Evaluation of electromagnetic fields in the treatment of pain in patients with lumbar radiculopathy or the whiplash syndrome.

Back pain and the whiplash syndrome are very common diseases involving tremendous costs and extensive medical effort. A quick and effective reduction of symptoms, especially pain, is required. In two prospective randomized studies, patients with either lumbar radiculopathy in the segments L5/S1 or the whiplash syndrome were investigated. Inclusion criteria were as follows: either clinically verified painful lumbar radiculopathy in the segments L5/S1 and a Laségue's sign of 30 degrees (or more), or typical signs of the whiplash syndrome such as painful restriction of rotation and flexion/extension. Exclusion criteria were prolapsed intervertebral discs, systemic neurological diseases, epilepsy, and pregnancy. A total of 100 patients with lumbar radiculopathy and 92 with the whiplash syndrome were selected and entered in the study following a 1:1 ratio. Both groups (magnetic field treatment and controls) received standard medication consisting of diclofenac and tizanidine, while the magnetic field was only applied in group 1, twice a day, for a period of two weeks. In patients suffering from radiculopathy, the average time until pain relief and painless walking was 8.2 +/- 0.5 days in the magnetic field group, and 11.7 +/- 0.5 days in controls p < 0.04). In patients with the whiplash syndrome, pain was measured on a ten-point scale. Pain in the head was on average 4.6 before and 2.1 after treatment in those receiving magnetic field treatment, and 4.2/3.5 in controls. Neck pain was on average 6.3/1.9 as opposed to 5.3/4.6, and pain in the shoulder/arm was 2.4/0.8 as opposed to 2.8/2.2 (p < 0.03 for all regions). Hence, magnetic fields appear to have a considerable and statistically significant potential for reducing pain in cases of lumbar radiculopathy and the whiplash syndrome.

A promising approach to the treatment of multi-infarct dementia.

Cerebrovascular multi-infarct dementia (MID) is associated with high fibrinogen levels and lipid fractions leading to an increase of both plasma and whole blood viscosity as well as raised aggregability of blood cells. One important goal in the treatment of MID therefore should be to reduce fibrinogen and lipoproteins and thereby to improve the Hemorheological State. The effect of heparin-induced extracorporeal LDL/fibrinogen precipitation (HELP), a method for safe and immediate reduction of parameters relevant to hemorheology, such as plasma fibrinogen and the lipoproteins, was investigated in 141 patients with MID. All the patients underwent two HELP applications within 8 days. The impact of HELP on MID was studied by changes of laboratory data and by evaluation of clinical symptoms before and after treatment. Each HELP session caused an immediate, safe and significant reduction of important rheological parameters such as fibrinogen, whole blood viscosity at high and low shear rate, plasma viscosity and red cell transit time. Also total cholesterol and low-density lipoprotein, lipoprotein(a) and the triglycerides had been reduced significantly. The results in laboratory measurement were followed by a statistically significant improved neurologic recovery, represented in the values of the Mathew Scale, the Mini Mental State Examination and the Activities-of-Daily-Living-Test. These results can indicate the importance and influence of hemorheology on clinical symptoms in MID.

Estrus and estrogen changes in mated and unmated free-living European ground squirrels.

The course of behavioral and vaginal estrus and patterns of circulating estrogens were followed in free-living European ground squirrels (Spermophilus citellus) after their emergence from hibernation. Normally mating females were compared to a second group in an area where males had been removed from the population before female emergence. Both groups showed vaginal estrus, but the patterns differed. Mating shortened vaginal estrus to a 3-day period compared to 8 days in unmated females. The extent (cell number) of cell cornification during estrus and the cellular components (percentage distribution) of metestrus did not differ between the two groups. Females in the area without males had significantly higher estrogen levels during estrus and metestrus compared to those in the control area. European ground squirrels were found to be monestrous, as none of the unmated females reentered estrus after metor diestrus was detected. The prolongation of vaginal estrus in unmated females can be viewed as either a physiological inevitability or an adaptation to low mate availability. The extension is still relatively short compared to other sciurid species and perhaps a product of constraints producing a strict time frame for reproduction.

Effects of ameliorated haemorheology on clinical symptoms in cerebrovascular disease.

