[Poverty, illness, prayer--thoughts on contemplating the votive painting of St. Notburga]. / Armut, Krankheit, Gebet--Gedanken bei der Betrachtung eines Votivbildes der heiligen Notburga.

A votive painting in the chapel of St. Donatus in Pavlovec (northern Croatia) from the 18th century depicts St Notburga of Eben with two paupers, a shepherd and an invalid. Although generally venerated as patron-saint of peasants and maids, Notburga seems to have captured the imagination of the anonymous painter as the helper of the poor and underprivileged. The vicious circle of poverty and disease is evoked by this painting, as well as the popular belief in divine assistance by supplication to patron saints.

[Sixty years of rheumatological service in Croatia (on the occasion of the 100th anniversary of the birth of Drago Cop)]. / Sezdeset godina reumatoloske sluzbe u hrvatskoj (U povodu stote obljetnice rodenja Drage Copa).

On the occasion of the 100th anniversary of the birth of Drago Cop and the 60th anniversary of the first rheumatological institution in Croatia founded by him, the person of Drago Cop is presented as well as his merits for Croatian rheumatology and medicine in general. He published the first programmatical article "Rheumatism, problem of national health and national economy" in 1930; he founded the first rheumatological institution in Croatia (Centralna reuma-stanica) in 1938; he actuated the founding of the section for rheumatology, physical medicine and balneology of the Croatian Medical Association in 1947; he started our first rheumatological journal "Reumatizam" in 1954. All this has deservedly earned him the attribute of founder of rheumatology in Croatia.

The prognosis of rheumatoid arthritis.

Sixty patients with early diagnosed rheumatoid arthritis according ARA criteria were followed up for 6.6 years with the goal to determine prognosis. The parameters relevant to patient and physician were selected for follow up. Radiological and functional deterioration was evident after 6.6 years in 3/4 of patients and there was no one of them to satisfy remission criteria. The most unfavourable predictor of final outcome was the degree of functional incapacity in early stage of rheumatoid arthritis. Second important predictor of poor prognosis was degree of radiological destructive changes especially on feet. Poor prognosis could be expected in patients with previous attacks and the beginning of disease in elderly age. General symptoms and affection of mesomelic joints can be also undesirable predictor. Sex, morning stiffness, joint pattern, laboratory findings and rheumatoid factor were not significant predictors for prognosis but they could influence certain variables of global assessment.

The influence of heat and cold on the pain threshold in rheumatoid arthritis.

Superficial heat and cold are commonly used therapeutic methods in patients with rheumatoid arthritis. Both procedures have analgesic effect. In 30 inpatients with rheumatoid arthritis the pain threshold was measured before and after warm bath and ice massage. Rheumatoid patients had significantly lower pain threshold compared to the healthy subjects in normal circumstances. Heat and cold remarkably raise the pain threshold right after the application. The pain threshold is also raised 10 and 30 min after cryotherapy, but not after the warm bath. Between investigated groups there were no statistically significant differences in the pain threshold values in any observed time. We consider that both methods have a reasonable place in the therapy of rheumatoid arthritis.

Medical decision making based on inductive learning method.

Medical decision making based on inductive learning has been studied in order to collect experience necessary for practical use of such methods in clinical and epidemiological work. The decision trees have been constructed by using the modified Quinlan's approach based on choosing relevant attributes according to their informativity. An inductive learning software tool, ASSISTANT Professional, has been used for experimenting. The variability in results has been studied under varying learning conditions. Two sets of data have been chosen for learning experiments: from a study on rheumatoid factors in patients with rheumatoid arthritis, and from an epidemiological investigation of aging. The results of this study indicate the necessity to determine inductive learning parameters for each particular problem. The pruning procedure is always recommended as it eliminates redundant elements in the tree. In problems with greater number of attributes, however, pruning itself is not guaranteeing satisfactory solutions. Interventions like the change of the minimal weight threshold might improve the situation. If these precautions are met, the method of inductive learning seems to be a useful guide in practical clinical and epidemiological decisions.

Migration of the femur head in rheumatoid coxitis.

The direction of penetration of the destroyed femoral head into the acetabulum in rheumatoid coxitis has been determined by means of the method of geometrical analysis in 81 affected hip joints. Of 48 patients, the duration of coxitis was 1-17 years (mean 4 years). Displacement of the femur head, destroyed by rheumatoid inflammation, was expressed in millimeters by means of a geometrical parameter called "transposition of the center of the femur head". The direction of transposition of the femur head into the deepened acetabulum has been expressed quantitatively by authors making use of the new geometrical parameter "the angle of transposition of the center of the femur head" which is referred to as angle delta. The angle delta is an angle between the line of transposition of the femur head center (tC) and its vertical component. The mean value of the delta angle for the entire group investigated measured 27.6 degrees and ranged from -5 degrees to +54 degrees, whereby an angle of 0 degrees marked the cranial direction of transposition, positive values marked the craniomedial transposition direction of the femur head. The angle delta varied from 21 degrees to 40 degrees in the majority of affected hip joints. The values of the delta angle were constant in every hip joint, thus indicating that the direction of transposition of the femur head did not change in the course of the progression of rheumatoid coxitis. It was found and statistically confirmed that no reciprocal dependence existed between the rate of progression of coxitis and the direction of displacement of the femur head into the acetabulum.(ABSTRACT TRUNCATED AT 250 WORDS)

A double-blind trial of ademetionine vs naproxen in activated gonarthrosis.

