Gaj Vidmar

Influence of foot orthoses on plantar pressures, foot pain and walking ability of rheumatoid arthritis patients–a randomised controlled study

Purpose. To compare the effectiveness of functional foot orthoses and unshaped (flat) orthotic material on plantar pressure redistribution, forefoot pain reduction and walking ability in rheumatoid arthritis (RA) patients. Methods. Forty patients with RA were randomised to receive unshaped material (UM) (n = 20) or functional foot orthoses (n = 20). Plantar pressure measurement was performed with an F-scan system. Foot pain was assessed by the pain subscale of the Foot Function Index. Walking ability was assessed by the 6-min walking test. Investigations were performed at baseline, 1 week after the patient received shoes with orthoses and 6 months later. Results. Plantar pressures were significantly higher at painful than at non-painful foot areas. No differences in plantar pressure redistribution were found between the groups. Notable reduction of pain and improvement of activity (walking ability) was observed in both groups. Foot pain has moderate impact on the walking ability of RA patients. Conclusions. The study showed no clear advantage of functional foot orthoses over UM.

Epidemiology of pediatric chronic inflammatory bowel disease in central and western Slovenia, 1994-2005.

Background: The aim of this study was to determine the epidemiological and clinical characteristics of inflammatory bowel disease (IBD) in children in central and western Slovenia during a 12-year period (1994–2005). Materials and Methods: The medical records of patients with newly diagnosed IBD during the period of 1994–2005 were retrospectively reviewed. Results: In the 12-year study period, 137 children received new diagnoses of IBD, 60% had Crohn disease (CD), 28% had ulcerative colitis (UC), and 12% had indeterminate colitis (IC). The mean annual incidence of IBD for the whole 12-year period was 4.03/100,000 children; for CD 2.42, for UC 1.14, and for IC 0.47. The annual incidence of IBD rose from 3.04 in the period 1994–1999 to 5.14 in the period 2000–2005. The incidences of CD, UC, and IC rose from 1.99, 0.77, and 0.28, respectively, in the first 6 years to 2.88, 1.57, and 0.69, respectively, in the second 6-year period. The most common type of CD at presentation was inflammatory. Pancolitis was the most frequent form of UC. Almost half of the patients had a severe form of CD at its onset. Conclusions: The incidence of total pediatric IBD in central and western Slovenia is high and seems to be still rising. CD is the most prevalent form of IBD; its incidence is comparable with that reported in other central and western European countries. The incidences of UC and IC are rising more rapidly than the incidence of CD.

The 2,6-Disubstituted Naphthalene Derivative FDDNP Labeling Reliably Predicts Congo Red Birefringence of Protein Deposits in Brain Sections of Selected Human Neurodegenerative Diseases

Deposition of conformationally altered proteins prominently characterizes pathogenesis and pathomorphology of a number of neurodegenerative disorders. 2‐(1‐{6‐[(2‐[F‐18]fluoroethyl) (methyl)amino]‐2‐naphthyl} ethylidene) malononitrile ([F‐18]FDDNP), a hydrophobic, viscosity‐sensitive, solvent‐sensitive, fluorescent imaging probe has been used with positron emission tomography to visualize brain pathology in the living brain of Alzheimer disease (AD) patients. Its non‐radiofluorinated analog FDDNP was shown to label senile plaques and neurofibrillary tangles (NFTs) in brain tissue sections. This work aimed at evaluating FDDNP labeling of various protein deposits in fixed, paraffin‐embedded brain tissue sections of selected neurodegenerative disorders: AD, cerebral amyloid angiopathy (CAA), transmissible spongiform encephalopathies, progressive supranuclear palsy (PSP), Pick disease (PiD), Parkinson disease, dementia with Lewy bodies, multiple system atrophy (MSA). Cerebral hypertensive vascular hyalinosis (HVH) was used as negative control. Significant agreement between amyloid histochemical properties and FDDNP labeling of the deposits was established. FDDNP labeling showed high positive predictive value for birefringence in senile plaques and NFTs in AD, prion plaques and amyloid deposits in CAA. No FDDNP labeled structures were observed in HVH, PSP, PiD or MSA tissue sections. Our findings may be of significant value for the detection of neuropathological aggregates with [F‐18]FDDNP in some of these disorders in the living brain of human subjects.