Cerebrovascular disease (CVD) is associated with high fibrinogen levels and lipid fractions leading to an increase of both plasma and whole blood viscosity as well as raised aggregability of blood cells. One important goal in the treatment of cerebral multiinfarct dementia (MID) therefore should be to reduce fibrinogen and lipoproteins and thereby to improve the haemorheological state. The effect of heparin-induced extracorporeal LDL precipitation (H.E.L.P.), a method for safe and immediate reduction of parameters relevant to haemorheology, such as plasma fibrinogen and the lipoproteins, was investigated in 98 patients with MID. All the patients underwent two H.E.L.P. applications within 8 days. The impact of H.E.L.P. on CVD was studied by changes of laboratory data and by evaluation of clinical symptoms before and after treatment. Each H.E.L.P. session caused an immediate, safe and significant reduction of important rheological parameters such as fibrinogen (P < 0.001), whole blood viscosity at high and low shear rate, plasma viscosity and red cell transit time (P < 0.01 each). Also total cholesterol and low density lipoprotein (P < 0.0001 each), lipoprotein (a) (P < 0.003) and the triglycerides (P < 0.0001) had been reduced. The results in laboratory measurement were followed by a statistically significant improved neurologic recovery, represented in the values of the Mathew Scale, the Mini Mental State Examination and the Activities-of-Daily-Living-Test. These results can indicate the importance and influence of haemorheology on clinical symptoms in CVD.

Heparin-induced extracorporeal fibrinogen/LDL precipitation (HELP): a promising regimen for the treatment of vascular diseases.

Current management of atherosclerotic diseases consists primarily of medical therapy designed to increase oxygen supply to the heart, the brain, retinal vessels, or lower limbs. The development of these diseases is based on atherosclerotic changes induced by risk factors such as elevated levels of fibrinogen and lipoproteins. These risk factors are related to a dramatic deterioration of the hemorrheologic pattern, which reduces perfusion. Consequently, attempts are now being made to treat ischemia via hemorrheological intervention. A new treatment modality utilizing the heparin-induced extracorporeal low-density lipoprotein (LDL) precipitation (HELP), offers the possibility of obtaining therapeutic success not only in cases of severe hypercholesterolemia but also in the field of hemorheology. With HELP a safe and rapid reduction of fibrinogen and lipid fractions has become feasible, thus providing acute improvements of red cell aggregation, of the filterability of blood cells, of whole-blood and plasma viscosity, and thereby of microcirculation. Because cerebrovascular diseases are known to be related to disturbances of the hemorrheological situation, the HELP system is used in the Department of Electrobiology of Graz for the treatment of acute stroke, cerebral multi-infarct disease, and occlusions of retinal arteries.

Application of HELP in nonarteritic anterior ischemic optic neuropathy: a prospective, randomized, controlled study.

BACKGROUND: Heparin-induced extracorporeal LDL/fibrinogen precipitation (HELP) eliminates selectively fibrinogen, LDL, cholesterol, triglycerides and LP(a) from blood plasma using extracorporeal circulation. The reduction of fibrinogen and LDL by about 50% after only one procedure immediately improves the hemorheological situation. METHOD: In a prospective, randomized, controlled study over a period of 3 months, 40 patients with nonarteritic ischemic optic neuropathy (NAION) were randomly assigned to either HELP or hemodilution therapy to determine the efficacy of these two treatments on visual acuity and fields. RESULTS: After transformation of the Snellen acuity into logMAR units the statistical analysis did not show a significant difference between the two groups (P = 0.48). An increase of the visual acuity by two or more lines was obtained in 9 patients (47.4%) of the HELP group, 10 (52.6%) remained stable and none got worse. In the hemodilution group, visual acuity increased in patients (33.4%), 9 (42.8%) remained stable and 5 (23.8%) experienced a decrease. The calculated mean sensitivity of visual fields at baseline improved statistically significantly (P < 0.01) in the HELP group from 6.83 +/- 4.52 dB to 8.27 +/- 4.89 dB, but did not change significantly in the hemodilution group (6.25 +/- 4.12 dB to 6.12 +/- 3.92 dB). CONCLUSION: The HELP system seems to be safe and more effective than hemodilution in improving the hemorheological and the functional situation in NAION and could be a promising regimen in the treatment of NAION.

