The role of ultrasound-guided triamcinolone injection in the treatment of de Quervain's disease: treatment and a diagnostic tool?

The purpose of this study was to describe the technique and usefulness of ultrasound-guided intrasheath injection of triamcinolone in the treatment of de Quervain's disease (dQD). Our study was retrospective in design. Seventy-one wrists of 62 patients who were treated with an ultrasound-guided triamcinolone injection for dQD were included. A literature search was performed to compare our results. In the literature we found supportive evidence that accurate injection of triamcinolone in the first dorsal compartment of the wrist is important for a good outcome. In this retrospective study we found that treatment with ultrasound-guided injections of triamcinolone is both safe and effective. After two injections, 91% of the patients had good long-term results, which is a higher cure rate than found in most other studies. Furthermore, we found that Finkelstein's test can give a false positive result. Therefore, ultrasound should not only be considered to improve the treatment outcome, but can also be useful as a diagnostic tool in the management of de Quervain's disease.

[A Matter of Balance: strategy for implementation in Dutch homecare organizations]. / Zicht op Evenwicht Landelijke implementatie van een cursus gericht op het verminderen van angst om te vallen bij zelfstandig wonende ouderen.

BACKGROUND: The Dutch version of A Matter of Balance (AMB-NL) is a cognitive behavioral group program to reduce fear of falling and related activity avoidance in community-living older persons. This paper presents the strategy for implementation of AMB-NL in Dutch homecare organizations and the outcomes of this implementation. The aim was to implement AMB-NL in at least 50 % of 64 homecare organizations in The Netherlands in 2009 and 2010. METHODS: The implementation strategy was based on the four phases of the Replicating Effective Interventions: pre-conditions, pre-implementation, implementation, and maintenance and evolution. RESULTS: After preparing the implementation activities, such as identifying implementation barriers, consulting stakeholders, preparing the materials involved in the implementation, and training the facilitators of the program (n = 53), AMB-NL was implemented in 16 of the 64 homecare organizations (25 %). Another five homecare organizations indicated that they would shortly include AMB-NL in their care program. These organizations conducted the intervention 19 times to a total of 178 participants. After the implementation phase another 16 facilitators were trained, and program materials were successfully disseminated. CONCLUSION: The implementation of AMB-NL was well performed. The targeted aim is not fully reached within the two-year timeframe, but the program is well received by participants, trainers and homecare organizations. Further implementation and maintenance of AMB-NL in primary health care is recommended.

Proceedings of the SRBR-KBVR osteoarticular section meeting of October 18, 2003 in Antwerp--Part one. Imaging of chronic ankle pain, with a focus on soccer injuries.

Chronic ankle pain is a very common problem encountered in soccer injuries. It can be divided into three regional entities, including anterior ankle pain, deep ankle pain and posterior ankle pain. The purpose of this presentation is to present the value of each imaging technique (standard radiography, multislice CT and Magnetic Resonance imaging) in the diagnosis of chronic ankle pain.

[Giant diverticulum of the sigmoid]. / Reuzendivertikel van het sigmoïd.

A 77-year-old woman who had been examined 8 months previously because of chronic abdominal pain and an altered pattern of defecation presented to the emergency department with complaints of nausea, vomiting and acute pain in the abdomen. Her appetite was diminished and she had lost 10 kg in the past year. The abdominal X-ray showed a balloon-like, gas-filled intra-abdominal configuration, which proved to be a giant diverticulum of the sigmoid. She was treated by resection of the diverticulum and the sigmoid. A giant diverticulum is a rare complication of diverticulosis, a frequently occurring condition that is encountered most often in the sigmoid; the complication can easily be missed. The presenting symptoms can vary from an acute abdomen to chronic non-specific abdominal complaints. The most important complications of a giant diverticulum are perforation, obstruction or a volvulus. In view of the severity of these complications, resection of that part of the intestine in which the giant diverticulum arises is the treatment of choice.

[Diagnostic imaging of injuries and overuse in soccer players]. / Bildgebende Diagnostik von Verletzungen und Uberlastungsschäden bei Fussballern.

Soccer is one of the most popular sports worldwide. There is a high incidence of injuries in soccer in which several intrinsic and extrinsic factors play a part. Most injuries are minor, self-limiting and do not need extensive medical treatment or imaging. Imaging can be required for several reasons e.g. when the clinical findings are doubtful, to replace arthroscopy (i. e. of the knee) or for prognostic reasons. All imaging modalities available to the radiologist can be used but MRI is the most valuable imaging modality with its superior contrast resolution and multiplanar capabilities. Basically, injuries in the soccer player can occur anywhere in the body like in every sport. The lower extremities, more specific the knee and ankle, are however the most injured parts.

Nimodipine: cognition, aging, and degeneration.

