Effect of triamcinolone acetonide injections on hemiplegic shoulder pain : A randomized clinical trial.

UNLABELLED: Background and Purpose-Hemiplegic shoulder pain is not uncommon after stroke. Its origin is still unknown, and although many different methods of treatment are applied, none have yet been proved to be effective. We sought to study the efficacy of 3 injections of intra-articular triamcinolone acetonide on pain and arm function in stroke patients with hemiplegic shoulder pain. METHODS: -In a multicenter, randomized, placebo-controlled clinical trial, patients with hemiplegic shoulder pain received either 3 intra-articular injections of 40 mg triamcinolone acetonide or 1 mL physiological saline solution (placebo). Primary outcomes were pain measured according to 3 visual analogue scales (score range, 0 to 10), and arm function was measured by means of the Action Research Arm test and the Fugl-Meyer assessment scale; secondary outcomes were passive external rotation of the shoulder and general functioning measured according to Barthel Index and the Rehabilitation Activities Profile. RESULTS: -In the triamcinolone group (n=18), the median decrease in pain, 3 weeks after the last injection, was 2.3 (interquartile range, 0.3 to 4.3) versus 0.2 (interquartile range, -0.5 to 2.2) in the placebo group. This result was not statistically significant. The change in the other outcome measures did not differ significantly between the 2 treatment groups. Twenty-five patients reported side effects. CONCLUSIONS: -In the 37 participants included in this study, triamcinolone injections seemed to decrease hemiplegic shoulder pain and to accelerate recovery, but this effect was not statistically significant. Therefore, on the basis of the results of this study, these injections cannot be recommended for the treatment of patients with hemiplegic shoulder pain.

Unusual negative side effects of non-steroidal anti-inflammatory drugs in the proximal colon.

Two cases of uncommon side effects of non-steroidal anti-inflammatory drugs (NSAID) are presented which show that in special cases NSAID lesions can be located predominantly in the proximal colon, that NSAID-caused lesions may present themselves as diaphragm-like strictures and that alterations by NSAID in this part of the bowel may bring enormous problems for the differential diagnosis.

[Success and complication rates of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography--a prospective study]. / Erfolgs- und Komplikationsraten der diagnostischen und der therapeutischen endoskopischen retrograden Cholangiopankreatikographie--eine prospektive Studie.

The aim of the prospective study was to evaluated the efficacy and the complications of 2,820 ERCP-examinations in 1,717 consecutive patients (performed over a three-year period). The rate of success was 82.8% for diagnostic ERCP, 96.6% for endoscopic sphincterotomy, 76.8% for the extraction of stones on common bile tract, 87.5% for drainage in bile tract obstruction, respectively. The rate of all complications amounted to 7.9% (4.9% diagnostic ERCP, 9.2% therapeutic ERCP, in detail: 3.8% acute pancreatitis, 2.1% cholangitis, 1.3% bleeding, 0.2% perforation, 0.5% other respectively). The total mortality was 0.1% (three cases of death). The frequency of complications increased with the number of procedure at the papilla Vateri in patients, who underwent needle knife papillotomy in combination with standard papillotomy.

[Foreign bodies in the bile ducts and their endoscopic removal]. / Fremdkörper in den Gallenwegen und ihre endoskopische Entfernung.

The diagnostic and therapeutic management is described in four cases with foreign bodies of the biliary tract: ball of thread, T-bougie, shell splinter, peel of greens. The possibilities of therapeutic endoscopy are emphasized.

[Causes of gastrointestinal hemorrhages in chronic liver diseases]. / Ursachen gastrointestinaler Blutungen bei chronischen Leberkrankheiten.

356 patients with chronic liver diseases hospitalized in our clinic during the period from January 1, 1981, to December 12, 1983, were enrolled in a retrospective study. Of them 55 had been admitted for acute gastrointestinal hemorrhage. It appears that gastroscopy is the only method allowing to localize the origin of the bleeding with high certainty. Bleedings from varices (45%) and ulcers or erosions (22%) were seen most frequently. With regard to case history, clinic, paraclinic and prognosis, no significant differences were found between these various origins of the hemorrhages. Also it is remarkable that all bleedings occur with higher frequency in portal hypertension.

[Emergency endoscopy in chronic liver diseases]. / Notfallendoskopie bei chronischen Lebererkrankungen.

Emergency endoscopy has to be regarded as a method of high diagnostic value. Based on the resulting therapeutic consequences and with allowance for the prerequisites and contraindications, emergency endoscopy in chronic liver diseases is to be considered a purposeful method. If endoscopic treatment possibilities in bleedings of the gastrointestinal tract continue to improve, the demonstration of an improvement in prognosis by emergency endoscopy seems to be merely a question of time.

[Effect of Visotrast (R) and bilirubin on lipase and alpha-amylase activities of pancreatic secretions]. / Der Einfluss von VisotrastR und Bilirubin auf die Aktivitäten von Lipase und alpha-Amylase im Pankreassekret.

