[Neurogenic bladder in diabetes mellitus]. / Les neurovessies du diabete.

BACKGROUND: Diabetic bladder dysfunction is among the most common complications of diabetes mellitus. It is principally caused by autonomic neuropathy defining diabetic cystopathy. AIM: characterize the bladder dysfunction in patients with diabetes mellitus. METHODS: The clinical and urodynamic records of patients with diabetes mellitus were reviewed. RESULTS: 40 patients with diabetes mellitus were included in the study mean aged 55 years. 32 patients had voiding dysfunction. Urinary frequency and difficulty emptying were the predominant symptoms that led to patient referral. 15 patients (31.25%) had decreased flow rates. 12 patients (37.5%) had diminished bladder sensation and/or impaired detrusor contractility. 10 patients (25%) had detrusor hyperreflexia and 6 patients had impaired detrusor contractility with increased bladder sensation. Vescico-uretral dyssynergia was found in 2 patients (5%). CONCLUSION: This study suggests that classical diabetic cystopathy is not the most common urodynamic findings in patients with diabetes mellitus and demonstrates the importance of urodynamic studies in diagnosing bladder dysfunction in diabetics before initiation of therapy.

[Functional impairment in patients with rheumatoid spondylitis of the pelvis]. / Evaluation du retentissement fonctionnel de la pelvispondylite rhumatismale a propos de 30 cas.

AIM: To assess functional impairment in patients with rheumatoid pelvispondylite. METHODS: cross-sectional study conducted on patients with rheumatoid pelvispondylite. Data are collected in a form specifying the epidemiological and demographic data, disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), metrological static and dynamic examination. Evaluation of functional impairment by Bath Ankylosing Spondylitis Functional Index (BASFI), and likert scale assessing social, economic and physical disability. RESULTS: 30 patients (22 men), the mean age is 37.2 years old; twenty one patients are without work. The mean duration of disease is 13.36 years, 50% are annoyed by morning stiffness than one hour, spinal pain and fatigue. The average value of BASDAI is 43.72/100; the average value of EVA fatigue is 56.16/100. The average value of BASFI is 56.36/100. An important or very important social, economic and physical disability was felt among 67% of the patients, which is correlated with duration of the disease, the BASDAI index, work, and the BASFI index. CONCLUSION: The functional impairment caused is statistically correlated with the intensity of the pain, the fatigue, the morning stiffness and BASDAI index, This impact on the quality of life is increased by the low level of education and poor professional integration.

[The contribution of home based exercise programme in case of osteoarthritis of the knee]. / Interet d'un programme d'auto reeducation a domicile dans la prise en charge de la gonarthrose.

BACKGROUND: Knee Osteoarthritis is the most frequent articular disease. It may cause disability and handicap. AIM OF THE STUDY: to assess the effect of a home based exercice programme in a Tunisian population having knee osteoarthritis, associated with medical treatment and education. METHODS: Prospective study during three months, including 34 Tunisian patients with knee osteoarthritis. A clinical and functional assessment of the patients was made using respectively the visual analogic scale for the pain, the Lequesne index, the Functional Independence Measure and the womac function score for the function, the HAQ and SF 36 for the assessment of the quality of life. RESULTS: Visual analogic scores for pain were reduced in the exercise group. Lequesne index scores reduced significantly in the exercise group and were unchanged in the controls. Quality of life was greater in the exercise group compared with the controls. CONCLUSION: Home based exercise programme contributes to relieving pain, maintaining function and to ameliorate the quality of life of people having knee osteoarthritis.

[Capsular distension and physical therapy in treatment of adhesive capsulitis]. / Association distension capsulaire et rééducation immediate dans la prise en charge de la rétraction capsulaire de l'épaule.

OBJECTIVE: to evaluate the efficacy of capsular distension combined with intraarticular glucocorticoid injections and immediate physical therapy in the treatment of adhesive capsulitis. METHOD: a prospective open study of patients with adhesive capsulitis. Clinical and radiological criteria was used for diagnosis. Clinical evaluation was realized before treatment, at the end of the treatment, after 1 month, 3 months and 6 months. It carried on: the measure of pain and handicap intensity by an Visual Analogue Scale, the algo-functional score of Constant, the measure of passive articular mobilities. We ended in a success of the treatment when the visual analogue scale of handicap < 30, the score of Constant >70, the passive abduction >90 and the external rotation (RE) >45 degrees. RESULTS: 19 patients were included, mean aged 56 years with capsular retraction evolving on average for 8.5 months. The parameters of evaluation of pain function and handicap improved significantly since the end of treatment. This improvement continued until 6 months after the treatment. Earning in articular amplitudes was significant since the end of treatment for forward extension and internal rotation. However, the improvement in abduction and internal rotation was significant only at 3 months. In spite of this early significant improvement in external rotation, 6 patients had an important limitation of the RE (<20 degrees). A subacromial bursography with steroid injection was proposed to them because subacromial bursa is almost consistently involved by retraction. Only, 4 patients among them accepted it. Out come was favorable in every case with a external rotation >45 degrees at I month of the treatment. The rate of success which was only 47.3% at the end of the treatment, is crossed in 73.6% at 1 month and reaches 89.4% at 6 months. CONCLUSION: The therapeutic association capsular distension, intraarticular steroid injections and physical therapy allows to shorten the course of adhesive capsulitis. Burso-infiltration seems to be effective as therapeutic complement in case of persistence of an articular limitation.

[Place of orthotic devices in the neuromuscular diseases]. / Place de l'appareillage orthopédique dans les maladies neuromusculaires.

UNLABELLED: INTRODUCTION-AIM: If neuromuscular diseases differ by the age of the beginning, the mechanism, the topography and the evolution, they have in common to pull a deficit of the muscular force which establishes the main consequence of these diseases. The orthopedic devices is an essential constituent of the coverage. The purpose is to warn or to correct orthopaedic deformations, to protect, to facilitate or to supply a function, to assure a better comfort and to get for the patient the best quality of life. The purpose of this study is to emphasize the place of the orthopedic devices in the therapeutic protocol, the modalities of attributions but also the frequent difficulties. MATERIAL AND METHODS: retrospective inquiry with patients affected by neuromuscular diseases justifying an orthopedic devices assessed at the monthly multidisciplinary consultation of the service of physical and rehabilitation medicine of the National Institute of Orthopaedics M. Kassab from November, 2002 till April, 2003, the patients listed in the National Institute of Neurology and the patients seen at home. RESULTS: 30 cases of average age 16.7 years with extremes of 6 years and of 54 years. All the subjects of our study use an orthopaedic device which is either an orthosis, or a technical device. The most prescribed orthosis are those of the trunk. the posterior thigh-leg-foot thermo-formable night splints come at the head of list of the orthosis of lower limbs. The lack of satisfaction is reported especially for the orthosis of the trunk. Delivery periods are on average of five months. CONCLUSION: the orthopedic device plays a fundamental role in the physiotherapy strategy. It is always prescribed in multidisciplinary way by taking into account deficits, environment and demand of the patient allowing so the purchase of an adapted and comfortable equipment. "Reproaches" and demands of the users are a delivery periods often long and an insufficient coverage notably for technical and organization of residence. We propose according to a review updated by the literature, the recommendations allowing a better prescription of an performing equipment.