[The Effect of Activation of the Shoulder Girdle Muscles on Functional Outcomes of Rehabilitation in Patients with Surgically Treated Distal Radius Fractures]. / Vliv aktivace pletencového svalstva na funkcní výsledek rehabilitace po frakturách distálního radia osetrených operacne.

PURPOSE OF THE STUDY The aim of the study was to assess the functional outcomes of rehabilitation in patients with surgically treated distal radius fractures in the early postoperative period. We compared the functional outcomes of patients undergoing standard rehabilitation with the group of patients whose postoperative rehabilitation was extended with shoulder girdle exercises of the affected upper limb while the wrist was immobilized. Several indices and variables were used for the assessment of the functional therapeutic outcomes of the affected wrist. MATERIAL AND METHODS Forty patients (32 females and 8 males, the mean age 60.5 years) with distal radius fractures treated by internal fixation using volar surgical approach were involved in the study between 2013-2016. The tested subjects were randomized and split into two groups according to the selected method of rehabilitation. The tested subjects with standard rehabilitation extended with shoulder girdle muscles activation were labelled as group I. It included patients (n = 20) of the mean age 59.8 (age range 42-73 years) with immobilized wrist (i.e. for 3-4 weeks) performing shoulder girdle muscles exercises at the same time. Furthermore, standard kinesiotherapy continued after their fixation was removed. The other tested group, labelled as group II (n = 20), the mean age 61.3 (variation 40-74 years of age) involved patients with distal radius fractures. Only standard rehabilitation was performed in this group as late as their forearm fixation was removed. The following indices and parameters were assessed in the early postoperative period (i.e. by 8 weeks after the fixation removal): wrist and fingers range of motion (ROM), hand grip strength (dynamometry), local swelling, pain, scores of a nine hole peg test (NHPT), and a DASH score. RESULTS After the fixation had been removed, the group I reported statistically significantly higher values of movement compared to the values of the contralateral limb in the following directions: dorsal flexion, palmar flexion, MP joints flexion, flexion of PIP joints (proximal interphalangeal), and flexion of DIP joints (distal interphalangeal). After eight weeks, the group I manifested significantly higher values in dorsal flexion, palmar flexion and ulnar deviation in the wrist. There were no significant differences in other movement directions. The hand grip strength mean value examined with a dynamometer was significantly higher in the group I in the sixth and eighth week of testing (group I - 58.9% strength of a healthy limb after six weeks, or 66.5% after eight weeks). The results in the group II were 49.9% strength of a healthy limb after six weeks, or 56.6% after eight weeks. The group I showed statistically significantly lower values of wrist swelling and higher finger dexterity in the NHPT in all measured weeks. Lower pain intensity in the group I during the measurements was observed. At the same time, this group showed significantly better results in the DASH score. DISCUSSION The results of this study are useful for clinical practice. They confirm a functional relation between the activity of hand muscles and the shoulder muscle activity. The differences in the functional ability of the hand and the functional state of the injured wrist were detected as early as in the early postoperative period. It could be stated that the tested subjects in the group I showed a greater and faster improvement in the physical function of the injured hand. This was also accompanied by a positive psychological effect. We had not found a study of a similar type in the available literature that we could have compared our submitted results to. CONCLUSIONS Shoulder girdle muscles exercises after a distal radius fracture, while wrist is immobilized, can evidently enhance functional capability and accelerate the hand-function restitution. Early functional outcomes of the injured wrist after the rehabilitation with shoulder girdle muscles exercises support the efficiency of this broadened rehabilitation protocol. Key words: distal radius frac,ture, hand, shoulder, functional treatment, rehabilitation.

[Heart rate variability during sleep]. / Variabilita srdecní frekvence ve spánku.

