Approaches to optimize focused extracorporeal shockwave therapy (ESWT) based on an observational study of 363 feet with recalcitrant plantar fasciitis.

INTRODUCTION: Extracorporeal shockwave therapy (ESWT) is an established second-line treatment option for plantar fasciitis. Longer term results of focused ESWT are rare in literature. This study assessed the treatment success-rates of single session ESWT compared to repetitive ESWT treatment sessions, the mid-term results as well as treatment- or patient-related factors influencing the outcome of focused ESWT for plantar fasciitis. METHODS: 284 patients (363 feet) received ESWT for plantar fasciitis and answered a questionnaire on socio-demographic and anamnestic data immediately before as well as 19-77 weeks after the first application of ESWT. RESULTS: 76 percent of patients treated only once and 74 percent of all patients reported satisfying pain relief (with up to three treatment sessions). This was consistent in the mid-term and over different physicians as well as independent of assessed patient- or treatment-related factors. DISCUSSION: Applying repeated ESWT in weekly intervals by default may be helpful in reducing healing time for those patients requiring more than one treatment session. Prospective research is needed to find out whether further treatment sessions are justifiable in patients who indicate no improvement after two or three treatment sessions. CONCLUSIONS: In many cases, focused ESWT needs to be applied only once. Further research should focus on the number of treatment sessions as well as the minimum energy flux density needed.

Radio-lunate arthrodesis in rheumatoid arthritis: outcome and techniques.

BACKGROUND AND PURPOSE: The wrist is one of the most affected joints in rheumatoid arthritis. The purpose of this retrospective study was to assess clinical, functional and radiographic results of radio-lunate arthrodesis. Two different operation and fixation techniques are compared and detailed outcome after this intervention is presented. METHODS: Twenty-seven patients with long-standing rheumatoid arthritis were operated on, either by stabilisation of the arthrodesis with Shapiro staples (n = 14) or by Herbert screw (n = 13) and followed for a mean of 5.4 years. RESULTS: Radio-lunate arthrodesis resulted in high overall and subjective satisfaction concerning function, grip and return to work. Grip strength was 35 kPa for the dominant and 26 kPa for the non-dominant hand. No revision, pseudoarthrosis or hardware failure was observed; only two conservatively treated wound healing problems were reported. The procedure resulted in a mean flexion of 26° and a mean extension of 24°; a clear improvement was also seen in activities of daily life. No difference between both groups was observed for pain, complication rate or functional outcome. INTERPRETATION: Due to high patient satisfaction and functional outcome, radio-lunate wrist arthrodesis can be recommended independent of fixation method.

[Reports of pain in the musculoskeletal system: results of a questionnaire among a representative Austrian population]. / Angaben über Schmerzen im Bereich des Bewegungsapparats: eine repräsentative Befragung der österreichischen Bevölkerung.

OBJECTIVE: The objective of this study was to document the prevalence of musculoskeletal pain in the Austrian population as well as an analysis of the different pain parameters and a comparison between the group of persons with and without pain. Relevant data like pain region, pain intensity, duration of treatment and geographic distribution are presented in detail. METHODOLOGY: 503 persons selected by the "quota procedure" as representative for the Austrian population were interviewed face to face. RESULTS: 36.2 % of the interviewed persons reported pain in the musculoskeletal system within the last 3 weeks. The regions of the spine were mentioned most frequently (53.9 %).The groups of persons with and without pain differed significantly in age and geographic distribution. The results are well comparable to data from a similar study from 2006. DISCUSSION: A high prevalence of musculoskeletal pain in the Austrian population is ascertained. The spine regions are most frequently affected and associated with older age and high intensity of pain. Therefore further specific treatment for patients suffering from musculoskeletal pain and appropriate preventive measurements should be targeted in the future.

Fusion of the wrist in rheumatoid arthritis: a clinical and functional evaluation of two surgical techniques.

