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Biomedical subjects

J Wessel

Publications and source records attributed to J Wessel.

At least 19 recordsLinked to original sources
PubMed2006

Validity of self-report measures of pain and disability for persons who have undergone arthroplasty for osteoarthritis of the carpometacarpal joint of the hand.

OBJECTIVE: To establish the validity of three self-report scales used to measure function following arthroplasty for osteoarthritis (OA) of the carpometacarpal joint. METHOD: Persons with OA of the carpometacarpal joint (n=122) were assessed on one occasion 9-117 months following tendon interposition arthroplasty. They completed three self-report measures of hand/upper limb disability: the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Patient-Rated Wrist Hand Evaluation (PRWHE), and the Disabilities of Arm, Shoulder and Hand (DASH). They also completed the Short Form 36 (SF-36) and performed tests of strength, range of motion (ROM), and dexterity. Factor analysis and correlations were used to determine the association among the scales and subscales considered to measure similar constructs (e.g., pain and physical disability). Correlations between the scales and measures of impairment were also conducted to examine construct validity of the disability measures. t-Tests evaluated the hypotheses that subjects with isolated hand OA would have lower scores than those with additional joint involvement. RESULTS: All three scales or their subscales loaded on one factor. Convergent validity of the disability measures was demonstrated by high correlations between similar subscales (r>0.75), and divergent validity by a lack of correlation between the measures and self-report hand appearance. As expected, correlations between disability and strength, dexterity, or a global measure of ROM were higher than with ROM of individual joints. The AUSCAN and the DASH were better able to discriminate those with localized hand OA from those with involvement of other joints. CONCLUSIONS: The AUSCAN, PRWHE, and DASH are valid assessments of pain and/or disability of hand OA, and provide information distinct from impairment measures.

Activities of Daily Living↗
PubMed2004

Plasma concentrations of endogenous hormones during one regular treatment cycle with a low-dose oral contraceptive and during two cycles with deliberate omission of two tablets.

In this open, prospective, phase-I study we closely monitored levels of endogenous progesterone, 17beta-estradiol, luteinizing hormone (LH) and follicle stimulating hormone in six healthy women. We determined plasma concentrations every 1-3 days during one untreated baseline cycle and during the first treatment cycle with regular pill intake of an oral contraceptive containing 30 microg ethinylestradiol plus 75 microg gestodene. During the following two treatment cycles, two tablets were deliberately omitted (in cycle 2 on days 6/7 and in cycle 3 on days 11/12). All but possibly one volunteer ovulated in the untreated pre-cycle, as concluded from LH peaks followed by marked increases of progesterone. During the regular first treatment cycle and even after deliberate omission of two tables in treatment cycles 2 and 3, the progesterone and estradiol levels remained low, so that we concluded that no ovulation took place. However, two volunteers showed some sort of LH peak in the first regular treatment cycle and all women showed LH increases of > 40 microg/ml in at least one omission cycle. In ten out of 12 cycles, omissions of pill intake were followed by an episode of intermenstrual bleeding. In conclusion, we have shown that, after omission of two consecutive oral contraceptive tables, the endogenous hormone parameters did not provide evidence for ovulation. Although this provides confirmation of the robustness of this oral contraceptive towards non-compliance, the widely published practical recommendations should be followed.

Adult↗
PubMed2003

A meta-analysis on the correlation between ovarian activity and the incidence of intermenstrual bleeding during low-dose oral contraceptive use.

