Peter Kryger

Intensive dynamic training for females with chronic neck/shoulder pain. A randomized controlled trial

Objectives: To compare the clinical effectiveness of an intensive three-month training programme with a less intensive programme on females suffering from chronic neck/shoulder pain. Study design: A prospective observer-blinded clinical trial including 12-month pretreatment follow-up. Setting: Patients were referred to the Departments of Rheumatology and Physical Medicine at Hvidovre Hospital by their general practitioners. Training was undertaken at a satellite clinic for physiotherapy of Hvidovre Hospital. Subjects: Female patients aged 18–65 years suffering from chronic neck/shoulder pain for a minimum of six months. Intervention: Patients were examined by a physician in order to exclude serious diseases. They were then randomized to either an intensive neck/shoulder training programme or a programme of lesser intensity but of similar duration. Main outcome measures: Scales measuring pain and activities of daily living (ADL) were used, and strength and endurance measurements of the cervical and shoulder muscles were carried out at baseline and completion of the study. Follow-up measurements were carried out by postal questionnaire at 6 and 12 months after inclusion, and included pain, ADL and treatment satisfaction measurements. Results: Seventy-seven patients were included in the trial, of whom 27 (69%) completed the intensive programme and 25 (61%) the lighter programme. Forty-one (>80%) completed the follow-up questionnaires. The patients in the two groups did not differ with regard to age, pain, ADL scores and physical measurements prior to training. Patients in both groups that completed the trial demonstrated statistically significant improvements in nearly all of the outcome measurements at completion. ADL scores maintained statistical significance at 12 months in both groups, but pain scores were only significantly improved in the intensive group at 12 months follow-up. There was no statistically significant difference between groups regarding pain or ADL, but overall 50% of all patients showed improvement. Conclusions: The type of low-tech dynamic training used in either of our two programmes resulted in both subjective and objective improvements in patients suffering from chronic neck/shoulder pain, but there were no statistically significant differences in outcome between the two approaches. The subjective improvements were maintained throughout the follow-up period.

Faecal Excretion of Hepatitis a Virus in Patients with Symptomatic Hepatitis a Infection

One hundred and eleven hospitalized patients with serologically confirmed hepatitis A infection were studied for faecal excretion of hepatitis A virus (HAV) by an enzyme-linked immunosorbent assay. Twenty-six out of 105 patients seen within 2 weeks after onset of jaundice had specimens positive for HAV. The rate of excretion exceeded 50% in patients above 35 years of age and in those with serum amino-transferase values above 2000 U/l, but none of various clinically or biochemically defined subgroups were completely without HAV-positive individuals. It is recommended that all patients should be regarded as infectious for at least 2 weeks after clinical onset of the disease, and hygienic precautions should probably be maintained until biochemical liver function tests approach the normal level.

The Accuracy of the Clinical Diagnosis in Acute Hepatitis and Alcoholic Liver Disease. Clinical versus Morphological Diagnosis

Microfilms were prepared from the case histories of 357 consecutive patients submitted to liver biopsy for the first time so that all information after the time of the liver biopsy was erased. The microfilms were assessed by four clinicians, and the pre-biopsy diagnostic proposals were graded according to the degree of certainty and were compared with the results of the liver biopsies. Out of 357 patients, 200 had a history of alcoholism, of whom 172 had alcohol-induced changes in the liver biopsies: 80 cases of alcoholic cirrhosis, 84 cases of steatosis, and 8 cases of alcoholic hepatitis without cirrhosis. In 65 of the 80 patients with biopsy-verified alcoholic cirrhosis the clinical pre-biopsy diagnosis was in agreement with the histological findings. In 51 cases in which the clinical diagnosis of alcoholic cirrhosis was given as moderately certain or very certain, 4 clinically incorrect diagnoses occurred. No incorrect diagnoses occurred in the 35 cases in which the clinicians claimed the greatest diagnostic accuracy. In the 84 patients with steatosis in the liver biopsies the clinicians felt uncertain or moderately certain about all but 2 patients, and 14 incorrect diagnoses occurred. In none of the 8 patients with histological alcoholic hepatitis without cirrhosis was a correct clinical diagnosis made. The clinical pre-biopsy diagnosis of acute hepatitis was in agreement with the results of the liver biopsies in 52 out of 57 patients. In 51 cases in which the clinical diagnosis of acute hepatitis was given as moderately certain or very certain, 1 clinically incorrect diagnosis occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

The Long-Term Prognosis of Non-Transfusion-Associated Non-A, Non-B Hepatitis: A Clinical, Epidemiological, and Histological Investigation

In a prospective study of the natural course of acute hepatitis, 157 of 1020 patients with biopsy-verified acute hepatitis could be classified as having hepatitis type non-A, non-B. We here report on the long-term prognosis for these 157 patients. The main type of exposure was drug addiction (40%), whereas 40% had no known hepatitis exposure. Only two patients had received blood products (blood transfusion and factor VIII). Follow-up liver biopsy (mean histological follow-up, 22 months) in 94 of the 157 patients showed chronic liver disease in 15-that is, cirrhosis in 6, suspicion of cirrhosis in 2, chronic aggressive hepatitis in 5, and chronic persistent hepatitis in 2. There was a striking predominance of elderly women with no known hepatitis exposure and with a high frequency of autoantibodies in serum among the patients with progression to chronicity, whereas chronic non-A, non-B hepatitis in drug addicts or after blood transfusions seems to be a limited problem. A comparison of histological features in the initial biopsies from patients with progression to chronicity or complete resolution showed piecemeal necrosis and abnormal bile duct epithelium to be of prognostic value.

Intra-articular and circulating levels of type I and III collagen markers in inflammatory and degenerative joint disease

In a chronic inflammatory disease as rheumatoid arthritis, the local processes in the affected tissues lead to destruction of the joint. When estimating the inflammatory activity in rheumatic joint diseases, a major problem is the rather unspecific and indirect character of the biochemical and the crude character of the clinical measures used.

Increased Prevalence of Cytomegalovirus Antibodies in Homosexual Men with Syphilis: Relation to Sexual Behaviour

Serum samples from 146 homosexual males, 40 heterosexual males and 51 females with at least one episode of syphilis were tested for the presence of IgG and IgM antibodies against cytomegalovirus (CMV IgG and CMV IgM). 100 blood donors served as a control group. CMV IgG was present in 95% of homosexual men compared with 68% of heterosexual men (p less than 0.001) and 73% of females (p less than 0.001) with past or present syphilis. CMV IgM was found in 43-68% of the venereal patients and with the highest percentage in homosexual men. Only 7% of blood donors had CMV IgM. It is concluded that CMV infection may be regarded as a venereal disease.