BACKGROUND: Changes in the tone of the autonomic nervous system during sleep occur and characterize individual sleep stages and probably also sleep cycles. The spectral analysis of the heart rate variability (SA HRV) is a tool for exact assessment of autonomic nervous activity giving us precise information on the activity of the autonomic nervous system--on its sympathetic and parasympathetic component. METHODS AND RESULTS: All night polysomnographic recording was performed in 11 healthy subjects, during which the SA HRV was carried out. The total spectral power of the heart rate variability and relative values of its individual components were evaluated: the very low frequency component (VLF), the low frequency component (LF), and high frequency component (HF). The absolute value of the RR-interval duration was assessed. The LF spectral band in normalized units was significantly higher during REM sleep than in non-REM sleep. On the other hand, the HF spectral band in normalized units was significantly higher during non-REM sleep compared to REM sleep. The LF/HF ratio, which reflects the sympathovagal balance, had a maximal value during REM sleep and reached its minimum in non-REM sleep. A gradual lengthening of the RR-interval and lowering of the LF/HF ratio during night was observed. CONCLUSIONS: The SA HRV showed to be a sensitive method for detection of activity of the autonomic nervous system during sleep. The sympathovagal balance was shifted to prevailing sympathetic activity in REM sleep. On the contrary, during non-REM sleep this balance was shifted towards prevailing parasympathetic influence. A gradual increase of parasympathetic influence during night was also observed.

[Spectral analysis of the variations in heart rate and cardiac activation on waking up in sleepwalking]. / Análisis espectral de la variabilidad del ritmo cardíaco y activación cardíaca durante el despertar en el sonambulismo.

INTRODUCTION: In sleepwalking, a disorder that is characterised by partial waking, the subject experiences an alteration of the microstructure of sleep that can affect autonomous activity during sleep and the waking state. AIMS: In order to evaluate any possible upset in the regulation of autonomous functioning in sleepwalkers during sleep and the waking state, we conducted a spectral analysis of their heart rate variability (HRV) during both sleep and the waking state. SUBJECTS AND METHODS: Spectral analysis of HRV was conducted in the group of 10 sleepwalkers and 10 normal controls during sleep and during the waking state in both the horizontal and vertical positions. Their pattern of cardiac activation was also analysed during different types of arousal. RESULTS: There were no differences between the group of sleepwalkers and the control group in the parameters used in the spectral analysis of HRV during sleep and in the horizontal position during the waking state. Sleepwalkers showed a greater shift in the sympathovagal balance in favour of sympathetic activity, as a response to standing. During the 5-minute sequences immediately before the start of pathological arousal in sleepwalkers, the total energy in the spectral analysis of HRV was seen to increase. No differences were found between the patterns of cardiac activation displayed by the groups of patients and normal subjects during several different types of arousal. CONCLUSIONS: Autonomous reactivity was seen to be altered as a response to the orthostatic load in sleepwalkers, which could be the consequence of the instability of these patients' sleep. The increase in the total energy in the spectral analysis of HRV immediately before pathological arousal during NREM 4 sleep in sleepwalkers suggests that autonomous activation precedes cortical arousal.

Análisis espectral de la variabilidad del ritmo cardíaco y activación cardíaca durante el despertar en el sonambulismo / Spectral analysis of the variations in heart rate and cardiac activation on waking up in sleepwalking

Introducción. En el sonambulismo, un trastorno caracterizado por un despertar parcial, se refiere una alteración de la microestructura del sueño que puede influir en la actividad autónoma durante el sueño y la vigilia. Objetivo. Para evaluar una posible desregulación autónoma en los pacientes con sonambulismo durante el sueño y la vigilia, realizamos un análisis espectral de la variabilidad del ritmo cardíaco (VRC) durante el sueño y la vigilia. Sujetos y métodos. En el grupo de 10 sonámbulos y de 10 sujetos normales se realizó el análisis espectral de la VRC durante el sueño y durante la vigilia en la posición horizontal y vertical, y un análisis del patrón de la activación cardíaca durante varios tipos de despertar. Resultados. El grupo de sonámbulos y el grupo de control no difirieron en los parámetros del análisis espectral de la VRC durante el sueño y en la posición horizontal durante la vigilia. En los sonámbulos se demostró un mayor cambio del equilibrio simpaticovagal en beneficio de la actividad simpática, en respuesta a la verticalización. Durante las secuencias de 5 minutos inmediatamente anteriores al inicio del despertar patológico en los sonámbulos, se observó el incremento de la energía total del análisis espectral de la VRC. El patrón de la activación cardíaca durante varios tipos de despertar no difirió entre los pacientes y los sujetos normales. Conclusiones. Se evidenció una alteración de la reactividad autónoma en respuesta a la carga ortostática en sonámbulos, lo que puede ser la consecuencia de la inestabilidad del sueño en estos pacientes. El incremento de la energía total del análisis espectral de la VRC, inmediatamente antes del despertar patológico durante el sueño NREM 4 en sonámbulos, sugiere que la activación autónoma precede el despertar cortical (AU)