We aimed to evaluate potential correlation between ovarian activity during use of combined oral contraceptives and the incidence of intermenstrual bleeding. Data from seven prospective clinical studies with five different combined low-dose oral contraceptives were retrospectively analyzed to determine ovarian activity measured by the Hoogland Score (follicle diameter and endogenous hormone levels) and cycle control. A total of 227 young fertile women were evaluated over three treatment cycles each. Women with intermenstrual bleeding had statistically significantly higher estradiol levels than those without intermenstrual bleeding. Also, women with intermenstrual bleeding had significantly larger follicle-like structures than those without intermenstrual bleeding. For example, in the second treatment cycle the difference of the mean follicle diameters between women without intermenstrual bleeding (12.5 mm) and women with spotting (16.9 mm) or breakthrough bleeding (16.1 mm) was statistically significant (p = 0.0179). Less than 17% of women with Hoogland Score 1, 2 or 3 (low ovarian activity) reported intermenstrual bleeding. On the other hand, 35.2% of women with Hoogland Score 4 (active follicle-like structures) reported intermenstrual bleeding. The association between bleeding and Hoogland Score was statistically significant (p < 0.0011). The findings of this retrospective analysis provide evidence that high ovarian suppression is positively correlated with improved cycle control in terms of less frequent intermenstrual bleeding - slight and heavy.

Contraceptives, Oral, Combined↗
PubMed2001

The Edmonton Functional Assessment Tool: further development and validation for use in palliative care.

The objective of this study was to examine the validity of the revised version of the Edmonton Functional Assessment Tool (EFAT-2), which was designed to measure physical impairment and functional performance of patients in palliative care. The EFAT-2 was administered to 275 patients on admission to an acute palliative care unit. Principal-components factor analysis was performed on the 10 items of the scale, and Cronbach's alpha was calculated to measure internal consistency. A one-way analysis of variance (ANOVA) was carried out to compare the admission EFAT-2 scores of three groups of patients: (a) deceased on the unit, (b) transferred to a continuing care palliative unit, (c) discharged home. Two main factors were revealed: physical and non-physical (cognitive/affective). Pain was identified as an independent item and did not correlate with any other item. Cronbach's alpha was 0.86. The ANOVA was significant (F [2,267] 29.063, p < 0.001). The results suggest that the EFAT-2 measures one construct. They also suggest that the EFAT-2 is able to discriminate between palliative care patients based on discharge location.

Activities of Daily Living↗
PubMed2001

Body weight change during use of a monophasic oral contraceptive containing 20 microg ethinylestradiol and 75 microg gestodene with a comparison of the women who completed versus those who prematurely discontinued intake.

OBJECTIVES: Evaluation of the impact of an oral contraceptive on body weight with a comparison ofwomen who completed versus women who prematurely discontinued intake. METHODS: Data on body weight were retrospectively analyzed from four large prospective clinical trials with an oral contraceptive containing 20 microg ethinylestradiol and 75 microg gestodene (EE/GSD). A total of 1971 young fertile women were included in the evaluation, and 1467 completed 12 cycles. RESULTS: We found no clinically relevant change of body weight during treatment with an oral contraceptive containing 20 microg ethinylestradiol and 75 microg gestodene in the vast majority of users after 12 treatment cycles. The mean change of body weight was less than 0.3 kg in this time period for all users. Nearly 70% of women experienced a minor change in their body weight of +/- 2 kg. An additional 13% lost more than 2 kg body weight in the course of 12 treatment cycles. A total of 11% increased their weight by 2-4 kg. A total of 1255 (85.5%) of women had a body mass index (BMI) of < or = 25 at baseline compared to 1253 (85.4%) after 12 cycles of treatment. There was no significant difference in the change ofbody weight between the women completing 12 cycles of treatment and those who prematurely discontinued EE/GSD. CONCLUSIONS: This retrospective analysis confirms that there was only a negligible change of body weight during intake of an oral contraceptive containing 20 microg ethinylestradiol and 75 microg gestodene. There was no difference in weight change between the women completing the study or discontinuing intake.

Adolescent↗
PubMed2000

Dose-dependent induction of transforming growth factor beta (TGF-beta) in the lung tissue of fibrosis-prone mice after thoracic irradiation.

