Caudal epidural injection in the management of lumbosacral nerve pain syndromes]

The effect of epidural steroid injections was assessed in 39 patients with lumbar nerve root compression syndromes in a double-blind controlled trial, the patients were allocated at random to 3 groups. In group A (n = 13) the patients received a caudal epidural injection of 1 ml (7 mg) bethametason (Diprophos) in 10 ml normal saline and 20 ml local anesthetic (Lignocaine 1%). The second group B (n = 13) received a caudal epidural injection of 20 ml local anaesthetic (Lignocaine 1%) and 10 ml normal saline. The third group C (n = 13) received a superficial injection of 1 ml (7 mg) bethametason around of the sacral hiatus. All injections were performed by the same experienced anaesthesiologist. An independent physician, who was not aware which type of injection had been given, carried out the clinical measurements and the evaluation. Taking of analgesic drug Tramadol was permitted. The symptoms were assessed by visual analogue scale (VAS 100 mm), lumbar flexion (Schober and finger-floor distance), the angle of raised leg sign (RLS degrees), and by complete neurological examination, the investigation was made 5 times (1 hour, 24 hours, 48 hours, 1 week, and 4 weeks after epidural injections). The results between 0-1 week and 0-4 week were statistically analysed by Student-, Wilcoxon-, and Mann-Whitney test and analysis of variance (ANOVA). The mean VAS values decreased in time in all patient groups. There was no difference between the three treatment groups either after one or after 4 weeks by ANOVA. The mobility of the lumbar spine improved in all patient groups, but there was no significant difference between the three treatment groups. The raised led sign--values improved in all patient groups. There was a significant difference between the three treatment groups by ANOVA after one week, due to the difference between group A and C. After four weeks there was no significant difference. No major complications or side effects were seen in our trial. The raised leg sign due to epidural steroid injection showed better results in comparison to steroid injection around of the sacral hiatus were seen.     

A randomised, placebo controlled, comparative trial of the gastrointestinal safety and efficacy of AZD3582 versus naproxen in osteoarthritis

OBJECTIVE: To evaluate the gastrointestinal safety and efficacy of the COX inhibiting nitric oxide donator AZD3582 in patients with hip or knee osteoarthritis. METHODS: 970 patients were randomised (7:7:2) to AZD3582 750 mg twice daily, naproxen 500 mg twice daily, or placebo twice daily in a double blind study. The primary end point was the six week incidence of endoscopic gastroduodenal ulcers (diameter > or =3 mm). Overall damage measured on the Lanza scale was a secondary end point. Safety and tolerability assessments included endoscopic upper gastrointestinal erosions and the gastrointestinal symptom rating scale (GSRS). Efficacy was primarily assessed by WOMAC. RESULTS: The incidence of ulcers with AZD3582 was 9.7% and with naproxen 13.7% (p = 0.07, NS), v 0% on placebo. The incidence of Lanza scores >2 was higher with naproxen (43.7%) than with AZD3582 (32.2%) (p<0.001). Compared with baseline, significantly fewer ulcers and erosions developed in stomach and stomach/duodenum combined, and fewer erosions developed in stomach, duodenum, and both combined on AZD3582 than on naproxen. GSRS reflux and abdominal pain subscale scores were lower for AZD3582 than for naproxen but there was no difference for indigestion, constipation, and diarrhoea. AZD3582 was as effective as naproxen at improving WOMAC scores. Both agents were well tolerated, with no significant effects on blood pressure. CONCLUSIONS: At doses with similar efficacy in relieving osteoarthritis symptoms, the primary end point of six week endoscopic gastroduodenal ulcer incidence was not significantly different between AZD3582 and naproxen. Most secondary endoscopic gastrointestinal end points favoured AZD3582.     

