What is the optimal number of treatment sessions of vestibular rehabilitation?

Vestibular rehabilitation is effective and safe in patients with instability. However, there is insufficient evidence for distinguishing between efficacies of different dosage of therapies. Therefore, the aim of the present study was to verify whether there were differences between two computerised dynamic posturography (CDP) therapies of different numbers of sessions, in order to establish the optimal strategy. We conducted a prospective, comparative study of two different dosage of CDP therapy (a 5-session group and another of 10-session group) in patients with instability due to chronic unilateral peripheral vestibular disorder. We used balanced block randomisation to include 13 patients in each group. Improvement was assessed using the Dizziness Handicap Inventory and the CDP with the sensorial organisation test (SOT) and limits of stability (LOS). We found a statistically significant improvement in both groups in composite score, visual and vestibular input (SOT); and in reaction time, distance and directional control (LOS). If we compare the groups regarding these improvements, we found that 10-session group showed a greater benefit in distance covered and directional control of LOS. Since significant improvement is obtained with only five sessions, we believe this to be the optimal number of treatment sessions for most patients with chronic unilateral peripheral vestibular disorder. Nevertheless, those patients with more reduced limits of stability, and consequently greater likelihood of falling as a result of their diminished base of support, are candidates for rehabilitation protocols with a greater number of sessions.

Incidence and significance of cardiac arrhythmia in geriatric oral surgery patients.

We recorded heart rhythms of 40 older patients (20 medicated for cardiovascular disease and 20 not medicated for cardiovascular disease) during an outpatient oral surgery visit to determine overall arrhythmia incidence and severity, differences in incidence associated with cardiovascular medication status, and the impact of surgical intervention on arrhythmia incidence. We hypothesized that both groups would show similar arrhythmia numbers and types during surgical visits and that a history of medication for cardiovascular disease would not be an indicator of cardiac arrhythmia. Enrollment remained open until 20 patients older than 60 years of age from each group agreed to participate. Data were analyzed using the chi square statistic and Fisher's exact test (2-tailed). Included in the study were 24 women and 16 men; their mean age was 70.5 years (range, 60 to 86 years). Arrhythmias were detected in 17 patients and 33 of the 160 recorded rhythms. None of the detected arrhythmias were considered life-threatening. Significantly more arrhythmias occurred before administration of anesthesia than during administration of epinephrine-containing local anesthetics (p = 0.0001), and a greater number of rhythm disturbances were seen during the surgical procedure when compared with anesthesia administration (p = 0.0170). No differences in arrhythmia incidence were seen with increasing age, when male patients were compared with female patients, or when patients pharmacologically treated for cardiovascular disease were compared with patients not taking cardiovascular therapeutic medications. We conclude that although arrhythmias in this ambulatory population are common, they are typically benign in character and cardiovascular medication status is not indicative of their presence. In addition, minor oral surgery intervention with local anesthetics used in recommended dosages has no effect on cardiac arrhythmia status in the ambulatory geriatric population.

The sulfation degree of membrane-associated proteoglycan from a hemopoietic cell line is determined by changes in the growth state of the cell.

Multipotential hemopoietic progenitor cells (FDCP-mix) proliferate in culture medium supplemented with horse serum. When transferred to a medium without serum, cells do not proliferate and enter a quiescent state. Both proliferative and quiescent cells synthesize only chondroitin sulfate proteoglycan (CS-PG) which is associated to the cell membrane. Incorporation of 35SO4 into CS-PG was 4-fold higher in quiescent than in proliferative cells. Flow cytometric studies using monoclonal antibodies which recognize the core protein or the CS chains, showed that the increased uptake of sulfate was not the consequence of an increase in the abundance of CS-PG. Further characterization demonstrated that CS-PG isolated from quiescent cells exhibited a slightly higher hydrodynamic size than CS-PG from proliferative cells. However, the glycosaminoglycan chains from PG derived from proliferative and quiescent cells have the same hydrodynamic size. Through ion-exchange chromatography we observed that the mean charge density of PG from quiescent cells was higher than in proliferative cells, suggesting a higher sulfation degree from PG synthesized by quiescent cells. This was confirmed by flow cytometric studies using monoclonal antibody 2B6, which recognizes the unsaturated terminal disaccharide of chondroitin-4-O-sulfate.