PURPOSE: The lung is the major dose-limiting organ for radiotherapy of cancer in the thoracic region. The pathogenesis of radiation-induced lung injury at the molecular level is still unclear. Immediate cellular damage after irradiation is supposed to result in cytokine-mediated multicellular interactions with induction and progression of fibrotic tissue reactions. The purpose of this investigation was to evaluate the acute and long-term effects of radiation on the gene expression of transforming growth factor beta (TGF-beta) in a model of lung injury using fibrosis-sensitive C57BL/6 mice. METHODS AND MATERIALS: The thoraces of C57BL/6 mice were irradiated with 6 and 12 Gy, respectively. Treated and sham-irradiated control mice were sacrificed at times corresponding to the latent period (1, 3, 6, 12, 24, 48, 72 hours and 1 week postirradiation), the pneumonic phase (2, 4, 8, and 16 weeks postirradiation), and the beginning of the fibrotic phase (24 weeks postirradiation). The lung tissue from three different mice per dosage and time point was analyzed by a combination of polymerase chain reaction (PCR), immunohistochemistry, and light microscopy. The mRNA expression of TGF-beta was quantified by competitive reverse transcriptase/polymerase chain reaction (RT-PCR); the cellular origin of the TGF-beta protein was identified by immunohistochemical staining (alkaline phosphatase-anti-alkaline phosphatase [APAAP]). The cytokine expression on mRNA and protein level was correlated with the histopathological alterations. RESULTS: Following thoracic irradiation with a single dose of 12 Gy, radiation-induced TGF-beta release in lung tissue was appreciable already within the first hours (1, 3, and 6 hours postirradiation) and reached a significant increase after 12 hours; subsequently (48 hours, 72 hours, and 1 week postirradiation) the TGF-beta expression declined to basal levels. At the beginning of the pneumonic phase, irradiation-mediated stimulation of TGF-beta release reached maximal values at 2 and 4 weeks. The elevated levels of TGF-beta mRNA during the latent phase have been found to correlate with immunohistochemical staining of alveolar macrophages. The most striking increase in TGF-beta immunoreactivity was seen during the acute phase of pneumonitis. Throughout this observation period, type II pneumocytes and fibroblasts (apart from inflammatory cells) served as important sources of TGF-beta expression. Increased TGF-beta expression was detected prominently in regions of histopathologic radiation injury. After exposure to a single radiation dose of 6 Gy, the lung tissue revealed only a minor radiation-mediated TGF-beta mRNA response. The modest upregulation ranged from 6 hours to 48 hours after irradiation. Corresponding to the only minor histopathologic changes after thoracic irradiation with 6 Gy, measurement of TGF-beta mRNA levels during the later time points revealed no significant alterations in comparison to untreated control mice. CONCLUSIONS: This study demonstrates an acute and long-lasting increase in the expression of TGF-beta in lung tissue following thoracic irradiation with 12 Gy. The predominant localization of TGF-beta in areas of inflammatory cell infiltrates and fibrosis suggests involvement of this cytokine in the pathogenesis of radiation-induced pulmonal fibrosis. Further studies should be performed to explore the role of other cytokines in the development of radiation injury. An improved understanding of the underlying mechanisms of pulmonary fibrosis may eventually lead to modulatory intervention at the molecular level to modify the fibrotic process.

Animals↗
PubMed2000

Frequency and significance of preterm delivery in twin pregnancies.

OBJECTIVE: We investigated the frequency of preterm delivery and its influence on the neonatal outcome in twin pregnancies at a perinatal center. Are there differences in the course of twin pregnancies with preterm or term delivery? METHOD: A retrospective investigation was carried out at the Department of Obstetrics on 502 twin pregnancies and deliveries between 1978 and 1993. Pregnancy history and clinical parameters were compared among preterm (<37+0 weeks) and term deliveries. RESULT: Median duration of all twin pregnancies was 36+3 weeks of gestation. In the preterm group, preterm labor was more frequent, both, the first and the second neonate had lower birth weight and were more often admitted to the neonatal intensive care unit (NICU) where they stayed longer than full-term neonates needing intensive care. Perinatal deaths occurred only in the preterm group. CONCLUSIONS: The incidence of preterm delivery is significantly elevated in twin pregnancies and consequently the incidence of low- and very-low-birth-weight-infants and perinatal mortality. Preterm delivery is the main reason why twin pregnancies are at a higher risk for an adverse neonatal outcome and thereby cause considerable costs.