Use of the International Classification of Functioning, Disability and Health (ICF) in patients with traumatic brain injury

Introduction: Many tools exist for assessing the functioning of a patient with traumatic brain injury. Possible benefits of the ICF in TBI rehabilitation are currently under discussion. Goal: The study explored to what extend the ICF is useful to organize existing clinical information and to retrospectively evaluate the effect of interventions in patients with TBI. Method: A retrospective patient record study was conducted. Medical records of 100 patients admitted to the Slovenian University Rehabilitation Institute from 2007–2009 were linked to the ICF. Results: The majority of the functional problems at the level of body functions corresponded to mental and movement-related functions. Within the list of activities and participation, the patients experienced more difficulties in tasks that require intellectual effort, communicational ability, mobility and self-care. The ICF detected substantial improvement after rehabilitation regarding body functions and activities related to mobility and self-care and little improvement regarding mental functions and related activities. Some important environmental factors were also identified. Conclusions: The translation of the information about functioning into the ICF format provided a well-structured functional profile of the selected group of patients in a language-independent format. ICF also clearly outlined the environmental factors important for the recovery and functioning.

Patients with preoperatively ultrasonically uninvolved axillary lymph nodes: a distinct subgroup of early breast cancer patients

SummaryIntroductionUltrasound (US) preoperative examination of the axillary lymph nodes combined with the fine needle aspiration biopsy (FNAB) is often used in order to reduce the number of sentinel lymph node (SLN) biopsy procedures in clinically node negative breast cancer patients. The pathohistological characteristics of the ultrasonically negative axillary lymph nodes in clinically negative axillary lymph nodes are not known. The aim of our study was to compare the pathohistological characteristics of ultrasonically uninvolved axillary lymph nodes (US group) versus clinically uninvolved axillary lymph nodes (non-US group) in SLN biopsy candidates.MethodsWe included 658 patients after SLN biopsy; 286 patients in the US group and 372 in the non-US group. The pathohistological characteristics of axillary lymph nodes were evaluated by univariate analysis and logistic regression.ResultsIn the univariate analysis, the proportion of macrometastastic SLN, total number of metastatic lymph nodes per patient, proportion of nonsentinel lymph node (NSLN) metastases and proportion of NSLN macrometastases were found to be lower in the US group compared to the non-US group. In the logistic regression model, only US of the axilla (p=0.010; OR: 0.57) and tumor size were significant predictors for the presence of SLN macrometastases or macrometastatic NSLN (p<0.001; OR: 0.23).ConclusionThe patients with US negative axillary lymph nodes form a distinct subgroup of early breast cancer patients having a significantly lower tumor burden in the axillary lymph nodes compared to those with only clinically negative axillary lymph nodes.

Applicability of the pediatric evaluation of disability inventory in Slovenia.

In the process of developmental (re)habilitation, determination of the functional abilities of an individual is an important step. For that we need appropriate measurement instruments. Because we do not have such measurement instruments in Slovenia, we chose the Pediatric Evaluation of Disability Inventory (PEDI), translated it, and applied it in daily practice to assess its usefulness and applicability. The purpose of the study was to find out whether the functional abilities of the population of Slovene children evaluated with the Pediatric Evaluation of Disability Inventory is comparable to the American normative data. We also wanted to assess the possible influence of gender, parent education, community size, and the presence of siblings on childrens functional abilities. The Pediatric Evaluation of Disability Inventory was administered in the form of a structured interview to the parents of 147 healthy children in three age groups (0.5—1 year, 3—3.5 years, and 5—5.5 years) in different health care centers in Slovenia. Data analysis showed significant differences in functional skills and caregiver assistance scale scores when comparing the Slovene sample with the American normative data, particularly in the youngest age group. Slovene children were found consistently to be different (scoring either higher or lower) from American children at comparable ages in several functional skills and caregiver assistance scales. The analysis also confirmed the importance of gender and the presence of siblings for gaining higher scores on some of the functional skills and caregiver assistance scales. The level of parent education did not prove to have a significant impact on the results. Our results suggest that the American normative data are not completely appropriate for reference purposes in Slovenia. The results are in agreement with the findings of other studies, demonstrating the importance of ascertaining intercultural differences. We believe that adaptation and norming of the Slovene version of the Pediatric Evaluation of Disability Inventory are necessary before using the instrument in clinical practice in our country. (J Child Neurol 2005;20:411—416).

