[Unclear chronic vertigo syndromes-experiences with an interdisciplinary inpatient diagnostic concept]. / Unklare chronische Schwindelsyndrome ­ Erfahrungen mit einem interdisziplinären stationären Diagnostikkonzept.

Dizziness is a common leading symptom. Especially patients with chronic vertigo syndromes experience a significant impairment in quality of life up to a limitation of their ability to work in the case of employed persons. The consequences are financial and capacitive burdens on the health system due to frequently multiple examinations and sick leave up to occupational invalidity of the affected patient. In 150 patients with chronic vertigo syndromes and an unclear outpatient diagnosis, at least one diagnosis that justified the complaint was made in over 90% of cases on the basis of a structured interdisciplinary inpatient diagnostic concept. Chronic vertigo syndromes are often multifactorial. Psychosomatic (accompanying) diagnoses were found in more than half of the patients. Targeted therapy can only be recommended after establishing a specific diagnosis. This justifies an interdisciplinary inpatient diagnostic concept for persistently unclear cases.

[S3 guidelines on treatment of polymyalgia rheumatica : Evidence-based guidelines of the German Society of Rheumatology (DGRh), the Austrian Society of Rheumatology and Rehabilitation (ÖGR) and the Swiss Society of Rheumatology (SGT) and participating medical scientific specialist societies and other organizations]. / S3-Leitlinie zur Behandlung der Polymyalgia rheumatica : Evidenzbasierte Leitlinie der Deutschen Gesellschaft für Rheumatologie (DGRh), der Österreichischen Gesellschaft für Rheumatologie und Rehabilitation (ÖGR) und der Schweizerischen Gesellschaft für Rheumatologie (SGR) und der beteiligten medizinisch-wissenschaftlichen Fachgesellschaften und weiterer Organisationen.

Polymyalgia rheumatica (PMR) occurs almost exclusively in persons aged 50 years or older and it is the second most common inflammatory rheumatic disease in older people after rheumatoid arthritis. Since there are no specific tests for PMR, the exclusion of clinically similar differential diagnoses is essential to ascertain the diagnosis. These recommendations for the management of PMR assume an already established diagnosis of PMR. It is recommended to initiate treatment with glucocorticoids immediately after diagnosis and to provide appropriate patient information and education about the impact of the disease and its treatment. Methotrexate should be considered in patients at high risk for relapse and/or glucocorticoid-related adverse events. These guidelines have been elaborated because there is significant heterogeneity in the management of PMR in clinical practice in Germany (but also Europe and worldwide), despite the large number of patients with this disease. These guidelines are primarily based on the 2015 EULAR-ACR recommendations for the management of PMR, which were updated by the guideline committee and adapted to the German speaking countries.

The influence of endurance exercise on the antioxidative status of human skin.

Oxidative stress is supposed to be responsible for a diversity of diseases. For protection purposes, the human organism exhibits a line-up of antioxidant substances functioning as radical catchers. As a result of neutralization of free radicals, antioxidants are destroyed. Therefore, the degradation of the antioxidants can be utilized as an indirect parameter for the measurement of free radical formation. As physical exercise may also induce oxidative stress, the aim of the present study was to determine the antioxidant substances, and more precisely, the carotenoid concentration in the skin of male volunteers during different sportive exposures (cycling and running with two different exercise intensities) with resonance Raman spectroscopic measurements. The results revealed that moderate and high intensity cycling and running decrease the carotenoid concentration of the skin, whereas both sport disciplines and both exercise intensities revealed similar results. It can be concluded that above a certain threshold, physical exercise leads to oxidative stress also in the skin associated with the decrease in the antioxidant concentration. This gives rise to the impairment of the first defence line of the skin and means an increase in the risk of sun exposure-induced damage, e.g., when exercise training is performed outside. Nevertheless, it has to be emphasized that sport in general applied at moderate loads has predominantly positive effects on the health of humans especially concerning cardiovascular and metabolic diseases.

[Physical medicine in hospital. Minimum standards in a physical medical department in acute inpatient areas in rheumatology]. / Physikalische Medizin im Krankenhaus. Minimalstandards in einer physikalisch medizinischen Abteilung im akutstationären Bereich in der Rheumatologie.

Standards for what should be available in terms of equipment and services in a department of physical medicine caring for acute inpatients do not exist in Germany. The profile of a department determines the therapeutic services it focuses on and hence the technical facilities required. The German catalogue of operations and procedures defines minimum thresholds for treatment. In the opinion of the authors a department caring for inpatients with acute rheumatic diseases must, as a minimum, have the facilities and equipment necessary for offering thermotherapeutic treatment. Staff trained in physical therapeutic procedures and occupational therapy is also crucial. Moreover, it is desirable that the staff should be trained in manual therapy.