Adolescent↗
PubMed2000

Inter-rater reliability of formally trained and self-trained raters using the Edmonton Functional Assessment Tool.

The primary objective of this study was to determine the inter-rater reliability of the revised version of the Edmonton Functional Assessment Tool (EFAT-2). A second objective was to determine whether both formally trained and self-trained therapists had an acceptable level of inter-rater reliability. The EFAT-2 was administered to consenting palliative care patients by one of two independent physical therapist rater pairs; one pair self-trained (R1, R2) and the other formally trained (R3, R4). The intraclass correlation [ICC (1,1)] for R1, R2 was 0.97 [95% confidence interval (CI) 0.94-0.99] and for R3, R4 was 0.95 (95% CI 0.90-0.98). The standard error of measurement was 1.09 and 1.44, respectively. The Kappa statistic for the rater pairs on individual EFAT items ranged from 0.17 to 0.96. The results suggest that both formally trained and self-trained therapists obtain an acceptable level of inter-rater reliability when using the EFAT-2.

Aged↗
PubMed1999

Validity and reliability of the 6 minute walk in persons with fibromyalgia.

OBJECTIVE: To assess the reliability and construct validity of the 6 minute walk (6MW) in persons with fibromyalgia (FM) and to determine an equation for predicting peak oxygen consumption (pVO2) from the distance covered in 6 minutes. METHODS: Ninety-six women who met the American College of Rheumatology (ACR) criteria for FM were tested on the 6MW and the Fibromyalgia Impact Questionnaire (FIQ). A subset (n = 23) were tested on a separate day for pVO2 during a symptom-limited, incremental treadmill test. Twelve subjects repeated the 6MW five times over 10 days. Heart rate and rating of perceived exertion (RPE) were recorded for each walk. Intraclass correlations were used to determine the reliability of the 6MW. Validity was examined by correlating the 6MW with pVO2 and the FIQ. Body mass index (BMI) and 6MW were independent variables in a stepwise regression to predict pVO2. RESULTS: A significant increase in distance occurred from Walk 1 to Walk 2 (p = 0.000) with the distance maintained on the remaining walks (p = 0.148) The correlations of the 6MW with the FIQ and pVO2 were -0.325 and 0.657, respectively. The regression equation to predict pVO2 from 6MW distance and BMI was: pVO2 (ml/kg/min) = 21.48 + (-0.4316 x BMI) + [0.0304 x distance(m)] (R = 0.76, R2 = 0.66). CONCLUSION: When using the 6MW it is necessary to conduct a practice walk, with the second walk taken as the baseline measure. It was determined from the correlations that the 6MW cannot replace the FIQ as a measure of function. The 6MW may be used as an indicator of aerobic fitness, although obtaining VO2 by means of a graded exercise test is preferable.

Analysis of Variance↗
PubMed1999

Isometric strength measurements in children with arthritis: reliability and relation to function.

OBJECTIVE: To examine the reliability of testing strength in children with juvenile arthritis (JA), and to determine the relationship between strength and function. METHODS: Children with JA were tested for grip and pinch strength (n = 32). Isometric force produced by hip abductors and knee extensors was tested with a hand-held dynamometer (n = 29). Two therapists both performed each of the tests twice so that intrarater and interrater reliability could be examined. Function was measured by means of the Childhood Health Assessment Questionnaire (CHAQ) and performance on a 50-meter run. Reliability was examined with intraclass correlations (ICC). The relationships of strength and function were determined with Pearson and Spearman correlations. RESULTS: All measures demonstrated good intrarater (ICC = 0.92-0.97) and interrater (ICC = 0.80-0.95) reliability. Grip strength and pinch were correlated with the CHAQ (r = -0.45 and -0.33, respectively), while hip abduction and knee extension torque were correlated with rankings on the 50-meter run (rho = -0.34 and -0.38, respectively). CONCLUSION: Isometric strength can be reliably measured in children with arthritis in a clinical setting.

