Dorsal disc prolapse with myelopathy: physical therapy influence

The purpose of this study was to identify the effect of postero-anterior spinal manipulation on dorsal disc prolapse with mild myelopathy; regarding back pain, ROM of lower dorsal trunk flexion and cadence. Ten volunteer's patients participated in the study. Their age ranged from 34 to 48 years, with duration of illness from one to six months. Patients were diagnosed clinically and by MRI as a dorsal disc prolapse. All patients complained of myelopathy with paraparesis with grade 1+ or 2 spasticity according to a modified Ashworth scale. VAS was used to measure local pain intensity. Functional plain X-ray was used to measure ROM of lower dorsal trunk flexion. Cadence was used as a kinematic parameter of gait for those patients. All these evaluation procedures were performed before and at the end of physiotherapy program. Physiotherapy consisted of ultrasound, hot packs and postero-anterior central spinal manipulation. This program was applied three times per week; for six weeks. Results of this study revealed a significant decrease of local back pain intensity at the end of the treatment program. Results also showed a significant increase of both ROM of lower dorsal trunk flexion and cadence at the end of treatment program. Results presented a strong correlation between clinical and kinematic parameters. In conclusion, postero-anterior central spinal manipulation was an efficient and non risky maneuver in the treatment of dorsal disc prolapse with mild myelopathy. Both local and cord manifestations can be improved in these patients

Alterations of P53, and BCL-2 protein expression in the recurrent laryngeal and pharyngeal squamous cell carcinoma

Identification of molecular events of the recurrent squamous cell carcinoma [SCC] of the larynx and pharynx may aid in refining treatment strategies and improving outcome. The underlying molecular events of these recurrent tumours involves alterations in the tumor suppressor genes [p53] and protooncogenes [Bc1-2]. We hypothesize that the development of these recurrent tumours involves alterations of the p53 and Bcl-2 proteins. To test this hypothesis, 15 laryngeal and pharyngeal biopsy specimens obtained from 15 patients with recurrent laryngeal or pharyngeal squamous cell carcinoma with different grades [II-IV] were immunostained for p53 and Bcl-2 protein expression. Examination of the percentage of positive cells in the normal mucosa and SCC, respectively, showed significant upregulation of p53 [0.0 +/- 0.0 Vs. 51.8 +/- 5.9; p= 0.00] and Bcl-2 protein expression [36.5 +/- 3.5 vs. 74.6 +/- 1.9; p= 0.00]. Alterations of the p53 and Bcl-2 proteins occur during the development of recurrent SCC. Additional studies are needed to confirm and extend our results

Assessment of ground reaction force components in parkinsonian patients

The purpose of this study was to evaluate the ground reaction force components in Parkinsonian patients and to compare them with that of age matched normal subjects. Twenty Parkinsonian patients and ten normal subjects participated in this study. This study calculated kinetic quantities of human gait, by using all components of the ground reaction force [vertical load, horizontal shear forces in the fore-aft and mediolateral directions], both in normal subjects and Parkinsonian patients by using force plate form. The results of this study showed a highly significant reduction of ground reaction force in all parameters of ground reaction force of Parkinsonian patients when compared with control group, except the reduction of the mediolateral component of the first peak which was non significant. So assessment of ground reaction force should be considered as a valuable tool in diagnosis, rehabilitation and prognosis of Parkinsonian patients

Study of anatomical and functional results of myringoplasty in children

Opinions about the timing and surgical techniques of myringoplasty in children with chronic supportive otitis media have been conflicting for many years. The aim of this study was to evaluate surgical and functional results of myringoplasty in selected children with tympanic membrane perforation and assess factors potentially influencing their outcome. The study included 82 patients aged from 7 to 14 years. Forty two were females and forty were males. All of the children underwent myringoplasty using underlay technique. Higher rate of anatomical failure was observed in cases with wet middle ear mucosa and with longer duration of discharge. The relation was statistically significant. One year postoperatively, the hearing level changes in patients with take11 grafts [66 patients] were as follows, in eleven cases the air bone gaps were closed to within 10 dB or less [mean preoperative gap was 21.5 dB and mean post-operative gap was 6.2dB]. In 51 cases the gaps were improved [the mean preoperative gap was 30.3 dB and mean postoperative gap was 18.15dB]. In three cases there were no changes and in one patient the hearing deteriorated. In cases with broken graft [12 cases] one year postoperatively there was seven cases of deterioration of hearing [mean preoperative ABG was 28 dB and mean postoperative gap was 47dB]. In five cases, there were no changes between pre and post-operative ABG. The overall clinical success rate after one year was 80.5% [66/82]. The overall audiological success rate after one year was 79.5% [62/78]. These cases included 11 cases with closed gap and 55 cases with azndioZogica1 improvement. Based on our study findings, we recommend pediatric myringoplasty to preserve and restore hearing, prevent recurrent attach of chronic otitis media and leave the child to bath and participate in water activities without restriction. The operation gives the child a safe, dry and functioning ear. We also recommend proper management of the ear to get a dry ear at the time of surgery; this will increase the success rate of the operation