Introduction. In sleepwalking, a disorder that is characterised by partial waking, the subject experiences an alteration of the microstructure of sleep that can affect autonomous activity during sleep and the waking state. Aims. In order to evaluate any possible upset in the regulation of autonomous functioning in sleepwalkers during sleep and the waking state, we conducted a spectral analysis of their heart rate variability (HRV) during both sleep and the waking state. Subjects and methods. Spectral analysis of HRV was conducted in the group of 10 sleepwalkers and 10 normal controls during sleep and during the waking state in both the horizontal and vertical positions. Their pattern of cardiac activation was also analysed during different types of arousal. Results. There were no differences between the group of sleepwalkers and the control group in the parameters used in the spectral analysis of HRV during sleep and in the horizontal position during the waking state. Sleepwalkers showed a greater shift in the sympathovagal balance in favour of sympathetic activity, as a response to standing. During the 5-minute sequences immediately before the start of pathological arousal in sleepwalkers, the total energy in the spectral analysis of HRV was seen to increase. No differences were found between the patterns of cardiac activation displayed by the groups of patients and normal subjects during several different types of arousal. Conclusions. Autonomous reactivity was seen to be altered as a response to the orthostatic load in sleepwalkers, which could be the consequence of the instability of these patients’ sleep. The increase in the total energy in the spectral analysis of HRV immediately before pathological arousal during NREM 4 sleep in sleepwalkers suggests that autonomous activation precedes cortical arousal (AU)

Spectral analysis of the heart rate variability in sleep.

Spectral analysis of heart rate variability (HRV) during overnight polygraphic recording was performed in 11 healthy subjects. The total spectrum power, power of the VLF, LF and HF spectral bands and the mean R-R were evaluated. Compared to Stage 2 and Stage 4 non-REM sleep, the total spectrum power was significantly higher in REM sleep and its value gradually increased in the course of each REM cycle. The value of the VLF component (reflects slow regulatory mechanisms, e.g. the renin-angiotensin system, thermoregulation) was significantly higher in REM sleep than in Stage 2 and Stage 4 of non-REM sleep. The LF spectral component (linked to the sympathetic modulation) was significantly higher in REM sleep than in Stage 2 and Stage 4 non-REM sleep. On the contrary, a power of the HF spectral band (related to parasympathetic activity) was significantly higher in Stage 2 and Stage 4 non-REM than in REM sleep. The LF/HF ratio, which reflects the sympathovagal balance, had its maximal value during REM sleep and a minimal value in synchronous sleep. The LF/HF ratio significantly increased during 5-min segments of Stage 2 non-REM sleep immediately preceding REM sleep compared to 5-min segments of Stage 2 non-REM sleep preceding the slow-wave sleep. This expresses the sympathovagal shift to sympathetic predominance occurring before the onset of REM sleep. A significant lengthening of the R-R interval during subsequent cycles of Stage 2 non-REM sleep was documented, which is probably related to the shift of sympathovagal balance to a prevailing parasympathetic influence in the course of sleep. This finding corresponds to a trend of a gradual decrease of the LF/HF ratio in subsequent cycles of Stage 2 non-REM sleep.

Decreased copper level in the blood serum of male stutterers and the occurrence of the vibratio brevis phenomenon.

The blood serum copper level and the phonation start were investigated in sixteen male subjects with developmental stuttering (mean age = 25.8 years). A statistically significant decrease in blood serum copper level was revealed in the stutterers under study. The differences between their mode and mean values and that of the control group were 4.6 mumol/l and 3.1 mumol/l, respectively. The negative linear regression between the copper level in serum and the vibratio brevis phenomenon was registered in the stutterers under study. A decreased copper level can be involved in the biochemical abnormalities of male developmental stutterers and it can be included among the factors participating in pathophysiology of an uncertain phonation start.

