[Neurogenic bladder in diabetes mellitus]

Diabetic bladder dysfunction is among the most common complications of diabetes mellitus. It is principally caused by autonomic neuropathy defining diabetic cystopathy. Characterize the bladder dysfunction in patients with diabetes mellitus. The clinical and urodynamic records of patients with diabetes mellitus were reviewed. 40 patients with diabetes mellitus were included in the study mean aged 55 years. 32 patients had voiding dysfunction. Urinary frequency and difficulty emptying were the predominant symptoms that led to patient referral. 15 patients [31.25%] had decreased flow rates. 12 patients [37.5%] had diminished bladder sensation and/or impaired detrusor contractility. 10 patients [25%] had detrusor hyperreflexia. And 6 patients had impaired detrusor contractility with increased bladder sensation. Vescico-uretral dyssynergia was found in 2 patients [5%]. This study suggests that classical diabetic cystopathy is not the most common urodynamic findings in patients with diabetes mellitus and demonstrates the importance of urodynamic studies in diagnosing bladder dysfunction in diabetics before initiation of therapy

[ contribution of home based exercise programme in case of osteoarthritis of the knee]

Knee Osteoarthritis is the most frequent articular disease. It may cause disability and handicap. To assess the effect of a home based exercice programme in a Tunisian population having knee osteoarthritis, associated with medical treatment and education. Prospective study during three months, including 34 Tunisian patients with knee osteoarthritis. A clinical and functional assessment of the patients was made using respectively the visual analogic scale for the pain, the Lequesne index, the Functional Independence Measure and the womac function score for the function, the HAQ and SF36 for the assessment of the quality of life. Visual analogic scores for pain were reduced in the exercise group. Lequesne index scores reduced significantly in the exercise group and were unchanged in the controls. Quality of life was greater in the exercise group compared with the controls. Home based exercise programme contributes to relieving pain, maintaining function and to ameliorate the quality of life of people having knee osteoarthritis

[Capsular distension and physical therapy in treatment of adhesive capsulitis]

Objective: to evaluate the efficacy of capsular distension combined with intraarticular alucocorticoid injections and immediate physical therapy in the treatment of adhesive capsulitis

Method: a prospective open study of patients with adhesive capsulitis. Clinical and radiological criteria was used for diagnosis. Clinical evaluation was realized before treatment, at the end of the treatment, after 1 month, 3 months and 6 months. It carried on: the measure of pain and handicap intensity by an Visual Analogue Scale, the algo-functional score of Constant, the measure of passive articular mobilities. We ended in a success of the treatment when the visual analogue scale of handicap < 30, the score of Constant > 70, the passive abduction >90 and the external rotation [RE] >45 degree

Results: 19 patients were included, mean aged 56 years with capsular retraction evolving on average for 8.5 months. The parameters of evaluation of pain function and handicap improved significantly since the end of treatment. This improvement continued until 6 months after the treatment. Earning in articular amplitudes was significant since the end of treatment for forward extension and internal rotation. However, the improvement in abduction and internal rotation was significant only at 3 months. In spite of this early significant improvement in external rotation, 6 patients had an important limitation of the RE [<20 degree]. A subacromial bursography with steroid injection was proposed to them because subacromial bursa is almost consistently involved by retraction. Only, 4 patients among them accepted it. Out come was favorable in every case with a external rotation >45 degree at I month of the treatment. The rate of success which was only 47.3 % at the end of the treatment, is crossed in 73.6 % at I month and reaches 89.4 % at 6 months

Conclusion: The therapeutic association capsular distension. intraartieuiar steroid injections and physical therapy allows to shorten the course of adhesive capsulitis. Burso-infiltration seems to be effective as therapeutic complement in case of persistence of an articular limitation