Proximal row carpectomy: Is early postoperative mobilisation the right rehabilitation protocol?

PURPOSE OF THE STUDY

To determine the feasibility and interest of an early rehabilitation protocol with no initial immobilisation after proximal row carpectomy.

MATERIAL AND METHODS

Thirteen patients were included in this retrospective study. Range of motion (ROM) and wrist strength (grip strength and grasp strength) were evaluated 3 and 6 weeks after surgery on the both wrists (operated and non-operated). Postoperatively, patients had no immobilisation of the wrist, and began a rehabilitation program immediately after surgery in the department of Physical Therapy and Rehabilitation under multidisciplinary team supervision. The same surgical technique was used for all patients by the same surgeon.

RESULTS

Six weeks after PRC, there was a 25-51% deficit in passive ROM and 54-64% deficit in active ROM compared to the corresponding non-operated wrist. Six weeks after PRC, mean overall grip strength was nearly 55% and Jamar dynamometer grip strength was 51% of the contralateral side.

DISCUSSION

This study shows that immediate immobilisation following PRC is unnecessary, and that early rehabilitation is of the essence. Early rehabilitation could reduce the delay necessary to recover range of motion and strength, and probably the time to return to work.

LEVEL OF EVIDENCE

Level 4, prospective cohort study.

Déficit cognitif et mesure de la qualité de vie dans la sclérose en plaques

INTRODUCTION

Cognitive disorders may bias perception of quality-of-life in patients with multiple sclerosis (MS).

METHODS

Neuropsychological tests (WAIS-vocabulary, Gröber and Buschke, Stroop, WCST, WAIS-similitude, fluency, Hamilton's depression scale) along with a French health-related quality of life self questionnaire for MS patients (the SEP59) were performed by 117 MS patients with a minor cognitive impairment (Mini Mental State over 24) in order to explore the links between quality of life perception and cognitive functioning.

RESULTS

Main Component Analysis and correlation analysis showed that cognitive impairment produced an overrating of the self perception of quality of life. Threshold analysis, splitting patients between the most and the less cognitively impaired, confirmed this relationship.

CONCLUSION

The level of cognitive functioning must be considered with caution when analyzing health-related quality of MS patients.

[Proliferative retinal vasculitis and multiple sclerosis: a case report]

INTRODUCTION

Retinal periphlebitis can precede the neurological effects of multiple sclerosis and reveal the disease. Although these occurrences of vasculitis are noted in 10% - 35% of multiple sclerosis patients, proliferative retinopathy is, on the contrary, an exceptional complication.

CASE REPORT

We report the case of a 28-year-old woman who presented bilateral, proliferative, retinal vasculitis complicated with recurrent vitreous hemorrhages occurring with multiple sclerosis. Initially, there was a unilateral, central venous thrombosis in a particularly ischemic and proliferative form. After a neurological, biological and radiological check-up, the diagnosis of multiple sclerosis was pronounced and treatment with Interferon was started. A pan-retinal laser photocoagulation and vitrectomy with proliferative membrane peeling were performed. After a follow-up of 2.5 years, a bilateral epiretinal membrane on the macula with a chronic macular edema persisted, with visual acuity limited to 0.2 Parinaud 4 in the right eye and 0.5 Parinaud 2 in the left eye.

DISCUSSION

This case shows that the diagnosis of multiple sclerosis must be established in cases of ischemic retinal vasculitis, especially as the literature does not seem to report a correlation between the retinal vascular affect and how far multiple sclerosis has progressed. Moreover, the visual prognosis of these proliferative lesions remains uncertain.

CONCLUSION

Multiple sclerosis can be revealed initially, although exceptionally, by bilateral, proliferative and severe retinal vasculitis complicated with recurrent vitreous hemorrhages and tractional retinal detachment.

[Validation of the combined SF36/MSQOL test of evaluation of quality of life in migraine patients in France]

The impact of migraine on patients quality of life is great, even between attacks. The aim of this study was to assess the properties of a French language quality of life questionnaire, which associates the Medical Outcome Study Short Form (MOS SF 36) with the Migraine-Specific Quality of Life (MSQOL). Data were obtained from 110 consultant patients of neurology units located in three University hospitals in the center of France. The results indicated a good acceptability of the association of the two questionnaires with a 84p.cent response rate. The Principal Component Analysis showed no change in both SF-36 and MSQOL structures. It also suggested that the two questionnaires were complementary. The high values of the Cronbach alpha coefficients for each scale indicated a high level of internal consistency. The quality of life scores were correlated with external parameters such as frequency, intensity and length of migraine attacks, and social activity reduction due to these attacks. In conclusion, the association of the SF-36 with the MSQOL has the interest of associating generic and specific questionnaire, in a complementary way. This association has good psychometric properties, and can be used to evaluate migraineurs quality of life in French speaking countries.

