Patricia Lang

Computerized dynamic posturography: the influence of platform stability on postural control.

ObjectivePostural stability can be quantified using posturography systems, which allow different foot platform stability settings to be selected. It is unclear, however, how platform stability and postural control are mathematically correlated. DesignTwenty subjects performed tests on the Biodex Stability System at all 13 stability levels. Overall stability index, medial-lateral stability index, and anterior-posterior stability index scores were calculated, and data were analyzed using analysis of variance and linear regression analysis. ResultsA decrease in platform stability from the static level to the second least stable level was associated with a linear decrease in postural control. The overall stability index scores were 1.5 ± 0.8 degrees (static), 2.2 ± 0.9 degrees (level 8), and 3.6 ± 1.7 degrees (level 2). The slope of the regression lines was 0.17 for the men and 0.10 for the women. ConclusionsA linear correlation was demonstrated between platform stability and postural control. The influence of stability levels seems to be almost twice as high in men as in women.

Dual Energy Computed Tomography in Musculoskeletal Imaging, with Focus on Fragility Fractures of the Pelvis

Dual energy computed tomography (DECT) is a constantly evolving technology, which opens up new diagnostic possibilities. It is particularly valuable for musculoskeletal (MSK) imaging. Due to the lack of recognition and availability of dual energy scanners, routine use is only established in a few centres. The intention of this review is to show the possibilities and fields of applications of the DECT in MSK imaging, as well as to describe technical principles and typical indications. We mainly focus on the use of DECT in the context of fragility fractures of the pelvis. The use of the DECT in pelvic fractures of the elderly could combine the advantages of CT diagnostics - fast and continuous availability, lower costs by dispensing with a supplementary MRI examination - and the high sensitivity of MRI to oedema in fragility fractures. Furthermore, the latest DECT scanners are dose neutral, so that these examinations can also be carried out without increased radiation exposure.

Verändertes Keimspektrum von Komplexwunden in Deutschland durch die Behandlung von Verletzten aus Konfliktländern

Background Treatment of the injured from war zones with wounds with multi-resistant pathogens is becoming more common in Germany, especially in German Armed Forces Hospitals. In most cases, the pre-treatment of these patients has been inadequate and they have a high load of rare pathogens. In Germany, hospitals have to evaluate these pathogens by law. The aim of this study was to review current German guidelines and data on the array of pathogens of complex trauma wounds in Germany and to compare patients with wounds and multi-resistant pathogens from war zones treated in Germany. Patients and Methods A PubMed search was performed on all multiresistant pathogens, antibiotic resistance and guidelines in Germany from 2005 to 2015. The databases and recommendations of the Robert Koch Institute, the Paul Ehrlich Society and the National Reference Centre for the Surveillance of Nosocomial Infections were analysed. The screening results of injured patients from war zones treated in the German Armed Forces Hospital Ulm were included. Results The array of pathogens for nosocomial infections has not changed, but the ratios of the pathogens has altered. Methicilin-resistant Staphylococcus aureus (MRSA) has decreased, but vancomycin-resistant enterococci have increased continuously. Enterococcus faecium (E. faecium) now make up the largest fraction of VRE. The databases do not yet provide data on the relatively new classification of multiresistant gramnegative (MRGN) pathogens. MRGN pathogens play the main role in injured patients from war zones. Conclusion In the last ten years, there have been changes in the resistance and ratios of multi-resistant pathogens. MRSA has decreased over the last ten years, but reserve antibiotics are increasingly needed. VRE are increasing and even some reserve antibiotics have lost their efficacy because of the use of modern antibiotics. There are not yet any German datasets available on 3- and 4-MRGN. These pathogens play the main role in injured patients from war zones treated in Germany: it is crucial to perform routine screening and to take all precautions, including isolation. Surgical wound therapy is of increasing importance and uncritical and expensive antibiotic therapy is becoming becomes less important.

Influence of Submaximal Exercise on Postural Control in Older Adults.

ObjectiveThe authors conducted this cross-sectional study to assess the influence of submaximal exercise on postural stability as measured by computerized dynamic posturography (CDP) and compared this study’s CDP results with clinical balance tests such as the Berg Balance Test and the Timed Up and Go test using a descriptive/explorative approach. DesignForty-three participants performed two exercise tasks (6-min walk test and stair climbing). CDP and established scores (Berg Balance Test and Timed Up and Go test) were used to assess postural instability. ResultsDespite significant pulse rate increases (approximately 20%, P < 0.05), no clear differences in CDP results were found after completion of either exercise task. The overall stability index scores for all subjects remained unchanged (P = 0.98). A descriptive analysis showed that excellent Berg Balance Test and Timed Up and Go test results were associated with good CDP results. ConclusionsSubmaximal exercise did not adversely affect postural stability in these older adults. To Claim CME Credits:Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives:After completion of this article, readers should be able to: (1) Appreciate the impact of falls on the health of the elderly; (2) Understand afferent input contributing to postural control; and (3) Appreciate the effects of submaximal exercise on postural stability in the elderly. Level:Advanced Accreditation:The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Diagnostic Accuracy of Fluoroscopy, Radiography, and Computed Tomography in Detecting Cement Leakage in Kyphoplasty

Purpose Cement leakage is a typical complication of kyphoplasty for vertebral fractures. It is unclear if cement application intraoperatively can be improved by using other techniques of visualization and which kind of postoperative imaging should be recommended to detect cement extravasation accurately. Objective To compare the rates of cement leakage detected by intraoperative fluoroscopy, postoperative radiography, and postoperative computed tomography (CT) in a retrospective study. Patients and Methods The study included 78 patients (60 women and 18 men; 115 vertebral bodies) who were treated with two kinds of kyphoplasty. The patients underwent intraoperative fluoroscopy and postoperative radiography and CT. After surgery, the images were evaluated to compare cement leakage rates and locations in the three visualization techniques. Leakage locations were described as epidural, intradiskal, extravertebral, or intravascular. Results Compared with CT, intraoperative fluoroscopy regularly detected intradiskal leakage (75%) but had a considerably lower sensitivity for visualizing epidural (21%), extravertebral (31%), and intravascular (51%) cement leakages. A comparison of radiography and CT showed that radiography had a high sensitivity for detecting intradiskal (82%) and intravascular (70%) cement extrusions but a lower sensitivity in identifying epidural (42%) and extravertebral (50%) leaks. Therefore, the CT scan overall was best in detecting location and accuracy. Conclusion CT detected more cement leaks than any of the other investigated techniques, especially epidural, extravertebral, and intravascular cement leakages. To achieve the best accuracy, only CT provides complete information.