The contamination of pancreatic juice obtained by endoscopic retrograde catheterism of the papilla by cannulation of the pancreatic duct with contrast medium is possible. When the amount of "VisotrastR 370" is more then 0.05 ml per ml one observes a decrease of the lipase while alpha-amylase is unchanged.--Bilirubin has also an influence on the activity of lipase - but not on the alpha-amylase.

[Sarcoidosis involvement and adenocarcinoma of the stomach]. / Sarkoidosebefall und Adenokarzinom des Magens.

A 59-years old woman showed 5 years after the diagnosis of a sarcoidosis of stage II--III according to Wurm and Reindell an abdominal symptomatology in the sense of an ulcerous disease. Radiological, endoscopical and bioptical examinations revealed a small contraction of the antrum, an ulcus at first diagnosed as benign and an adenocarcinoma. In the resected part of the stomach were found noncaseating granulomas with Epithelioid cells and Giant cells as well as the adenocarcinoma. 1 1/2 years after partial resection of the stomach (B II) a recurrence of the carcinoma near the anastomosis and metastases in the lymphonoduli of the abdomen were found by autopsy. Thoracic of abdominal manifestations of the sarcoidosis could no longer be demonstrated.

[Early stomach cancer in our clinical sample]. / Das Magenfrühkarzinom im eigenen Krankengut.

In the period from 1971 to 1980 we studied 11 650 patients undergoing endoscopy of the stomach. We found in 427 patients a gastric cancer. In 63 patients we found an early cancer, according to 14% of all gastric cancers. The main symptoms were pain and loss of appetite. In 34% of the patients the duration of complaints was more than 1/2 year. In more than 50% the early cancer was located in the distal part of stomach. In 52% we observed the ulcerative lesion of the gastric mucosa. The histological findings were in 52% the intestinal type and in 72% the diffuse type of early gastric cancer. The precise diagnosis of an early cancer based on the histological examination of the gastric wall after gastric resection, with the exception of loopectomy and polypectomy with well-defined diagnosis of an early cancer. By the aid of preventive examination of patients with so-called precancerous condition of the gastric mucosa we see a possibility to increase the detection of early gastric cancer.

[Results of coloscopic polypectomy in respect of the dignity (author's transl)]. / Ergebnisse der koloskopischen Polypektomie im Hinblick auf die Dignität.

The commonest type of polyps in the large intestine in our series of 506 polypectomies in 262 patients were adenomas (64%) especially tubular adenomas. Severe epithelial atypia being present in 11% of all adenomas and it was three times more discovered in villous adenomas than in tubular forms and with increasing adenomas size. Because severe epithelial atypia could be observed in polyps with diameters less than 5 mm it should be demanded to remove each polyp for an exact histological examination independent of his size. Single forceps biopsies of polyps do not allow the estimation of their further development in view of malignancy.

[Malignant lymphomas: involvement and complications of the gastro-intestinal tract (author's transl)]. / Maligne Lymphome: Manifestationen und Komplikationen im Gastrointestinaltrakt.

Among 100 patients with malignant lymphomas we found 7 with primary involvement of the gastrointestinal tract and 2 with secondary affection. 2 patients suffered from M. Hodgkin and 7 from non-Hodgkin-lymphoma. The absence of characteristic diagnostic data may lead to incorrect results, as shown. There false diagnoses cannot be excluded neither by endoscopy nor by histology of biopsy material. Every operation on the gastrointestinal tract under the suspicion of a malignant lymphoma should be improved used for the staging. A radio- and/or polychemotherapy has stage depending to follow. On the other hand these are followed by a high percentage of gastrointestinal complications (6% incomplete ileus) which require a gastrointestinal intensive care.

[Pharmacokinetics of cefaclor and initial therapeutical experience (author's transl)]. / Zur Pharmakokinetik von Cefaclor und erste therapeutische Erfahrungen.

Twelve normal volunteers in the fasting state were given 1000 mg cefaclor, and the serum and urine concentrations over 8 h and 24 h respectively were measured. The average peak serum concentration was 34.6 +/- 7.8 mg/l, this value being reached after 65.2 +/- 11.1 min; the half-life was 42.5 +/- 8.3 min. In another six volunteers the absorption of 500 mg of 'cefaclor following administration in the fasting state and after a test breakfast was studied. The peak serum concentrations after administration in the fasting state were 16.1 +/- 3.2 mg/l, and after a meal 12.5 +/- 1.9 mg/l; the areas under the curve did not differ. The low recovery rate of cefaclor in urine observed in this series of investigations could be partly explained by the inactivation of the substance in urine. Cefaclor was administered therapeutically to 23 patients, most of whom were suffering from bronchopulmonary infections and chronic pyelonephritis. The results of therapy were good in four patients, satisfactory in 13 patients and unsatisfactory in three patients. Intolerance was rare.