Plexusläsion als Folge einer Strahlentherapie

Ohne Zusammenfassung     

Bestimmung einer Beckenasymmetrie – Sinn oder Unsinn

Manuelle Medizin - Pathologien des tiefen Rückens, der Becken- sowie Knie- und Hüftgelenke werden immer wieder mit einer Messung der Beinlänge und Feststellung einer Beckenasymmetrie...     

Therapeutische Empfehlungen in einer pädiatrischen Schmerzambulanz

Background

Supplementary pain-related recommendations for the treatment of chronic pain in children and adolescents are an essential component of multimodal pain treatment. Studies are scarce regarding adherence to these recommendations and their effectiveness.

Objective

The aim of this study was to evaluate patient adherence to pain-related recommendations and their effectiveness 12 months after initial presentation of children and adolescents with chronic pain to a pediatric outpatient pain clinic.

Materials and methods

A total of 413 patients were assessed using a structured telephone interview. The assessment included pain characteristics during the last 4 weeks as well as information regarding the implementation of the pain-related recommendations and the effectiveness. Due to different recommendations given to migraine patients this subgroup was dealt with separately.

Results

Patients reported significant improvements 12 months after the initial presentation and 29.5?% of the patients were pain free. Adherence levels and estimated effectiveness regarding recommendations, such as change of lifestyle, multimodal inpatient treatment and use of medication were high. Other recommendations, such as active relaxation and outpatient psychotherapy had low adherence levels and low estimated effectiveness. Migraine patients had a significantly higher adherence rate and estimated effectiveness regarding the recommendation use of medication than non-migraine patients.

Conclusion

The adherence level as well as the estimated effectiveness regarding the majority of pain-related recommendations was high. Some recommendations had low adherence rates and low estimated effectiveness. These results can help to further improve the performance of outpatient clinics for children and adolescents with chronic pain.

     

Ungew?hnliche Ursache einer Erythrozytose bei einer 23-j?hrigen Erstgeb?renden in der 22. Schwangerschaftswoche

Zusammenfassung Fallbeschreibung: Eine 23-jährige Erstgebärende in der 22. Schwangerschaftswoche wurde wegen einer Erythrozytose und eines unplausibel erhöhten HbA_1c-Wertes (glykiertes Hämoglobin) internistisch vorgestellt. Familienanamnestisch ließ sich eruieren, dass ihr Vater seit zwei Jahren aufgrund einer Erythrozytose unklarer Ätiologie durch regelmäßige Aderlässe behandelt werde. Die weiterführende Familienuntersuchung erbrachte bei der Patientin und ihrem Vater eine Hämoglobinopathie vom Typ Hämoglobin (Hb) Andrew-Minneapolis. Diskussion: Die Hämoglobinvariante vom Typ Hb Andrew-Minneapolis ist in die Grupp der Hämoglobinopathien mit stark erhöhter Sauerstoffaffinität und konsekutiver kompensatorischer Erythrozytose einzuordnen. Die betroffenen Patienten sind in der Regel beschwerdefrei und normal körperlich belastbar; eine erhöhte Inzidenz von kardiovaskulären Erkrankungen konnte bisher hicht beobachtet werden. Es gibt keine sicheren Hinweise, dass eine Hämoglobinanomalie der Mutter mit deutlich erhöhter Sauerstoffaffinität mit negativen Auswirkungen auf den Fetus oder einer erhöhten Komplikationsrate unter der Geburt vergesellschaftet ist. Schlussfolgerung: Hämoglobinopathien mit deutlich erhöhter Sauerstoffaffinität sind eine seltene, aber wichtige Differentialdiagnose der Erythrozytose, deren Klärung diagnostische Irrwege für Patient und Arzt vermeidbar macht. Für die prognostische Beurteilung ist bedeutsam, dass diese Erythrozytose bei den betroffenen Patienten in weiteren Grenzen als kompensatorisch zu akzeptieren ist. Ein außergewöhnlich erhöhter oder erniedrigter HbA_1c-Wert ohne Vorliegen einer diabetischen Befundkonstellation sollte an eine Hämoglobinopathie denken lassen. Abstract Case Report: A 23-year-old pregnant woman presented with erythrocytosis and a spuriously elevated HbA_1c. Family history revealed that her father has been treated with phlebotomies for the last 2 years because of erythrocytosis of unknown cause. An examination of the family members demonstrated that the patient and her father were carriers of the hemoglobin (Hb) variant Hb Andrew-Minneapolis. Discussion: Hb Andrew-Minneapolis belongs to a group of hemoglobin variants with a high oxygen affinity resulting in compensatory erythrocytosis. The carriers of such hemoglobin variants are usually clinically asymptomatic, exercise tolerance appears unimpaired and there is no higher incidence of cardiovascular diseases. There is no clear-cut evidence that a maternal hemoglobinopathy with high oxygen affinity is accompanied by negative consequences for the fetus or a higher abortion rate. Conclusion: Hemoglobinopathies with a high oxygen affinity are a rare but important differential diagnosis of polycythemia. Under these circumstances erythrocytosis has to be accepted as the primary mode of compensation and does not require treatment, as long as blood viscosity is kept within tolerable limits. An excessively elevated or lowered HbA_1c without a history or symptoms of diabetes should lead to further investigations concerning the possibility of hemoglobinopathy.     

