[Physical therapy in the treatment of stress urinary incontinence].

INTRODUCTION: Stress urinary incontinence (SUI) is an involuntary release of urine through the urethra during the increase of abdominal pressure in the absence of m. detrusor contraction. The exercise of pelvic floor muscles is recommended as the first line of cure. It is the least invasive and the only method without any undesirable side effects, which leads to either improvement or complete cure of SUI in 80-85% of cases. OBJECTIVE: The aim of this study was to establish whether the strengthening of pelvic floor muscles using proprioceptive neural facilitation (PNF) spiral dynamic technique was more efficient in comparison to classical Kegel exercise. METHODS: The research was carried out at the Centre for Physical Medicine and Rehabilitation, Clinical Centre Kragujevac. Sixty-six female patients with the symptoms of SUI were monitored in the period of two years. Thirty-four patients did pelvic floor muscle exercises twice a day, in the morning and in the evening, with 15-20 contractions. Thirty-two patients used PNF spiral dynamic technique for strengthening pelvic floor muscles. The patients who used the spiral dynamic technique also did some exercises from the program; they exercised twice a day, in the morning and in the evening, following the prescribed schedule. Treatment outcome was assessed by measuring the pelvic floor muscles by a vaginal dynamometer. RESULTS: The values of the pelvic floor muscle force that were measured using the vaginal dynamometer in both examined groups (PNF spiral dynamic technique or Kegel exercise) were statistically significantly higher after the implemented exercise program (t-test; p=0.000). No statistically significant difference in pelvic floor muscle values was found between the patients who applied PNF spiral dynamic technique and those who did Kegel exercise either before or after the exercise (two-factor analysis of variance with repeated measurements, factor of exercise type; p=0.899). CONCLUSION: Strengthening of pelvic floor muscles by exercises results in a significant increase of pelvic floor muscle strength and reduction of SUI symptoms, regardless of the used exercise program, PNF spiral dynamic technique or Kegel exercise program.

Cartilage oligomeric matrix protein - inflammation biomarker in knee osteoarthritis.

Chondrocytes and synovial cells synthesize Cartilage Oligomeric Matrix Protein (COMP) when activated by proinflammatory cytokines. The aim of this study was to analyze and compare ultrasound parameters of joint inflammation, effusion and synovitis with the levels of COMP in the serum of patients with primary osteoarthritis. Ultrasound was done and the concentration of COMP (ng/mL was examined in 88 patients. 75% of patients had effusion (size 10.13±4.35 mm), 62.5% had effusion in lateral recessus (LR), 28.4% (size 8.53±2.27 mm) in suprapatelar (SR), and 27.3% (size 11.38±4.44 mm) in medial (MR). 67% of patients had synovitis size 4.84±3.57 mm in SR, 3.15±1.86 mm in MR; and 6.09±2.80 mm in LR. 17.0% of patients had nodular type of synovitis, 30.7% had diffusive, and 19.3% nodular - diffusive. There was a significant link between the size of synovitis and effusion in SR (r = 0.966, p = 0.000), MR (r = 0.812, p = 0.009) and LR (r = 0.886, p = 0.003). The median of COMP concentration was 54 (44.5-58) ng/mL in patients without effusion. In those with effusion it was 57 (48.75-64.25) ng/mL (p = 0.030). Without synovitis it was 52 (45.5-58) ng/mL, with synovitis 58 (50-66) ng/mL, (p = 0.006), diffusion type synovitis 60 (50-67) ng/mL, nodular 57 (50-62) ng/mL, nodular-diffusion 54 (44.5-66.5) ng/mL (p = 0.014). With longer osteophytes the median of COMP was 56 (48-64) ng/mL, with shorter osteophytes 55 (46.5-59) ng/mL (p = 0.000). Cartilage oligomeric matrix protein has a moderate significance in the assessment of disturbance of the metabolism of synovial and cartilage tissue in patients with knee osteoarthritis (sensitivity = 59%; specificity = 50%; cut off = 53.5 ng/mL).

[Detection of bone erosions in knee osteoarthrosis by serum biomarkers].

INTRODUCTION: Osteoarthrosis (OA) is a degenerative chronic disease characterized by destruction of joint articular cartilage and subchondral bone with formation of osteophytes and usuries on joint surface. Quantitative and dynamic changes in remodeling of joint tissue reflect matrix molecules that dismiss as fragments in joint liquid, blood and urine where they can be detected. Human cartilage glycoprotein (YKL-40) is synthesised by chondrocytes and synovial cells and plays a significant role in remodel tissue. OBJECTIVE: The aim of the paper was the parallel analysis and determination of the degree of correlation between ultrasound indicators destruction of joints, bone erosion (usuries), and serum YKL-40 concentrations in patients with primary osteoarthrosis of the knee. METHODS: The analysis included 88 patients with the diagnosis of knee OA. Ultrasound review of knees was done by two rheumatologists. The analysis of serum samples determined the concentration of YKL40 by ELISA method. RESULTS: The average age of patients was 69.97 +/- 9.37 years, duration of knee OA 6.46 +/- 6.73 years. The mean value of age in 59 patients with usuries was 72.05 +/- 7.74, at 29 without usuries 65.75 +/- 11.00 (p = 0.003). The average value (median) thickness cartilage in medial condyl femur (front access) in patients with usuries was 1.25 mm (1.12-1.36 mm), without usuries 1.35 mm (1.20-1.51 mm) (p = 0.016). The central YKL40 value of biomarkers in the patients without usuries was 81 ng/ml (46.5-120.5 ng/ml), with usuries the medial condyil 138 ng/ml (89.5-175.0 ng/ml), the lateral 106 ng/ml (63.0-201.5 ng/ml) and both condyl 86 ng/ ml (69.75-140.5 ng/ml) (p = 0.004). The central value YKL40 after 5 year-duration of disease was 83.68 +/- 33.65 ng/ml, after 10 years 138.22 +/- 48.88 ng/ml, after 15 years 209.30 +/- 79.36 ng/ml, and after 20 years 218.50 +/- 106.51 ng/ml (p = 0.000). The biomarker YKL 40 may be a marker for usuries (area 0.691, p = 0.004; confidence interval 0.574-0.808). If you took the optimal cut-off of 84.5 ng/ml, then YKL40 sensitivity to the usuries was 69.5%, and specificity 51.7%. CONCLUSION: Increased concentrations of biomarkers YKL40 may be an indicator of the degree of destructive changes in the knee osteoarthrosis.

