Treatment of articular effusions with local deep microwave hyperthermia.

Local deep microwave hyperthermia (LDMWH) may be considered as a therapeutic tool for joint diseases because it has the advantage of heating the target organ e.g. synovium, while sparing the adjacent tissues, as demonstrated in animals. The effect of this new microwave device has been evaluated on seven rheumatoid arthritis patients with knee effusion. The hyperthermia apparatus consists of a 915 MHz power source with a cooling system to the skin. LDMWH was operated for one hour, twice a week for two weeks. Intra-articular knee temperature reached the level of 40.6 +/- 1.1 degrees C within 15 minutes, raised to 41.2 +/- 0.7 degrees C after 30 minutes and to 41.3 +/- 0.9 degrees C at one hour. The skin temperature over the heated knee joints remained at 24.3 +/- 1.1 degrees C during treatment. All patients noted a sensation of warmth in the treated knee. Aspiration of synovial fluid was performed before and immediately after each treatment. Walking time was improved (p = 0.04) and significant decrease in pain (p = 0.01) was noted following treatment. Synovial fluid leukocyte count and prostaglandin E2 level, knee circumference and range of motion did not change. Severity of pain, walking time, knee circumference and range of motion remained stable in the six weeks following the last hyperthermia application. No adverse reaction could be observed. These results suggest LDMWH to be safe and successful as an adjuvant treatment of chronic inflammatory joint effusions.

Intra-articular temperature measurements after superficial heating.

Superficial heating of the joint is widely used in various rheumatic conditions and is considered as decreasing the intra-articular temperature. This study shows that heating the joint with hot pack significantly increases the articular temperature from 35.2 +/- 1.5 degrees C (mean +/- SD) to 36.4 +/- 1.0 degrees C (p less than 0.001), while intra-cavity temperature of the contralateral unheated knee joint did not change significantly. Since such elevation of temperature of one degree C is liable to enhance the inflammatory process, the use of superficial heating has to be carefully reconsidered in acute and chronic inflammatory joint diseases.

Deep heat in the treatment of inflammatory joint disease.

There is now a growing body of clinical evidence suggesting a therapeutic approach to cancer and prostatic hypertrophy by using hyperthermia. It is proposed that such a hyperthermic modality can produce thermal synovectomy in inflammatory arthritis. Heating the joint cavity up to 42 deg C can inhibit the enzymatic effect of collagenase, oxygenase, and other enzymes playing a role in the inflammatory process. If this hypothesis is correct, therapeutic intervention using hyperthermia may offer hope for the treatment of isolated inflammatory joint diseases.

Transcutaneous electrical nerve stimulation in experimental acute arthritis.

Transcutaneous electrical nerve stimulation (TENS) is applied for the relief of various types of pain, including rheumatoid arthritis and osteoarthritis. This study evaluated the influence of TENS on intraarticular (IA) temperature and pressure and synovial tissue of inflamed rabbit joints. Four hours after induction of acute bilateral hind joint arthritis by single intraarticular injection of urate crystals, the knees of 14 anesthetized rabbits were fixed at 90 degrees between femur and tibia. TENS was supplied from an electrical stimulator to the left knee joint while the other joint was unstimulated as a control. A microprobe needle for temperature measurement was inserted into the knee joint. Intraarticular pressure was recorded by polygraph connected to an IA needle. Readings were carried out at 10-min intervals three times before and four times after 5 min of TENS. A significant increase in IA temperature from mean 36.2C to 36.6C and significant reduction of IA pressure (mean decrease of 0.8 mmHg, from 2.5 mmHg to 1.7 mmHg) were found in the stimulated joints, which also showed a reduction of synovial fluid volume and total leukocyte count in comparison to the controls. While the nonstimulated synovial membrane showed massive leukocytic infiltration with neutrophilic exudate and fibrin clot in the intraarticular cavity, the stimulated synovial membrane demonstrated moderate homogeneous leukocytic infiltration through all layers, with absence of inflammatory exudate in the intraarticular cavity. These results suggested that the analgesic effect of TENS on arthritis may be partially attributed to decrease in IA synovial fluid pressure, volume, and leukocyte count. Therefore, TENS may be useful for reducing pain from inflammatory arthritis.

Transcutaneous electrical stimulation of the normal rabbit joint.

To determine the effect of transcutaneous electrical stimulation on the rabbit joint, we studied skin and intraarticular temperatures and pressure both before and following the stimulation in nine rabbits. An elevation in skin temperature by a mean of 0.6 degrees C (p less than 0.05) and increase in intraarticular temperature by a mean of 0.8 degrees C (p less than 0.01) was noted following the electrical stimulation. Intraarticular pressure in the stimulated joints has only a trend to increase, but not significantly. In four other rabbits, synovial tissue of the stimulated joint showed blood vessels congestion and interstitial edema. These results suggest that the analgetic effect produced by electrical stimulation on joints may partially involve intraarticular temperature and pressure alterations.

Continuous high-dose intravenous desferrioxamine treatment for iron overload.

We describe a patient with heavy posttransfusion iron overload, to whom continuous high-dose i.v. desferrioxamine was administered shortly before his death. The administration of nearly 500 g of this agent was followed by urinary excretion of 5.4 g of iron. The chelator therapy lost its efficiency in the last of five courses and the patient eventually died as a result of cardiac and hepatic damage related to iron overload. The theoretical and practical implications of these observations are discussed.

Lack of response to vitamin D therapy in a patient with hypoparathyroidism under anticonvulsant drugs.

Case report of a 16-year-old boy suffering from idiopathic hypoparathyroidism with severe seizures who erroneously and unsuccessfully had received anticonvulsive therapy for 12 years. When the correct diagnosis was made, treatment with massive doses of vitamin D2 was started. However, this treatment became effective only after the anticonvulsive therapy was discontinued; the serum calcium, phosphorus and the plasma 25-hydroxycholecalciferol returned to normal values, and the seizures stopped.