Effects of visual feedback balance training by using computerised dynamic posturography in patients with multiple sclerosis

To study the effects of the visual feedback balance training on the Berg Balance Scale [BBS] under static and dynamic conditions, the somatosensory, visual and vestibular systems by dynamic posturography before and after training program in patients with multiple sclerosis [MS]. Retrospective case training study. Physical Medicine and Rehabilitation Hospital, Ministry of Health, Kuwait. A total of 23 patients with MS were recruited. All patients were evaluated using both the BBS and the sensory organization test [SOT] using computerized dynamic posturography [CDP] before and three months after the training program. The SOT consists of six conditions and composite equilibrium score [CES]. CES [%] and SOT were calculated. Before training, all patients had a reduction of BBSS and parameters of the SOT. After training, a significantincrease of BBS [p < 0.05], all parameters of the SOT [p < 0.05] and CES [p < 0.001] were observed. Improvement in all parameters of the SOT after training program could be explained by change in the somatosensory system of the posture control system. Also, there is impairment of the somatosensory system, rather than a specific lesion of vestibular and/or visual systems

Intracavernous injection of prostaglandin E1 for the treatment of erectile dysfunction in spinal cord injured patients: experience with 30 patients

To evaluate the efficacy of intracavernous injections of alprostadyl [Caverject] in the treatment of erectile dysfunction in patients with spinal cord injury [SCI] and to determine the mean necessary dose to obtain functional erection. Material and Thirty patients aged between 20 to 44 years, duration of lesion from one to 13 years and level of SCI from C5 incomplete to L3 complete, were included in the study. The treatment started with a minimal dose of 1.125 micrograms and the dosage was titrated to achieve rigid erection. Following the establishment of the effective dose, the patients were trained in the technique of self-injection. They returned periodically for follow up. Twenty seven patients achieved functional erection [Schramek grade 4 or 5] with a dose equal or less than 20 micrograms [mcg] of Caverject. The average effective dose was 11.75 +/- 4.6 mcg. Average duration of erection was 48.3 minutes. No side effects from the t reatment were observed except discomfort in two patients and mild penile pain in one patient. 76% of the patients were satisfied and very satisfied with the treatment. Intracavernous injections of Caverject are e ffective and safe therapy for erectile dysfunction provided that individual dose is established by titration, the patients are trained in the technique of self-injection

Methods for measurement of tibial torsion

No conventional technique for routine assessment of tibial torsion, the twisting of tibia around the longitudinal axis, has yet gained acceptance. Clinical measurements give approximate values only. Methods employing tropometers and other mechanical devices have mainly been used for measurement in skeletal specimens and in patients, though on a limited scale. Certain roentgenographic methods are considered complicated, whereas others require trigonometric calculations on the roentgenograms. With the development of the whole body computed tomography [CT] where distinct cross-sectional images can be obtained, reference points are easy to be determined, which make it possible to accurately measure this torsional deformity. Considering the demands for availability, simplicity, and precision, fluoroscopic techniques have been developed

Rotational malalignment in osteoarthritic knees

To study the rotational alignment of lower limbs in patients with osteoarthritis of the knees, measuring two of its components, knee rotation and tibial torsion, by computer tomography. Material and Method: 46 subjects [36 patients with osteoarthritis of the knees and 10 age- and sex-matched asymptomatic volunteers] were included in the study. Cases were required to be "knee pain positive", ascertained using a previously standardized questionnaire and to have at least grade 3 radiographic changes using Kellgren and Lawrence criteria. All 92 limbs were scanned at the level of distal femoral condyle, proximal tibial condyles and ankle joint. Rotation of the knee joint was measured as an angle between the tangent to the dorsal aspect of femoral condyles [pro x i m a l reference line] and the dorsal tangent to the tibial condyles. Tibial torsion was measured as an inclination between the dorsal tangent to the tibial condyles and the tangent to the distal tibia at the level of the medial malleolus. The mean values of the two variables were reduced in patients with osteoarthritis of the knee. The decrease of tibial torsion [28.3° +/- 5.1°] in the osteoarthritic patients compared to the control group [35.4° +/- 6.2°] showed significance. Rotational malalignment may have some implications in the genesis of osteoarthritis of the rotationally intolerant knee joint

Serum levels of insulin-like growth factor-1 in patients with osteoarthritis of the knee

Insulin related growth factor-1 [IGF-1] is an important growth promoting peptide which has anabolic effects on cartilage metabolism. The fact that serum levels tend to decrease in elderly subjects while osteoarthritis [OA] increases in prevalence suggests that suboptimal levels of IGF-1 may play a part in the development of OA. This study therefore considers the hypothesis that IGF-1 levels are low in subjects with OA of the knee. Serum levels of 48 patients with symptomatic knee OA and radiographic changes of different grade were compared with normal controls. No significant difference was found in serum levels between cases and controls [mean [SD] 20,67 [7.73] for cases and 23.91 [12.0] mmol for controls]. No significant correlations were shown between IGF-1 levels, age and total radiographic score. The study provides no evidence that serum levels of IGF-1 are low in OA