[Quality of life in multiple sclerosis]

The insensitivity of the clinical scales usually performed in MS patients led to measure the quality of life (QoL). QoL includes several important domains of health which are regarded by patients as being more important determinants of their overall health states. Some aspects of QoL of MS patients (early collapse in the disease, impact of interferons therapy) suggested that its measurement is relevant in assessing the effect of treatment and progression of the disease.

[Quality of life and multiple sclerosis: validation of the french version of the self-questionnaire (SEP-59)]

We conducted a prospective study among 166 multiple sclerosis (MS) patients (103 from an university hospital, 63 from a MS rehabilitation center) to assess the properties of the French version of the Multiple Sclerosis Quality Of Life - 54 items (MS QOL-54) which combines the MOS SF36 together with MS specific items. The SF-36 had been translated into French through the IQOLA project. We translated and adapted the MS specific items with the help of three different teams. The translation into French has an addition of five items, because we kept the MS specific items of an earlier unpublished form. Acceptability is excellent with a response rate over 90p.100. Test-retest reliability is good except for the "role limitation-emotional" scale of the SF-36. Construct validity, based on factor analysis, shows no change in the SF-36 internal consistency and the specific items provided their own information. External validity, tested against both medical (Expanded Disability Status Scale, Kurtzke scale, Mini-Mental-State and disease stage) and rehabilitation (Functional Independence Measure) parameters is excellent. The French MS QOL questionnaire contains 59 items including both the SF-36 and the MS QOL-54 items. This will permit international comparisons of MS patients' care and therapy.

Using the Short Form-36 with multiple sclerosis patients in five countries: a cross-cultural comparison

Questionnaires measuring health-related quality of life are increasingly used in international studies of medical effectiveness. It is important to know if data from these instruments are comparable across countries. We initiated a collaboration among five research groups--from the USA, The Netherlands, Belgium, France, and the UK--in the field of health-related quality of life in multiple sclerosis. All groups used the 36-item Short Form Health Survey. The goal of our study was to make a cross-cultural comparison. In the five countries under study the sample size varied from 50 to 134 patients with multiple sclerosis. The survey was completed by a total of 457 patients, who were heterogeneous in relation to age, duration of illness, severity and type of multiple sclerosis. There appeared to be major differences among the samples in scores on each of the eight scales. These findings may be influenced by differences in method of recruitment, demographic and disease-related characteristics, administration, and cultural factors. After having performed a number of analyses, it appeared that the differences were mainly attributable to sampling effects; however, cultural influences could not be excluded.

[Vertebral compression in epilepsy. Analysis of 8 cases]

Epileptic seizures can produce dislocations or fractures of the limbs and vertebral compression fractures. We tried to determine the clinical and radiological features of the latter in 8 patients: 6 men and 2 women including one aged only 41 years. The often multiple compression fractures involved the first thoracic (n = 3) and the intermediate thoracic (n = 3) or lower lumbar (n = 2) vertebrae but, contrary to common osteoporosis, never the thoracolumbar hinge. In 2 cases, the appearance of the fracture and the neurological signs led to surgery. Posterior dislocation of the shoulder was associated with the fractures in 2 cases. Chronic alcoholism (4 cases), anti-epileptic drugs (1 case) or corticosteroids (1 case) might have facilitated a demineralization which was however not obvious on X-ray films. The seizure was a first ever event in 6 cases. In the absence of controls the fracture was considered to be spontaneous. These particularities explain why a metastatic compression fracture was initially suspected in 3 cases, leading to explorations which sometimes were aggressive. In the presence of a suspicious vertebral compression fracture the clinician must consider the possibility of an epileptic seizure, a trauma which is sufficient to explain the fracture, as shown by the complications of electro-convulsive therapy.