Short-term heart rate variability changes after exercise training in subjects following myocardial infarction.

Heart rate variability reflects the activity of autonomic nervous system. The aim was to evaluate the value of short-term spectral analysis of heart rate for monitoring the effects of exercise training on the autonomic nervous system in subjects following myocardial infarction. Short-term spectral analysis of heart rate variability was performed during standardised supine-standing-supine test in a group of 29 clinically stable patients after myocardial infarction and the same test was repeated after 2 months of exercise training (ergometry or rapid walking). Each subject exercised at 60-80% of his maximal performance for 30 minutes once a day. Short-term spectral analysis of heart rate variability was assessed in the frequency range of 0.02-0.5 Hz involving very low frequency (VLF, 0.02-0.05 Hz), low frequency (LF, 0.05-0.15 Hz) and high frequency (HF, 0.15-0.5 Hz) spectral bands. The influence of exercise training on the autonomic nervous system was registered in the physically active group (n = 16) as a decrease in sympathetic response to standardised orthostatic load. In conclusions the regular exercise influenced an altered neural autonomic regulation of heart rate in post-infarction patients shown by a decrease in sympathetic activity in the short-term heart rate variability. This method enables monitoring of the effects of physical training on the autonomic nervous system in patients following myocardial infarction.

Magnesium and its combination with cinnarizine in the long-term treatment of headache.

Some of the so-called calcium antagonists are effectively applied in the prophylactic treatment of migraine. Magnesium compounds reveal some calcium- antagonistic features, which was the reason of magnesium compounds (magnesium sulphate i.m. or magnesium lactate p.o.) evaluation at chronic migraine-patients. The compounds were administered or alone or in combination with cinnarizine (in case of magnesium sulphate). Beneficial effects were registered both after application of magnesium sulphate and, more markedly, after the combination with cinnarizine. The potentiation of the effect is likely due, at least partially, to their own calcium-antagonistic features. The side-effects of the applied drugs were not registered.

Autonomic and verbal responses to the experimental nociceptive stimulation.

Human pain studies require a multidimensional evaluation for the complex understanding of the stated problem. For this reason, not only the subjective verbal evaluations but also objective indices are considered. To estimate the latter ones, autonomic, vasomotor and electrodermal responses to electric stimulation were selected in the presented study together with the verbal assessment. In comparison with the chronic non-malignant pain patients, different findings were obtained in healthy subjects, both in the objective and subjective indices. In the second part of the study, the analgesic effects of acetylsalicylic acid or codeine or placebo were compared under indentical experimental conditions. The differences were less impressive than those found in the first part of the study. The antinociceptive effect was registered only after codeine administration.

[Comparison of the results of therapy with vinblastine iontophoresis in post-diskectomy syndromes and other painful conditions]. / Srovnání výsledku lécby vinblastinovou iontoforézou u postdiskotomických syndromu a u jiných algických stavu.

The authors tested in 36 patients treatment of chronic intractable pain by percutaneous iontophoretic administration of an inhibitor of microtubular transport, Vinblastine inj. (G. Richter, Hungary). The groups comprised: (1) 16 patients with severe radicular pain after one or several operations of prolapsed lumbar intervertebral discs, (2) 20 patients with severe pain in the area of radicular dermal zones or dermal innervation areas of peripheral nerves. In every patient a minimum of 15 procedures were tried. Evaluation of the therapeutic effect was based on subjective data of the patient on the mitigation of pain in per cent, on the intensity of the current pain and the interference of the intensity of pain with daily activities. According to all criteria improvement was achieved in 31 subjects, i.e. in 86%. A favourable effect of treatment was observed after the 8th-10th administration. In the first group of patients clinically significant mitigation of algic symptoms was achieved in 69% of the treated subjects. In the second group a therapeutic effect was achieved in 90% of the patients. A marked difference between the two groups was found with respect to mitigation of the intensity of pain on completion of treatment. The mean mitigation of pain intensity in the first group was 24.1%, in the second group 47.7%. This difference is highly significant. With the exception of one female patient always a positive effect at the site of administration (beneath the anode) was observed.

