Evaluation of the effect of Lake Hévíz thermal mineral water in patients with osteoarthritis of the knee: a randomized, controlled, single-blind, follow-up study.

BACKGROUND: Osteoarthritis is the most frequent joint disease and is a leading cause of pain and locomotor disability in elderly people. The treatment of osteoarthritis includes non-pharmacological, pharmacological, and surgical therapies. Silver level evidence has been found concerning balneotherapy in osteoarthritis. AIM OF THE STUDY: The aim of this study was to evaluate how Lake Hévíz thermal mineral water therapy influences pain, knee function, and quality of life in patients with knee osteoarthritis, compared to the control group. STUDY DESIGN: randomized, controlled, single-blind, follow-up study. SETTING: Spa Hévíz and St. Andrew Hospital for Rheumatic Diseases POPULATION: This study included 77 outpatients between 45 and 75 years of age with mild to moderate osteoarthritis of the knee meeting the American College of Rheumatology classification criteria. METHODS: Patients were randomized into two groups. In group I (n = 38), subjects bathed in Lake Hévíz and in group II (N.=39), patients were treated in a pool full of tap water. Water temperature was 34 °C for both groups. Participants underwent 30-minute therapy sessions, five times a week for three weeks. Outcome measures were pain visual analogue scale scores, active flexion degree, knee circumference, stair-climb time, Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and EuroQoL Group 5-Dimension Self-Report Questionnaire score (EQ-5D). Study parameters were recorded at baseline, immediately after treatment, and after 15 weeks. RESULTS: Comparison of the two groups revealed a statistically significant difference in pain visual analogue scale scores (P<0.01), active flexion degree (P<0.01), physical function components of WOMAC (P<0.05), and EQ-5D scores (P<0.05) even after 15 weeks. CONCLUSIONS: Balneotherapy improved pain, function as well as the quality of life in patients with knee osteoarthritis. CLINICAL REHABILITATION IMPACT: Balneotherapy is a potentially useful treatment modality for patients with knee osteoarthritis.

[Sesamoid osteoopathy of the foot]. / A láb sesamoid osteopathiája.

Taking parts of sesamoids in several arthroosteopathies of 160 males and 156 females in the retrospective study were investigated. On the comparative dorsi-plantar, oblique, inversion and eversion pedal plain films could demonstrate bony hypotrophy and hypertrophy of sesamoids in 124 (39.55%) of 316 subjects. Until the dorsi-plantar radiographs were obtained with 15 degrees cephalic tube angulation, then the oblique, inversion and eversion ones were unangled. Radiographically the sesamoid osteopathies were divided into mild (grade 1, 36 of 124 cases), moderate (grade 2, 44 of 124 cases) and severe (grade 3, 44 of 124 cases) forms. The affictions involved the constant sesamoid bones of forefeet (1st and 5th metatarsophalangeal joints) exclusively. Sesamoid osteopathy was clinically specified by the serious locomotive pain of ball of the feet as well unfavourable chances against conservative treatment.

[Enhanced accuracy of the X-ray diagnosis of acute abdomen with patient in the supine (pregnancy standard) position]. / Az akut hasi röntgendiagnosztika teljesítöképességének növelése dorsalis decubitus (terhességi típusú) felvételekkel.

The value of exposed to vertical central ray supine (dorsal decubitus or pregnancy standard) plain films was determined in this retrospective study in diagnosing pneumoperitoneum based on comparing of exposed to horizontal X-ray beam abdominal radiographs in 54 patients associated with perforation of hollow viscus (48 stomachs or duodenums of them). Until the anteroposterior erect or sitting and semi-recumbent positioning views moreover laterolateal supine and posteroanterior left lateral projections were negative in all cases, then in 24 of 54 subjects free intraperitoneal gas collections as spotted radiolucencies were detected inside the right upper quadrant of abdomen on pregnancy standard dorsal aspects. The orientation of gas to left upper abdominal quadrant was noted in additional 2 cases. The 18 of 26 perforations were not proceeded to free intraperitoneal space. The pregnancy standard plain film is a sensitive technique for visualisation of pneumoperitoneum after perforation of the hollow viscus between 3-6th penetration hours just as in unable to cooperation patients, particularly.

[Degenerative chondroarthropathy of the sternocostal joint following heart surgery]. / Degeneratív chondroarthropathia a sternocostalis ízületeken szívmütétek után.

Involvement of the sternocostal joints was investigated in a series of 46 males and 18 females following median sternotomy annually in a 5-year period and compared to 62 age- and sex matched control subjects after one year solely. Both groups had a mean age of 49.2 years. The degenerative chondroarthropathy of sternocostal joints was 1.69-times more frequent in heart operated upon patients as compared to control persons. Based on radiographic findings the degenerative chondroarthropathies were classed in 0 to 3 severity groups. Were seen articular space narrowing in 95.4%, osteophytes of the margin of the articular surface in 88%, subchondral bony eburnation in 79% and cystic radiolucencies in 48.9% of sternocostal joints on poststernotomy standard plain film tomograms. Not occurred intraarticular gas phenomenon and bony ankylosis. The development of arthropathies is traced back to mechanical stress-related predisposing factors and stressed the importance of oculoneutral dehiscences that simulated normal roentgenanatomic projections and caused a masked insufficiency in sternocostal junctions.

