The effects of the calcium-magnesium-bicarbonate content in thermal mineral water on chronic low back pain: a randomized, controlled follow-up study.

The aim of this study was to investigate the effects of balneotherapy on chronic low back pain. This is a minimized, follow-up study evaluated according to the analysis of intention to treat. The subjects included in the study were 105 patients suffering from chronic low back pain. The control group (n = 53) received the traditional musculoskeletal pain killer treatment, while the target group (n = 52) attended thermal mineral water treatment for 3 weeks for 15 occasions on top of the usual musculoskeletal pain killer treatment. The following parameters were measured before, right after, and 9 weeks after the 3-week therapy: the level of low back pain in rest and the level during activity are tested using the Visual Analog Scale (VAS); specific questionnaire on the back pain (Oswestry); and a questionnaire on quality of life (EuroQual-5D). All of the investigated parameters improved significantly (p < 0.001) in the target group by the end of the treatment compared to the base period, and this improvement was persistent during the follow-up period. There were no significant changes in the measured parameters in the control group. Based on our results, balneotherapy might have favorable impact on the clinical parameters and quality of life of patients suffering from chronic low back pain.

Effects of sulfur bath on hip osteoarthritis: a randomized, controlled, single-blind, follow-up trial: a pilot study.

The effects of balneotherapy were evaluated in patients with osteoarthritis of the hip. This randomized, controlled, investigator-blinded study enrolled outpatients with hip osteoarthritis according to ACR criteria. In addition to home exercise therapy, one patient group received balneotherapy for 3 weeks on 15 occasions. The mineral water used in this study is one of the mineral waters with the highest sulfide ion content (13.2 mg/L) in Hungary. The control group received exercise therapy alone. The WOMAC Likert 3.1 index and the EQ-5D quality of life self-administered questionnaire were completed three times during the study: prior to first treatment, at the end of the 3-week treatment course, and 12 weeks later. The main endpoint was achievement of Minimal Clinically Important Improvement (MCII) at 12 weeks, defined as ≥7.9 points in a normalized WOMAC function score. The intention to treat analysis included 20 controls and 21 balneotherapy patients. At 12 weeks, 17 (81 %) balneotherapy group patients had Minimal Clinically Important Improvement and 6 (30 %) of controls (p = 0.001). Comparing the results of the two groups at the end of treatment, there was a significant difference in the WOMAC stiffness score only, whereas after 12 weeks, the WOMAC pain, stiffness, function, and total scores also showed a significant difference in favor of the balneotherapy group. The difference between the two groups was significant after 12 weeks in point of EQVAS score, too. The results of our study suggest that the combination of balneotherapy and exercise therapy achieves more sustained improvement of joint function and decreases in pain than exercise therapy alone.

The effect of sulphurous water in patients with osteoarthritis of hand. Double-blind, randomized, controlled follow-up study.

The aim of the study was to demonstrate the effectiveness of sulphurous water in patients with osteoarthritis of the hand. Forty-seven patients with osteoarthritis of the hand were enrolled into the double-blind, randomized, controlled study, satisfying ACR criteria. One group of the patients (n = 24) received balneotherapy, bathing in sulphurous thermal water for 20 min per occasion, 15 times in all during a period of 3 weeks. The control group (n = 21) had a bath exclusively in warm tap water. Assessments were carried out in both groups on four occasions: at the beginning and at the end of the treatment, and 3 and 6 months after the beginning of the treatment. The parameters studied were the following: pain in the hand, morning stiffness in the joints, grip strength of both hands, and Health Assessment Questionnaire Disability Index (HAQ) and AUSCAN Hand Osteoarthritis Index and EuroQol quality of life questionnaire. At the end of treatment, the improvement was more pronounced in the patient group treated with the sulphurous water. After 3 months, significant improvement could be detected in all parameters, except the morning stiffness and EQ5D. After 6 months, the values of pain, HAQ and AUSCAN continued to be significantly better in comparison with the baseline values. The improvement in quality of life was significant only at the end of the treatment, 6 months later not any longer. The difference between the two groups was significant after 3 months in point of pain and EQVAS. Balneotherapy and within this the sulphurous spa water alone may be effective for the attenuation of pain in patients with hand osteoarthrosis.

[Radio-chemotherapy for non-resectable primary esophageal malignant melanoma]. / Irreszekábilis elsôdleges nyelôcsô melanoma malignum radiokemoterápiája.

AIM: to demonstrate the simultaneous radio-chemotherapy of primary esophageal malignant melanoma on the basis of one case. PATIENT AND METHODS: 68-years-old male patient with malignant melanoma in middle part of the esophagus. The therapy was started with intraluminal high-dose-rate afterloading brachytherapy for the recanalisation of the esophagus (8 Gy in 0.5 cm deep), followed by percutaneous megavolt therapy two weeks after the last HDR AL session (50 Gy total dose, 5 x 2 Gy/week fractions for 5 week, 3D conformal planning). The chemotherapy was started simultaneously with the percutaneous megavolt irradiation (three courses of Cisplatin-5-Fluorouracil combination, repeated in four-week intervals). After the radio-chemotherapy a supraclavicular metastasis was verified, so the radio-chemotherapy was followed with megavolt therapy of the metastasis at 30 Gy dose (5 x 2 Gy/week fractions), and chemotherapy (Cisplatin-Dacarbazine combination in 6-session, four-week intervals) and after them immunotherapy was started. RESULTS: The swallow function has been improved, the supraclavicular metastasis was in partial remission. After the beginning of the radio-chemotherapy the swallow function was good for 16 months, and 18 months after the beginning of radio-chemotherapy the patient died due to pulmonary and hepatic dissemination. CONCLUSION: Radio-chemotherapy of esophageal malignant melanoma has favorable palliative effect with acceptable quality of life.