The effects of pole walking on health in adults: a systematic review.

The aim of this systematic review was to summarize the effects of pole walking (PW) programs on physical and psychosocial health. Randomized controlled and controlled trials were identified from literature searches in PubMed, Cochrane library, EMBASE, SPORTdiscuss, CINAHL and PEDRO. A total of 14 articles from 13 studies met the inclusion criteria. Eleven of the included studies had a quality score of 50% or higher. Most studies included mid to older aged men and women in clinical populations with various medical conditions. Only two studies included nonclinical populations. The majority of the PW programs consisted of supervised group sessions performed two to three times weekly for 8 weeks or longer. Most studies investigated the effects of PW on both physical and psychosocial health and the majority examined effects on four to five outcomes. The effects of PW on cardiorespiratory fitness were most extensively studied. The most frequently examined psychosocial measure was quality of life. All studies reported at least one beneficial effect of PW compared with the control group. The results of this systematic review indicate that PW programs have some beneficial effects on both physical and psychosocial health in adults with and without clinical conditions.

Expression of neurotransmitter genes in motor regions of the dyskinetic rat after iminodipropionitrile.

Rats treated with iminodipropionitrile develop a neurobehaviour syndrome with dyskinesia. Searching for the molecular correlates, we have examined the expression of selected genes involved in neurotransmission in motor regions using hybridization histochemistry. Frontal cortical and thalamic vasoactive intestinal peptide (VIP) expression, and striatal dynorphin, enkephalin (ENK) and substance P expression were increased. No change in cortical cholecystokinin (CCK), ENK, glutamic acid decarboxylase (GAD) and somatostatin (SRIF) expression, in striatal GAD, SRIF, nitric oxide synthase (NOS) and guanylate cyclase expression, and in thalamic CCK, GAD and thyrotropin-releasing hormone expression was found. NOS expression in the subthalamic nucleus as well as tyrosine hydroxylase, GAD and CCK expression in the substantia nigra were unchanged. These results confirm the involvement of striatal projection neurons in dyskinesia and suggest a novel role for VIP.

Hyperperfusion of anterior cingulate gyrus in a case of paroxysmal nocturnal dystonia.

The authors report the clinical, EEG, and SPECT findings of a patient with nocturnal paroxysmal dystonia. Ictal and interictal scalp EEG showed epileptiform activity over both frontal lobes. Subtraction ictal SPECT co-registered to MRI indicated a bilateral significant hyperperfusion in the anterior part of the cingulate gyrus. These results support earlier electrophysiologic investigations by others suggesting that anterior cingulate epilepsy may manifest as nocturnal paroxysmal dystonia, and illustrate the usefulness of computer-assisted SPECT analysis.

[The diabetic foot--view of the primary care physician]. / Der diabetische Fuss--aus der Sicht des Hausarztes.

When dealing with feet of diabetic patients, disciplined and structured action on the part of the primary care physician--general practitioner or specialist--will ward off disabling and costly consequences. The physician replaces the patient's missing neuropathic sensibility; he demonstrates leadership during visits by checking the patient's feet, their pulse, look, feel of their skin, temperature, neurologic deficits and state of care. Shoes need to be checked thoroughly. Findings include dermatologic, angiologic, neurologic, orthopedic and hygienic problems. These require rapid and expert therapy and prophylaxis even when considered of lesser importance in non-diabetic patients. Practical schemes and sound reasoning along with a treatment team (podologist, orthopedist, diabetic consultant) are the steps to success: keeping the feet free of disease, even with a progressing degree of diabetes.

Cavernous malformations of the brain stem. A review of 139 cases.

A retrospective analysis of 139 patients with brain stem cavernous malformations is presented. The material consists of 41 cases from Bern and Phoenix and 98 further well-documented cases from the literature. Sixty-eight patients were male, 70 were female. The average age was 31.8 + 11.8 years. Sixty-two percent of the cavernous malformations were in the pons, 14% were in the mesencephalon, 12% were in the pontomesencephalic and in the pontomedullary junction, and 5% were in the medulla. Eighty-eight percent of the patients showed evidence of recent or previous hemorrhage, 55% had one hemorrhage. 17% had two hemorrhages, and 17% had three or more hemorrhages. Twelve patients died from a hemorrhage, 5 with the first bleeding and 7 with a rebleeding. The minimum bleeding rate was 2.7% per year and the average rebleeding rate 21% per year and per lesion. Most lesions had a diameter between 10 and 30 mm. Increase in size was observed in 12 of the patients; this corresponds to about 21% when only patients with a follow-up of at least one year are considered. In 93 patients the cavernous malformation was removed operatively while in 30 patients the lesion was not removed. In the group with conservative management at the end of the observation period (up to 25 and 32 years), 66.6% had no or only a slight neurological deficit, 6.7% were moderately disabled, 6.7% were completely dependent, and 20% had died. In the group treated surgically 83.9% had no or only a slight neurological deficit, and 15% were moderately disabled. One patient remained severely disabled, no patient died. The limitations of the retrospective nature of this study are stressed.

Current pattern of in-hospital aneurysmal rebleeds. Analysis of a series treated with individually timed surgery and intravenous nimodipine.