[H.E.L.P. therapy (heparin-induced extracorporeal LDL precipitation) in sudden deafness]. / Die H.E.L.P.-Therapie (Heparin-induzierte extrakorporale LDL-Präzipitation) beim Hörsturz.

BACKGROUND: The H.E.L.P. (Heparin-induced extracorporal low-density lipoprotein precipitation) system selectively eliminates fibrinogen, LDL (low-density lipoprotein) cholesterol, triglycerides, and LP (a) (lipoprotein a) from the blood plasma by means of extracorporal circulation. The reduction of these macromolecules immediately improves the hemorheological situation and leads to a significant decrease of plasma viscosity and red cell transmission time (RCTT), which correlates to the deformation of red blood cells. There are no known contraindications for this therapy. PATIENTS: Sudden hearing loss patients who present to our hospital are admitted for up to ten days. All patients undergo the same standardized imaging studies and examinations, consisting of audiological tests, X-rays and CT of the base of the skull, X-rays of the cervical vertebral column, neurological and internal examination, blood tests, and CSF aspiration. Patients with no obvious etiology for their hearing loss and no improvement of their hearing after two weeks of treatment with intravenous vasodilators and corticosteroids were referred for the H.E.L.P. protocol. RESULTS: We report on five patients with idiopathic sudden hearing loss who following the H.E.L.P. protocol showed complete remission or evident improvement of hearing after H.E.L.P. therapy. CONCLUSIONS: Heparin-induced extracorporal LDL (low-density lipoprotein) precipitation (H.E.L.P.) improves the blood flow and the microcirculation and therefore could be a new and effective method for the treatment of sudden hearing loss.

Influence of a single HELP application on hemorheology and retinal hemodynamics.

The heparin-induced extracorporeal low-density lipoprotein precipitation (HELP) eliminates selectively fibrinogen, total cholesterol, low-density lipoproteins (LDL) and triglycerides and improves hemorheology. We investigated the hemodynamic changes in 10 patients without ocular diseases performing a video fluorescein angiography after a single HELP procedure measuring the arm-retina time (ART) and the arteriovenous passage time (AVP). Laboratory parameters such as fibrinogen, cholesterol, LDL, triglycerides, red cell transit time, plasma and whole-blood viscosity were determined and retinal circulation was measured immediately before and after the HELP application. All of the laboratory parameters were lowered significantly. The ART was unaffected by the HELP procedure; however, there was a significant AVP reduction from 2.41 +/- 0.49 to 1.97 +/- 0.47 (p < 0.005). These results support the hemorheological and hemodynamic efficiency of the HELP system in microcirculatory diseases.

Increased cerebral perfusion following reduction of fibrinogen and lipid fractions.

High levels of plasma fibrinogen in cerebrovascular disease cause deterioration in the hemorheologic pattern, microcirculation and cerebral perfusion. We compared the value of heparin-induced extracorporeal LDL precipitation (HELP) which is a method that safely and effectively reduces plasma fibrinogen and lipoproteins and so improves the hemorheologic pattern and blood flow properties. Regional cerebral blood flow (rCBF) was measured by the 133Xe SPECT clearance method. After first measuring rCBF, 15 patients suffering from cerebral multi-infarct disease underwent a single HELP application. One hour later a second measurement of rCBF was performed. Fifteen other patients with similar clinical symptoms and findings on CAT scans who were not subjected to HELP served as controls. The HELP treatment produced an immediate and statistically significant reduction of all parameters relevant to hemorheology, such as plasma fibrinogen, whole blood viscosity at both high and low shear rate, plasma viscosity, and red cell transit time. Total cholesterol, low density lipoprotein, and triglycerides were also reduced. The treated group showed 9.7-19.9% increased rCBF in different vascular regions examined relative to the untreated controls. The results obtained indicate that HELP has a potent effect in a situation demanding rapid and significant improvement of the blood flow.

Extracorporeal fibrinogen and platelet precipitation as a new haemorheological treatment for acute stroke.

