[Future Trends in Medical Rehabilitation in the Context of Multimorbidity - Part II: Structural Requirements to Manage an Appropriate Rehabilitative Healthcare]. / Die Zukunft der medizinisch-rehabilitativen Versorgung im Kontext der Multimorbidität ­ Teil II: Strukturelle Voraussetzungen und Anforderungen an das rehabilitative Versorgungssystem.

BACKGROUND: Rehabilitative health care is paying increasing attention to multimorbid people with 2 and more coexistent chronic diseases of sociomedical relevance. METHODS: Terms, requirements, design, configuration, challenges and supply of sociomedical rehabilitation were described in part I. A project group of the Medical Advisory Board of the Federal Rehabilitation Council describes manifold fields of actions to be taken in the rehabilitation of persons with multimorbidity. RESULTS: The actions proposed range from reviewing existing forms of management to identifying rehabilitative needs and initiating accurately fitting interventions, sensitizing and enlarging competences of involved personnel, considering multimorbidity in guidelines and further research on questions still open.

Increased F-wave duration in patients with spasticity.

F-wave responses of the posterior tibial nerve have been studied in 22 patients with spasticity and in 18 normal control subjects with surface EMG. Mean amplitude and mean duration of the F-waves were significantly (p less than 0.001) longer in patients with spasticity than in healthy controls. These findings could be the result of an enhanced spinal excitability in spasticity. Based on the present results F-wave recording may be used as a simple and practical technique for detection and documentation of spasticity.

Morvan's fibrillary chorea. A case with possible manganese poisoning.

The clinical picture of Morvan's fibrillary chorea includes a. spontaneous muscular activity resulting from repetitive motor unit action potentials of peripheral origin (multiplets), b. autonomic dysregulation with profuse hyperhidrosis, and c. central nervous system involvement as shown by severe insomnia and hallucinosis. A case featuring all these symptoms is presented. Whereas known causative factors range from gold or mercury poisoning to autoimmune disorders, the presented case is the first one in which chronic manganese intoxication (occupational exposure) seems to be implicated. Manganese has been found to inhibit acetylcholine esterase, and, as a consequence, may produce peripheral and central cholinergic hyperactivity.

[Post-traumatic intracerebral hematoma]. / L'hématome intracérébral secondaire post-traumatique.

The clinical and therapeutic features of 18 delayed traumatic intracerebral hematomas (DTICH) were compared with those of 84 primitive traumatic intracerebral hematomas in order to determine the origin of this complication. This retrospective study found that: DTICH usually occurs the first week after trauma, but could happen several weeks later; patients with skull fractures are at higher risk (p less than 0.01); osmotherapy as well as barbiturate therapy seem to have no influence on this complication; craniotomy (or craniectomy) appears to be a significant factor in the cause of DTICH (p less than 0.05). The pathogenesis of DTICH could be the evolution of delayed necrosis in vessel walls from the contused area which frequently bleed after the evacuation of an extracerebral hematoma. On the other hand the cause of a DTICH after conservative therapy remained unclear.