Station?re Schmerzkonsile einer universit?ren Schmerzambulanz

Background

The aim of this study was to conduct an audit of a university inpatient pain consultation service and to examine the quality and the implementation of the recommended therapeutic measures. Factors that influenced the implementation should be identified.

Patients and methods

All inpatients treated by the consultation service in the years 2009 and 2010 were analyzed retrospectively. Demographic patient characteristics as well as quality parameters of the consultation service and pharmacological and non-pharmacological recommendations and their implementation were analyzed.

Results

In total 1,048 requests for the consultation service were processed of which 39.7% of the requests were for patients with acute pain, 33.8% with chronic and 19.9% with tumor-associated pain. Measures recommended most were medication, physiotherapy and psychological treatment. Recommended medications were actually prescribed in more than 80%, physiotherapy recommended in about 75% and psychological treatment recommended in 47% of the cases. Only a few influencing factors for the implementation of the recommended measures could be identified.

Conclusion

Many different pain states are seen in an inpatient pain consultation service. The recommendations given are implemented in most cases especially concerning the medication.     

Evaluation einer multimodalen Schmerztherapie am UniversitätsSchmerzCentrum Dresden

Background

Data of a multimodal pain management program of the multidisciplinary pain management centre at the University Hospital of Dresden is presented. Over a period of 4 weeks, supplemented by an additional week 3 months later (booster week), patients with chronic pain of different origins are being treated in groups of 12. Based on the principles of the biopsychosocial pain model and the idea of functional restoration, the program is dedicated for pain patients where outpatient treatment was insufficient.

Methods

The program was evaluated on the basis of pain intensity (NRS), pain disability (PDI), fear and depression (HADS-D), catastrophizing (CSQ) and health-related quality of life and vitality (SF-36). The data were collected at the beginning and end of the initial 4 week treatment period, at the end of the booster period as well as 6 and 12 months after the end of active treatment.

Results

A total of 189 patients were included in the program in the period from January 2006 until August 2008. All outcome parameter showed statistically significant improvements with small to high effect sizes (ES 0.20–0.95). The results stayed stable even 1 year after the treatment. The highest effect sizes were found in catastrophizing (ES 0.86) and average pain intensity (ES 0.95). The primary pain diagnosis (e. g. low back pain versus headache) had no impact on treatment outcome.

Conclusion

Significant and clinically relevant improvements could be achieved with the multimodal pain management program in groups of 12 patients. The results were stable over a time period of 1 year. Pain diagnosis had no impact on the outcome.     

Polysomnographische Früherkennung einer kardialen Dekompensation infolge hochgradiger Aortenklappenstenose

Zusammenfassung Hintergrund:   Das obstruktive Schlafapnoesyndrom (OSAS) wird als unabhängiger kardiovaskulärer Risikofaktor diskutiert. Zentrale Apnoen mit Cheyne-Stokes-Atmung wiederum sind Folgen einer kongestiven Herzinsuffizienz und von prognostischer Bedeutung. Fallbeschreibung:   Berichtet wird über den Fall eines 74-jährigen Patienten mit langjähriger nasaler Continuous-Positive-Airway-Pressure-Therapie wegen eines bekannten OSAS. In einer Kontrollpolysomnographie zeigten sich neu aufgetretene zentrale Apnoen vom Typ der Cheyne-Stokes-Atmung ohne Zeichen einer manifesten Herzinsuffizienz. In weiteren Untersuchungen stellte sich eine neu diagnostizierte hochgradige Aortenklappenstenose mit guter linksventrikulärer Funktion dar. Klinische Zeichen einer kongestiven Herzinsuffizienz wurden erst 2 Wochen nach dem ersten Auftreten von Cheyne-Stokes Atmung beobachtet. Schlussfolgerung:   Cheyne-Stokes-Atmung kann infolge einer akuten kardialen Dekompensation schon vor den ersten klinischen Zeichen einer Herzinsuffizienz auftreten und sollte immer Anlass zu einer weiteren Abklärung sein. Anhand des Fallberichts wird das gegenwärtige pathophysiologische Verständnis der Cheyne Stokes Atmung resümiert.     