In thromboembolic brain infarctions high fibrinogen levels are associated with an increase of both plasma and whole blood viscosity as well as increased aggregability of blood cells. This decreases cerebral perfusion and might reduce blood flow in the penumbra surrounding infarction. An important goal in the treatment of acute cerebral infarction is to reduce fibrinogen and thereby improve the haemorheological state. Heparin-induced extracorporeal low-density lipoprotein/fibrinogen precipitation (HELP) appears to be successful in achieving this. Such treatment reduces lipid fractions, including total cholesterol, low-density lipoproteins (LDL) and triglycerides (p < 0.0001 each), as well as fibrinogen (p < 0.0001) in a safe and efficacious manner. Whole blood and plasma viscosity are also improved when measured by oscillo-rheometry. Furthermore, the number and aggregation tendency of blood cells is influenced positively as determined by Coulter counting and aggregometry. HELP improves the haemorheological profile to a degree which has not been achieved by haemorheologically active substances.

[Heparin-induced extracorporeal LDL precipitation (H.E.L.P.). A new therapeutic possibility in vascular occlusion of the retina--initial results]. / Heparin-induzierte extrakorporale LDL-Präzipitation (H.E.L.P.). Eine neue Therapiemöglichkeit bei Gefässverschlüssen der Netzhaut--Erste Ergebnisse.

Heparin-induced extracorporeal LDL precipitation (HELP) eliminates selectively fibrinogen, LDL cholesterol, cholesterol, triglycerides and LP(a) from the blood plasma using extracorporeal circulation. The reduction of fibrinogen and LDL about 50% after only one procedure immediately improves the hemorrheological situation, which has so far not been achieved by any hemorrheologically active substance. Five patients (1 central retinal vein occlusion, 3 branch vein occlusions, 1 central arterial occlusion) ranging from 59-76 years underwent HELP treatment six times over a 5-week period. After the first HELP procedure the fibrinogen was lowered from 278 +/- 57.8 to 157 +/- 22.2 mg/dl and LDL from 162.2 +/- 58 to 82.4 +/- 32.5 mg/dl. Plasma viscosity decreased from 1.3 +/- 0.07 to 1.1 +/- 0.05 mPa/s. At the end of the treatment an increase in visual acuity of 3 or more lines and an improvement in the visual field was seen in all patients. Measurements of the arteriovenous passage time with laser scan video fluorescein angiography before and at the end of the therapy showed a significant decrease from 3.5 +/- 1.59 to 2.88 +/- 1.54 s (P < 0.05) without influencing the arm-retina time. This first clinical and hemorrheological data on the HELP procedure in retinal vessel occlusion demonstrate a promising regimen in the treatment of acute retinal microcirculatory diseases.

A new type of database of antiepileptic medication for everyday use.

AED InfoBase, a first concept for a personal computer based database with an adequate design for everyday use is presented. AED InfoBase operates under a hypertext control program. At present it provides information about pharmacodynamics, pharmacokinetics, side effects and availability of drugs on the market of first choice anticonvulsives. A certain accent is put on drug interactions and drug therapy in epileptics.

Results of a two-month follow-up after single heparin-induced extracorporeal LDL precipitation in vascular dementia.

A trial was undertaken with 44 patients with the diagnosis of cerebral multi-infarct dementia. Of these, 24 had been exposed to single heparin-induced extracorporeal low-density lipoprotein (LDL) precipitation (HELP) whereby an immediate, safe, and statistically significant reduction of total cholesterol, LDL, triglycerides, fibrinogen (<0.0001 each), lipoprotein (a) (p < 0.003), whole-blood viscosity (p < 0.005 at high shear and p < 0.007 at low shear rate), plasma viscosity (p < 0.0002) and red cell transit time (p < 0.0001) to between 17.9% and 58.8% could be obtained within 2 h. Even an amelioration in the neuropsychological state, objectified by the Mathew Scale (p < 0.01), the Mini-Mental State Examination (p < 0.03), and the Activities-of-Daily-Living Test (p < 0.05) was observed. Despite the fact that the laboratory parameters had reached their pretreatment values within 10 days after the HELP procedure, the scores of the test battery remained stable during a follow-up period of 2 months. Within a control group (n = 20), no changes in laboratory data or in test scoring could be observed.