Rehabilitation of Critical Illness Polyneuropathy and Myopathy Patients: An Observational Study.

Critical illness polyneuropathy and myopathy (CIPNM) frequently develops in patients hospitalized in intensive care units. The number of patients with CIPNM admitted to inpatient rehabilitation is increasing. The aim of this study was to comprehensively evaluate the outcome of their rehabilitation. Twenty-seven patients with CIPNM were included in the study. The diagnosis was established clinically and confirmed electrophysiologically. Manual muscle testing was used for the assessment of function. Activity was assessed using the functional independence measure and two walking tests. The patients were also assessed using an adapted International Classification of Functioning, Disability and Health (ICF) checklist. All assessments were performed at admission and discharge. Clinically important and statistically significant improvements were found in all observed measures. High and significant correlations were found between the measures, except between muscle strength and the results of walking tests. Improvement in body functions during rehabilitation decreased as the time from established diagnosis to the start of rehabilitation increased, but it was not related to rehabilitation duration. Improvements in terms of the ICF mainly corresponded to the gain in functional independence measure scores. Major improvement regarding body functions and activities/participation was achieved in patients with CIPNM with a relatively short rehabilitation. Rehabilitation of such patients should start as early as possible once the diagnosis has been established. Comprehensive assessment of such patients combining established scales, objective clinical tests, and the ICF is recommended. Eine Critical-Illness-Polyneuropathie und -Myopathie (CIPNM) tritt häufig bei intensivpflichtigen Patienten auf. Die Zahl der CIPNM-Patienten, die sich einer stationären Rehabilitation unterziehen, steigt. Die vorliegende Studie sollte die Ergebnisse ihrer Rehabilitation umfassend bewerten. Für die Studie wurden 27 Patienten mit CIPNM rekrutiert. Die Diagnosestellung erfolgte klinisch, die Bestätigung elektrophysiologisch. Manuelle Muskeltests wurden zur Funktionsbeurteilung eingesetzt. Die Aktivität wurde mit Hilfe des funktionalen Selbständigkeitsindexes und zweier Gehdistanz-Tests bewertet. Die Patienten wurden darüber hinaus auch unter Zuhilfenahme einer modifizierten ICF-Checkliste (Internationale Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit) bewertet. Alle Untersuchungen wurden bei der Aufnahme und der Entlassung durchgeführt. Bei allen beobachteten Maßnahmen wurden klinisch wichtige und statistisch signifikante Verbesserungen festgestellt. Zwischen den einzelnen Maßnahmen wurden hohe und signifikante Korrelationen festgestellt, ausgenommen zwischen Muskelstärke und den Ergebnissen der Gehdistanz-Tests. Die Verbesserung der Körperfunktionen im Laufe der Rehabilitation nahm ab, die Zeit, die ab Diagnosestellung bis zum Start der Rehabilitation verstrich, nahm dagegen zu, stand aber in keiner Beziehung zur Dauer der Rehabilitation. Verbesserungen bzgl. der ICF bezogen sich primär auf den Zuwachs der Werte der funktionalen Selbständigkeitsmessungen. Deutliche Verbesserungen bgzl. Körperfunktionen und Aktivitäten/Teilhabe wurden bei CIPNM-Patienten mit einer relativ kurzen Rehabilitationsphase erzielt. Die Rehabilitation solcher Patienten sollte möglichst früh nach der Diagnosestellung ansetzen. Es empfiehlt sich eine umfassende Untersuchung solcher Patienten mit etablierten Wertungsskalen, objektiven klinischen Tests und der ICF. La polineuropatía y miopatía del paciente crítico (PNMPC) a menudo se desarrolla en los pacientes hospitalizados en unidades de cuidado intensivo, y el número