[Administration of morphine into the cerebral ventricles in chronic intractable pain]. / Podání morfinu do mozkových komor u chronických neztisitelných bolestí.

The study evaluated the effect of intraventricular morphine administration on chronic pain associated with malignant diseases in five subjects. To facilitate repeated application of the analgesic a reservoir was fixed subcutaneously on the calvaria with the catheter tip place in the lateral ventricle. The described approach made it possible to reduce substantially the dosage and to protract the action of morphine, as compared with intramuscular administration. No serious complications developed when the described mode of application was used. Because of the technically unpretentious procedure, the simple administration into the reservoir and the significant analgetic effect this method can be used in patients with malignant pain even in advanced stages of the disease.

Intracerebroventricular application of morphine in the treatment of intractable malignant pain.

The authors' own experience with the application of morphine into the lateral cerebral ventricles of patients with intractable pain of tumorous origin is reported. The Salmon-Rickham reservoir implanted under the skin with a ventricular catheter inserted into the right lateral ventricle of the brain, allows easy and repeated application of small doses of the opiate (opioid) analgesic. This approach brings the pain relieving effect that make this method beneficial to patients suffering from chronic malignant pain in the preterminal stages of the disease.

Vinblastin iontophoresis in treating intractable pain.

A group of 36 patients were tested for the effects of percutaneous iontophoretic application of Vinblastin inj., a microtubular transport inhibitor (Gideon Richter, Hungary) in the treatment of chronic intractable pain. The group is divided into two subgroups: (1) 16 patients with persistent root pain following one or more operations for lumbar intervertebral disk herniation. (2) 20 patients with persistent pain in the area of the radicular skin zones or in the skin innervation areas of peripheral nerves. Vinblastin was injected in the place of maximal pain, 0.01% concentration in the total amount of 5 mg of active substance. The active electrode was the anode. There were at least 15 procedures per patient. The therapeutic effect was evaluated from the patients' subjective reports on pain relief in per cent, from the intensity of actual pain and from the interference of pain intensity with daily activities. Considering all the criteria, an improvement was achieved in 29 cases, i.e. 81%. The beneficial effect of the therapy was observed from the 8th to 10th application. In the first group of patients, 69% showed a clinically significant relief of the algetic symptoms. In the other group, the therapeutic effect was 90% of cases. A significant difference between both these groups was found to be in the degree of pain relief after the end of therapy. In the first group the average pain relief was 22.2%, in the other one 47.7%. This difference is statistically highly significant. Except for one case, the beneficial effect was always recorded in the place of administration (under the anode). Apart from local skin irritation in 2 patients and spot burns under the electrode in 2, no other side adverse effects were seen in the course of therapy, after its termination or at the checks made after some time interval (maximum 3 years).

Adverse effects of antiepileptic drugs on the nervous system.

The paper provides a brief account on undesired antiepileptic drug effects on the nervous system and implies both the typical pictures and also the less common symptoms of intoxications promoted by these drugs. It describes cognitive dysfunctions, various disorders of psychic functions including paradoxical reactions, emotivity and affectivity disorders, hyperkinesias and dyskinesias, peripheral neuropathies and other undesired effects. Individual groups of antiepileptic drugs are referred. Attention is also paid to some interactions and risk antiepileptic drug combinations.

[Iontophoretic administration of vinblastine in the control of refractory spinal root pain and postherpetic neuralgia]. / Iontoforetická aplikace vinblastinu k ovlivnení refrakterních korenových bolestí a postherpetické neuralgie.

Iontophoretic administration of substances which influence the function of microtubuli in the peripheral nerves is one of the new ways how to suppress some types of refractory chronic pain. Based on a number of experimental data and encouraging clinical results, the authors used in the submitted work repeated iontophoretic administration of 0.01% Vinblastine (G. Richter, Hungary) into the painful zone in a group of 20 patients with several types of non-malignant pain. Objectivization of the evaluation was partly also due to the authors' own version of McGill Pain Questionnaire, along with the graphic presentation of algetic zones. Clinically detectable mitigation of pain was achieved in 14 subjects, in eight improvement persisted for more than six months and one year resp. No serious undesirable side-effects were observed in the investigated subjects.