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Edouard P, Vernay D, Martin S, Hirsch P, Bardoux S, Grange C, Claus D, Claise JM. Proximal row carpectomy: Is early postoperative mobilisation the right rehabilitation protocol? Orthop Traumatol Surg Res 2010; 96:513-20. [PMID: 20538538 DOI: 10.1016/j.otsr.2010.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 12/08/2009] [Accepted: 02/18/2010] [Indexed: 02/02/2023]
Abstract
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.
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Jauss M, Hamann GF, Claus D, Misselwitz B, Kugler C, Ferbert A. [Billing based on a case-based lump sum for stroke. Did this lead to discharge of patients in a worse clinical condition?]. DER NERVENARZT 2010; 81:218-25. [PMID: 20119655 DOI: 10.1007/s00115-009-2910-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It has been supposed that the introduction of a new inpatient reimbursement system starting in 2004 in Germany using the German diagnosis-related groups (G-DRG) may lead to false incentives with encouragement of premature hospital discharge of patients. Exploring a large database on stroke patients, we addressed the question whether length of stay (LOS) and discharge in more severe condition were associated with the introduction of the G-DRG. We further examined other factors with probable effect on LOS such as variations of patient characteristics and treatment during the observation period. PATIENTS AND METHODS All stroke patients treated in 2003-2006 in the German state of Hesse (6,100,000 inhabitants) were assessed with respect to stroke severity, symptoms on admission and discharge, LOS and stroke-related deficits on discharge. We compared LOS and outcome in 2003 (before introduction of the G-DRG) with 2004 when the G-DRG had recently been introduced and with 2006 when the G-DRG was already well established in the clinical routine. The effects of LOS and treatment year on outcome were assessed using a logistic regression model. RESULTS During the observation period, we evaluated 37,396 stroke patients. The length of stay was reduced significantly from 12.2 to 10.4 days (p<0.001). Both severity of stroke on admission and outcome on discharge decreased during the observation period. A multivariate analysis revealed a minor but significant association [odds ratio (OR): 1.020 per day of hospital treatment; 95% confidence interval (CI): 1.016-1.024] of LOS on outcome. Treatment in 2006 compared to 2003 led to good outcome with an OR of 1.378 (95% CI: 1.279-1.485). Subgroup analysis limited to patients with severe stroke revealed that LOS was significantly lower in 2006 compared to 2003 also in this patient subgroup; moreover, the proportion of patients discharged with severe outcome was lower in 2006 compared to 2003. CONCLUSIONS This study reveals a significant reduction of LOS during the years after introduction of the G-DRG. However, reduction of LOS was not associated with more severe outcome on discharge, possibly due to changes in stroke treatment implemented during the observational period. Our results do not support the conjecture that changes in the reimbursement system were associated with compromised patient care.
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Claus D. Diabetische neuropathische Kachexie. KLIN NEUROPHYSIOL 2009. [DOI: 10.1055/s-0029-1220437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Claus D, Huppert P, Bauersachs R, Diegel H, Hedtmann G. Endovascular therapy of carotid artery stenosis: a prospective case study. J Neurointerv Surg 2009; 2:59-64. [DOI: 10.1136/jnis.2009.000836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Claus D. Botulismus. KLIN NEUROPHYSIOL 2009. [DOI: 10.1055/s-0028-1090239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bremecker K, Gartenschläger M, Zerr I, Claus D. Differenzialdiagnose rasch progredienter Demenz. AKTUELLE NEUROLOGIE 2009. [DOI: 10.1055/s-0029-1238678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Plewe A, Claus D, Weis M, Jahnke U. INVESTIGATION OF COMPOUND MUSCLE RESPONSES AFTER TRANSCRANIAL DOUBLE STIMULATION. BIOMED ENG-BIOMED TE 2009. [DOI: 10.1515/bmte.1992.37.s2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Babacan S, Claus D, Gartenschläger M. Hirninfarkt im Bereich der hippocampalen Formation als Ursache der transienten globalen Amnesie. KLIN NEUROPHYSIOL 2009. [DOI: 10.1055/s-0029-1216229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bamberg C, Schoser B, Tews S, Claus D. Rippling-muscle-Phänomen bei Thymitis-assoziierter Myasthenia gravis. KLIN NEUROPHYSIOL 2009. [DOI: 10.1055/s-0028-1090127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tschernatsch M, Dierkes C, Gerriets T, Hosch J, Stolz E, Kaps M, Krasenbrink I, Claus D, Blaes F. Paraneoplastic neurological syndromes in patients with carcinoid. Eur J Neurol 2009; 15:1390-4. [PMID: 19049559 DOI: 10.1111/j.1468-1331.2008.02328.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Paraneoplastic neurological syndromes (PNS) are mainly associated with small-cell lung cancer, gynaecological tumours and lymphomas. Few studies report the association of neurological syndromes with a carcinoid, the majority being a serotonin-related myopathy. We report four patients with a PNS associated with carcinoid. PATIENTS AND RESULTS The clinical syndromes were sensory neuropathy, limbic encephalitis, myelopathy and brain stem encephalitis. Two patients had antineuronal autoantibodies (one anti-Hu, one anti-Yo), one patient had antinuclear antibodies, and one patient had no autoantibodies. For two of the carcinoids, expression of HuD in the tumour could be demonstrated. CONCLUSION This study demonstrates that carcinoids can also be associated with classical antineuronal antibody-associated PNS.