de dichos pacientes admitidos en rehabilitación continúa en aumento. El objetivo de este estudio fue evaluar de forma exhaustiva el resultado de la rehabilitación de dichos pacientes. Veintisiete pacientes con PNMPC participaron en el estudio. El diagnóstico se estableció clínicamente y se confirmó mediante electrofisiología. Para evaluar las funciones, se utilizó la prueba manual muscular. La actividad fue evaluada mediante la medida de independencia funcional y dos pruebas de marcha. También se evaluó a los pacientes mediante una adaptación de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF). Todas las pruebas se realizaron en el momento de admisión y de alta del paciente. Se observaron mejoras clínicamente importantes y estadísticamente significativas en todas las mediciones. Además, también se observaron correlaciones elevadas y significativas entre las mediciones, excepto entre la fuerza muscular y los resultados de las pruebas de marcha. La mejora de las funciones corporales durante la rehabilitación disminuyó, mientras que se vio un aumento del tiempo transcurrido desde el establecimiento del diagnóstico hasta el comienzo de la rehabilitación, aunque esto último no estuvo relacionado con la duración de la rehabilitación. Las mejoras en cuanto a CIF correspondieron principalmente al incremento de la puntuación de la medida de independencia funcional. Se logró una gran mejora con respecto a las funciones corporales y las actividades/participación de los pacientes con PNMPC sometidos a un período de rehabilitación de duración relativamente corta. La rehabilitación de dichos pacientes deberá comenzar tan pronto como sea posible una vez que se haya establecido el diagnóstico. Se recomienda llevar a cabo una evaluación exhaustiva mediante la combinación de escalas establecidas, pruebas clínicas objetivas y CIF. Des polyneuropathies et des myopathies graves (PMG) se développent souvent chez les patients hospitalisés dans les unités de soins intensifs. Le nombre de patients atteints de PMG admis en rééducation avec hospitalisation est en augmentation. Cette étude avait pour objet d’évaluer de manière exhaustive les résultats de leur rééducation. Soixante-dix-neuf patients atteints de PMG ont été inclus dans l’étude. Le diagnostic a été établi d’un point de vue clinique et confirmé électrophysiologiquement. Un test musculaire manuel a été employé pour évaluer la fonction. L’activité a été évaluée en utilisant la mesure d’indépendance fonctionnelle et deux tests de marche. Les patients ont également été évalués en utilisant une liste de contrôle adaptée de la classification internationale du fonctionnement, du handicap et de la santé (CIF). Toutes les évaluations ont été effectuées lors de l’admission à l’hôpital et de la sortie. Des améliorations cliniquement importantes et statistiquement significatives ont été identifiées pour toutes les mesures observées. Des corrélations élevées et significatives ont été constatées entre les mesures, excepté entre la force musculaire et les résultats des tests de marche. L’amélioration des fonctions du corps pendant la rééducation diminuait en fonction de l’augmentation du temps entre l’établissement du diagnostic et le début de la rééducation, mais elle n’était pas liée à la durée de la rééducation. L’amélioration concernant la CIF correspondait essentiellement au gain des scores de mesure de l’indépendance fonctionnelle. Une amélioration majeure des fonctions du corps et des activités/de la participation a été observée chez des patients atteints de PMG avec une rééducation relativement courte. La rééducation de ces patients devrait commencer dès que possible une fois le diagnostic établi. Une évaluation poussée de ces patients combinant les échelles établies, des tests cliniques objectifs et la CIF est recommandée.