The efficacy and safety of ademetionine (A) vs naproxen (N) were tested in a double-blind trial carried out in 20 patients, each with activated gonarthrosis. The trial lasted 6 weeks. During the first week, A was administered at a daily dose of 3 x 400 mg and afterwards at a dose of 2 x 400 mg, whereas the daily dose of N during the first week was 3 x 250 mg and subsequently 2 x 250 mg. During the first two weeks, the patients were allowed to take paracetamol as an additional analgesic. The patients were examined at the beginning of the study and after 2, 4 and 6 weeks. The parameters tested were: pain (under different conditions), crepitation, joint swelling, circumference of joint, extent of motility and walking time over 10 meters. In addition to the usual laboratory tests, the serum keratane-sulphate concentrations (with monoclonal antibodies according to the ELISA technique of Eugene et al. [1985]) were also determined. At the end of the 6th week no statistically significant difference between the two patient groups treated was found; both groups exhibited a marked improvement on all parameters. At the end of medication, the keratane-sulphate concentrations were not significantly changed. Five patients under A and 3 under N reported gastrointestinal side effects which were possibly drug-related. This study, performed in a small number of patients, showed a good efficacy and safety of ademetionine. Only further studies on a larger scale will show the importance of ademetionine in the therapy of rheumatic diseases.

[Use of non-steroidal antiinflammatory drugs in specialty polyclinic practice]. / Primjena nesteroidnih antiinflamatornih lijekova u specijalistickoj poliklinickoj praksi.

A retrospective investigation of the prescription of nonsteroidal antiinflammatory drugs (NSA) was performed in the Rheumatologic out-patient-institute in Zagreb, including 1000 patients of both sexes, aged 20-70 years. 500 outpatients were treated by NSA during 1987 and 1989 respectively for lumbosacral syndrome, rheumatoid arthritis, ankylosing spondylitis and coxarthrosis. The kind of NSA as well as the registered side-effects were analysed from case histories. During 1987, NSA were applied to 365 (73%) and during 1989 to 390 (78%) of the 500 patients. In both groups a phenyl-acetic acid derivative (diclophenac) was most often applied, followed by propionic acid derivatives and oxycams. The most rarely applied drugs were indol-acetic acid derivatives. Pyrazolones were given only to 2 patients with an acute flare of ankylosing spondylitis in 1987. A gastro-duodenal ulcer was the absolute counterindication for this kind of treatment. The number of side-effects in this investigation was relatively small (6.5% in 1987 and 5% in 1989), probably because this investigation was a retrospective one. The most common among them appeared in the gastro-intestinal tract.

[Determination of early changes in the rheumatoid hand with an electronic color analyser]. / Bestimmung von Frühveränderungen an der rheumatoiden Hand mit einem elektronischen Farb-Analysator.

Using soft rays, X-ray pictures were taken of the hands of patients with possible and probable rheumatoid arthritis, and were then subjected to electronic colour analysis. This method represents a contribution to early diagnosis of rheumatoid arthritis, makes the distinction between the joint capsule and rheumatoid pannus possible, and ensures the early discovery of cartilage damage, which has not been possible with any other noninvasive method.

Double-blind crossover comparison of piroxicam and indomethacin in rheumatoid arthritis.

This 10-week, double-blind, crossover study compared piroxicam (20 mg administered once daily) and indomethacin (25 mg administered three times daily) in patients with rheumatoid arthritis. In the 30 patients evaluated, both drugs produced statistically significant improvement after 4 weeks compared to placebo in all parameters measured with the exception of joint swelling and 10 m walking time. Piroxicam provided greater improvement with respect to the severity of pain, joint tenderness and restoration of motion, and was significantly more effective than indomethacin in reducing the consumption of paracetamol and in improving morning stiffness. Both drugs were equally effective in improving the remaining parameters measured. Roughly, two-thirds of the patients considered piroxicam to be the more effective agent. With both drugs side effects were mild and infrequent.

[Pustular arthro-osteitis. A new entity among rheumatic diseases?]. / Pustulöse Arthroosteitis. Eine neue Entität unter den rheumatischen Krankheiten?

A patient is shown with symptoms of the anterior thoracic wall syndrome and pustulous changes on the palms an soles. In the clinical picture, a painful swelling of the medial third of the right clavicle dominated, while the general state of the patient was good. Laboratory findings showed positive tests of inflammatory activity, while the rheumatoid factors and the HLA B 27 antigen were negative. Radiologically wide-spread destructive changes of the medial part of the right clavicle were found, with signs of periostosis in the active phase of the disease and osteosclerosis in remission. The symptoms of the anterior thoracic wall have often relapsed, while the plamo-plantar pustulosis was present only at the onset of the disease. The function of locomotor system remained undamaged even after eight years of the disease duration. The disease was, after its clinical, laboratory and radiological aspect, different from all up to now known rheumatic diseases as well as from other diseases with symptoms on the locomotor system. It fits into the syndrome which was described by japanese authors under the name of "pustulous arthroosteitis".

Double-blind crossover comparison of piroxicam and indomethacin in rheumatoid arthritis.

This 10-week, double-blind, crossover study compared piroxicam (20 mg given once daily) and indomethacin (25 mg given three times daily) in patients with rheumatoid arthritis. In the 30 patients evaluated, both drugs produced statistically significant improvement after 4 weeks compared to placebo in all measured parameters with the exception of joint swelling and 10 m walking time. Piroxicam tended to provide greater improvement in the severity of pain and joint tenderness than indomethacin, while both drugs were equally effective in improving morning stiffness, grip strength, and range of joint motion, and in decreasing paracetamol consumption. Nevertheless, roughly two-thirds of the patients considered piroxicam to be the more effective agent. With both drugs side effects were mild and infrequent.