[An uncommon cause of testalgia]. / Méne castá prícina testalgií.

Ten men aged 30-55 years suffered for many years from unilateral testalgia without subjective vertebrogenic complaints, and comprehensive urological examination did not reveal the cause of pain. Detailed functional examination of the spine revealed in all patients homolateral blocks of the Th-L transition, in nine men spasms of the musculus psoas, in five moreover a block of the SI synchondrosis on the same side. After a single or repeated release of the block the testalgias receded.

[Comparison of the results of therapy with vinblastine iontophoresis in post-diskectomy syndromes and other painful conditions]. / Srovnání výsledku lécby vinblastinovou iontoforézou u postdiskotomických syndromu a u jiných algických stavu.

The authors tested in 36 patients treatment of chronic intractable pain by percutaneous iontophoretic administration of an inhibitor of microtubular transport, Vinblastine inj. (G. Richter, Hungary). The groups comprised: (1) 16 patients with severe radicular pain after one or several operations of prolapsed lumbar intervertebral discs, (2) 20 patients with severe pain in the area of radicular dermal zones or dermal innervation areas of peripheral nerves. In every patient a minimum of 15 procedures were tried. Evaluation of the therapeutic effect was based on subjective data of the patient on the mitigation of pain in per cent, on the intensity of the current pain and the interference of the intensity of pain with daily activities. According to all criteria improvement was achieved in 31 subjects, i.e. in 86%. A favourable effect of treatment was observed after the 8th-10th administration. In the first group of patients clinically significant mitigation of algic symptoms was achieved in 69% of the treated subjects. In the second group a therapeutic effect was achieved in 90% of the patients. A marked difference between the two groups was found with respect to mitigation of the intensity of pain on completion of treatment. The mean mitigation of pain intensity in the first group was 24.1%, in the second group 47.7%. This difference is highly significant. With the exception of one female patient always a positive effect at the site of administration (beneath the anode) was observed.

Vinblastin iontophoresis in treating intractable pain.

A group of 36 patients were tested for the effects of percutaneous iontophoretic application of Vinblastin inj., a microtubular transport inhibitor (Gideon Richter, Hungary) in the treatment of chronic intractable pain. The group is divided into two subgroups: (1) 16 patients with persistent root pain following one or more operations for lumbar intervertebral disk herniation. (2) 20 patients with persistent pain in the area of the radicular skin zones or in the skin innervation areas of peripheral nerves. Vinblastin was injected in the place of maximal pain, 0.01% concentration in the total amount of 5 mg of active substance. The active electrode was the anode. There were at least 15 procedures per patient. The therapeutic effect was evaluated from the patients' subjective reports on pain relief in per cent, from the intensity of actual pain and from the interference of pain intensity with daily activities. Considering all the criteria, an improvement was achieved in 29 cases, i.e. 81%. The beneficial effect of the therapy was observed from the 8th to 10th application. In the first group of patients, 69% showed a clinically significant relief of the algetic symptoms. In the other group, the therapeutic effect was 90% of cases. A significant difference between both these groups was found to be in the degree of pain relief after the end of therapy. In the first group the average pain relief was 22.2%, in the other one 47.7%. This difference is statistically highly significant. Except for one case, the beneficial effect was always recorded in the place of administration (under the anode). Apart from local skin irritation in 2 patients and spot burns under the electrode in 2, no other side adverse effects were seen in the course of therapy, after its termination or at the checks made after some time interval (maximum 3 years).

Paravertebral polymyositis.

Pains in the back are usually of vertebrogenic etiology, though such discomfort can be caused by a primary muscular involvement as well - polymyositis of paravertebral muscles. Five patients were studied in the present investigation with this quite rare disease. Four of them had the diagnosis confirmed by histology, the last patient could not have the biopsy performed as she was already on a successful corticosteroid therapy. Histopathology of the muscles demonstrated a polymyositis of the parenchymatous type. Owing to a considerable polymorphism showed by the troubles and often also coincidence with the vertebrogenic component, the diagnosis and classification of primary chronic polymyositis face a series of difficulties. The disease becomes clinically manifested by muscle pain, both spontaneous and on palpation, atrophies and frequent muscle contractions. These symptoms can then result in disorders affecting the dynamics and statics of the spine. The possible participation of repeated microtraumas as one of the factors contributing to the origin of polymyositis is also discussed on the present study. The disease is treated in the same way as most of the other collagenoses, the primary chronic forms showing a much more favourable prognosis than the secondary chronic ones developing from acute and subacute forms.