女性压力性尿失禁的超声尿动力学初步分型

目的 对女性压力性尿失禁进行超声尿动力学分型，探讨女性压力性尿失禁的病理生理机制。方法 对64例压力性尿失禁患者和35例正常妇女进行了超声尿动力学检查，测量膀胱颈移动度（UVJ—M）和腹压漏尿点压（ALPP）两个特征性参数。结果压力性尿失禁组ALPP均值显著低于正常组（P〈0．01），UVJ—M显著高于正常组（P〈0．01）。根据UVJ—M和ALPP两个特征性参数，将压力性尿失禁组的64例病例初步分为四型：A型，UVJ—M≤1．5cm，ALPP〉55cm H2O；B型，UVJ—M〉1．5cm，ALPP〉55cmH2O；C型，UVJ—M≤1．5cm，ALPP≤55cmH2O；D型，UVJ—M〉1．5cm，ALPP≤55cmH2O。结论 压力性尿失禁超声尿动力学初步可分为四型，各型可反映尿道、膀胱颈的不同病理生理及形态改变，有助于该病治疗方案的合理选择。     

应力性漏尿点压测定在女性真性压力性尿失禁诊断中的应用

背景尿失禁包括压力性、急迫性以及二者混合型,临床上凭经验很难准确判断其类型和程度,常发生误诊误治.目的为探讨尿动力学检查,尤其是应力性漏尿点压测定对女性压力性尿失禁的诊断价值.设计回顾性平行对照观察.单位解放军第三军医大学西南医院全军泌尿专科中心.对象选择1996-01/2002-05来第三军医大学西南医院泌尿外科就诊的尿失禁女性患者120例.方法①膀胱尿道造影测定患者膀胱尿道后角＜100°判定为正常,＞100°判定为异常.尿道倾斜角＜45°判定为正常,＞45°判定为异常.膀胱尿道连接部(静态时)无下降判定为正常,下降0.5 cm判定为异常.②尿动力学检查检查项目依次为充盈性膀胱测压,静态尿道压力图测定、漏尿点压测定.③分型标准膀胱尿道造影分型标准Ⅰ型膀胱尿道后角消失,尿道倾斜角＜45°,最大尿道关闭压＞20 cmH2O;Ⅱ型膀胱尿道后角消失,尿道倾斜角＞45°,最大尿道关闭压＞20 cmH2O;Ⅲ型膀胱尿道后角正常,尿道倾斜角＜45°,最大尿道关闭压＜20 cmH2O.应力性漏尿点压分型标准Ⅰ型应力性漏尿点压＞120 cmH2O;Ⅱ型应力性漏尿点压90～120 cmH2O;Ⅲ型应力性漏尿点压＜60 cmH2O;Ⅱ/Ⅲ型应力性漏尿点压60～90 cmH2O.主要观察指标①尿失禁患者尿动力学检查结果.②应力性漏尿点压分型结果及其与膀胱尿道造影分型结果的比较.结果120例患者均进入结果分析.①尿动力学检查结果经检查确诊为真性压力性尿失禁患者56例,症状性压力性尿失禁患者64例,其中不稳定膀胱28例,低顺应性膀胱36例.②应力性漏尿点压分型与膀胱尿道造影分型结果比较56例真性压力性尿失禁患者中Ⅰ型20例;Ⅱ型16例;Ⅱ/Ⅲ型10例;Ⅲ型10例.两种分型在Ⅰ和Ⅲ型上吻合率达到100%,Ⅱ和Ⅱ/Ⅲ型的吻合率分别达到94.1%和90.1%,无显著差异(P＞0.05)结论应力性漏尿点压测定能够对女性真性压力性尿失禁进行准确的的分型,并对其治疗有着重要的指导作用.     

TOT手术治疗女性压力性尿失禁的影像尿动力学检查评价

目的:采用影像尿动力学检查对TOT经闭孔尿道中段吊带术治疗女性压力性尿失禁(stress urine incontinence)的临床疗效进行评价。方法:对2008年11至2010年5月28例女性压力性尿失禁患者行TOT术,治疗前、治疗后3个月及6个月均进行国际尿失禁问卷简表(ICI-Q-SF)、尿垫实验、影像尿动力学检查疗效评价。结果:28例患者随访时间6～14个月。其中27例患者术后尿控满意,1例有轻度尿失禁。尿动力学检查:术后3个月、术后6个月最大膀胱容量(MCC)、残余尿(RU)、最大尿流率时逼尿肌压力(Pdet,Qmax)与术前比较差异无统计学意义(P>0.05)。术后3个月,腹压漏点压力(ALPP)与术前比较差异有统计学意义(P值为0.000)。术后6个月,最大尿流率(Qmax)、ALPP,与术前比较差异有统计学意义(P值分别为0.012、0.000)。静态尿道压力图手术前后参数术前、术后3个月、术后6个月,最大尿道关闭压力(MUCP)分别为(35.4±19.9)、(52.5±26.7)、(51.8±18.2)cmH2O(1cmH2O=0.098kPa),功能尿道长度(FUL)分别为(3.5±1.1)、(4.2±1.3)、(4.2±1.0)cm,术后6个月MUCP、FUL与术前比较差异有统计学意义(P值分别为0.002和0.016)。影像学方面比较,术后显示在增加腹压或咳嗽试验时,膀胱颈及后尿道活动度下降,中段尿道相对固定,尿道闭合。在影像学提示,手术后显示在增加腹压或咳嗽实验时,膀胱颈及后尿道活动度下降。结论:通过影像尿动力学评价,TOT经闭孔尿道中段吊带术是治疗女性压力性尿失禁有效的方法之一,6个月内影像尿动力学评价提示手术能提高尿道压、加强控尿功能,同时对膀胱功能无显著影响。     

