Ultrasound-guided needling combined with shock-wave therapy for the treatment of calcifying tendonitis of the shoulder.

We carried out a prospective, randomised controlled trial on two groups of 40 patients with painful calcific tendonitis and a mean age of 48.4 years (32.5 to 67.3). All were to undergo arthroscopic removal of the calcific deposit within six months after randomisation. The 40 patients in group I received ultrasound-guided needling followed by high-energy shock-wave therapy and the 40 in group II had shock-wave therapy alone. In both groups one treatment consisting of 2500 impulses of shock waves with an energy flux density of 0.36 mJ/mm(2) was applied. The clinical and radiological outcome was assessed using the 100-point Constant shoulder scoring system and standardised radiographs. The mean follow-up was 4.1 months and no patient was lost to follow-up. Both groups had significant improvement in their Constant shoulder score. Radiographs showed disappearance of the calcific deposit in 60.0% of the shoulders in group I and in 32.5% of group II (p < 0.05). Significantly better clinical and radiological results were obtained in group I than in group II. Arthroscopic removal of the deposit was avoided in 32 patients of group I and in 22 of group II. No severe side-effects were recorded.Ultrasound-guided needling in combination with high-energy shock-wave therapy is more effective than shock-wave therapy alone in patients with symptomatic calcific tendonitis, giving significantly higher rates of elimination of the calcium deposits, better clinical results and reduction in the need for surgery.

[Neck pain. Functional and radiological findings compared with topical pain descriptions]. / Nackenschmerz. Klinische und radiologische Befunde im Vergleich zur Schmerztopik.

Topical pain descriptions of the neck are summarized under the unspecific diagnosis "cervical syndrome" (CS). Neck pain localized in the cranial half of the cervical spine attended with occipital extension is defined as "cervicocephalic syndrome" (OCS). Pain concerning the caudal half with extention in both upper limbs or into the interscapular region is called "cervicobrachial syndrom" (UCS). The combination of both syndromes is described as "cervicocephalic and -brachial syndrom" (OUCS).The retrospective analyzed cohort of 75 patients showed a distribution of incidence of 1:20:17 of OCS : UCS : OUCS. Symptoms like headache, vertigo or tinnitus were reported in 34.7% of all cases, only 4% had MRI documented radicular lesions. Functional disturbances showed a maximum in the segments C2-3 (81.4%) and C3-4 (66.7%). Segmental blockades occurred 6 times more frequently than segmental hyper-mobility. Most of the radiological findings were localized in the vertebral segments C4-5 and C5-6, degenerative disc and joint diseases were predominant. The distribution of functional disturbances and radiological findings of the vertebral segments showed no significant coincidence. Therefore this study proved that there are no correlations between manual-medical findings and radiological results related to the subtypes of chronic neck pain.

Iloprost for the treatment of bone marrow edema in the hindfoot.

The parenteral application of the vasoactive drug, iloprost, might be a viable option for the treatment of BMES of different origins, especially ischemic ones. In edema that is secondary to osteoarthrosis or stress, the effect of therapy with iloprost depends on the grade of the basic disease. The natural course of the disease, as well as the normalization of the signal pattern of the MRI, seem to be accelerated.

Juvenile bone-marrow oedema of the acetabulum treated by iloprost.

The bone-marrow oedema syndrome is associated with local vascular disturbances and may be treated either conservatively or by core decompression after which recovery may take several weeks. We describe a 15-year-old girl with bone-marrow oedema of the left acetabulum which was confirmed by MRI. She presented with a four-week history of severe constant pain. Routine blood tests and plain radiographs were normal. She was treated with intravenous infusions of iloprost on five consecutive days (20 microg administered in 500 ml of sodium chloride). Iloprost causes vasodilatation with reduction of capillary permeability and it inhibits platelet aggregation. She had relief from pain at rest after three days of treatment and was completely free from symptoms after two weeks. MRI after six weeks showed almost complete resolution of the marrow oedema and was normal after four months. This is the first report of the pharmacological treatment of the bone-marrow oedema syndrome in children.

Treatment of bone-marrow oedema of the talus with the prostacyclin analogue iloprost. An MRI-controlled investigation of a new method.

Bone marrow oedema syndrome of the talus is a rare cause of pain in the foot, with limited options for treatment. We reviewed six patients who had been treated with five infusions of 50 microg of iloprost given over six hours on five consecutive days. Full weight-bearing was allowed as tolerated. The foot score as described by Mazur et al was used to assess function before and at one, three and six months after treatment. The mean score improved from 58 to 93 points. Plain radiographs were graded according to the Mont score and showed grade-I lesions before and after treatment, indicating that no subchondral fracture or collapse had occurred. MRI showed complete resolution of the oedema within three months. We conclude that the parenteral administration of iloprost may be used in the treatment of this syndrome.

A cholesterol intervention program for public health nurses in the rural southeast: description of the intervention, study design, and baseline results.

Residents of the rural South are at high risk for heart disease and are frequently identified as having high blood cholesterol, but sources for nutrition counseling in rural areas are often limited. To increase the availability of high quality nutrition counseling, the Food for Heart Program was developed for public health nurses and is designed to circumvent many of the obstacles common to dietary counseling. We conducted a randomized trial to assess the effectiveness of this program to lower blood cholesterol. In this report, we describe the study design, intervention program, and baseline characteristics of participants. Nurses at 17 health departments screened 781 subjects to enroll 468 with high blood cholesterol: three-quarters of the subjects were female, the mean age was 55, and 80% were white. Participants were at high risk for heart disease: 60% had two or more risk factors for coronary disease, the majority were overweight with a mean BMI of 29, and the mean cholesterol was 257 mg/dL. Reported baseline dietary intake included relatively modest consumption of high fat meats and snack foods, excessive consumption of sweets, modest intake of complex carbohydrates, and inadequate consumption of fruits and vegetables.