Temperature changes in superficial and deep tissue layers with respect to time of cold gel pack application in dogs.

Despite the widespread clinical use of cryotherapy, there is only limited and inconsistent data on application times. The aim of this study was to determine the changes in tissue temperature and the duration of this effect. In this experimental study, five adult dogs were used. A cold gel pack (10 x 20 cm) was applied transversally over the right leg femoral region. Temperatures were recorded simultaneously: rectal by a mercury thermometer; right leg skin by probe of Nihon Kohden 6000 polygraph; and right leg subcutaneous, intramuscular, and periosteal, and left leg intramuscular temperatures by a fluorooptic biomedical fiber optic (0.6 mm diameter) thermometer connected to a computer system. Total system accuracy was 0.01 degrees C. Cold gel packs were applied for 10, 15, 20, 25, and 30 minutes duration. The results can be summarized as cooling and rewarming data. 1) The superficial tissues such as skin and subcutaneous demonstrated the most rapid and profound cooling effect. The deeper tissues such as bone and muscle exhibited a smaller and more gradual decline in temperature. 2) There was a prolonged rewarming period in all tissues after the removal of the cold gel pack but this period was longer in deeper tissues. According to cold gel pack application time, the rewarming time in intramuscular layers to baseline or plateau temperatures was about: 60 +/- 3 minutes for 10 minutes application, 100 +/- 4 for 15, 130 +/- 5 for 20, 140 +/- 7 for 25, and 145 +/- 8 for 30. It can be concluded from these results that with increased cold gel pack application time, deep tissue temperature decreased and the duration of cooling effect increased. However, the data indicated that the length of application time and the duration of cooling effect were not linearly related. Especially after 20 minutes of application this ratio decreased progressively. There may be implications of these results for clinical practice.

Bone mineral density in women with sarcoidosis.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Almost any organs of the body, but mostly the lungs, are involved. Bone mineral density (BMD) can be affected directly or indirectly in chronic granulomatous systemic diseases such as sarcoidosis. The aim of our study was to evaluate BMD in premenopausal and postmenopausal sarcoidosis patients with or without prednisone treatment and to compare their BMD values with those of a control group having the same menopausal status. Thirty-five premenopausal women (18 untreated, 8 treated, and 9 controls) and 21 postmenopausal women (5 untreated, 5 treated, and 11 controls) were included in the study. All of the patients had a histologically proven diagnosis and were being followed-up at the Sarcoidosis Outpatient Clinic of our unit. BMD of the lumbar (L) spine and femoral neck was measured by dual-energy absorptiometry (DEXA). The subgroups of premenopausals and postmenopausals were compared separately. Comparison among the groups was performed by using analysis of variance. Age, duration of the disease, and body mass index were comparable in treated, untreated, and control subgroups of the pre- and postmenopausal groups, and the subgroups of postmenopausals had comparable durations since menopause. For premenopausals, BMD values at L1-4 were not significantly different among the subgroups (0.920 +/- 0.08 g/cm(2), 0.801 +/- 0.09 g/cm(2), and 0.910 +/- 0.05 g/cm(2), for untreated, treated, and controls, respectively). However, the BMD value at the femoral neck in treated patients (0.921 +/- 0.1 g/cm(2)) was significantly lower than the values in untreated patients (1.080 +/- 0.2 g/cm(2); P < 0.01) and in controls (1.028 +/- 0.17 g/cm(2); P < 0.05). For postmenopausals, the BMD value at L1-4 in controls (1.019 +/- 0.07 g/cm(2)) was significantly higher than the values in untreated patients (0.783 +/- 0.01 g/cm(2)) and in treated patients (0.751 +/- 0.08 g/cm(2); P < 0.001 for both). The BMD value at the femoral neck in controls (0.890 +/- 0.1 g/cm(2)) was higher than the values in untreated patients (0.745 +/- 0.08 g/cm(2)) and treated patients (0.747 +/- 0.1 g/cm(2)), but the difference was not statistically significant (P = 0.06). We concluded that sarcoidosis patients, especially postmenopausal patients with corticosteroid treatment, may have an increased risk of bone mineral loss. Large-scale studies are warranted in order to delineate the exact roles of the disease itself, menopausal status, and corticosteroid treatment in this bone mineral loss.

Multicenter, randomized, double-blinded, placebo-controlled trial of thiocolchicoside in acute low back pain.

OBJECTIVE: To evaluate the efficacy of intramuscular injection of thiocolchicoside (4 mg-2 ml) compared to placebo administered twice daily for 5 days in patients suffering from acute low back pain. PATIENTS AND METHODS: Multicenter, randomized, double-blinded, placebo-controlled trial. The study was conducted between July 1998 and March 2000 in five centers. Hospitalized patients with acute low back pain were included. The primary evaluation criterion was spontaneous pain at rest assessed by visual analog scale (VAS). Hand-to-floor distance, muscle spasm intensity, patients' global evaluation and analgesic tablet (paracetamol) consumption were used as secondary evaluation criteria. RESULTS: One hundred and forty nine patients were included. Both groups showed improvement on spontaneous pain assessed by VAS at the end of day 1; however, improvement was statistically significant in thiocolchicoside group on day 3 (P < 0.001). Hand-to-floor distance and muscle spasm determined by palpation decreased significantly on day 5 in thiocolchicoside group (P < 0.0005 for both). According to the patients' global evaluation, 76.8% of patients in thiocolchicoside group evaluated the treatment as very good/good (P < 0.0005). Also a significant difference was observed in favor of the thiocolchicoside group in the total paracetamol consumption (P < 0.001). Treatment was well tolerated in both groups and none of the patients was withdrawn from the study due to an adverse effect. CONCLUSION: Twice daily administration of 4 mg thiocolchicoside for 5 days provides an efficient and safe treatment for patients with acute low back pain accompanied by muscle spasm.

Gastrointestinal side effect profile due to the use of alendronate in the treatment of osteoporosis.

The aim of our study was to evaluate the upper gastrointestinal (GI) tract side effect profile in 759 female patients that had taken alendronate (10 mg/day), for at least 6 months, for the treatment of osteoporosis, in relation to the safety of alendronate and the compliance of patients to its absorption rules. This study was a multicentered retrospective, clinical, non- placebo controlled, study of 759 female subjects carried out at 26 centres in 6 different regions of Turkey. The mean age of our patients was 62.6 +/- 8.6, with 51.2%in the age range 60 to 69 years. 158 patients (20.8%) were considered to have upper GI tract complaints with nausea as the most often encountered symptom. Of the subjects with upper GI tract complaints, 20% reported discontinued drug use, and 30% reported the requirement of an additional drug in order to abolish their complaints. Approximately 537 (71%) of the patients stated they had been given written information about the administration of the drug, and at least 93 patients (12%) and 73 patients (18.4%) acknowledged non compliance with the safety and absorption rules, respectively. In our study, no significant difference was found between the adherence to the safety measures and upper GI tract complaints (p > 0.05), but that upper GI tract complaints were higher in patients taking additional medication to alendronate (p < 0.05).