Comparative Evaluation of Local and International Reference Databases for Forearm Densitometry: Different Impacts on Diagnostic Decisions

Reference databases play a key role in the management of osteoporosis. The aim of this preliminary study was to compare the diagnostic consequences of using either an international or a local reference database in peripheral densitometry. For this purpose, standard curves for bone mineral density (measured by dual-energy X-ray absorptiometry at the distal and proximal forearm) were generated for healthy Hungarian men and women. In total, 303 healthy volunteers of both sexes (age range: 20–94 yr) were recruited from four osteoporosis centers. Subjects with medical conditions or taking medication affecting the bone metabolism were excluded. Bone densitometry was performed with pDEXA (Norland-Stratec, Fort Atkinson, WI) devices in each center after cross-calibration of the machines. The precision error of the forearm measurement was also determined (< 1% in vitro, and 1.2–2.5% in vivo). In females, the peak forearm density was detected in the 30–39-yr group. The density decreased by 8% per 5 yr in early postmenopausal females, and by 10% per 10 yr in late postmenopausal females. In males, the highest bone mineral density was found in the 30–39-yr group for the distal forearm, but 1 decade later for the proximal site. Subsequently, a 5% decrease in density occurred per 10 yr, except in the 8th decade, in which a 20% decrease was demonstrated. One thousand four hundred thirty-four patients with suspected osteoporosis were classified according to the forearm density T-scores using both the new Hungarian reference database and the international database provided by the manufacturer. Comparison of the results measured at the distal forearm with the two different databases led to similar outcomes. However, at the proximal site, one fifth of the female patients were reclassified from the low-density group to the normal group using the domestic normative database. An opposite difference was observed for the males: use of the Hungarian reference data resulted in 40% more men being categorized in the low-density group than when the international normal database was applied. Our results suggest that not only geographic differences, but also the reference database used, can influence the prevalence of the diagnosis of osteoporosis. Further data are currently being collected to increase the statistical power of the study.     

Problems of differential diagnosis in synovial sarcoma]

The authors present a woman's case (age 50), who was hospitalised several times as she often had pain in her left leg and knee for one year. The pain increased in the last 2 months. The final diagnosis, the primer synovial sarcoma of the left knee was justified only post mortem. Not only this alteration in the knee caused the pain in the left leg. The symptoms of sciatic pain caused by lumbal discus herniation also occurred which made the diagnosis more difficult. Referring to relevant data in literature the authors analyse the differential diagnostic aspects of the final diagnosis and the clinical spectrum of the illness.     

Establishing a standard for patient-completed instrument adaptations in Eastern Europe: experience with the Nottingham Health Profile in Hungary

The widely used generic patient-completed measures of health status were developed in the USA or the UK. Few Eastern European versions of these measures have been produced and these have used questionable translation methodologies. Clinical trials now commonly include patients from Eastern Europe and require the use of patient-completed instruments. The absence of such instruments led to the development of a Hungarian version of the Nottingham Health Profile (NHP). The adaptation process employed (translation, field-testing and psychometric assessment) also served as a test of whether the standardised rigorous methodology used for adapting the NHP could be applied in Eastern Europe. Few problems were found in producing a conceptually equivalent Hungarian NHP that was acceptable to interviewees. Reliability and internal consistency of the Hungarian NHP were comparable to other language versions. The measure also correlated as expected with perceived physical disability, general health, disease severity and rating of day. This successful adaptation confirms the value of the methodology applied. The Hungarian NHP will be invaluable as an outcome measure in both clinical and health economic trials and (in the absence of a generic quality of life instrument) as a comparator instrument for the validation of future Hungarian adaptations of disease-specific quality of life instruments.     

Human leukocyte antigen‐A, ‐B, ‐C, ‐DRB1 and ‐DQB1 allele and haplotype frequencies in an Albanian population from Kosovo

HLA‐A, HLA‐B, HLA‐C, HLA‐DRB1 and HLA‐DQB1 genotyping was performed in a sample of Albanian population from Kosovo. The comparison of the respective allele frequencies through F_st analysis resulted in a close relationship with the Albanians from Albania, the Bulgarians, FYROM Macedonians and Greeks, while the other neighbouring populations are slightly more distant.