[Inflammation in knee osteoarthrosis--cause of aggravation].

INTRODUCTION: Knee osteoarthrosis is a degenerative disease which induces intense trouble. MATERIAL AND METHODS: The aim of the study was the parallel analysis of clinical and ultrasound examination in patients diagnosed with knee osteoarthrosis. A group of 88 patients underwent the clinical examination and the outflow and size of flexion were determined, the intensity of pain was assessed by the patient's mark on VAS, the functional ability by HAQ index, and the size of effusion and synovitis by arthrosonography. RESULTS: The minimal outflow was diagnosed in 34.1% of patients, medium in 22.7%, and significant in 4.5%. Synovitis was evident in 67% of patients, 17.0% had nodular, 30.7% diffuse and 19.3% nodular-diffuse type. Effusion was observed in 75% of patients. The average size of synovitis in suprapatellar recess (SR) in the patients with significant, medium and lateral outflow was 6.68 (2.93-10.04) mm (p = 0.000), 1.57 (0-5.53) mm (p = 0.006) and 6.18 (3.44-7.10) mm (p = 0.000), respectively. The grade of pain on VAS was the highest in patients with significant outflow 70 (60-95) (p = 0.014), effusion 60 (50-80) (p = 0.024) and nodular type of synovitis 70 (50-90) (p = 0.029). There was a significant correlation on VAS in the positive direction with the size of effusion (r = 0.238, p = 0.025) and synovitis in LR (r = 0.215, p = 0.044), HAQ index (r = 0.502, p = 0.000), and in the negative direction with the size of flexion (r = -0.346, p = 0.001). The average size of flexion in the patients with significant outflow was 90 (82.5-90) degrees (p = 0.000), HAQ index 1.99 (1.49-2.30) (p = 0.078). HAQ index depended on effusion in LR in the positive direction (p = 0.014). DISCUSSION AND CONCLUSION: Clinically significant outflow is shown by arthrosonography as the biggest in SR, moderate and minimal only in LR. Moderate or significant outflow, effusion and nodular type of synovitis lead to intensive pain. Patients with bigger functional disability had intense pain, significant outflow in LR and significantly limited motions.

[Muscle strength measurement of pelvic floor in women by vaginal dynamometer].

INTRODUCTION: The pelvic floor is made of a mutually connected system that consists of muscles, connecting tissue and nerve components. Damage to any of these elements creates dysfunction which is exerted through stress, urinary incontinence, prolapse of genital organs and faecal incontinence. OBJECTIVE: The primary aim of this study was to present the possibility of objective assessment of pelvic floor muscle force in healthy and sick women using a newly designed instrument, the vaginal dynamometer, as well as to establish the correlation between the values of pelvic floor muscle force obtained by the vaginal dynamometer and digital palpation method. METHODS: The study included 90 female patients, age 20-58 years. One group of respondents was made of healthy women (who gave birth, and those who have not given birth), while the other one consisted of sick women (who suffered from incontinence or prolapse of genital organs, operated on or not). The pelvic floor muscle strength of every woman was measured with a newly-constructed device for measuring and monitoring of the pelvic floor muscle force in women, the vaginal dynamometer. Then it was compared with the valid clinical digital palpation (palpation with two fingers) based on the scale for measuring muscle contractions with the digital palpation - the digital pelvic assessment rating scale. The vaginal dynamometer consists of a redesigned speculum which is inserted into the vagina and a sensor for measuring the force. RESULTS: Statistically significant linear correlation was found in the values of the measured muscle force with the vaginal dynamometer and ratings produced by digital palpation (r = 0.92; p < 0.001). Mean value of the muscle force of the healthy women measured by the vaginal dynamometer was 1.44 +/- 0.38 daN and that value of the sick women was 0.78 +/- 0.31 daN (t = 8.89 for df = 88; p < 0.001). Mean value of the ratings produced by digital palpation in healthy women was 4.10 (95% of trust limits 3.83-4.37), while the value in sick women was 2.41 (95% of trust limits 2.10-4.16) (Z = -6.38; p < 0.001). CONCLUSION: The vaginal dynamometer has been presented as an attempt to overcome the limitations of the previously presented techniques for muscle force measurement. The application of the vaginal dynamometer in clinical practice makes objective and numerical assessment of pelvic floor muscle force possible, independent of the subjective assessment of the examiner. The usage of this instrument enables not only the diagnostics of women's pelvic floor muscle problem, but also the objective monitoring of rehabilitation gynaecological medicine results.