应力性漏尿点压测定在女性真性压力性尿失禁诊断中的应用

背景：尿失禁包括压力性、急迫性以及二者混合型，临床上凭经验很难准确判断其类型和程度，常发生误诊误治。目的：为探讨尿动力学检查，尤其是应力性漏尿点压测定对女性压力性尿失禁的诊断价值。设计：回顾性平行对照观察。单位：解放军第三军医大学西南医院全军泌尿专科中心。对象：选择1996-01／2002-05来第三军医大学西南医院泌尿外科就诊的尿失禁女性患者120例。方法：①膀胱尿道造影：测定患者膀胱尿道后角：〈100&;#176;判定为正常，〉100&;#176;判定为异常。尿道倾斜角：〈45&;#176;判定为正常，〉45&;#176;判定为异常。膀胱尿道连接部（静态时）：无下降判定为正常，下降0.5cm判定为异常。②尿动力学检查：检查项目依次为充盈性膀胱测压，静态尿道压力图测定、漏尿点压测定。③分型标准：膀胱尿道造影分型标准：Ⅰ型：膀胱尿道后角消失，尿道倾斜角〈45&;#176;，最大尿道关闭压〉20cmH2O；Ⅱ型：膀胱尿道后角消失，尿道倾斜角〉45&;#176;，最大尿道关闭压〉20cmH2O；Ⅲ型：膀胱尿道后角正常，尿道倾斜角〈45&;#176;，最大尿道关闭压〈20cmH2O。应力性漏尿点压分型标准：Ⅰ型：应力性漏尿点压〉120cmH2O；Ⅱ型：应力性漏尿点压90～120cmH2O；Ⅲ型：应力性漏尿点压〈60cmH20；Ⅱ／Ⅲ型：应力性漏尿点压60-90cmH2O。主要观察指标：①尿失禁患者尿动力学检查结果。②应力性漏尿点压分型结果及其与膀胱尿道造影分型结果的比较。结果：120例患者均进入结果分析。①尿动力学检查结果：经检查确诊为真性压力性尿失禁患者56例，症状性压力性尿失禁患者64例．其中不稳定膀胱28例，低顺应性膀胱36例。②应力性漏尿点压分型与膀胱尿道造影分型结果比较：56例真性压力性尿失禁患者中Ⅰ型20例；Ⅱ型16例；Ⅱ／Ⅲ型10例；Ⅲ型10例。两种分型在Ⅰ和Ⅲ型上吻合率达到100％，Ⅱ和Ⅱ／Ⅲ型的吻合率分别达到94.1％和90.1％，无显著差异（P〉0．05）。结论：应力性漏尿点压测定能够对女性真性压力性尿失禁进行准确的的分型，并对其治疗有着重要的指导作用。     

用自制吊带行经闭孔经阴道无张力尿道中段悬吊术治疗女性压力性尿失禁6例

目的:探讨应用自制吊带系统行经闭孔经阴道无张力尿道中段吊带术(tension-free vaginal tape-obturator,TVT-O)治疗女性压力性尿失禁的临床价值.方法:采用网状疝气补片自制TVT-O吊带,施行TVT-O手术治疗6例女性压力性尿失禁患者.结果:6例患者均顺利完成手术,术后尿失禁消失5例,咳嗽增加腹压后偶有尿液溢出1例.术后1个月复查尿动力学指标,均无剩余尿;腹腔漏尿点压(abdominal leak point pressures,ALPP)为119(106～142)cmH2O,与术前[32(12～57) cmH2O]比较差异有统计学意义(P＜0.05).所有患者术后随访2～6个月,均无排尿困难,亦无尿失禁.结论:应用自制吊带系统行TVT-O治疗女性压力性尿失禁,操作简便、疗效确切、创伤小、患者恢复快,可供临床酌情选用.     