We retrospectively compared wrist arthrodesis using the Mannerfelt technique in 19 or an AO-plate in 23 patients with long-standing rheumatoid arthritis. The mean follow-up was for 76 months. Compared with the Mannerfelt fusion group, patients in the AO-plate group reported greater satisfaction with their wrist function (74% vs 37%, p = 0.015). Complications were reported in six wrists in the AO-plate group and two wrists in the Mannerfelt fusion group (p = 0.258). At final follow-up, 95% of patients (41) reported either no pain or only mild pain. There was improvement in flexion of the finger joints in both groups but no significant improvement in the extension lag in either group. Both methods relieve pain and improve function. Overall, the activities of daily living scores and the patients' subjective assessment of outcome tended to be higher in the AO-plate group than in the Mannerfelt fusion group, although the difference was not statistically significant. Similarly, although more postoperative complications occurred in the AO-plate group, the difference between the two groups was not statistically significant.

[Pain patterns of disc lesions of the lumbar spine]. / Schmerztopik bei lumbalen Bandscheibenschäden.

AIM: The aim of this study was to find out the reliability of several dermatomic maps (description of pain pattern within a nerve root lesion) according to the respective segmental area. METHODS: Different studies which deal with pain pattern caused by disc lesions were searched for with MedLine support and then reviewed. RESULTS: A clear correlation between the pain projections of the lumbar spine does not seem to exist. A contradiction of the most common pain projection (S1) and operated disc (L4/5) is described. CONCLUSION: Even though there are studies of high scientific design and value (Nitta H, Wolff A) the pain pattern of dermatomic maps is only of limited value for the definition of the affected segment.

[Virologic detection of arboviruses in greater cormorants]. / Virologické vysetrení kormoránu velkých na arboviry.

Cormorants (Phalacrocorax carbo, Pelecaniformes) caught in southern Moravia (Czech Republic) in 1989-1990 were examined for arbovirus infections. Isolation experiments were carried out using blood samples of 56 birds. The results were negative. Serological examinations of 31 birds were performed by haemagglutination-inhibition test (HIT) using 5 arboviral antigens of the genera Alphavirus (Sindbis--SIN) and Flavivirus (tick-borne encephalitis--TBE, West Nile--WN) and of the family Bunyaviridae (Tahyna--TAH, Calovo--CVO). Antibodies were detected only to viruses SIN, WN and TAH at different frequencies: 9.7%, 9.7% and 22.6%. The titres ranged from 1:20 to 1:80.

[Botulism in birds living in an aquatic environment in Nové Mlýny in the Breclav District]. / Botulismus ptactva na vodním díle Nové Mlýny (okres Breclav).

Epizootic of wild water birds caused by the toxin Clostridium botulinum of C type occurred in extensive shallow artificial lakes of the Nové Mlýny dam system from May to October 1988 and later on from February to early April 1989. In total more than 3,000 dead or dying birds of 44 species were found, the following orders were prevailing: Anseriformes (56%), Lariformes (33%), Charadriiformes (6%) and Ralliformes (4%). Botulotoxin was detected at high concentrations in sarcophagic fly larvae of Calliphora vomitoria and Lucilia sericata which were collected in bird cadavers, but it was not found in different components of the aquatic environment (water, submersed vegetation, phytoplankton, zooplankton, Gastropoda, Crustacea, Oligochaeta, larvae of Odonata, Chironomidae and Ceratopogonidae). Future development of the epizootic situation in the Nové Mlýny artificial lakes will depend on the water level and meterological conditions in the critical period (May to September).

Bone demineralization in rheumatoid arthritis.

In a group of 210 patients with various stages of rheumatoid arthritis divided according to mobility in 3 groups the highest clavicular cortico-diaphyseal indices were found in the group of exercising patients and the lowest results were in the immobilized group. Double measurements repeated after two years allowed us to establish the annlay loss of cortical bone in each group: -2.19% in the exercising group, -6% in the non-exercising group and -8.94% in the immobilized group. Studying the effect of corticosteroids used in the treatment of rheumatoid arthritis in another group of 153 patients we found lower results of cortical thickness only in dependence on daily dose of this drug and not on the whole used dose. The computed annual loss of cortical bone thickness was 7% in patients on doses 5-10 mg of prednisolone, while in patients on doses 12.5-20 mg of prednisolone the annual loss exceeded 10%.