Assessment of Cardiac Autonomic Regulation and Ventricular Repolarization after Off-Pump Coronary Artery Bypass Grafting

BACKGROUND Altered autonomic regulation precipitates cardiac arrhythmias and increases the risk of sudden cardiac death. This risk is further increased by changes in ventricular repolarization. Autonomic regulation is deranged in patients after myocardial on-pump revascularization. We aimed to clarify how off-pump coronary artery bypass grafting (CABG) affects postoperative cardiac autonomic regulation and ventricular repolarization within 4 weeks after CABG. METHODS Forty-two patients (mean age, 61.9 +/- 9.3 years; mean EURO score 2.6 +/- 1.9) were electively admitted for off-pump CABG. The electrocardiographic and respiratory waveform recordings were performed in the afternoon in the supine position for 10 minutes. Autonomic modulation was assessed using heart rate variability analysis. Power spectra were computed from 5-minute stable RR intervals using Fourier Transform analysis. Total power of spectra was defined in the range of 0.01 to 0.40 Hz, high-frequency power within 0.15 to 0.40 Hz, and low-frequency power within 0.04 to 0.15 Hz. Normalized power was defined as a ratio of power in each band/total power. The high- and low-frequency power as well as their normalized values indicated cardiac vagal and sympathetic modulation, respectively. Ventricular repolarization was assessed using QT interval, QT interval variability, and QT-RR interdependence analysis. QT intervals were determined from the beginning of the 5-minute segments. QT interval variability was evaluated by a T-wave template-matching algorithm. Pearson correlation between length of RR and QT interval was applied to study QT-RR characteristics. The results were tested for significance using the Fisher exact test, nonpaired t test, and analysis of variance; a P <.05 was considered significant. RESULTS The frequency of arrhythmic events and heart rate increased from the fourth to the seventh postoperative day and returned to preoperative levels 4 weeks after CABG. Heart rate variability measures indicating autonomic modulation remained depressed even 4 weeks after the procedure. QT variability index increased from -1.2 +/- 0.5 to -0.8 +/- 0.4 on the fourth day after the operation (P <.05) and returned to -1.0 +/- 0.5 4 weeks after CABG (P = not significant). QT-RR correlation decreased from 0.41 to 0.23 (P <.05) and remained significantly impaired as long as 4 weeks after CABG. CONCLUSIONS Observed faster heart rates until 1 week after off-pump CABG imply excessive adrenergic activation, which is comparable to on-pump CABG procedure rates. The results indicate profound autonomic derangement and loss of rate-dependent regulation after off-pump CABG even 4 weeks after operation. Restituted repolarization as assessed by QT variability index 4 weeks postoperatively corresponded with decreased frequency of rhythm disturbances 4 weeks after CABG. The loss of coupling between QT and RR intervals shows increased electrical instability postoperatively, which may serve as an additional promoter for postoperative arrhythmias, especially at higher heart rates.

Cementum thickness in multirooted human molars: A histometric study by light microscopy

Cementum distribution was studied on transversely sectioned roots of 33 three-rooted maxillary and 33 two-rooted mandibular permanent molars. The roots were sectioned at a level midway between furcation and apical region. Cementum thickness was measured at the midpoint of each of the four root surfaces and at a site exhibiting maximal cementum thickness. A reflected light microscope was used. Midpoint cementum thickness ranged between 5 and 800 microm in maxillary molars and between 5 and 700 microm in mandibular molars. Maximal cementum thickness ranged between 25 and 1140 microm in maxillary molars and between 20 and 700 microm in mandibular molars. The results indicate that cementum tends to accumulate along interradicular surfaces of multirooted molars. In addition, a tendency was noted for more cementum to occur orally than vestibularly in roots of mandibular molars as well as in buccal roots of maxillary molars. Furthermore, this study indicates that cementum accumulates in root concavities (developmental depressions), although the exact mechanism still awaits a clear explanation. Previous studies have suggested that tensile forces stimulate cementum apposition. It may be assumed, however, that masticatory function and continuing eruption of the teeth exert no discernible effect on cementum thickness in the examined region of the root. In conclusion, the observed cementum distribution could be attributed to at least two factors: one is buccal drift and the second may be the effect of root concavities. From a clinical viewpoint, the established pattern of cementum distribution in multirooted molars should be considered in endodontic and periodontal treatment.

Prevalence and risk factors for osteopenia/osteoporosis in an HIV-infected male population.

