[Reliability of functional x-ray analysis of cervical vertebrae flexion and extension]. / Reliabilität von Röntgenfunktionsanalysen der HWS-Flexion/-Extension.

Functional radiographic analysis of the cervical spine in flexion and extension position is increasingly used as screening method for the diagnosis of segmental functional disorders. The objective of this study was to prove Penning's evaluation method for the metrical recording of segmental angles in the sagittal plane for selectivity, reliability and usability. Passive functional radiographs of the cervical spine in flexion and extension were taken of 20 patients with painful limitation of mobility of the cervical spine and 20 subjects, similar in sex and age, without complaints. The radiographs were duplicated. Five physicians measured the angles of segmental mobility in a blind study. Statistical analysis was conducted using the t-test and calculating the correlation coefficient "r". The results of the study prove that the evaluation method by Penning shows a usable and, for segments C3/C4 to C6/C7, significant selectivity. The selectivity of p < or = 0.05 and p < or = 0.01 is sufficient to distinguish patients from healthy subjects. The correlation between the five reviewers showed good to very good results (0.6 < r < or = 0.8; r > 0.8). The measured values, however, have to be considered, in connection with the appropriate clinical symptoms, as still "normal" or "functionally disordered" in the context of segmental hypo-resp. hypermobility.

[Electrotherapy or electrommythology? Possibilities and limitations of electrotherapy]. / Elektrotherapie oder Elektromythologie? Möglichkeiten und Grenzen der Elektrotherapie.

All of the established methods of electrotherapy are based on-at least-one of the following three scientifically and clinically confirmed working principles: electro-analgesia, muscle stimulation and tissue heating. The well defined indications for the different electrotherapeutical currents are inferred from these three principles, which are briefly described-together with their principal indications-in this contribution. At present some "complementary" forms of electrotherapy are being increasingly advocated. They are not clinically confirmed and, moreover, they lack a rationally founded working principle. These methods, so called "electromythology", are based on hypothetical and often clearly erroneous assumptions. Their therapeutic objective seems to be an unspecific stimulation of the cell metabolism, and their diagnostic goal is equally unspecific and universal. Frequently, these applications surmise an universal healing power inherent in the electric current as such. Because "electromythology" currently invades veterinary medicine, this contribution should help the reader to distinguish between realistic and excessive expectations.

Clinical meaning of the torque between stance leg and ground for the analysis of gait mechanism.

Transversal torque between the stance leg and the ground was measured in 169 test persons with normal gait (91 women, 78 men; ages 15-79 years) using three-dimensional force plates. Taking the average of six to ten single steps produces reproducible person- and group-specific data. This permits the isolation and study of individual solutions to specific problems of locomotion, so-called gait mechanisms. The relatively great torque during the double-stance phase is caused mainly by the medially directed, short-term impact peak at heel strike, with the stride length as lever arm. Double-stance torque is therefore determined by motion dynamics and does not help in understanding individual gait mechanisms. Torque measured during the single-stance phase is, in comparison, rather small and is interindividually relatively variable. Experimentally measured torque is considered in terms of various hypotheses concerning the creation of torque in the human gait. Men obviously tend, for reasons of equilibrium and stability, to compensate the various torques. Better than the more known vertical, sagittal, and frontal force components, the remaining torque represents the individual problem solution and therefore permits the study of specific gait mechanisms, both physiological and pathological. Using the characteristic gait of patients with hemiplegia as an example, it is shown that pathological torque observed systematically on the nonaffected side in such patients is a quantitative measure of the trunk rotation necessary to move the plegic side forward. Measurement of this torque therefore permits precise determination of the degree of damage, as well as quantitative control and objective documentation of the rehabilitation progress.

[Ultrasound cystometry with reference to urinary bladder form and bladder filling]. / Sonographische Zystometrie unter Berücksichtigung der Harnblasenform und der Harnblasenfüllung.

In 103 patients we performed sonographic determination of the volume (V) of the urinary bladder, being the product of the transversal (q), ventrodorsal (t) and craniocaudal (h) diameters, and compared this with the excreted volumes of urine. Depending on the shape and filling of the bladder we found different correlations from which it was possible to calculate three correction factors (F) for the formula V = (q x t x h) x F:F = 1.25 for volumes less than 150 ml; F = 0.9 for spherically sagittal section and volumes greater than 150 ml. The factor 0.5 given in most textbooks on sonography will in the majority of cases result in underestimating the urinary bladder volumes. Accurate sonocystometry taking the shape and filling into consideration is imperative for performing follow-up and treatment monitoring in neurogenic disturbances of voiding of the bladder or occlusive disturbances of flow in the region of the urethra.

[The diuretic effect of a bath. Study in healthy pregnant females and patients with edema and gestosis]. / Die "ausschwemmende" Wirkung des Bades. Untersuchung an gesunden Schwangeren und Patienten mit Odemen bzw. Gestose.