[Heparin-induced extracorporeal LDL precipitation (HELP). A new therapeutic possibility in cerebral multi-infarct dementia]. / Heparin-induzierte extrakorporale LDL-Präzipitation (HELP). Eine neue therapeutische Möglichkeit bei zerebraler Multiinfarktdemenz.

High fibrinogen levels have been assessed in cerebrovascular disease with a direct relationship to blood rheology. Heparin-induced extracorporeal LDL precipitation (HELP) is a method that effectively reduces fibrinogen and lipoproteins at the same time, thus improving the hemorheologic pattern. We studied 45 patients with cerebral multiinfarct dementia. After computer-randomization 30 patients received a HELP treatment, while the remaining 15 patients served as controls. HELP produced an immediate and statistically significant reduction on parameters relevant to hemorheology, such as fibrinogen (P < 0.001), total cholesterol, low-density lipoprotein, triglycerides (P < 0.0001 each) and whole blood viscosity (at high and low shear rate) as well as plasma viscosity and red cell transit time (P < 0.01 each). The treated group showed improvement after HELP (P < 0.05 for each test) on the Mathew Neurological Scale, Mini Mental State Examination and Activities-of-Daily-Living Test and also relative to the untreated controls (P < 0.05 each). These results may be regarded as a basis for some reflections about new hemorheological interventions in cases of cerebral multiinfarct dementia.

[Hemorrheology and quality of life in fibrinogen- and lipid-lowering therapy]. / Hämorheologie und Lebensqualität bei Fibrinogen- und Lipid-senkender Therapie.

Previous studies have demonstrated that heparin-induced extracorporeal LDL precipitation is able to reduce total cholesterol, LDL, triglycerides and plasma fibrinogen at the same time and thus improve the hemorheologic pattern. A combination of H.E.L.P. and bezafibrate, which also has a lipid- and fibrinogen-lowering potency, was applied in patients suffering from cerebral multi-infarct dementia and disturbances of the hemorheologic situation. In view of observations regarding improved quality of life after H.E.L.P., a prospective, randomized trial was conducted to determine possible interactions between improved hemorheology and better quality of life. To obtain a low baseline of laboratory parameters, all the patients underwent a single H.E.L.P. session and were then (double-blind) stratified into 2 groups: group 1 (16 males, 5 females, age 67.9 +/- 6.8 years) received sustained-release bezafibrate 400 mg (Bezalip) per day, while group 2 served as controls, and comprised 14 males and 5 females (age 69.2 +/- 6.8 years) who received placebo for a period of 56 days. After H.E.L.P. a statistically significant reduction of the following parameters relevant to hemorheology was obtained: fibrinogen (p < 0.0001), whole blood viscosity (low shear rate p < 0.007 and high shear rate p < 0.005), plasma viscosity (p < 0.002) and red cell transit time (p < 0.0001). Also, the metabolic parameters were influenced positively (p < 0.0001 for total cholesterol, LDL and triglycerides).(ABSTRACT TRUNCATED AT 250 WORDS)

Improved neurological recovery of cerebral infarctions after plasmapheretic reduction of lipids and fibrinogen.

BACKGROUND AND PURPOSE: High fibrinogen levels have been assessed in cerebrovascular disease with a direct relation to both plasma and whole-blood viscosity, as well as cerebral blood flow. Heparin-induced extracorporeal low density lipoprotein precipitation (HELP) is a new method that safely and effectively reduces fibrinogen and plasma lipoproteins and improves blood flow properties. METHODS: We studied 26 patients with acute embolic stroke and 22 with multi-infarct dementia. Each received two treatments with HELP within 8 days. Each patient had measurement of the important blood constituents and evaluation of changes in clinical signs and symptoms related to their cerebrovascular disease. RESULTS: Each HELP treatment safely produced an immediate and significant reduction in rheological measures, including fibrinogen (P < .001), whole-blood viscosity at high and low shear rates, plasma viscosity, and red cell transit time (P < .01 each). Total cholesterol, low density lipoprotein (P < .0001 each), lipoprotein(a) (P < .003), and triglycerides (P < .0001) were also reduced. The treated group in both the acute stroke group and the multi-infarct group showed improvement relative to the untreated control subjects in Mathew scale, Mini-Mental State Examination, and activities of daily living test scores. These uniform improvements persisted at least 3 days past the second HELP treatment. CONCLUSIONS: These results support the hypothesis that the improved hemorheologic property of blood is an important factor in clinical recovery as well as basic neurological function.