[Aspiration of barium contrast medium and its prevention]. / A bárium kontrasztanyag aspiráció és megelözése.

The authors have been noted aspiration bronchograms associated with barium-filling study of the upper gastrointestinal tract in 58 patients involving basal medial, anterior, lateral and posterior segments of the lower pulmonary lobes, mammary segment of the middle lobe, moreover inferior lingula. In 75.9% of patients (44 cases) the barium meal got to bilateral basal medial, anterior and lateral segments. The 34 men and 24 women had a mean age of 69 years (range, 29-88 years). The aspiration was found 3.8-times more frequent after completion of patient's 50th year than before it observed. A transient tertiary mobility disorder of the esophagus, extrasystoles and tendency for collapse were on barium-filling of bronchi. In 15 of the 18 patients the Valsalva's maneuver proved a pharyngomyodystonia. Carrying out of endoradiography depended on function of the lateral pharyngeal wall. The bronchi with physiological saline following aspiration of the contrast medium within 30 minutes were lavaged.

[Spontaneous pneumoperitoneum localized in the left posterior pararenal space in acute pancreatitis]. / A bal hátsó pararenalis térre lokalizált spontán pneumoretroperitoneum heveny pancreatitisben.

The authors have analysed the 220 native, erect and supine abdominal X-ray views of 65 males and 45 females with the acute pancreatitis. The localized spontaneous pneumoretroperitoneum inside the left posterior pararenal space was observed in 3.8% of patients (4 cases). The extraperitoneal gas paralleled laterally and inferiorly the margins of kidney and medially the lateral margin of the iliopsoas muscle. Superiorly the gas collection overlay the suprarenal area and outlined the medial crus of the diaphragm, occasionally. The plain-film roentgenogram depended on the quantity of the extraperitoneal gas and of the perirenal fat, besides the subdiaphragmatic adhesions. The pathognostic pneumoretroperitoneum evolved within the initial stage of acute pancreatitis. Afterwards the extraperitoneal gas was hidden by the intraluminal gas bubbles and fluid levels of the dilated small and large bowels.

[Esophageal motility disorders with palpitation]. / Nyelöcsö motilitási zavarok palpitatiónál.

The author has been studied the routine postero-anterior and profile chest screen roentgenphotographs and barium-esophagograms of the 7,152 patients with the palpitation and esophageal esthesia. The 3,612 men and women had a mean age of 23 years (range, 15-54 years). He observed extrasystoles in 20.1% of the patients during the fluoroscopy. The dysmotility and dysmorphosis of the thoracal part of the esophagus occurred in 28.9% of the tested individuals. The single and multiple spasms represented a kebab-spit, a nut-cracker, a corkscrew and after the spontaneous spasmolysis a sausage-esophagus. First the orbicular muscles relaxed. In 70.5% of the patients the abnormal motility and silhouette of the barium-filling esophagus were revealed by the profile chest screen roentgenograms.

[Early calcipenic osteopathy in the panoramic x-ray image of the maxillary and mandibular alveolar process of young adult alcoholics]. / Az állcsont és az állkapocs pars alveolarisának korai calcipeniás osteopathiája fiatal felnött alkoholbetegek panoráma felvételein.

The authors have examined 220 maxillary and mandibular panoramic roentgenograms of 55-55, all 110, between 21-34 years of age alcohol addict males and females with a complete dentitions and intact parodontium. In 19 per cent of patients developed osteoporomalacia, cystic rarefications and multiple pathologic microfractures of the alveolar spongy bone tissues. The calcipenic osteopathia was verified by the routine laboratory disorders of calcium and phosphor metabolisms, besides by the diminution of roentgenmorphometrical index of right 2nd metacarpus and tibia. The osteoporomalacia of alveolar parts preceded calcipenic osteopathia of all bones in 52 per cent of patients. A quantity of 25-50 g alcohol consumed daily would be resulting the calcipenic osteopathia after 3-5 years. Its development may be due to individual praedisposition influenced by nutritional, hormonal, genetic and hepatopancreatic factors.

[Hypertrophic osteopathy in alcoholic males]. / Alkoholbeteg férfiak hypertrophiás osteopathiája.

Hypertrophic osteopathy was observed in 5 alcohol addict men. Periosteal newbone formation on the femur, tibia, fibula, radius and ulna appeared symmetrical. The short tubular and flat bones of hands and feet did not suffer impairment. Liver biopsy confirmed in each case portal cirrhosis. Hypertrophic osteopathy is a late complication of alcohol disease. Its development may be due to individual predisposition influenced by nutritional, hormonal, genetic, pancreatohepatic and biomechanical factors.

[Cortical hyperostosis of the pisiform bone in stage I Dupuytren contracture in chronic alcoholics]. / Die kortikale Hyperostose des Erbsenbeins im I. Stadium der Dupuytrenschen Kontraktur bei chronischen Alkoholikern.

The author examined the carpalia of 40 male alcoholics suffering from Stage I of Dupuytren's contracture. In four subjects he observed a cortical hyperostosis of the right pisiform bone on the tangential films. The hyperostosis can be ascribed to the ethanol-induced hyperlipoproteinemia type II/B. The lipoids leaving the vascular paths infiltrate the connective tissue capsule of the pisiform bone and stimulate the formation of osteoblasts at the border between bone and soft tissue. The ossification must be regarded as enteropathic hyperostosis.