Clinical study on the effect of mineral waters containing bicarbonate on the risk of urinary stone formation in patients with multiple episodes of CaOx-urolithiasis.

Investigations in healthy persons have shown that drinking mineral water containing HCO(3) has a positive effect on urine supersaturated with calcium oxalate (SS(CaOx)). The present study evaluates in a common setting whether these effects are also relevant in patients with multiepisodic urinary stone formation. A total of 34 patients with evident multiepisodic CaOx-urolithiasis were included in the study. Patients with hyperparathyroidism, renal tubular acidosis, Wilson's disease, Cushing disease, osteoporosis and malignant diseases were excluded. In a cross-over design and double-blinded the patients received 1.5 l of a mineral water with 2.673 mg HCO(3)/l (test water) or the same amount of water with a low mineral content (98 mg HCO(3)/l) (control water) daily for 3 days. During the study period the patients diet was recorded in a protocol, but not standardised. The main target parameter was SS(CaOx )in 24 h urine. In addition, urinary pH and the most important inhibiting and promoting factors were measured in 24 h urine (Ca, Ox, Mg, Cit). Both waters tested led to a highly significant increase in 24 h urine volume without a difference between each other. In the group, drinking the water containing HCO(3) the urinary pH increased significantly and was within a range relevant for metaphylaxis of calcium oxalate stone formation (x=6.73). This change was highly significant compared to the control group. In addition, significantly increased magnesium and citrate concentration were also observed. Supersaturation with calcium oxalate decreased significantly and to a relevant extent; however, there was no difference between the waters tested. As expected, the risk of uric acid precipitation also decreased significantly under bicarbonate water intake. However, an increase of the risk of calcium phosphate stone formation was observed. It is evident that both waters tested are able to lower significantly and to a relevant extent the risk of urinary stone formation in patients with multiepisodic CaOx-urolithiasis. In addition, the bicarbonate water increases the inhibitory factors citrate and magnesium due to its content of HCO(3) and Mg. Thus, it can be recommended for metaphylaxis of calcium oxalate and uric acid urinary stones.

[Prospective study of the long-term effectiveness of inpatient rehabilitation of patients with chronic cervicobrachial syndromes and the effect of prescribing special functional pillows]. / Prospektive Studie über die Langzeitwirksamkeit stationärer Heilverfahren bei Patienten mit chronischen Zervikobrachialsyndromen und zum Effekt einer zusätzlichen Verordnung spezieller Funktionskopfkissen.

In order to investigate the long-term effect of clinical rehabilitation measures as well as the additional effect of prescription of a special pillow in patients suffering from chronic cervicobrachialgia a total of 149 patients was investigated. All patients suffered from chronic cervicobrachialgia and were admitted for rehabilitative treatment in the orthopaedic Elfenmaar-Klinik of Bad Bertrich. For a four-week period the patients were treated with physical therapy including gymnastics, electrotherapy, thermotherapy, and massage. Additionally they underwent a health-promoting programme specially designed for patients with spondylopathia. The patients were randomly divided into two groups, one receiving a special pillow (Curavario, Pala-Medic-Company) for the use during and after the rehabilitative treatment (n = 76 or n = 73, respectively). For two weeks before the treatment, during the four-week treatment period and for two weeks after the treatment the patients had to fill in a questionnaire, comprising among others six questions on the intensity of their cervicobrachialgic symptoms (pain-intensity [local pain, radiation of pain], muscular tenseness, paraesthesia and sleep disorders [caused by pain or paraesthesia]). Three, six, and nine month after the treatment period the patients received a similar questionnaire. Immediately after the treatment period a significant reduction of mean pain intensity and muscle tenseness (p < 0.001; Rep.-Mes.-ANOVA) was found. At the same time significantly lower frequencies of pain radiation and sleep disorders caused by pain or paraesthesia (p < 0.001; chi-square-test) were found. During the following nine months the intensity of the symptoms slightly re-increased, however, all parameters were still reduced nine months after treatment compared to the values before treatment (p < 0.01). Before and during the treatment no difference between the two groups could be detected, however, the follow-up showed significantly lower scores of pain intensity (p < 0.05; Student-t-test) and sleep disorders (p < 0.01; chi-square test) in the patients who had received the special pillow. It is concluded that the rehabilitative treatment is effective in patients suffering from chronic cervicobrachialgia and that the complaints in the post-treatment period can be reduced by prescription of special pillows.