased diuresis with urine dilution and correspondingly reduced concentration of lithogenic salts and hence supersaturation of urine; reduced concentration of microorganisms; changes in the physiological condition of the renal medulla; changes in inhibitors of crystallization, in urinary pH; mechanical effect on the urinary passages; increased ureter motility; expulsion of small stones and sand; preventive action on recurrences after surgery and after extra-corporeal shock-wave treatment, percutaneous therapy and uretero-nephroscopy.