[The role of the cervical spine and the craniomandibular system in the pathogenesis of tinnitus. Somatosensory tinnitus]. / Die Rolle der Halswirbelsäule und des Kiefergelenks bei Tinnitus. Der sog. somatosensorische Tinnitus (SST).

The causes of tinnitus, vertigo, and hearing disturbances may be pathological processes in the cervical spine and temporomaxillary joint. In these cases, tinnitus is called somatosensory tinnitus (SST). For afferences of the cervical spine, projections of neuronal connections in the cochlear nucleus were found. A reflex-like impact of the cervical spine on the cochlear nucleus can be assumed. The tinnitus treatment concept of the Charité University Hospital in Berlin involves the cooperation of ENT specialists with many other disciplines in an outpatient clinic. A standardized examination protocol has been established, and physical therapy has been integrated into the interdisciplinary tinnitus treatment. For tinnitus-modulating therapy of muscular trigger points, local anesthetics as well as self-massage or treatment by a physiotherapist or osteopath are useful.

[Group therapeutic concept for chronic tinnitus]. / Gruppentherapeutische Ansätze bei chronischem Tinnitus.

The aim of this article is to show an established group therapeutic concept for chronic tinnitus. The treatment of chronic tinnitus is intended to improve the way patients cope with tinnitus but it does not eliminate it. It means that patients learn how to reduce the impairment they are experiencing. Patients with tinnitus are supported in the process of habituation through the treatment. Multimodal cognitive behavioral therapeutic interventions in a group setting are particularly helpful because they may demonstrate differences in the influence of cognitive processes on the emotional perception of the tinnitus between the patients. Psychological factors like emotional support through other patients and learning from other examples can ease the process of internalizing coping strategies. Psychological processes seem to be of particular importance. Those processes can have an effect on concentration, appraisal, and coping with the tinnitus. Progressive muscle relaxation using Jacobson's technique, physical therapy, education via lectures, training of selective attention and change of appraisal, mental attitude and behavior concerning the tinnitus are the main factors in tinnitus therapy and can enable tinnitus patients to decrease their psychological strain.

[Peripartum changes of the pelvic ring: usefulness of magnetic resonance imaging]. / Peripartale Veränderungen des Beckenringes: Wie sinnvoll ist die Magnetresonanztomografie?

PURPOSE: Postpartum pelvic pain beyond the normal level poses a problem to obstetricians. Beyond normal physiologic loosening of the pubic symphysis and sacroiliac joints (SIJs) during pregnancy, symphyseal separation and rupture must be excluded. The aim of this prospective study was to determine whether magnetic resonance imaging (MRI) allows for reliable differentiation of normal postpartum findings and pathologic lesions. MATERIAL AND METHODS: The study included a total of 77 women (mean age 30), among them 21 healthy subjects (group A), 21 asymptomatic postpartum women (group B), and 35 patients with postpartum pelvic pain (group C). The analyzed parameters comprised symphyseal and iliosacral tenderness, subjective pain assessed on a visual analog scale, and data pertaining to obstetric history. All 77 women underwent 1.5T MRI of the pelvic ring using oblique angulated coronal T 1-weighted and STIR sequences for imaging of the symphysis and SIJs in one slice package. Analysis of the MR images comprised signal intensities of pelvic bone marrow, width of the symphyseal cleft, and the symphyseal capsule. RESULTS: Subjects in group A in general had a normal bone marrow signal. The STIR sequence showed increased signal intensity of the pubic bone near the symphysis in 16 women (76 %) of group B and 31 patients of group C (86 %) (not significant). An increased periarticular bone marrow signal of the SIJs on the STIR images was seen in 13 women (62 %) of group B and 23 patients (63 %) of group C. The mean width of the symphyseal cleft differed significantly among the three groups (3.4 mm vs. 5.4 mm vs. 6.7 mm). A width >10 mm was observed in only 4 cases (11 %). Moreover, associated findings such as interpubic hematoma (n=23) or tears of the symphyseal capsule (n=7) were detected in patients of group C. CONCLUSION: The wide overlap of findings between symptomatic and asymptomatic postpartum patients does not allow reliable differentiation by MRI of normal and abnormal findings. MRI contributes to the differentiation of symphyseal contusion and rupture and provides information on severe associated changes.

Qigong versus exercise therapy for chronic low back pain in adults--a randomized controlled non-inferiority trial.

