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Biomedical subjects

V Fialka

Publications and source records attributed to V Fialka.

At least 19 recordsLinked to original sources
PubMed1996

Pattern recognition in five-phase bone scintigraphy: diagnostic patterns of reflex sympathetic dystrophy in adults.

The objective of this study was to assess qualitative and quantitative patterns of tracer accumulation to increase the diagnostic utility of bone scintigraphy in reflex sympathetic dystrophy (RSD). Of 120 patients with high clinical suspicion for RSD, 96 were confirmed as having RSD during follow-up, while the remaining 24 were used as controls. Clinical parameters were measured and correlated to five activity ratios (0-30 s, 0.5-5 min, 5-15 min, 3 h, 24 h) and five scintigraphic signs. Monitoring three dynamic phases revealed different tracer kinetics of potential diagnostic utility; however, the 24-h bone phase offered no additional diagnostic contribution and can be omitted. Quantification provided objective parameters for the duration of symptoms, pain and impairment of movement but not for surface temperature differences, swelling and impairment of physical force. It is of limited use for diagnosis except for the exclusion of disease. Discriminant analysis revealed the combination of three signs (diffuse uptake in carpus/tarsus+diffuse uptake in all small joints+increased activity ratio in the late blood pool phase) to be the pattern with the highest diagnostic accuracy independent of localisation, sex, age and precipitating factors. It is concluded that the scintigraphic confirmation of RSD is based on lateralisation in the late blood pool phase and the described pattern in the early bone phase.

Adult↗
PubMed1996

Impaired hemorheology in patients with postmastectomy lymphedema.

Lymphedema of the arm is one of the most disabling and serious complications of breast cancer. Apart from tumor infiltration or fibrosis of lymphatic pathways, little is known about factors favoring the development of lymphedema. In the present study, we investigated the impact of rheologic parameters, e.g. red cell aggregation (EA) and plasma viscosity (PV), and of capillary morphology and capillary flow in patients with breast cancer with (n = 18) and without (n = 18) lymphedema. Patients with lymphedema showed a significant increase of red cell aggregation (p < 0.001) that indicates a systemic component of lymphedema and might offer a possibility of prevention and therapy of this condition. A hitherto unclassified protein factor favoring red cell aggregation and lymphedema might be postulated.

Aged↗
PubMed1996

[Differential diagnosis of diseases of the Achilles tendon. A clinico-sonographic concept].

Ultrasound of the Achilles tendon is a suitable means of differentiating various diseases of the tendon and the surrounding tissue. Different forms of degenerative disease (tendinitis, peritendinitis or bursitis, fibroosteitis, and Haglund's disease) can be discriminated from rheumatic and metabolic diseases. Congenital and developmental abnormalities can also be detected. Tendon degeneration mainly occurs in the ventral part of the medial third of the tendon ("critical zone"). Immature tissue in this area leads to temporary [correction of temorary] instability of the tendon with a high risk of rupture ("vulnerable phase"). With sonography, lesions of the Achilles tendon are visible early in the course of the disease.

Achilles Tendon↗
PubMed1996

[Wobenzyme and diuretic therapy in lymphedema after breast operation].

The authors of this clinical study report the results of a controlled clinical trial in randomized parallel groups (Wobenzym vs. diuretics) of 55 female patients suffering from brachial arm lymph edema subsequent to ablatio mammae. All patients received manual and machine lymph drainage as well as gymnastics as concomitant therapy. After 7 weeks of therapy the results of the volometric assessments of the arm, the circumference of the arm and the skinfold thickness showed significant improvements compared to diuretics. In addition, the patients receiving Wobenzym reported a significantly higher proportion of patients free of pain compared to the diuretics patients. Overall safety assessment results are satisfactory thus resulting in a superior benefit/risk relation of the Wobenzym group.

Adjuvants, Immunologic↗
PubMed1996

Five phase bone scintigraphy supports the pathophysiological concept of a subclinical inflammatory process in reflex sympathetic dystrophy.

This study evaluates quantitative and qualitative patterns of bone scintigraphy and correlates them to laboratory findings and clinical signs to reveal possible inflammatory reactions in RSD. Activity ratios between the affected hand/foot and the contralateral side were calculated in 99mTc DPD-bone scintigraphy for five phases (arterial: 0-30 sec, early blood pool: 0.5-5 min. late blood pool: 5-15 min, 3 hrs early bone, 24 hrs late bone phase) and the presence of five scintigraphic signs in the bone phases was assessed. Activity ratios of all phases correlated with ESR those in the early and late bone phase correlated with alpha 2 globulin and beta globulin concentrations and those in the arterial, the early and late blood pool phase with the gamma globulin concentrations, respectively. Clinical features such as pain, swelling, physical force, temperature differences and the duration of symptoms did not correlate to the activity ratios. However, three signs in the bone phase were negatively correlated to albumin concentrations. Positive correlations were found for alpha 2, gamma globulin concentrations, ESR, neutrophil cell counts and individual uptake patterns. We conclude that the quantitative analysis of five phase bone scintigraphy in RSD reveals different aspects of tracer kinetics and provides different pathophysiological information. Lateralization of regional hyperemia, increased micro vascular permeability and bone metabolism in RSD parallels shifts in protein concentrations and blood cell counts that are suggestive of a subacute inflammatory process, even in patients with no overt signs of inflammation.