Over the years, it has become apparent that many cytotoxic events employ a common pathway in destroying cells, namely the disruption of calcium homeostasis. Further studies show that the aging process is also accompanied, perhaps even partly caused, by changes in cellular calcium regulation. Finally, initial evidence has appeared in the literature showing that the Alzheimer beta-amyloid protein also interferes with calcium homeostasis. In these situations, the use of calcium antagonists, such as nimodipine, is expected to prevent part of the damage resulting from disrupted calcium regulation. Indeed, studies with nimodipine show that the compound reduces neuronal degeneration in a variety of toxic conditions. In addition, the compound has a functional effect in that it increases spontaneous neuronal firing of aged neurons, presumably by reducing the age-dependently increased afterhyperpolarization. Nimodipine also reduces age-related perivascular anomalies and increases cerebral blood flow. A combination of these effects is probably why the substance is found to improve cognition in aged animals and in aged humans with impaired brain function.

Learning-induced afterhyperpolarization reductions in hippocampus are specific for cell type and potassium conductance.

Hippocampal slices were prepared from rabbits trained in a trace eye-blink conditioning task and from naive and pseudoconditioned controls. Measurements of the post-burst afterhyperpolarization (AHP), action potential, and other cellular properties were obtained from intracellular recordings of CA1 pyramidal (N = 49) and dentate gyrus granule cells (N = 52). A conditioning-specific reduction in the amplitude of the AHP was found in CA1 cells but not in dentate granule cells. This reduction in the AHP was apparent at 50 ms after the end of a depolarizing current pulse, and was maintained for at least 650 ms. Other measured cell characteristics (input resistance, resting membrane potential, action potential shape, inward rectification, spike threshold) were not affected by training, in either CA1 pyramidal or dentate granule cells. Time-course measures indicate that both the medium, Ca2(+)-independent AHP and the slow, Ca2(+)-dependent AHP are reduced by conditioning. The slow AHP largely reflects the Ca2(+)-dependent K+ current, IAHP. Rising and falling slopes, peak amplitude, and width of individual action potentials were not changed by learning. This contrasts with observations from invertebrates in which action potential broadening was reported following learning. We conclude that the reduction in AHP that follows hippocampally-dependent associative learning occurs in specific hippocampal cell types and not others, and is mediated by changes in a Ca2(+)-independent AHP and a particular Ca2(+)-dependent K+ current, IAHP.

Radionuclide renography to evaluate urodynamically expected upper tract obstruction in patients with meningomyelocele.

Radionuclide renography showed an obstructed pattern in 6 patients with meningomyelocele without dilatation of the upper urinary tract or reflux when the bladder was filled to the volume that during previous urodynamic testing had resulted in an intravesical pressure of 40 cm. water but not when these patients were studied with an empty bladder. Therefore, this study indicates that treatment should be directed at avoiding long-standing intravesical pressure exceeding 40 cm. water in patients with meningomyelocele.

Cough-induced microtransducer movements in the urethra affecting pressure measurements.

Ratios of the amplitudes of the pressure increments in the urethra and vagina during coughing have been measured with two types of microtransducer catheters in fixed and loose positions. The data obtained from 14 urge incontinent women clearly indicate an artifactual contribution to the cough-induced urethral pressure increment measured by a semirigid microtransducer catheter attached to a withdrawal apparatus. This contribution due to urethral movement over the microtransducer catheter is negative in the proximal urethra and positive distally and accounts for the S-shaped distribution of transmission ratios along the urethra, as has been described for continent women. Transmission ratios exceeding 100 per cent were found over at least a part of the urethra. This excess proved to be present in all four versions of measurement and consequently cannot be considered as artifactual.

Time separation between cough pulses in bladder, rectum and urethra in women.

Time separations between cough pulses detected by microtip transducer catheters in bladder, urethra and rectum were studied in 10 healthy female volunteers, 10 genuine stress incontinents, 10 motor urge incontinents and 9 motor urge incontinents after bladder retraining. From the measurements that could be analyzed in the group of volunteers, 25 per cent showed a significant advanced onset of the pressure rise in the urethra and 50 per cent a prolonged duration of the urethral cough pulses. None demonstrated delayed onset or shortened duration compared to the vesical pulses. In the genuine stress incontinent group none of the women had an advanced urethral start whilst the motor urge incontinents had figures somewhere in between, except for a remarkable prolonged duration of the urethral cough pulse in the bladder retrained women. The data obtained can be explained by introducing, besides the passive transmission of abdominal pressure, a 2nd component actively engaged in maintaining continence.

The static urethral closure pressure profile in female incontinence. A comparison between sphincter and detrusor incontinence.

The objective of the study was to ascertain if the determination of urethral data in static conditions allows to discriminate between sphincter and detrusor incontinence. Using a standardized recording technique with three Millar microtransducer catheters (in bladder, urethra and rectum) urethral pressure profile measurements were done in two groups of female patients, with either sphincter incontinence (n = 38) or detrusor incontinence (n = 28). The urethral examination was performed in two conditions, with an empty bladder when the patient was in supine position and with a full bladder in standing position. A Millar catheter with a small balloon was drawn through the urethra at a speed of 25 mm per minute (static, i.e. without coughing). The parameters measured were the functional urethral length, the anatomical urethral length and the maximal urethral closure pressure. Results showed that there was no clear difference between both groups with respect to the urethral lengths or the maximal closure pressure. Comparing the data in the condition of empty bladder supine, with those in the condition of full bladder standing, we could not demonstrate clear specificity for either sphincter or detrusor incontinence. It was concluded that static urethral profile studies are of poor value to discriminate between sphincter incontinence and detrusor incontinence.