Einfluss einer Motivationsintervention auf die Bewältigung chronischer Schmerzen

Background

For effective self-management of chronic pain changes of cognitive and behavioral attitudes are required. The readiness to change can be described within the framework of the transtheoretical model (TTM) and is facilitated through motivational interviewing. This prospective study evaluated the effectiveness of brief motivational interviewing by telephone for the variables self-efficacy, cognitive and behavioral coping and psychological strain through chronic pain over a period of 9 months.

Methods

Different questionnaires, the self-efficacy expectations (ASES-D), cognitive, behavioral coping and psychological strain through chronic pain (FESV) and the German version of the pain stages of change questionnaires (PSOCQ), the FF-STABS were distributed to 147 patients at a rehabilitation clinic (indications: fibromyalgia syndrome, rheumatoid arthritis, ankylosing spondylitis). The intervention group participants received 3 telephone calls at intervals of 2 months with a follow-up time of 9 months after first study admission. At the end of the study 91 patients were enrolled for analysis (drop out rate 38%). To evaluate the effects of treatment nonparametric-analysis for longitudinal data was used.

Results and conclusion

The analysis showed significant positive effects in the intervention group for cognitive coping (U-value ?2.423; p=0.015 group × time-effect) and for coping with emotional strains of chronic pain (subscale anxiety: U-value ?2.3618; p=0.018; subscale anger: U-value 2.8638; p=0.004; group × time-effect). No significant effects were shown for self-efficacy expectations and behavioral coping with pain. Further explorative analysis of subgroups revealed slightly better treatment effects for patients with rheumatoid arthritis and ankylosing spondylitis than for those with fibromyalgia syndrome.     

Lebensqualität und Schmerz bei Patienten einer medizinisch-geriatrischen Abteilung

BACKGROUND: To determine objective and subjective indications of quality of life in hospitalized geriatric patients. METHODS: Data were collected on 267 items using standardized interviews of 90 patients, including B-L and SF-36. RESULTS: In comparison to the control population, geriatric patients have worse SF-36 values; 91% have pain, and 63% depression and elevated B-L values. Pain therapy is usually with non-opiates and with warm/cold physical therapies. CONCLUSION: Pain therapy in the geriatric population surveyed does not reach the same standard as is usually offered to hospitalized medical and surgical patients.     

Effekte einer Okklusionsschiene auf die Oberkörperstatik beim HWS-Syndrom

Aims

The aim of the study was to investigate how the movement functions of the cervical spine, shoulder and pelvic regions and the symptomatic of patients alter while using an occlusal splint for patients with problems in the cervical spine and shoulder-neck region.

Probands and methods

A total of 34 patients aged between 19 and 72 years participated in the study (12 males and 12 females). Following the initial admission examination all subjects wore an occlusal splint in a centric relation position which has to be worn at night over a period of 6 weeks. The entrance and termination investigations of posture were documented according to a manual therapeutic investigation scheme and with a 3-D back scanner.

Results

The results of the 3-D back measurements showed differences in the spinal and pelvic parameters. In the manual therapeutic examination alterations were found particularly in shoulder height and rotation and also alterations in pelvic rotation with respect to the height of the iliac crest and differences in leg length.

Discussion

The documented results of this study indicate that effects of the craniomandibular system have an influence on body posture due to an occlusal splint. However, the 6-week study period of wearing the splint seems to be too short to be able to draw conclusions. Because each examination method gives different results, the combination of manual therapeutic examination and technical measurement methods for diagnostics and control of therapy with an occlusal splint in the dental orthodontic course of treatment seems to be appropriate.     

Therapie-Outcome ein Jahr nach Erstvorstellung in einer pädiatrischen Schmerzambulanz

Background

Interdisciplinary pain treatment has been shown to be effective for children and adolescents with chronic pain, both in an outpatient and inpatient setting. Until now, the effectiveness has been analyzed with various outcome measures. Although it has only rarely been used for adolescents so far, Chronic Pain Grading (CPG) developed by Von Korff could be an appropriate general outcome measure.

Objective

The study aims at prospectively investigating and comparing the therapy outcome one year after initial presentation for both outpatients and inpatients using the CPG.

Materials and methods

Data of 258 adolescents were gathered at initial presentation and one year later and analyzed using the CPG. Changes from pretreatment to follow-up and predictors of good therapy outcome were investigated for the whole sample and separately for outpatients and inpatients.

Results

Compared to inpatients, outpatients were characterized by a lower CPG both before and one year after initial presentation. Large effects were found both for outpatient and inpatient therapy regarding the improvement of the CPG. In outpatient therapy, boys were two times more likely to display therapy success.