Activities of Daily Living↗
PubMed1998

The relationship between strength and function in females with juvenile rheumatoid arthritis.

OBJECTIVE: To describe the relationship between isokinetic concentric and eccentric quadriceps strength and function in females with juvenile rheumatoid arthritis (JRA). METHODS: Twenty girls with JRA aged 6 to 16 years participated in the study. Function and strength were measured on one occasion. Isokinetic concentric and eccentric quadriceps torque was measured on the Kin-Com dynamometer. Function was measured with the Childhood Health Assessment Questionnaire (CHAQ) and the Canada Fitness Award 50 m run. Pain and joint count were taken as measures of disease activity. Pain was assessed on a visual analog scale through parent- and self-report. Correlations between function, standardized torque values, pain, and joint count were determined. Stepwise multiple regression analyses with function as the predicted variable were performed. RESULTS: Correlations between standardized torque and CHAQ scores were moderate (r = -0.48, p = 0.03 for concentric torque and r = -0.43, p = 0.06 for eccentric). Correlations between torque and run scores were also moderate (r = -0.48, p = 0.03 for concentric, r = -0.31, p = 0.19 for eccentric). Pain and total joint count were the best predictors of CHAQ score (r2 = 0.80), while concentric torque was the best predictor of running ability (r2 = 0.23). CONCLUSION: Quadriceps torque was moderately correlated to function in girls with JRA. Function as determined on the CHAQ was best predicted from measures of disease activity, while function as determined on the 50 m run was best predicted from concentric quadriceps torque. Further research is required to determine a cause-effect relationship between strength and function in girls with JRA.

Adolescent↗
PubMed1997

Pregnancy and delivery in a patient with mutilating dystrophic epidermolysis bullosa (Hallopeau-Siemens type).

BACKGROUND: Epidermolysis bullosa dystrophica of the mutilating Hallopeau-Siemens type is a rare inherited skin disease. Those afflicted have blisters and pronounced scarring of skin and mucous membranes after minor trauma. Pregnancies are very rare in affected women. CASE: A 24-year-old woman, gravida 1, with a severe form of the Hallopeau-Siemens type was monitored closely during pregnancy. The patient spontaneously delivered a healthy female neonate at term. Episiotomy wound healing was uncomplicated. Seven months later, she returned in her second pregnancy, which was complicated by mild anemia and polyhydramnios from possible gestational-onset diabetes mellitus. Again, vaginal delivery of a healthy neonate was performed at term. We did not observe pregnancy-induced exacerbations of the skin disease. CONCLUSION: Women with epidermolysis bullosa dystrophica of the Hallopeau-Siemens type may decide to have children after careful evaluation of the degree of impairment and a thorough explanation of the risks associated with pregnancy and delivery. Close monitoring of the pregnant patient is important. Vaginal delivery should be the first choice. Breast-feeding is difficult, but not contraindicated.

Adult↗
PubMed1996

Isometric strength measurements of knee extensors in women with osteoarthritis of the knee.

OBJECTIVE: To compare torque-angle characteristics of the knee extensors of women with and without osteoarthritis (OA) of the knee, and to determine the reliability of these measures. METHODS: The isometric torque of the knee extensors of both legs was tested on 3 occasions in 17 women with OA of the knee and 17 healthy women. Tests were performed on an isokinetic dynamometer at 3 knee angles (30 degrees, 60 degrees, 90 degrees). The peak torque values were subjected to 4 way analysis of variance (group vs leg vs angle vs time), and intraclass correlation coefficients were calculated. RESULTS: The reliability coefficients for repeated measures of isometric torque varied from 0.83 to 0.94 in the OA group and from 0.90 to 0.95 in the comparison group. The ANOVA and post hoc analyses revealed that the OA group had significantly (p < 0.05) lower knee extensor torque than the comparison group, and that the more symptomatic OA knee had lower torque than the contralateral limb. The torque was different across the 3 angles, but the torque-angle relationship was the same for both groups. CONCLUSION: Isometric torque of the knee extensors can be measured reliably in women with OA of the knee. The torque is lower in women with OA than in women with no knee problems, and the changes are similar across different knee angles.