BACKGROUND: The value of qigong in the treatment of chronic low back pain is unclear. In a randomized controlled trial, we evaluated whether qigong is non-inferior to exercise therapy in patients with chronic low back pain. METHODS: German outpatients (aged 46.7 ± 10.4) with chronic low back pain [mean visual analogue scale (VAS), 53.9 ± 12.5 mm] were enrolled and randomly allocated in a 1:1 ratio to receive either qigong (64 patients, 12 sessions with 1 × 90 min/week over 3 months) or exercise therapy (63 patients, 12 sessions 1 × 60 min/week). The primary outcome measure was the average pain intensity over the last 7 days on a VAS (0-100 mm, 0 = no pain, 100 = worst imaginable pain, non-inferiority margin = 5 mm) after 3 months. Follow-up was measured after 6 and 12 months. RESULTS: The mean adjusted low back pain intensity after 3 months was 34.8 mm [95% confidence interval (CI) 29.5; 40.2] in the qigong group and 33.1 mm (95% CI 27.7; 38.4) in the exercise group. Non-inferiority of the qigong group compared with the exercise group failed to show statistical significance (p = 0.204). In both groups, 10 patients reported suspected adverse reactions (e.g., muscle soreness, dizziness, pain) the total number was comparable in both groups (qigong n = 40, exercise n = 44). CONCLUSIONS: Qigong was not proven to be non-inferior to exercise therapy in the treatment of chronic low back pain. Its role in the prevention of chronic low back pain might be addressed in further studies.

[Functional disturbances of the cervical spine in tinnitus]. / Funktionsstörungen der Halswirbelsäule bei Tinnitus.

BACKGROUND: A total of 189 patients with tinnitus, Meniere's disease, and sudden hearing loss underwent manual therapeutic examination at the Department of Physical Medicine and Rehabilitation in the setting of an interdisciplinary program for the management of patients of the tinnitus daycare center and inpatients of the ENT department of the Charité Medical School. METHOD: In all patients, global and segmental joint mobility of the cervical spine, cervicothoracic junction, first rib, and craniomandibular system was assessed using standardized documentation. Muscle extensibility and trigger points were determined for the sternocleidomastoid muscle, the descending part of the trapezius muscle, the levator muscle of the scapula, and the masseter muscle. RESULTS: Results of the statistical analysis show that patients with tinnitus have characteristic and specific patterns of abnormalities in the joints and paravertebral muscles. The dominant finding is an overall impairment of cervical spine mobility, to which various factors contribute. These include disturbed function of segmental joints of the head and the cervicothoracic junction as well as muscular imbalances of the shoulder and neck muscles. CONCLUSION: Our results corroborate the clinical significance of manual therapeutic findings as part of the diagnostic workup for tinnitus. They show that a uniform and standardized examination protocol is needed, and that appropriate physical therapeutic measures should be incorporated into the interdisciplinary therapeutic management of patients with tinnitus.

[The role of stress in the pathogenesis of tinnitus and in the ability to cope with it]. / Stress bei der Tinnitusentstehung und -verarbeitung.

Besides the impairment of somatic functions, other factors including stress, and psychological and social characteristics are known to be important factors in the pathogenesis of tinnitus and the ability to cope with it. Existing coping strategies and psychosocial factors may have an influence on the degree of stress perceived through tinnitus. In the case of missing habituation, serious psychological, neurological and immunological responses to tinnitus are possible. In order to reduce the cognitive and emotional tinnitus-distress associated with this, there should be a focus on providing functional coping strategies combined with cognitive behavioural elements.

[Integrated intensive treatment of tinnitus: method and initial results]. / Integrierte Tinnitusintensivbehandlung: Konzept und erste praktische Erfahrungen.

In recent years, no major advances have been made in understanding the mechanisms underlying the development of tinnitus. Hence, the present therapeutic strategies aim at decoupling the subconscious from the perception of tinnitus. Mindful of the lessons drawn from existing tinnitus retraining and desensitisation therapies, a new integrated day hospital strategy of treatment lasting 7-14 days has been developed at the Charité Hospital and is presented in the present paper. The strategy for treating tinnitus in the proximity of patient domicile is designed for patients who feel disturbed in their world of perception and their efficiency due to tinnitus and give evidence of mental and physical strain. In view of the etiologically non-uniform and multiple events connected with tinnitus, consideration was also given to the fact that somatic and psychosocial factors are equally involved. Therefore, therapy should aim at diagnosing and therapeutically influencing those psychosocial factors that reduce the hearing impression to such an extent that the affected persons suffer from strain. The first results of therapy-dependent changes of 46 patients suffering from chronic tinnitus are presented. The data were evaluated before and after 7 days of treatment and 6 months after the end of treatment. Immediately after the treatment, the scores of both the tinnitus questionnaire (Goebel and Hiller) and the subscales improved significantly. These results were maintained during the 6-month post-treatment period and even improved.