Reumatizam
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Operative treatment of Ankylosing spondilitis is usually performed in treatment of extraspinal pathology, i.e. in treatment of hip contractures. Operative treatment of fixed spinal kyphosis in AS is rarely indicated, and patients make their decision for the operation when deformation becomes extreme. Instead of several hundred of operated patients in foreign literature, authors describe only 5 operations from 1989 to 2000. ⋯ However, reconstruction of lumbar lordosis significantly improve quality of life in operated patients. It is concluded that indication for the operation in AS should be indicated earlier. Better results with less risk would be achieved.
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Current opinions in chronic pain treatment with opioid analgesics are presented in this review. Justified use of opioid analgesics in treatment of chronic non-malignant pain in inflammatory and degenerative processes is emphasised. Advantages of opioid analgesics compared with non-opiod analgesics are stressed. ⋯ Trial was performed in Pain clinic of Karlovac General Hospital as a part of international multicentric clinical trial. Regarding efficacy, compared to the previous therapy, TTS fentanyl was evaluated positively by patients, both in pain control and ease of use, and by the author, for around the clock, non-invasive administration. Slow dose adjustment in rapid illness progression was recognised as disadvantage.
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In this article the advantages and the faults of diclofenac are described with short review of pharmacodynamic and pharmacokinetic properties and results of the recent clinical trials. The advantages of VOLTAREN are: efficacy in all NSAID indications, good tolerability, favourable COX-2/COX-1 ratio, the wide range of drug forms, long treatment experience and extremely acceptable cost-benefit ratio. Precaution in patients with risk is recommended.
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Tramadol hydrochloride is a centrally-acting, synthetic analgesic with a dual mechanism of action-weak opioid and monoaminergic effects. Tramadol is a racemic mixture and its mechanism of action via opioid and noradrenergic/serotonergic mechanisms is related to the independent effects of its two enantiomers. ⋯ In several post-marketing surveillance studies tramadol is showed as effective as codeine, penthazocine, pethidine and morphine with good tolerability. Tramadol might be analgesic of choice for a wide variety of painful conditions.
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Comparative Study Clinical Trial Controlled Clinical Trial
[Tramadol (Tramal) in the treatment of rheumatic diseases-- comparative study].
In order to evaluate the efficacy of centrally acting analgesics. In treating rheumatic diseases, tramadol hydrochloride (Tramal Grunental) has been administered to a group of 68 patients (36 women and 32 men), who received 100 mg twice a day during a 10-day treatment. The testing comprised 14 female patients with rheumatoid arthritis, 20 patients (7 women and 13 men) with degenerative (OA) hip and knee diseases and 34 patients (15 women and 19 men) affected by the vertebrogen painful syndrome of lumbar spine. ⋯ The visual analogue scale has been used in following the pain relief assessments during the therapy. It has thus been observed that the intensity of pain has not been significantly relieved with the acute rheumatic diseases (p > 0.05) in the control group either; that the significant pain relief has occurred with the degenerative (OA) rheumatic diseases (p < 0.05) but not in the control group; while the best analgetic effect of tramadol has been proved on the patients affected by the vertebrogen painful syndrome of lumbar spine (p < 0.01) but was not significant in the control group. During the therapeutic treatment 13 patients (19%), mostly the elderly, experienced side effects, manifested as nausea and the dry mouth.