雌犬压力性尿失禁模型的尿动力学检测与分析

目的:对术前雌犬以及术后尿失禁雌犬进行尿动力学检测,探索合适的尿动力学检测方法并分析检测结果.方法:9只无尿失禁的1岁龄雌性比格犬,术前行尿动力学检测,手术制作压力性尿失禁模型,术后4周再次行尿动力学检测,分析尿动力学结果.结果:术前犬最大尿道关闭压为(47.0±15.6)cmH2O,腹压漏尿点压为(131.9±24.1)cmH2O,尿道关闭面积为(659.6±208.7)cmH2O·mm,术后尿失禁犬的最大尿道关闭压为(28.6±11.9)cmH2O,腹压漏尿点压为(74.0±10.6)cmH2O,尿道关闭面积为(286.5±158.5)cmH2O·mm.结论:对雌犬进行尿动力学检测可行,最大尿道关闭压、腹压漏尿点压和尿道关闭面积的变化反映了压力性尿失禁犬尿控能力的减弱.     

超声尿动力学对尿道最大关闭压和腹压漏尿点压及膀胱颈移动度的研究

目的应用超声尿动力学技术研究静态和动态尿道关闭压及膀胱颈移动度的关系。方法对40例真性压力性尿失禁和22例正常入进行超声和尿动力学同步观察,标化测定静态最大尿道关闭压、腹压漏尿点压和膀胱颈移动度。结果真性压力性尿失禁腹压漏尿点压与尿道最大关闭压呈明显的线性相关(r=0.49,P=0.001),其回归方程y=21.90+0.88x。压力性尿失禁尿道最大关闭压、腹压漏尿点压均值显著低于正常组(P＜0.01)。膀胱颈部移动度显著高于正常组(P＜0.01)。腹压漏尿点压＞55cmH     

超激光穴位照射联合盆底康复治疗在绝经后压力性尿失禁患者中的应用

目的:探讨超激光穴位照射联合盆底康复治疗在绝经后压力性尿失禁患者中的应用方法及效果。方法:将2018年7月1日~2019年3月31日86例绝经后压力性尿失禁患者随机均分为观察组和对照组各43例,对照组采用超激光穴位照射治疗,观察组采用超激光穴位照射联合盆底康复治疗。比较两组患者盆底肌力、尿动力学指标及疗效情况。结果:观察组护理后8周Ⅰ类、Ⅱ类盆底肌肌力,尿流动力学指标腹压漏尿点压力(ALPP)、最大逼尿肌压力(MDP)及最大尿道闭合压(MUCP)水平均高于对照组(P<0.01);观察组护理后8周1 h尿垫试验重量低于对照组(P<0.05);观察组总有效率高于对照组(P<0.01);对照组患者需往返医院40次,观察组需往返医院28次。结论:超激光穴位照射联合盆底康复治疗应用于绝经后压力性尿失禁患者,能有效改善盆底肌肌力,减轻尿液溢出程度,提高尿流动力及临床疗效,减少患者往返医院次数。     

女性压力性尿失禁患者的尿动力学研究——附41例临床分析

目的：探讨女性压力性尿失禁（stress urinary．incontinence，SUI）患者的尿动力学特点：方法：回顾性分析41例SUI的女性患者（尿失禁组）的尿动力学检查结果，并与同期的非SUI的29例同龄女性患者（对照组）的检查结果比较。结果：尿失禁组及对照组的最大尿流率、平均尿流率分别为28（17～43）mL／s、21（10～33）mL／s及19（7～31）mL／s、8（2～16）mL／s，两组比较差异均有统计学意义（均为P〈0.05）；尿失禁组及对照组的最大逼尿肌压、最大尿流率时的逼尿肌压、最大尿道闭合压分别为23（11～34）cmH2O、13（5～25）cmH2O、31（10～50）cmH2O及38（16～62）cmH2O、28（8～48）cmH2O、41（22～82）cmH2O，两组比较差异均有统计学意义（均为P〈0.05）。结论：SUI患者的最大尿流率、平均尿流率增大，而最大逼尿肌压、最大尿流率时的逼尿肌压、最大尿道闭合压均降低.     

尿动力学检查诊断女性压力性尿失禁探讨77例

目的:探讨尿动力学检查在女性压力性尿失禁(stress urinary incontinence,SUI)诊断中的作用.方法:对77例SUI行系统的尿动力学检查,21例同时行半卧位和站立位腹压漏尿点压(abdominal leak point pressure,ALPP)测定.结果:77例中不稳定膀胱者7例(9.1％).61例(79.2 ％)ALPP测定见有漏尿:其中56例半卧位测定有35例(62.5％)见有漏尿;42例站立位测定有36例(85.7％)见有漏尿;半卧位无漏尿,改为站立位见漏尿的有8例.最大尿流率为(31.4±11.3)(16.3 ～ 70.1) mL/s、最大尿流率时的逼尿肌压为(16±8)(2 ～ 37) cmH2O.33例手术,随访21例,16例无尿失禁复发,5例改善.结论:尿动力学检查有助于SUI的诊断和鉴别诊断,对手术有指导意义,站立位ALPP测定能提高检查准确性.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.