Physiotherapeutic interventions before and after surgery for degenerative lumbar conditions: a systematic review.

BACKGROUND: Physiotherapeutic management of patients immediately following lumbar spinal surgery is common. However, there is considerable variability in the interventions provided. OBJECTIVES: To assess the effect of peri-operative physiotherapeutic intervention in adults undergoing surgery for the management of degenerative lumbar conditions. DATA SOURCES: The Cochrane Library, Medline, Embase, CINAHL and PEDro were searched from inception to August 2012. STUDY SELECTION: Randomised controlled trials investigating physiotherapeutic interventions prior to and immediately following surgery for degenerative lumbar conditions were included. DATA EXTRACTION AND SYNTHESIS: Two reviewers extracted data independently using a standardised form. Risk of bias was assessed using a modified version of the Cochrane Collaboration tool. The quality of evidence was assessed using the GRADE approach, and the treatment effect size was calculated where comparable outcome measures were used across multiple trials. RESULTS: Four studies were included. There is very-low-quality evidence that pre- and post-operative exercise in addition to standard physiotherapeutic care may reduce pain, time taken to achieve post-operative functional milestones, and post-operative time off work. Results from one study indicated that there is no clear benefit or risk of harm from performing either prone or side-lying transfers. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS: Very-low-quality evidence suggests that physiotherapy may improve pain and function following lumbar surgery. Due to low numbers of included studies and variation in the interventions assessed, the current evidence provides limited guidance for physiotherapeutic practice. Further research is required to determine the effectiveness of physiotherapeutic interventions in this population.

T-cell subsets with a naive phenotype are selectively decreased in the peripheral blood of patients with mycosis fungoides.

Peripheral blood lymphocytes of 33 patients with histopathologic confirmation of mycosis fungoides and 27 healthy controls matched for age and sex were analyzed with a panel of monoclonal antibodies using both single and dual color immunofluorescence. Patients with mycosis fungoides had a significant reduction in the percentage of circulating T cells with a naive phenotype (i.e., CD4+2H4+ and CD4+Leu8+), as well as a significant reduction in the absolute numbers of circulating lymphocytes with the phenotype CD8+Leu8+ compared to the control cohort. The reduction in circulating naive T cells was found to occur irrespective of stage of disease, duration of disease, or mode of treatment. The depletion of circulating naive T cells may reflect increased conversion to memory T cells in the peripheral blood or skin.

Serum interleukin-2 receptor levels and cutaneous T-cell lymphoma.

The serum of twenty-four patients with histopathological confirmation of cutaneous T-cell lymphoma, including three with Sezary's syndrome, and twenty age matched controls was examined for soluble interleukin-2 receptor using a commercially available ELISA kit. Whilst there was no significant difference in the mean concentration of the interleukin-2 receptor between patients with mycosis fungoides and controls, six of twenty-one patients had interleukin-2 receptor levels outside the mean plus two standard deviations of the age matched cohort. Patients with Sezary's syndrome had markedly elevated levels of this receptor. Our data support a previous report suggesting serum levels of soluble interleukin-2 receptor increase with advancing age, highlighting the need for age matched controls when studying soluble interleukin-2 receptor levels in disease states.

Safety and efficacy of mometasone furoate cream in the treatment of steroid responsive dermatoses.

The safety and efficacy of once daily application of mometasone furoate cream 0.1% was determined by comparison with twice daily applications of betamethasone dipropionate cream 0.05% in a single blind, dual centre, randomized study in patients with a variety of steroid-responsive inflammatory dermatoses, the most common of which was psoriasis. Morning plasma cortisol levels revealed little adrenal suppression in either of the two study groups and there was no significant difference between the two groups. Routine laboratory investigations showed no trends in values outside the normal ranges that were of clinical significance. Less skin atrophy was seen in the group treated with mometasone furoate. In comparison to the betamethasone dipropionate treated group, those treated with mometasone furoate exhibited only slight evidence of skin atrophy, and this was not observed before four to twelve weeks of treatment. Eighteen percent of patients using mometasone reported adverse reactions but all were of limited duration and did not persist despite continued application of the drug. Nine percent of patients using betamethasone dipropionate reported adverse effects. Both drugs were found to be highly effective with no significant difference between the two groups at the termination of the treatment period. Of importance is the fact that whilst mometasone furoate is found to be a highly effective treatment for a variety of steroid-responsive dermatoses, this drug has only a limited potential for production of local and systemic side effects. Thus, a high margin of safety can be expected for patients using this drug.