ZusammenfassungZiel unserer Untersuchung war es, die Prävalenz von Osteopenie/Osteoporose bei männlichen HIV/AIDS Patienten zu erheben und den Einfluss von antiretroviraler Behandlung (ART), HIV und anderen Risikofaktoren auf die Reduktion der Knochenmineraldichte zu erfassen. Alle bekannten slowenischen HIV-infizierten ART-naiven und ART-behandelten Männer (länger als 12 Monate infiziert bzw. behandelt) wurden eingeladen, an dieser horizontalen Studie teilzunehmen. Es wurden Alter, BMI, Taille-Hüfte-Quotient, Familienanamnese bezüglich Hüftfrakturen, Dauer der Infektion, Dauer der ART, Nikotinund Alkoholkonsum, körperliche Aktivität, Viruslast, und CD4+ Zellen erhoben. Die Knochendichte wurde mittels DXA gemessen. Insgesamt wurden 96 Patienten erfasst (von 133, die die Einschlusskriterien erfüllten). Diese wurden in drei Gruppen geteilt: Gruppe A (n = 24): ART-naiv; Gruppe B1 (n = 37): mit mit ART ohne Proteaseinhibitor (PI) behandelt; Gruppe B2 (n = 35): mit ART mit PI behandelte Patienten. Die Prävalenz der Osteopenie/Osteoporose lag bei 57 (59%), wobei 45 (47%) eine Osteopenie und 12 (12%) eine Osteoporose hatten. In der Gruppe A wurde eine signifikant erniedrigte Knochendichte beobachtet (p = 0,02). Die multiple logistische Regressionsanalyse zeigte, dass ART ein unabhängig negativer Prädiktor für eine reduzierte Knochendichte war (p = 0,037; OR = 0,29, 95% CI 0,09–0,93). Vitamin-D3-Mangel wurde in 79 (82%) der Patienten entdeckt. Die in dieser Studie untersuchten Patienten repräsentieren 72% aller männlichen mit HIV infizierten slowenischen Patienten, dies ist der höchste bisher jemals publizierte Anteil. Die Prävalenz einer reduzierten Knochendichte war deutlich höher als bei nicht HIV-infizierten slowenischen Männern der gleichen Altersgruppe. Es gab keine Abhängigkeit der reduzierten Knochendichte von jeglicher Form von ART. Unsere Ergebnisse zeigen, dass das Fehlen einer ART einen unabhängigen Risikofaktor für Osteopenie/Osteoporose darstellt. Gezieltes Screening und frühe Behandlung stellen unseres Erachtens eine sinnvolle Strategie zur Vorbeugung einer reduzierten Knochendichte bei HIV-infizierten Männern dar. Die Korrektur von Vitamin-D3-Spiegeln könnte eine zusätzliche wichtige Komponente darstellen.SummaryThe objective of our investigation was to estimate the prevalence of osteopenia/osteoporosis in men with HIV/AIDS and evaluate the role of antiretroviral treatment (ART), HIV and other risk factors in reducing bone mineral density (BMD). All known Slovenian HIV-infected ART-naïve and treated males (infected or treated > 12 months) were invited to participate in a cross-sectional study. Data were collected on age, BMI, waist-hip ratio, family history of hip fracture, duration of infection, duration of ART, smoking, alcohol, exercise, viral load and CD4+ cells. BMD was measured using dual X-ray absorptiometry. A total of 96 patients (out of 133 who fulfilled the inclusion criteria) were assessed and allocated into three groups: group A (n = 24), ART-naïve; group B1 (n = 37), treated with non-protease-inhibitor (PI) containing ART; and group B2 (n = 35), treated with PI-containing ART. The prevalence of osteopenia/osteoporosis was 57/96 (59%): osteopenia 45/96 (47%) and osteoporosis 12/96 (12%). Significantly lower BMD was detected in group A (P = 0.020). Multiple logistic regression analysis showed ART to be an independent negative predictor for reduced BMD (P = 0.037; OR = 0.29, 95%CI 0.09–0.93). Vitamin D3 deficiency was detected in 79 (82%) of the patients. The study group represented 72% of the national HIV-infected male population; this proportion being higher than in any other study reported to date. The prevalence of reduced BMD was notably higher than the national prevalence among men of comparable age. There was no association between reduced BMD and any specific ART. According to our results, absence of ART was confirmed as an independent predictor of osteopenia/osteoporosis. Targeted screening and early treatment present a reasonable strategy for preventing reduced BMD in HIV-infected patients, but correcting vitamin D3 levels could also be an important component.