Urinary elimination of salsolinol enantiomers in alcoholics

The analysis of the urine from 6 chronic alcoholics showed that (R)- and (S)-salsolinol were detectable in 4 subjects, the R enantiomer was only found in one and that both enantiomers were under the limit of detection in another one. 1,2-Dehydrosalsolinol was present in the urine of all of them. There was no correlation between the presence of alcohol in blood upon admission to the hospital and that of either salsolinol enantiomer in urine In a previous study (Strolin Benedetti et al., 1989 b), both salsolinol enantiomers were found in the urine of 3 out of 6 healthy subjects, possibly in relation with regular intake of alcoholic beverages. The content in (R)- and (S)-salsolinol was determined in the same 3 subjects after deprivation of alcohol for 24 h. Under these conditions, only (R)-salsolinol was detected in urine and this also after ingestion of 50 g of alcohol (500 ml Chianti). The possible involvement of the non-physiological enantiomer of salsolinol in alcohol addiction deserves further study.

[The elderly and psychotropic drugs]

The incidence of adverse reactions to drugs is two or three times greater in elderly people than in adults. Elderly people are great consumers of psychotropic drugs which are most often responsible for these reactions, the chief culprits being anticholinergics and neuroleptics. These drugs must be avoided at that age, but neuroleptics may be justified in some circumstances, such as uncontrollable excitement or delusions. The dysautonomia associated with ageing induces functional disorders that are similar to those induced by psychotropic drugs, so that the responsibility of these drugs is frequently under-evaluated. In those rare cases where psychotropic agents are mandatory, only one of them must be prescribed in low doses and, whenever possible, for a limited period.

Enantiomeric composition of urinary salsolinol in parkinsonian patients after Madopar

Urinary salsolinol output had been shown to be lower in Parkinsonian patients than in controls and to increase largely after L-dopa therapy. It had also been established that the R enantiomer of salsolinol is either the predominant or the sole enantiomer present in the urine of healthy subjects. When Madopar was administered to Parkinsonians, the enantiomeric composition of urinary salsolinol showed an S/R ratio around 1. Considering brain and plasma concentrations in dopamine, acetaldehyde and pyruvate, it is suggested that, under physiological conditions, urinary salsolinol should have a central origin in humans. Conversely, urinary salsolinol in Madopar-treated Parkinsonian patients might be predominantly formed at the periphery.

[Salsolinol, an endogenous molecule. Possible implications in alcoholism, Parkinson's disease and pain]

Salsolinol can be formed either by condensation of dopamine with acetaldehyde, or by condensation of dopamine with pyruvic acid followed by decarboxylation. Salsolinol has a complex pharmacologic profile. Its opium-like activity may be related to alcohol dependency and to the effectiveness of naloxone during acute alcohol intoxication. Because they had noticed that alcoholism and Parkinson's disease rarely coexist, the authors undertook a study to confirm this fact and attempt to explain it by implicating salsolinol. Urinary excretion of salsolinol was found to increase following ingestion of alcohol, as well as in Parkinson patients under L-dopa treatment. The authors also found that urinary salsolinol was very low in untreated patients with Parkinson's disease. Salsolinol was detected in a number of foods and beverages. Separate assays of enantiomeres showed that the S enantiomere predominates in some foods whereas the R enantiomere is more abundant in humans. Lastly, the antinociceptive effects of salsolinol and its enantiomeres were studied in mice and antidepressant effects were evidenced using predictive tests.

Walk headache: an unusual manifestation of ischemic heart disease

A 71 year old man sought neurological advice because for two years he had suffered from headache every time he made an effort. A treadmill stress test showed a relation between effort, headache and depression of ST segments on E.C.G. With isosorbide dinitrate and diltiazem, the manifestations improved. This suggests a referred head pain due to myocardial ischemia.

Comparison of the central and peripheral effects of cetirizine and terfenadine

The peripheral and central effects of 10 mg cetirizine 2 HCl and 60 mg terfenadine have been compared with placebo in 9 healthy male volunteers. The peripheral effect, in terms of cutaneous reactivity to 1 microgram histamine i.d., was measured by planimetry of the wheal and erythemas. Central effects were assessed with a self-evaluation visual scale and from the results of electroencephalographic spectrum analysis. Peripheral inhibition of histamine reactivity was more intense and quicker for cetirizine than for terfenadine. On the self-evaluation scale, no significant difference between terfenadine, cetirizine and placebo was noted. The quantified EEG did not show any variation in spectral parameters at any time after cetirizine. By contrast, at 6 h terfenadine had increased slow waves and had inhibited the alpha band. Thus, 10 mg cetirizine 2 HCl had less effect on the central nervous system than terfenadine 60 mg, whilst its peripheral action appeared more quickly and was more intense.