Diagnostic criteria in patients with complex regional pain syndrome assessed in an out-patient clinic.

BACKGROUND: Specific criteria have been described and accepted worldwide for diagnosing patients with complex regional pain syndrome (CRPS). Nevertheless, a clear-cut diagnosis cannot be confirmed in a number of cases. AIM: The objective of this study was to investigate the effectiveness of the described diagnostic criteria used by several clinical disciplines. METHODS: We included 195 patients who were referred to our pain clinic within a period of 1 year. Data were collected on patient characteristics, signs, symptoms, disease-related medication, and the background of the referring clinicians. RESULTS: The Harden and Bruehl criteria were confirmed in 95 patients (49%). These patients used a higher than average number of analgesics, opiates, and anti-oxidants, and frequently received prescriptions for benzodiazepines instead of anti-depressants. The mean disease duration was 29 +/- 4.6 months and the mean visual analogue score for pain was 8.1 +/- 0.19. A subgroup of patients had a colder temperature in the affected extremity compared with the unaffected extremity. This subgroup showed a longer disease duration and higher visual analogue scale pain. CONCLUSION: The diagnostic criteria used to determine CRPS should be further improved. A large number of referred patients experienced substantial pain, without receiving adequate medication. Disease-related medication is unrelated to CRPS-specific disease activity. Knowledge of underlying mechanisms is warranted before an adequate pharmaceutical intervention can be considered.

Age and pattern of intellectual decline among Down syndrome and other mentally retarded adults.

A comparison was made of Down Syndrome and other mentally retarded young adults in community work and residential settings for differences in cognitive profile across age groups using the Wechsler Intelligence Scale for Children. Evidence is of a significant erosion of test scores, especially performance scale scores for the non-DS mentally retarded subjects from the third to fourth decades of life. The Down Syndrome cohort remained relatively stable for cognitive profile over time with the notable exception of the Block Design subtest which declined significantly over the two decades; and in contrast with the control sample. Further investigation is suggested in the event that the Block Design subtest has potential as a diagnostic 'marker' for the early identification of DS individuals likely to be most susceptible to premature Alzheimer's-like senile dementia.

Effectiveness of rehabilitation programs on a remainder population: a retrospective analysis.

Retrospective analyses were conducted on a remainder population of 361 individuals with mental retardation at a rehabilitation institute. Program effectiveness was determined by means of aggregate and individual changes in performance on several instruments. Psychometric tests showed no significant increases in test scores whereas gains were found on all adaptive functioning instruments. Programs dealing with daily living and more conceptual material appeared to be more effective than vocational programs. One third of the remainder clients gained from the institute's programs.

Measuring oscillatory potential during the course of an arterial occlusion: a method based on Fourier analysis.

Recently we developed a quantitative method of measuring the Oscillatory Potentials (OP's) for a clinical study in diabetic patients. Several problems were experienced in interpreting the results obtained with digital filtering. The main dilemma was the separation of the first OP from the a-wave, since their frequencies are within the same range. The fast Fourier transform (FFT) was applied for this purpose. From the FFT response the power of the OP's was calculated and expressed in microwatts. The advantage of this method is clearly demonstrated in the case of a patient with central retinal arterial occlusion.

Performance of adults with developmental handicaps on alternate forms of the Peabody Picture Vocabulary Test.

A total of 154 adults with developmental handicaps involved in a comprehensive community-based habilitation program were tested on alternate forms of the PPVT and PPVT--Revised to determine interest reliabilities. A comparison of response profiles indicated that there was a significant degree of correspondence in general performance using alternate forms (p less than .0001). This correspondence was maintained regardless of whether overall raw score or mental age equivalents were used. However, a comparison of performance on individual test items that were identical on alternate forms showed less consistent results. Particular aspects of the administration and structure of the PPVT/PPVT-R and response characteristics of individuals with developmental handicaps are suggested as being important factors in test administration and interpretation with this population.

Measuring oscillatory potentials: Fourier analysis.

Studying the oscillatory potentials in diabetic retinopathy, the authors experienced several problems interpreting results of digital filtering. The main problem was the separation of the first potential from the a-wave, since their frequencies are within the same range. To improve the procedure of measuring implicit times and of calculating amplitudes, the filtering was started with a finite impulse response filter and followed by a fast Fourier transform. The power of the oscillatory potential was calculated by determining the dominant frequency in the Fourier transformed response and expressed in microwatts. A group of normal subjects was compared with a group of early diabetic retinopathy patients. It appears that even in pathological circumstances a quantitative expression of the oscillatory potential is possible.

Mental development of adults with Down syndrome.

Measures of cognitive, verbal, and functional performance obtained at widely separated time periods were examined for adults with Down syndrome. Comparisons of first and last test profiles for Raven Coloured Progressive Matrices, Peabody Picture Vocabulary Test, and Adaptive Functioning Index (Social Education) Test all demonstrated significant increases over a mean time span of 5 years. These increases could not be attributed to year of entry into program, history of institutionalization, or age of the individuals. The findings indicate that mental development of adults with Down syndrome continues well into the third and fourth decade of life.