The effect of a 40 minute thermoneutral bath on diuretic function and blood volume in a total of 27 pregnant women (13 healthy and 14 pregnant women with edema rsep. EPH-gestosis) was investigated. In both groups water immersion led to a significant increase of urine flow, natriuresis, kaliuresis, osmotic and free water clearance. Plasma volume increased about 8-9%. The patients with gestosis showed a higher creatinine clearance. The same group also showed a higher osmotic clearance and relatively more sodium excretion. Regarding the flushing effect of bath, two mechanism of water immersion that originated in hydrostatic pressure have to be discussed-activation of renal functions and mobilisation of interstitial fluid.

Pharmacokinetics of methotrexate during regional hyperthermia in a pig model.

In the pig model, regional hyperthermia in the gluteus was combined with the infusion of 150 mg MTX over a period of 100-120 min. The pharmacokinetic data reveal that this approach is capable of simulating the situation that is necessary and achievable in medium-dose MTX therapy of human tumours. Under MTX infusion, serum levels in the region of 10(-5) M are attained. As an expression of a renal and hepatic MTX excretion, high levels of MTX are found both in the urine and in the bile. Especially high concentrations of MTX are found in the liver and kidney tissue. In the normothermic and hyperthermic muscle, very low MTX levels are found. The pharmacokinetic data obtained show that the selected model is suitable for the future investigation of the effect of regional hyperthermia and MTX on transplanted tumours.

[Hemorheologic changes in chronic polyarthritis]. / Hämorheologische Veränderungen bei chronischer Polyarthritis.

The haemorheological status of plasma-(P eta) and blood-viscosity (B eta), erythrocyte aggregation (EA) and erythrocyte filterability (EF), blood sedimentation rate (BSG), haematocrit (HCT), plasma fibrinogen and alpha-2-macroglobulin was investigated on 46 patients suffering from chronic polyarthritis (c.P.). The results were compared with those from a control group of 20 healthy subjects with a similar distribution of age and sex. All the haemorheological data from the c.P. patients showed a significantly decreased blood fluidity (p less than or equal to 0.001 or p less than or equal to 0.01). These differences were highly significant for the female patients (n = 29), but for the men (n = 17) only at slight shift was seen. The comparison of clinically acute and non-acute disease in the patients showed a significant worsening of P eta, B eta and EF during the acute state, while the EA remained unaffected. The limited blood fluidity is seen as a result of the basic illness. At present, the pathophysiological meaning of these findings is still hypothetical: further investigations are required.

An investigation of the microcirculation of the human tympanic membrane with laser-Doppler flowmetry.

The present investigation was performed to evaluate the use of laser-Doppler flowmetry as a means for measuring the blood flow of the microcirculation of the human tympanic membrane. The blood cell flux in the microvascular bed of the normal tympanic membrane was measured in healthy subjects. The laser-Doppler output signals continuously recorded showed a steady value ranging from 70 to about 120 V, as well as spontaneous oscillations (or rhythmical active vasomotion). Our findings show that the laser-Doppler instrument tested seems to be useful for evaluating blood flow changes in the microcirculation of the human tympanic membrane.

What is the efficacy of "soft" and "mid" lasers in therapy of tendinopathies? A double-blind study.

The efficacy of "athermic" lasers (HeNe lambda = 632.8 nm and IR diode lambda = 904 nm) in the treatment of tendinopathies was investigated in a randomized double-blind study. On 10 consecutive days, 64 patients (32 therapy, 32 placebo) were treated for 15 minutes each with a switched-on or switched-off laser under otherwise identical conditions. The extent of movement in involved joints (neutral 0 method) and rating on a pain scale for resting pain, movement pain, and pressure pain before treatment, after treatment, and 2 weeks after conclusion of therapy, as well as infrared thermography, served to check therapy. After the end of therapy, a significant reduction (P = less than 0.001) of 50% was shown for resting pain as well as reductions of 30% for movement and 30% for pressure pain. This result was identical in the therapy group and in the placebo group. There was also no indication of a different result of therapy between the therapy and placebo groups with regard to the thermographic control and the extent of movement. The breakdown of the data in terms of age, sex, and duration of disease did not provide any indications of different results for placebo or therapy. It was striking that the patients who reported sensations during or after the treatment (irrespective of whether pleasant or unpleasant) had a greater reduction of pain than the patients without sensations. This laser therapy thus did not show any effect above and beyond that in the untreated group in our double-blind clinical study.

The effects of external CO2 application on human skin microcirculation investigated by laser Doppler flowmetry.

The effects of an aqueous solution of CO2 applied to a small skin site were investigated by means of a laser Doppler flowmeter. The circulatory response to CO2 was an increased blood flow, reaching a maximum level within approximately 2-3 minutes. In addition there was a marked stimulation of rhythmical vasomotion, especially an increase in amplitudes. The effects, strongly dependent on dose and temperature, ceased rapidly when the CO2 sample was withdrawn.