Aged↗
PubMed1995

The reliability and validity of pain threshold measurements in osteoarthritis of the knee.

The purpose of this study was to examine the reliability and validity of measuring pain threshold (PT) of persons with osteoarthritis (OA) of the knee. The PTs of women with and without OA of the knee were measured on 3 occasions at 6 sites at the knee with a pressure dolorimeter. Subjects with OA also recorded their pain on a visual analogue scale (VAS) and on the McGill Pain Questionnaire (MPQ). The reliability coefficients for repeated measures of PT varied from 0.61 to 0.91 in the OA group and from 0.71 to 0.90 in the control group. PT was lower in the OA group at all sites. Only the control group demonstrated significant differences between sites. The correlations between PT and measures of pain intensity were poor. It is concluded that the measurement of PT at the knee distinguishes OA from healthy controls, and that it has moderate reliability. However, it cannot substitute for a measure of pain intensity.

Aged↗
PubMed1994

Torque of trunk flexion and trunk flexion with axial rotation in healthy men and women.

The purpose of this study was to determine normal values for torque of trunk flexion and trunk flexion with axial rotation. Eighty-two healthy subjects (39 men, 43 women) were tested for isometric torque of trunk flexion at four angles, and eccentric and concentric torque at 30 degrees/sec. All tests were performed in three positions of axial rotation: neutral rotation, trunk rotated 30 degrees to the right, and trunk rotated 30 degrees to the left. The results of two separate three-way analyses of variance (gender vs. position vs. angle/contraction) indicated that the torque of men was greater than that of women, eccentric torque was greater than concentric, and the torque in neutral rotation was greater than in right or left rotation. Isometric torque decreased with increased trunk flexion. Regression and correlation analyses demonstrated that gender was generally the best predictor of torque, and that all the torque measures were significantly correlated.

Abdominal Muscles↗
PubMed1994

Acupuncture for the treatment of pain of osteoarthritic knees.

OBJECTIVE: The purpose of this study was to determine whether acupuncture was more effective than sham acupuncture in the reduction of pain in persons with osteoarthritis (OA) of the knee. METHODS: Forty subjects (20 men, 20 women) with radiographic evidence of OA of the knee were stratified by gender and randomly assigned to either the experimental (real acupuncture) or control (sham acupuncture) groups. Subjects were treated three times per week for 3 weeks and evaluated at three test sessions. Outcome measures were: 1) the Pain Rating Index of the McGill Pain Questionnaire, 2) the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, and 3) pain threshold at four sites at the knee. RESULTS: The analyses of variance showed that both real and sham acupuncture significantly reduced pain, stiffness, and physical disability in the OA knee, but that there were no significant differences between groups. CONCLUSIONS: Acupuncture is not more effective than sham acupuncture in the treatment of OA pain.

Acupuncture Therapy↗
PubMed1994

Nutrition considerations in the neonatal extracorporeal life support patient.

Extracorporeal life support (ECLS) is a type of heart-lung bypass commonly used to support neonates with life-threatening respiratory or cardiac failure. These patients are among the most critically ill patients in the neonatal intensive care unit and are at significant nutritional risk. Unfortunately, there is a paucity of literature regarding guidelines for nutrition support of the neonatal ECLS patient. The purpose of this article is to provide an overview of the indications, techniques, and complications of ECLS and to address the approach to nutrition support of these patients. Emphasis will be placed on issues unique to the neonatal ECLS patient.

Enteral Nutrition↗