Influence of various laser therapy methods on knee joint pain and function in patients with knee osteoarthritis.

BACKGROUND: The aim of the study was to estimate the influence of various laser therapy methods on knee joint pain and function in patients with knee osteoarthritis. MATERIAL AND METHODS: 125 patients were randomly assigned to 4 groups: • group I received one-wave laser irradiation (wave length 810 nm, dose 8 J/point) • group II received two-wave MLS laser irradiation (power 1100 mW, frequency 2000 Hz, dose 12.4 J/point) • group III received a similar regimen of two-wave MLS laser irradiation, but at a dose of 6.6 J per point • group IV was a placebo group where laser therapy procedures were simulated without actual irradiation. The effectiveness of the therapy was evaluated by means of Lequesne's scale, a modified Laitinen questionnaire and a visual analogue scale (VAS). Statistical analysis utilised non-parametric Wilcoxon's and Mann-Whitney's tests. Calculations were carried out with MedCalc v. 11.6.1.0. RESULTS: Statistically significant improvements in knee joint function and pain relief were seen in all groups (I, II and III). When groups I, II and III were compared, the largest improvement was found in group II (MLS laser, dose 12.4 J/point). The degrees of improvement in groups I and III were similar. CONCLUSIONS: One-wave laser irradiation at a dose of 8 J per point and two-wave laser irradiation with doses of 12.4 J and 6.6 J per point significantly improved knee joint function and relieved knee pain in patients with osteoarthritis.

Prognostic value of NT-proBNP levels in patients undergoing permanent pacemaker implantation.

INTRODUCTION: Several reports confirmed the prognostic value of the N-terminal fragment of B-type natriuretic peptide prohormone (NT-proBT) in various patient populations. Patients with medical indications for implantation of an artificial cardiac pacemaker are at high risk of cardiovascular events. There is limited data assessing the prognostic value of NT-proBNP in this group. OBJECTIVES: The aim of the study was to establish the prognostic value of NT-proBNP in patients scheduled for the implantation of a cardiac stimulator. PATIENTS AND METHODS: The study included 59 patients (average age 79.8 +/-6.3 years) with indications for implantation of a permanent pacemaker. NT-proBNP was measured in each patient on admission and 46 patients had their NT-proBNP measured 1 month after implantation. All patients were followed up for 4 years. We examined the incidence of cardiovascular events as endpoints. Finally, we analyzed the relationship between the initial concentration of NT-proBNP measured on admission and at 1 month and the risk of the occurrence of the endpoint (analysis in the group in whom events occurred vs. group without the endpoint). RESULTS: NT-proBNP values at baseline and at 1 month (NT-proBNP1month) were significantly higher in patients who experienced cardiovascular events than in those who were free of such events (NT-proBNP: 2310.6 +/-2657.7 pg/ml vs. 1177.6 +/-1364.6 pg/ml, P <0.2; NT-proBNP1month: 2538 +/-3341.4 pg/ml vs. 1139.4 +/-1294.1 pg/ml, P <0.03, respectively). A cut-off point of the initial NT-proBNP value of 577 pg/ml was estimated as the most accurate prognostic risk factor for cardiovascular events within a 4-year follow-up (sensitivity 77%, specificity 52%). CONCLUSIONS: The level of NT-proBNP prior to as well as 1 month after cardiac pacemaker implantation can be useful in identifying patients with higher risk of future cardiovascular events. We suggest using the baseline NT-proBNP concentration of 577 pg/ml as a cut-off value for assessing the risk for such events.

[Thyrometabolic disorders and heart failure]. / Zaburzenia tyreometaboliczne a niewydolnosc serca.

Thyroid hormones are essential to maintain normal function of many systems including the cardiovascular system. Their excess or deficiency may upset human body homeostasis. Hyperthyroidism leads to cardiovascular system's hyperdynamic status which is characterized by tachycardia, increased difference between systolic and diastolic arterial pressure, significant increase of the stroke volume and improvement of the left ventricular diastolic function. Long-lasting thyrotoxicosis in patient with heart disease may result in atrial fibrillation, deterioration of angina pectoris or congestive heart failure. Hypothyroidism leads to hemodynamic disturbances which are quite different than those observed in hyperthyroidism, but cardiac symptoms are scant in clinical practice. Hypothyroidism's clinical significance is limited to atherosclerosis progression and intensification of ischaemic heart disease symptoms. Both leads to symptomatic cardiovascular system failure or its deterioration. We should emphasize that cardiovascular system dysfunction associated with thyrometabolic disturbances subsides when euthyreosis is restored. It sounds promising that there are reports suggesting a potential advantage of thyroxin treatment in patients with acute or chronic cardiovascular system diseases. These hypotheses result from the observations that heart dysfunction in hypothyroidism is similar to that observed in heart failure.

The analgesic effectiveness of laser therapy in patients with gonarthrosis: an evaluation.

Background. Osteoarthrosis is a very common disease of the musculo-skeletal system. Laser therapy can be used to alleviate the pain associated with this syndrome, which markedly impinge the patients physical comfort and limit physical activity. Material and methods. The research involved 32 patients (26 women and 6 men, average age 57.3 A+/-12.1 years) with pain complaints in one knee joint and radiologically confirmed degenerative changes. The control group consisted of 32 matched patients awaiting treatment. Laser biostimulation was applied with a semiconductor laser (400 mW, wave length 810 nm). Contact (point) irradiation was applied, with a surface energy density of 12.7 J/cm2. One series of 10 procedures was performed on one knee joint, 5 days a week. Pain intensity was evaluated with the Visual Analogue Scale (VAS) and a modified version of the Laitinen questionnaire. Results. In 29 patients (91%) there was a statistically significant reduction in pain complaints in the affected knee measured by VAS. In 19 patients (59%) there was a statistically significant reduction in the frequency and intensity of pain complaints on the Laitinen questionnaire. The improvement in daily motor activity and the reduced use of antalgesic drugs were not statistically significant. Conclusions. Laser biostimulation in patients with knee pain reduces symptoms on the VAS, and significantly reduces the intensity and frequency of pain as assessed by the Laitinen questionnaire. One series of laser treatments has no significant effect on motor activity and use of painkillers in patients with chronic knee pain due to osteoarthrosis.