Conclusion

The study shows that the CPG is an appropriate outcome measure to display the long-term effectiveness of an inpatient and outpatient interdisciplinary pain treatment. The interdisciplinary pain treatment needs to be better tailored to girls to improve its effectiveness.

     

Hörscreening an Kindergärten: Ergebnisse einer Evaluierungsstudie

OBJECTIVE: This study aimed to evaluate the hearing screening of pre-school children at nursery schools in Tyrol, Austria. METHODS AND SAMPLE: 47 nursery schools with a total of 2199 enrolled children participated in the study. At the screening, the children were presented a series of tones at frequencies 0.5 kHz (25dB), 1 kHz, 2 kHz, 3 kHz, and 4 kHz (20 dB each) from portable audiometers. The tones were presented over headphones for each ear separately and at irregular intervals. Failure to respond to any of the frequencies was considered failure of the screening. Parents were then advised in written form to have the child examined by an ENT-specialist. RESULTS: 1832 individuals were screened (coverage: 83% of nursery school children; corresponding to at least 63% of all Tyrolean children aged 3 to 5 years). Of these, 390 failed the test (referral rate: 21% of all screened). Examination through an ENT-specialist occurred with 217 children, and this confirmed the positive test in 139 children (hit rate: 64%). In most cases, a temporary conductive hearing loss due to external or middle ear problems (glue ear, tube dysfunction, cerumen, otitis media) was diagnosed. A sensorineural hearing loss was found in 4 children (in 3 of them bilateral). The need for therapy was recognized in 81 children (4% of all screened). CONCLUSION: Pre-school hearing screening identifies children with ear and hearing problems that need therapeutical intervention. Although the hearing problems are mostly of a temporary nature, some may require monitoring over some period. Also some children with permanent sensorineural hearing loss may be detected through this measure. Hearing screening is an efficient means of assessing ear and hearing problems in pre-school children. However, the follow-up rate needs to be improved for optimizing the efficacy.     

Zystische Fibrose - Erstdiagnose bei einer 39-j?hrigen Patientin

Zusammenfassung Hintergrund: Die zystische Fibrose ist die häufigste autosomal vererbbare Erkrankung in der weißen Bevölkerung, die meistens im Kindesalter diagnostiziert wird. Bei den wenigen Fällen, die erst im höheren Alter auffällig werden, wird die zystische Fibrose aufgrund der Tatsache, dass dieses Krankheitsbild vielen Erwachsenenmedizinern relativ unbekannt ist und die Diagnosestellung einer Mukoviszidose im Erwachsenenalter eine Rarität ist, oft nicht in die Differentialdiagnose mit einbezogen. Eigene Fallbeobachtung: Bei einer 39-jährigen Patientin wurde nach langer Krankheitsgeschichte eine zystische Fibrose diagnostiziert. Obwohl sie die typische klinische Symptomatik mit Bronchiektasie und Pseudomonasnachweis, einer Leberzirrhose und einer exokrinen Pankreasinsuffizienz aufwies, hatte aufgrund des Alters der Patientin niemand diese Erbkrankheit differentialdiagnostisch erwogen. Die Erkrankung der Patientin blieb daher jahrelang unerkannt. Schlußfolgerung: Auch im Erwachsenenalter sollte eine zystische Fibrose bei unklarer Leberzirrhose, Bronchiektasen und Pankreasbeteiligung in Kombination oder auch einzeln in die Differentialdiagnose mit einbezogen werden. Abstract Background: Cystic fibrosis is the most common hereditary disorder among Caucasians. Most of the patients are diagnosed as children. However, some cases are going undiagnosed into adulthood and are then often misdiagnosed because the non-pediatricians do not know cystic fibrosis very well and do not consider this diagnosis in adult patients. Case Report: We present the medical history of a woman, who was diagnosed with cystic fibrosis at the age of 39 years, although she had suffered from bronchiectasis, pancreatic insufficiency and liver cirrhosis since many years. Her medical history was long with some diagnosis, but because of her age nobody considered the final diagnosis. Conclusion: In adult patients with bronchiectasis, liver cirrhosis and pancreatic insufficiency in combination or with only one of these symptoms, cystic fibrosis should be included into the differential diagnosis.     

Über die Schwierigkeit einer umfassenden Definition des Phänomens Schmerz

Although pain is part of our everyday life, to date there has been no generally accepted definition of pain. In this article is presented on a survey the various attempts to define pain. Four types of definitions can be distinguished: (a) definitions of pain oriented to a stimulus; (b) definitions of pain oriented to a reaction; (c) definitions of pain oriented to the experience of pain; (d) definitions of pain by determining the components of pain. The advantages and disadvantages of these types of definition are discussed. Using a component model, it is demonstrated that scientific investigation of pain can only grasp single aspects. Therefore, the nature of the subject implies that interdisciplinary cooperation is necessary.