[The FADI score--a possibility for the quantified differential diagnosis of discogenic pain]. / Der FADI-Score -- eine Möglichkeit zur quantifizierten Differenzialdiagnose des diskogenen Schmerzes.

AIM: Chronic, non-radicular low-back pain has varying reasons. The main causes are a zygoapophysial joint syndrome, discogenic pain, especially the rupture of the inner disc, the IS joint syndrome as well as a myofascial syndrome. Especially the differentiation between zygoapophysial joint pain and discogenic pain often proves to be difficult in the clinical routine. In the literature, different criteria can be found concerning the distinction of zygoapophysial joint pain and discogenic pain. Clinical criteria, criteria of imaging as well as intensive diagnostics are described. So far there is a lack of a summarizing evaluation of these aspects. METHOD: The FADI score uses clinical criteria with combinations of motion, consisting of rotation, side inclination, anteflexion and pressure-sensitive spots, imaging aspects and the invasive diagnostics by means of selective blockades of zygoapophysial joints and discography or rather disc stimulation. The examination results are summed up and judged as to their relevance as well as validity through our score. RESULTS: First of all the relevance of the single aspects was judged in a primary test with 30 patients. The diagnostic block and the clinical criteria for the zygoapophysial joint syndrome as well as discography and MRI for discogenic pain had the best results. Afterwards the score was tested in the clinical area with 56 patients and showed its value under clinical conditions. CONCLUSION: Especially when dealing with patients suffering from chronic back pain, the score serves to simplify the choice of a further therapy, including invasive procedures, or rather to avoid unnecessary major surgery at the spine.

Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial.

OBJECTIVE: To investigate the safety and efficacy of 2 extracts of echinacea for preventing upper respiratory tract infections. DESIGN: Three-armed, randomized, double-blind, placebo-controlled trial. SETTING: Four military institutions and 1 industrial plant. PARTICIPANTS: Three hundred two volunteers without acute illness at time of enrollment. INTERVENTIONS: Ethanolic extract from Echinacea purpurea roots, Echinacea angustifolia roots, or placebo, given orally for 12 weeks. MAIN OUTCOME MEASURE: Time until the first upper respiratory tract infection (time to event). Secondary outcome measures were the number of participants with at least 1 infection, global assessment, and adverse effects. RESULTS: The time until occurrence of the first upper respiratory tract infection was 66 days (95% confidence interval [CI], 61-72 days) in the E angustifolia group, 69 days (95% CI, 64-74 days) in the E purpurea group, and 65 days (95% CI, 59-70 days) in the placebo group (P = .49). In the placebo group, 36.7% had an infection. In the treatment groups, 32.0% in the E angustifolia group (relative risk compared with placebo, 0.87; 95% CI, 0.59-1.30) and 29.3% in the E purpurea group (relative risk compared with placebo, 0.80; 95% CI, 0.53-1.31) had an infection. Participants in the treatment groups believed that they had more benefit from the medication than those in the placebo group (P = .04). Adverse effects were reported by 18 subjects in the E angustifolia group, 10 in the E purpurea group, and 11 in the placebo group. CONCLUSION: In this study a prophylactic effect of the investigated echinacea extracts could not be shown. However, based on the results of this and 2 other studies, one could speculate that there might be an effect of echinacea products in the order of magnitude of 10% to 20% relative risk reduction. Future studies with much larger sample sizes would be needed to prove this effect.

Myogenic changes of the levator ani muscle in premenopausal women: the impact of vaginal delivery and age.

