Reliability of posturographic measurements in the assessment of impaired sensorimotor function in chronic low back pain.

UNLABELLED: The evaluation of postural stability using posturography could be both a valuable functional diagnostic and treatment outcome monitoring tool in rehabilitation practice of patients with chronic low back pain (cLBP). No evidence, however, seems to exist, whether or not such posturographic measures are reliable in these patients and therefore clinically and scientifically useful. The aims of this study were manifold and aimed at investigating (1) differences of posturographic measures between cLBP patients and healthy controls (HCs), (2) short- (intrasession-) and long-term (intersession-) reliability of these measurements, and (3) the relationship between both pain intensity and test-related feelings and significant learning effects of the posturographic measures in cLBP. A total of 32 cLBP patients and 19 non-sportive HCs completed (1) comprehensive clinical examination, (2) quantitative posturographic testing (SMART EquiTest, Neurocom International, Clackamas, Oregon) that included all the sensory organisation test (SOT), the motor control test (MCT) and the adaptation test (ADT) and (3) psychological ratings of pain as well as posturographic test related personal feelings and fear associated beliefs. Of these, 22 cLBP patients who received no therapy repeated all measurements and examinations on a second day, 2-3 weeks later. Results revealed significant differences between cLBP patients and HCs in the more demanding postural test conditions of the SOT and the SOT composite score only. Intra-session reliability testing demonstrated significant improvements of the SOT and ADT measures for both HCs and cLBP patients. Results of long-term reliability testing showed significant improvements of the more challenging SOT conditions and SOT composite score. VAS ratings of pain, feelings and fear associated beliefs were not associated with such longitudinal changes. CONCLUSION: Our findings suggest that the significant learning effects observed for the SOT conditions may limit the clinical application of SMART EquiTest postural stability measures for cLBP patients in rehabilitation everyday practice. Further development in software processing will be necessary to identify new postural parameters that are less prone to learning effects.

Implementation of the Vienna Hydrotherapy Group for Laryngectomees--a pilot study.

GOALS: Laryngectomy involves several problems for the individual, such as the need to cope with a stoma, adjustment to tracheostomal breathing, and the formation of a voice. Contact with water, resulting in aspiration, may prove fatal for laryngectomized patients in the absence of appropriate aids. The aim of this pilot study was to conduct a hydrotherapy group for laryngectomized patients and to evaluate its feasibility and outcome in relation to the goals of therapy. PATIENTS AND METHODS: Six male patients who had undergone laryngectomy were included in a pilot study. The patients underwent a structured hydrotherapy rehabilitation program (three times a week for 8 weeks), using a special underwater therapy device. The patients' posture was controlled by posturography and their endurance capacity by standard ergometry and the 6-min walk. The parameters of fatigue, expectoration, mobility, elasticity/flexibility, postural control/coordination, and general well being were registered on a visual analog scale (VAS). Quality of life was assessed by having the patients fill out the German version of the SF-36 Health Survey. MAIN RESULTS: Posturograpy findings showed an improvement of two subtests ( p<0.028). Exercise testing showed an improved endurance capacity ( p<0.028). The patients were able to walk a greater distance in the 6-min walking test ( p<0.028). The VAS also showed an improvement of endurance capacity ( p<0.028), fatigue ( p<0.028), expectoration ( p<0.043), mobility of the neck and shoulder ( p<0.027), flexibility ( p<0.027), postural control and coordination ( p<0.028), and general well being ( p<0.028). On the SF-36 Health Survey, the patients were improved in the items "Physical functioning" ( p<0.027), "Vitality" ( p<0.027) "Role-physical" ( p<0.026), and "Social functioning" ( p<0.043). CONCLUSIONS: A hydrotherapy group for laryngectomized patients proved to be safe, feasible, and effective in this pilot study.

Azathioprine treatment and male fertility in inflammatory bowel disease.

BACKGROUND & AIMS: Long-term treatment with azathioprine (AZA) is well established in inflammatory bowel disease (IBD). AZA is metabolized to 6-mercaptopurine (6-MP), which interacts in purine metabolism and is therefore considered to have mutagenic potentials. This is the first study to examine the influence of AZA on semen quality. METHODS: Semen quality was examined and compared with World Health Organization (WHO) standards regarding sperm density, motility, morphology, ejaculate volume, and total sperm count in 23 IBD patients treated with AZA. In 10 of these patients, a semen sample was assessed before and during AZA treatment; in another 5, semen analysis was performed twice during at least 2 years of AZA therapy. RESULTS: In 18 patients treated with 1.5-2 mg/kg AZA daily for at least 3 months but without sulfasalazine, sperm density was 94 +/- 84 Mio/mL (94% within WHO standard), motility was 60% +/- 20% (67% within WHO standard), the proportion of sperm with normal morphology was 44% +/- 21% (67% within WHO standard), ejaculate volume was 3.4 +/- 1.5 mL (89% within WHO standard), and total sperm count was 297 +/- 272 Mio (94% within WHO standard). No changes in semen parameters were noted after 11 +/- 5 months of AZA administration or during long-term treatment (49 +/- 14 months). Sulfasalazine administration in 5 patients was associated with markedly reduced semen morphology. During the study period, 6 patients fathered 7 healthy children. CONCLUSIONS: Our data show that AZA does not reduce semen quality and thereby male fertility in IBD.