The management of aneurysmal subarachnoid haemorrhage has recently changed considerably. Emergency admission to specialized centres and early surgery have become common practice. In addition, the use of nimodipine has gained widespread acceptance. Little data are available concerning the frequency and temporal profile of reruptures under the current policies. The case histories of 387 patients treated for aneurysmal subarachnoid haemorrhage between January 1984 and March 1992 were reviewed with regard to the incidence of in-hospital reruptures. All patients were managed according to the same protocol including a policy of individually timed early surgery and intravenous nimodipine. A total of 44 first in-hospital rebleeds were observed during the waiting period. Two percent of the patients admitted on the day of haemorrhage had a rebleed on the same day after admission to the hospital. No rebleeds were observed on the day after subarachnoid haemorrhage. Rebleed rates on day 2 and 3 were also low with 0.6 and 0.8% of the population with an unclipped aneurysm. For the following 10 days, the daily rate of rerupture increased. A further peak was observed during the 4th week. Using life-table methods, the cumulative rate of rebleeds was calculated as 23% within 2 weeks and 42% within 4 weeks. Although patients suffering rebleeds differed in several respects from patients without rebleeds, most of the differences could be identified to be a consequence of a selection bias resulting in a longer period of exposure to the risk of rerupture for certain subgroups. Only patients suffering a loss of consciousness after the initial subarachnoid haemorrhage were definitively exposed to a higher daily risk of rerupture.(ABSTRACT TRUNCATED AT 250 WORDS)

The contact phase of blood coagulation in diabetes mellitus and in patients with vasculopathy.

The contact phase has been studied in diabetics and patients with macroangiopathy. Factor XII and high molecular weight kininogen (HMWK) are normal. C1-inhibitor and also alpha 2-macroglobulin are significantly elevated in diabetics with complications, for alpha 2-macroglobulin especially in patients with nephropathy, 137.5% +/- 36.0 (p less than 0.001). C1-inhibitor is also increased in vasculopathy without diabetes 113.2 +/- 22.1 (p less than 0.01). Prekallikrein (PK) is increased in all patients' groups (Table 2) as compared to normals. PK is particularly high (134% +/- 32) in 5 diabetics without macroangiopathy but with sensomotor neuropathy. This difference is remarkable because of the older age of diabetics and the negative correlation of PK with age in normals.

Platelet aggregation, beta-thromboglobulin and platelet factor 4 in diabetes mellitus and in patients with vasculopathy.

We have studied 155 subjects, 48 normals, 36 diabetics without complications, 44 with complications and 27 patients with macroangiopathy. beta-Thromboglobulin (beta-TG) and platelet factor 4 (PF4) are elevated in the patients groups. There is no correlation between the plasma levels of beta-TG and the stages of either retinopathy or macroangiopathy or nephropathy. The difference is more marked between normals and diabetics with neuropathy (p = 0.026). The aggregation response to ADP and platelet activating factor (PAF) is enhanced at lower stimulator concentration. Using the beta-TG, PF4 and aggregation values the discriminant analysis allows a distinction of several subgroups especially with nephropathy and neuropathy (Table 6).

Fifteen coagulation and fibrinolysis parameters in diabetes mellitus and in patients with vasculopathy.

Fifteen haemostasis parameters have been measured in 48 normal persons, 36 diabetic without and 44 with complications and 27 with peripheral arterial disease. Since the patient groups are older than normals, part of the differences are due to age. However, the differences are significant between normals and patients. They become highly significant for the diabetics with complications and nephropathy (Table 7). In diabetics without complications factor VIII functions, fibrinogen and thrombin time are related to age whereas there is a negative correlation for the fibrinolytic activity and antithrombin III. The diabetic complications shade off the correlations, which subsist only for VIIIR:CoF, VIIIR:Ag, ATIII and lysis before stasis. With Hbalc as dependent variable VIIIR:CoF is the only significant predictor variable in diabetics (Table 9).

[Systemic thrombolysis of arterial occlusions of the lower extremities. Comparison of various treatment schedules]. / Systemische Thrombolyse arterieller Verschlüsse der unteren Extremitäten. Vergleich verschiedener Behandlungsschemata.

From 1971-1982 121 patients with arterial occlusions of the lower limbs underwent systemic thrombolysis treatment at the Kantonsspital Basel. During 4 time-periods, 3 different treatment schedules were evaluated consecutively: a) individually titrated high dose streptokinase (SK), b) individually titrated low dose SK and c) p-plasmin, followed by low dose SK-infusion. Thrombolytic success rates did not differ significantly with the 3 treatment schedules. Nevertheless, the p-plasmin-SK scheme tended to the thrombolytically more effective (68%) than high-dose (58%) or low-dose (50%) SK. The most frequent side effects were bleeding complications. In 6 out of the 121 patients, intracranial bleeding occurred and was lethal in 1 of the patients. The incidence of this most serious complication of 4/47 during the sequential p-plasmin-SK schedule led the authors to abandon this scheme for the treatment of arterial occlusions. The intracranial bleeding complications are much less frequent in patients with deep venous thrombosis undergoing systemic thrombolysis, and hence seem to be due in part to the generalized arteriopathy often present in patients with arterial occlusions. The p-plasmin-SK schedule induced the strongest systemic proteolysis in the light of thromboplastin time and factor V values. Comparison of these data with those of other authors is very difficult because of differences in patient selection, treatment schedules and observance of contraindications. The serious prognosis for patients with acute arterial occlusions, with an overall hospital mortality of 26% (experience at the Kantonsspital Basel, 1978-1982) relativizes the importance of the side effects due to systemic thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)