study of balance disorders in old patients

This work studied 50 cases and 20 control patients complaining of dizziness and balance problems. The study also included 20 normal volunteer subjects to detect the 5th percentile of the used score. Each patient was diagnosed depending on history, examination and audiological and balance investigations. Semiquantitative clinical measures of equilibrium and subjective improvement were studied in patients and control groups before and after therapy. It was found that there was statistically highly significant improvement of mean score in clinical static and dynamic equilibrium after completing the vestibular rehabilitation regimen. There was a highly significant difference between the patient and the control groups in static assessment, but a insignificant difference in dynamic assessment. It was found that the static equilibrium score is more accurate than the dynamic one. There was a negative correlation between age and the degree of improvement in both static and dynamic assessment in patients and control groups. It was found that the vestibular subgroup of patients showed a statistically significant better improvement than the non-vestibular and the unknown subgroups. The benefit of vestibular rehabilitation therapy [VRT] was also found to be limited in patients with multiple medical problems. 62% of the patients' group and 15% of the control group achieved major improvement after VRT

Endoscopic t-tube application in inferior dacryocystorhinostomy

Nineteen patients diagnosed as having nasolacrimal duct obstruction were included in this study. Endoscopic diode laser assisted DCR with minimal bone work was done for all cases, then T-tube was applied to maintain the patency of the ostium instead of the silicone intubation. At the end of six months 15 out of 19 patients were relieved of their symptoms completely, while four patients continued to have persistent epiphora. The success rate was about 79%. Endoscopic diode laser assisted DCR with otologic T-tube application compares favorably with silicone stenting described in the literature. This technique has the following advantages: Easy, T-tube is a cheap, self-retaining stent, less granulomatous reaction, can be done under local anesthesia, less operative time, less intra-operative bleeding, less postoperative morbidity faster patient recovery, the procedure can be repeated and bilateral cases can be performed in the same setting

Evaluation of office balance tests

Balance tests may give valuable information that sometimes can be of help. Of these tests we evaluated five to study their sensitivity, specificity and correlation with electronystagmographic [ENG] results. These tests are; head shaking test [HST], Unterberger [UT] or Fukuda stepping test [FST], Dix-Hallpike test [DHT], Romberg's test [RT] and Tandem gait test [TGT]. We found that HST has low sensitivity and high specificity while UT has high sensitivity and low specificity. Dix-Hallpike test is both sensitive and specific for diagnosing benign paroxysmal positional vertigo [BPPV]. Romberg's and TGT tests are positive only in acute vestibular loss and neurological dysfunction. Correlation with ENG results was done and described. We concluded that HST is a good bed-side test in screening for unilateral vestibular hypofunction yet, it is better done using ENG tracing. Dix-Hallpike test is the most sensitive test in diagnosing BPPV without the need for ENG. Unterberger test had 86% sensitivity and 18% specificity. It is a good screening test and it correlates positively with ENG results. Romberg's test and TGT were good screening tests for acute vestibular loss and neurological dysfunction but don 't correlate with the ENG results

Infrared laser per se or with ultrasound in management of carpal tunnel syndrome

The aim of this study was to find out the role of laser therapy in the treatment of carpal tunnel syndrome [CTS]. Thirty female patients suffered from CTS participated in this study, their age ranged between 20 and 40 years with a mean of 30.83 +/- 7.15 years. They were classified into two groups of an equal number: Group 1 received infrared [IR] laser only, while group 2 received both IR laser and pulsed 1:4 ultrasound [US]. IR laser in each group was applied for ten minutes on the skin of the palmar surface of the affected hand, started 3 cm proximal to flexor retinaculum, then passed distally across the retinaculum to pass laterally 2 cm over thenar eminence. Pulsed US was applied for 15 minutes on the area which extends from wrist crease to palmar region to cover an area of 3-5 cm length and 2-2.5 cm width. Both groups received three sessions per week for four weeks. The patients were assessed clinically [visual analogue scale and pinch dynamometer] and electrophysiologically [motor and sensory distal latencies and sensory conduction velocity] before and after treatment program