Prediction of response to iron sucrose in inflammatory bowel disease-associated anemia.

OBJECTIVE: Inflammatory bowel disease (IBD)-associated anemia responds to i.v. iron therapy. However, because of concurrent chronic inflammation, some patients do not respond adequately. Erythropoietin therapy has been shown to be effective in the latter cohort. Our goal was to find parameters that can predict the effectiveness of iron sucrose in IBD-associated anemia. METHODS: One hundred three patients with severe IBD-associated anemia (Hb < or = 10.5 g/dl) were treated prospectively for 4 wk with iron sucrose (total iron dose = 1.2 g) in an open label, multicenter trial. Treatment response was defined as an increase in Hb of > or =2.0 g/dl. A logistic regression analysis was performed with treatment response as the dependent variable and the following independent variables: serum erythropoietin, mean corpuscular Hb, transferrin, ferritin, soluble transferrin receptor (sTfR), C-reactive protein, interleukin 6 (IL-6), and disease activity. RESULTS: Sixty-seven of 103 patients (65%) responded to iron sucrose. From the variables under investigation, erythropoietin, sTfR, transferrin, and IL-6 were significantly associated with treatment response. The R2 values showed that erythropoietin (8.0%), sTfR (11.4%), and transferrin (10.4%), but not IL-6 (1.3%), contribute a relevant amount of information to the model. An estimated 80% probability of treatment response was found at erythropoietin levels of >166 U/L, sTfR levels of >75 nmol/L, or transferrin levels of >3.83 g/L. CONCLUSIONS: Serum erythropoietin, sTfR, and transferrin concentrations have the potential to predict the response to iron sucrose therapy in IBD-associated anemia. These parameters may help to identify individuals who benefit the most from additional erythropoietin treatment.

Scaling-violation phenomena and fractality in the human posture control systems.

By analyzing the movements of quiet standing persons by means of wavelet statistics, we observe multiple scaling regions in the underlying body dynamics. The use of the wavelet-variance function opens the possibility to relate scaling violations to different modes of posture control. We show that scaling behavior becomes close to perfect, when correctional movements are dominated by the vestibular system.

Health-related quality of life in patients with Crohn's disease: influence of surgical operation--a prospective trial.

Improvement of health-related quality of life (HRQOL) is a major determinant in decision-making for surgery in patients with Crohn's disease (CD). This study was designed to investigate the short- and long-term effect of surgical resection for CD on HRQOL. Sixteen patients were investigated within one week before surgery and 3, 6, and 24 months postoperatively. Besides the Crohn's disease activity index (CDAI), four instruments: the time trade-off technique (TTO), the direct questioning of objectives (DQO), the rating form of inflammatory bowel disease patients concerns (RFIPC), and the Beck depression inventory--were used for assessment of HRQOL. CDAI decreased significantly after operation and 10 patients remained in remission for 24 months. Two patients had postoperative relapses and went into remission after prednisolone treatment. Four patients developed chronic active disease. HRQOL was significantly improved in all patients three and six months postoperatively. Except for the four patients with chronic active disease, all other patients (N = 12) had also significantly improved HRQOL after 24 months. In conclusion, surgical resections in CD lead to a long-term improvement of HRQOL with the exception of patients with chronic active disease. This finding might be taken in consideration for the indication of surgery in CD.

Autologous blood donation for surgery in inflammatory bowel disease--a report of six cases.

BACKGROUND: Surgery in inflammatory bowel disease (IBD) is frequently associated with need for perioperative blood transfusions carrying the potential risk of infection. Autologous blood donation is often limited by IBD-associated anemia which is reversible by intravenous iron and erythropoietin. We therefore tested the feasibility of autologous blood donation in IBD. METHODS: Six patients (five Crohn's disease, one ulcerative colitis) with indication for elective bowel resection were treated after informed consent was obtained. Two to four blood donations were scheduled during four weeks prior to surgery. Once a week 350-450 ml of blood were collected from patients with a hemoglobin level above 11.0 g/dl. After each donation 200 mg of iron saccharate diluted in 0.9% saline were given to all patients intravenously as substitute for donation-related iron loss. Patients with preexisting anemia or C-reactive protein above 2.0 mg/dl received concomitant erythropoietin. RESULTS: The scheduled number of packed red cells was donated successfully by four patients. Due to low hemoglobin levels two patients donated one unit less than intended. Four patients received autologous blood transfusions intra- or postoperatively. No patient needed homologous blood. No serious adverse events were observed during blood donations, perioperatively, and during the one year follow-up period. CONCLUSION: Preoperative autologous blood donation is save and feasible in IBD patients with elective bowel resection.

[The importance of the cystic medio-necrosis of aorta and great arteries in cardio-vascular surgery (author's transl)]. / Die Bedeutung der zystischen Medianekrose von Aorta und grossen Arterien für die kardiovaskuläre Chirurgie.

Based on the experiences of 14 observations a correlation between clinical picture and histological damage of aortic wall in medio-necrosis Erdheim-Gsell is tried. In the preoperative phase the definitive diagnosis is seldom possible. Atypical pathological findings at the aorta or great arteries must be suspected to be caused by medio-necrosis Erdheim-Gsell.