First experiences with the heparin-induced extracorporeal low-density lipoprotein precipitation in the treatment of critical limb ischaemia: a new therapeutical approach?

The heparin-induced extracorporeal low-density lipoprotein (LDL) precipitation (HELP) system is based on the fact that besides lipoproteins even fibrinogen, which seems to be a very important factor in pathogenesis of peripheral arterial disease, is precipitated by high-dose heparin at acid pH values. The elimination of excess fibrinogen and lipoproteins, in particular LDL, leads to a markedly improved microcirculation. The restoration of the latter obviously enabled us to perform limb-saving surgical procedures instead of mutilating amputations. 12 patients suffering from peripheral arterial disease were submitted to 18 HELP treatments in each case instead of having their critically ischaemic legs removed. Surgery could be limited to necrosectomy only and the wounds were either primarily sutured or covered with skin grafts. We were able to avoid 13 amputations in these 12 patients who could finally walk out of the hospital. HELP treatment was free of side effects in all of them.

Effect of heparin-induced extracorporeal low-density lipoprotein precipitation and bezafibrate on hemorheology and clinical symptoms in cerebral multiinfarct disease.

The effects of heparin-mediated extracorporeal low-density lipoprotein (total cholesterol, lipoprotein (a), triglycerides, fibrinogen) precipitation (HELP) and bezafibrate on fibrinogen, metabolic parameters, hemorheological patterns and clinical symptoms were studied in 40 patients suffering from cerebral multiinfarct disease. After a single HELP application, the patients were randomly assigned to two groups, either receiving sustained-release bezafibrate 400 mg (n = 21) or placebo (n = 19) over a period of 8 weeks. In all cases, HELP led to a statistically significant reduction of fibrinogen (p < 0.0001) and other parameters relevant to hemorheology, this effect, however, only being retained in the bezafibrate group. Parallel to this development, the Mathew scale revealed an improvement after HELP (p < 0.01 in each group) with a further improvement in the bezafibrate group (p < 0.05). The Mini Mental State Examination also showed improved results after HELP (p < 0.0005 and p < 0.03, respectively), a further improvement being observed in the bezafibrate group (p < 0.05). Comparing the day after HELP treatment to that at the end of the study, the Activities of Daily Living Score showed a statistically significant difference in the fibrate group (p < 0.05). These results support the hypothesis that the improved hemorheologic property of blood is an important factor in clinical recovery as well as basic neurologic function.

First experience in application of heparin-induced extracorporeal LDL precipitation (H.E.L.P.) in acute thromboembolic stroke.

Heparin-induced Extracorporeal LDL < total cholesterol, triglycerides, fibrinogen > Precipitation (H.E.L.P.) was applied in cases of acute thromboembolic stroke within 48 to 96 hours after onset. 42 patients had been randomized for the trial. In Group A 12 patients underwent a single H.E.L.P. application, while remaining 10 patients formed a control group. In group B 10 patients had 10 H.E.L.P. applications, the other 10 patients firmed as controls. Results of group A: 4 days after H.E.L.P. an improvement in the Mathew Scale and in the Mini Mental State Examination could be obtained (p < 0.05 each). 10 days after H.E.L.P. all the tests showed significant changes (p < 0.05 in the Mathew Scale and in the Mini Mental State Examination and p < 0.01 in the Activities-of-Daily-Living Score). Relatet to the controls there appeared a statistically significant difference 4 days after H.E.L.P. in the Mini Mental State Examination and in the Activities-of-Daily-Living Score (p < 0.05 each). At day 10 all the tests showed a difference to the controls (p < 0.05 in the Mathew Scale and p < 0.01 in the other tests). Results of group B 10: One day after 1st H.E.L.P. a statistically significant difference could be observed in all the tests (p < 0.05 in the Mathew Scale and the Mini Mental State Examination and p < 0.01 in the Activities-of-Daily-Living Score). At that time even a difference to the controls became visible (p < 0.05 in the Mathew scale, p < 0.01 in the other tests).(ABSTRACT TRUNCATED AT 250 WORDS)