Beta-Globulins↗
PubMed1996

[Description of a patient profile of ambulatory physical medicine facilities].

UNLABELLED: Beside objective diagnosis, the subjective feelings, of patients is of great importance in the field of physical medicine and rehabilitation. Evaluation of demographic data and quality of life of patients referred to an outpatient clinic of physical medicine and rehabilitation. DESIGN: Prospective, multi-center cross sectional study. Evaluation of impairment of the activities of daily living by a questionnaire based on the "Functional Assessment Screening Questionnaire" and the "Oswestry low back pain disability questionnaire" and of the perceived pain by a 100 nm visual analog scale (VAS). 1404 consecutive patients were included, 89% completed the questionnaire (n = 1250). Women 57.6%, men 42.3%, age 54.1 years. 67.6% of all diagnoses were related to the spine (36.7% cervical spine, 32.8% lumbar spine, 30.5% whole spine). 13.8% to joints of the lower and 8.4% to joints of the upper extremities. Intensity of pain was rated: 79.7 mm on the VAS (38.9% of all patients claimed to perceive pain all time). Patients referred to an outpatient facility of physical medicine are impaired in their activities of daily living and their well-being by pain. Further outcome studies of physical medicine outpatient treatment will be based on questionnaires developed in this present study.

Activities of Daily Living↗
PubMed1996

[Therapy relevant aspects of anatomy, pathophysiology and diagnosis of urinary incontinence in women].

Many aspects of the pathogenesis of urinary incontinence are poorly understood. Most studies show good results for physical therapy for instance for pelvic floor exercises and biofeedback. Unfortunately most of these studies lack an objective diagnostic and neurophysiological assessment. This could be one reason for the strongly divergent therapeutical success rates reported (30 to 90%). We recommend the use of objective parameters, for instance the PAD test with standardized bladder volume and a neurophysiological and short urodynamic assessment as well as subjective parameters [satisfaction with the outcome of treatment measured with the VAS (visual analog scale), documentation of the changes in ADL (activities of daily living)] in future therapeutical studies. A more precise assessment of the pathological cause of the impairment will help to develop optimal therapeutic procedures. Because of poor documentation in the past the analysis of therapeutic failures and the decision if mono-or complex physiotherapy is more appropriate has not been possible. This aspect will become even more important as the cost-effectiveness of treatments becomes a more important issue.

Female↗
PubMed1994

[Neural therapy in the light of recent data].

In German-speaking countries, local injection of anesthetic is a popular form of treatment, either as "neural therapy", a complementary method intended to stimulate adaptive body functions, or as pure analgesia. While the latter is unquestionably effective, neither the rationale nor the individual mechanisms, nor its therapeutic efficacy have been investigated scientifically. Recent data show that the analgesic effect does not depend on the injection of local anesthetic. It is conceivable that this form of treatment acts via a mechanism known as diffuse noxious inhibition control.

Acupuncture Analgesia↗
PubMed1994

Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy.

Among the physical treatments to reduce pain, ice has had its place for many years. Experience tells us that ice has a strong short-term analgesic effect in many painful conditions, particularly those related to the musculoskeletal system. Serial applications may also be helpful. The scientific evidence from clinical trials is, however, fragmentary. This applies both for acute and serial cold-induced analgesia. The mechanisms by which cryotherapy might elevate pain threshold include an antinociceptive effect on the gate control system, a decrease in nerve conduction, reduction in muscle spasms, and prevention of edema after injury. It is concluded that ice may be useful for a variety of musculoskeletal pains, yet the evidence for its efficacy should be established more convincingly.

Analgesia↗
PubMed1994

[Cryotherapy].

Cryotherapy is defined as cooling of definitive parts of the body by means of ice packs, ice cubes, ice water or ethylchloride sprays. It is used in the treatment of a range of conditions including spasticity and hypertonus of the muscles, soft tissue lesions, arthritises, edema and pain. The known physiological effects and clinical efficacy associated with cooling are considered. Further research i.e. randomized, controlled studies in the field of clinical application is high-lighted.

Cryotherapy↗
PubMed1993

A review of the clinical effectiveness of exercise therapy for intermittent claudication.