The aim of this study was to evaluate the impact of parity and age on histomorphology of the pelvic floor muscles in female cadavers of reproductive age and to find out whether there is evidence of myogenic or neurogenic muscle injury. In a cross-sectional study 45 premenopausal unfixed and fresh female cadavers were studied. Four groups were defined: nulliparous and parous women under the age of 40 and over 40 years of age. The pelvic floor was biopsied at six standardized locations. For evaluation of the quantitative parameters and fiber type identification, actomyosin ATPase at pH 9.4 was used. For histomorphological evaluation, sections were stained with hematoxylin/eosin, van Gieson, and Gomori trichrome. The circumference of type I fibers is significantly larger in nulliparous women younger than 40 years compared to nulliparae older than 40 years. Comparing these groups, the form factor of type II fibers also increases significantly, presenting a more circular cell form. Compared to nulliparae, vaginal delivery led to a significant difference regarding the presence of centrally located nuclei, fibrosis, and variation in fiber diameter. In nulliparous women, these significant changes were also found with increasing age. In women with a history of vaginal delivery, no further increase in these characteristics could be detected with increasing age. Comparing the three different biopsy sites, all three changes were more pronounced in the ventral part. There was no evidence of grouped fiber atrophy, small angulated fibers, or type grouping in any of the biopsy specimens. Aging and vaginal childbirth lead to histomorphological changes of the pelvic floor muscle that are consistent with changes of myogenic origin. Evidence of neurogenic damage could not be demonstrated.

Topographic mapping of brain electrical activity in children with food-induced attention deficit hyperkinetic disorder.

UNLABELLED: In 15 children suffering from food induced attention deficit hyperkinetic syndrome, topographic EEG mapping of brain electrical activity was carried out following avoidance and ingestion of previously identified provoking foods. A crossover design was used and recordings were interpreted independently by two investigators, one of whom was blind to the order of testing. During consumption of provoking foods there was a significant increase in betal activity in the frontotemporal areas of the brain. This investigation is the first one to show an association between brain electrical activity and intake of provoking foods in children with food-induced attention deficit hyperactivity disorder. CONCLUSIONS: These data support the hypothesis that in a subgroup of children with attention deficit hyperactivity disorder certain foods may not only influence clinical symptoms but may also alter brain electrical activity.

Vaccine tolerance in steroid substituted patients with congenital adrenal hyperplasia.

The tolerance and side effects of vaccinations were determined in patients with congenital adrenal hyperplasia (CAH) who receive physiological corticosteroid substitution. In a retrospective approach, questionnaires about the frequencies of vaccinations and observed side effects were sent to CAH patients, and medical records were reviewed. We received 82 questionnaires from 63 patients with CAH and salt-losing and 19 patients without salt-losing. Patients age ranged from 2-40 years. No statistical differences were found for vaccination frequencies between patients with or without salt-losing. CAH patients had received complete vaccinations against diphtheria, tetanus and poliomyelitis in 79%, 85% and 78%, respectively, whereas pertussis vaccination was complete in only 23%. Live vaccination against measles, mumps and rubella was performed in 63%, 50% and 38%. Side effects of vaccination were indicated in 5 out of 82 questionnaires who all belonged to CAH patients with salt-losing. Transient side effects were an anaphylactic reaction, probably to tetanus immunoglobulin, in 1 case, and fever and convulsions after diphtheria, pertussis and tetanus (DPT) vaccine in 2 cases. In 2 further patients putative complications were noted. Encephalitis with permanent disabilities was observed after the third DPT vaccination, but a causative relation could not be established. In another boy, encephalopathy noticed after measles vaccination was induced by previous toxicosis. Although encephalopathy was described in 2 patients after vaccinations, no vaccination damage could be proven in our retrospective study. As expected, an increased vaccination risk in CAH patients was not demonstrated.

Critical evaluation of papers reviewing controlled clinical trials in homoeopathy

An analysis was made of papers reviewing controlled clinical trials designed to assess efficacy of homoeopathic treatment strategies, the aim being to demonstrate selective and critical assessment of such papers. The papers were systematically collected and evaluated for content and quality using predefined criteria, finally comparing the results. 9 of 41 papers considered in detail after screening the literature met the criteria for inclusion in the analysis. Each considered between 22 and 107 trials. 7 papers met 2 or less of the predefined quality criteria, one met 6 one 8 criteria. Only 1 of the papers allowed full representation and reproducible evaluation of treatment strategies for the controlled clinical studies considered in that paper. The analysis has shown that review papers must clearly specify issues, objectives, methods of literature screening and quality assessment