BACKGROUND: Intermittent claudication is both frequent and disabling. Conservative treatment consists of the elimination of risk factors, particularly smoking, drug treatment, and physical exercises. This review represents an attempt to define how effectively exercise prolongs the walking ability of claudicants. METHODS: A computerized literature search was done to identify all controlled trials on the subject. In addition, other studies were admitted if they were in accordance with certain quality criteria. RESULTS: Without exception, these studies showed that exercise can prolong the pain-free walking distance of claudicants. Even though this message seems uniform and convincing, one should point out that all trials are burdened with methodological flaws. The variability of increase in walking ability demonstrated in these studies is impressive and cannot be fully explained. A multitude of possible mechanisms could be involved in bringing about the clinical effect; at present it is impossible to define their relative importance. CONCLUSIONS: The optimal exercise program should be supervised, performed regularly for at least 2 months, and of high intensity. Appropriate steps to guarantee patients' compliance must be taken. Even though many fundamental questions remain unanswered, it is justified to prescribe exercise therapy for intermittent claudication more generally than is realized in today's practice.

Clinical Trials as Topic↗
PubMed1993

[Conservative therapy of backache. Part 5: TENS, acupuncture, biofeedback, traction, cryotherapy, massage and ultrasound].

In addition to the major therapeutic modalities for use in back pain already discussed, a number of other forms of treatment are also available and in common use some of which at least have a solid scientific basis. Recent data suggest that subthreshold TENS is no effective treatment for low back pain. Whether this is also true of higher-dose TENS is not yet clear. Electro-acupuncture, in contrast, does appear to be effective, but not biofeedback or traction. Other commonly employed treatment modalities, such as cryotherapy, heat, massage or ultrasound cannot definitively be assessed at present, since controlled trials have not been carried out.

Acupuncture Points↗
PubMed1993

[Conservative therapy of backache. Part 4: Manual therapy].

The literature on the clinical effectiveness of manipulation in low back pain is extensive, although scientific studies that are free from flaws are much rarer. Most of the studies so far done show--with some reservations--a positive effect for manipulation. Given the proper indication, and with care being taken to observe contraindications, this modality can thus be recommended if performed by an experienced manipulator. However, this should not blind us to the fact that further investigations are necessary, and that the technique has no unequivocal advantages over exercise.

Contraindications↗
PubMed1993

[Conservative therapy of backache. Part 3: Physical therapy].

Physical exercise is accepted by many as the first line of treatment of low back pain. Nevertheless, hard data published so far have failed to demonstrate its benefit as clearly as we would wish. A wealth of exercise programs is available that escape systematic classification. The authors differentiate between general endurance training, and stretching, flexion and extension exercises. Whether endurance training is of benefit has not yet been unequivocally established. In contrast, stretching exercises have been shown to be effective. Flexion exercises have both proponents and opponents, while most randomized studies on extension exercises appear to demonstrate their effectiveness. Thus, physical exercise may be considered, at least in part, an effective form of treatment. Further research is needed to define the optimal exercise program for the individual patient as accurately as possible.

Exercise Therapy↗
PubMed1993

[Conservative therapy of low back pain. 2: Drug therapy].

Drug treatment of back pain is a useful adjunct to initial bedrest. A number of groups of drugs have proved effective. Analgesics and non-steroidal anti-inflammatory drugs can be recommended for short term treatment of acute cases. The effectiveness of muscle relaxants is unclear and, if prescribed they should be given only over the short term. Tricyclic antidepressants should be given only to patients with chronic pain complicated by a depressive component. A number of injection techniques are available for the treatment of refractory severe pain.

Anesthesia, Conduction↗
PubMed1993

[Conservative therapy of low back pain. Part 1: Immobilization].

The most common treatment for low back pain is bedrest, the purpose of which is to minimize pain caused by movement. Randomized studies have shown that this form of treatment is of use only over the short term. Whenever possible, the patient should be mobilized again after only 2 days. Long-term immobilization has a number of disadvantages. Lumbar corsets may be considered a form of partial immobilization, and are usually not recommended for unspecific back pain. As initial treatment of acute back pain, short term bedrest with proper positioning of the sufferer, possibly in combination with drug treatment can be employed.

Aged↗
PubMed1993

[Low-dose laser therapy: critical analysis of clinical effect].

Low dose laser therapy (LDLT) has been available for the treatment of various diseases for almost two decades. The aim of therapy is usually to reduce pain. The literature offers a plethora of reports, some negative and some positive. This review discusses the relatively few placebo-controlled, double-blind trials on the subject, in an attempt to provide an evaluation of the clinical effectiveness of LDLT. The majority of these studies suggest that LDLT is not clinically effective. There is no particular disease or symptom which seems to respond to LDLT. The same can be said of the type of laser light or its intensity. Based on this collective data, LDLT does not seem to be a scientifically proven therapy.

Analgesia↗