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Bamberg C, Deschauer M, Tews D, Claus D. Koinzidenz einer Myasthenia gravis und einer Myotonen Dystrophie Typ 2. KLIN NEUROPHYSIOL 2009. [DOI: 10.1055/s-0028-1090103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lindenlaub T, Claus D. Die superfizielle Siderose des Zentralnervensystems, eine häufiger als bislang angenommene Erkrankung? KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-0028-1083829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schepelmann K, Winter Y, Spottke A, Dodel I, Claus D, Grothe C, Schröder R, Heuß D, Vielhaber S, Mylius V, Kiefer R, Schrank B, Dodel R. Krankheitskosten der neuromuskulären Erkrankungen in Deutschland. AKTUELLE NEUROLOGIE 2008. [DOI: 10.1055/s-0028-1086490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hogardt M, Claus D, Riehn-Kopp H, Tümmler B. First European CF microbiology quality assurance trial. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60111-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Haegele-Link S, Claus D, Dücker S, Vogt T, Birklein F. Evaluation of the autonomic nervous system using the FAN device -- range of normal and examples of abnormal. Open Neurol J 2008; 2:12-9. [PMID: 19018302 PMCID: PMC2577935 DOI: 10.2174/1874205x00802010012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 03/11/2008] [Accepted: 04/09/2008] [Indexed: 01/30/2023] Open
Abstract
Different components of the autonomic nervous system may be affected by different disorders to varying degrees. The aim of this study is to report first experiences with a new device (FAN®, Schwarzer, Germany) which measures heart rate variability (HRV), sympathetic skin responses (SSR) and the pulse wave transit time (PTT). We examined 190 healthy volunteers (102 men, 88 women) and in 89 subjects (46 men, 43 women) PTT during VM was investigated. In a subset of 24 subjects PTT was compared to conventional blood pressure recording. Thereafter, normal data were compared to patients with polyneuropathy (PNP) and Parkinson syndromes. All parameters of HRV decreased with age. 6 parameters for HRV at rest, during deep respiration and the valsalva ratio were reclassified into three age categories: under 40 (n=96), 40 – 60 (n=71) and 60 or older (n=23). Applying the lower limits of normal (5%-tile) subjects did not have more than 2 of these 6 parameters in the pathological range PTT reduction during phase IV of the valsalva manoeuvre was greater than 7.7 ms (5%-tile) but not age dependent. Patients with PNP had reduced HRV and SSR, Parkinson patients had more frequently impaired blood pressure regulation according to PTT assessment. Our investigation shows that the FAN® might be useful for clinicians to detect autonomic disorders.
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Claus D, Lang C, Kotzian J. Zur Beziehung zwischen Long loop-Reflexbefund und Topographie von Hirninfarkten. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Claus D, Linsenmeier R, Sturm U, Engelhardt A. Somatosensorisch evozierte Potentiale nach taktilen Hautreizen. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Claus D. Klinische Neurophysiologie bei Polyneuropathien. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Scheglmann K, Claus D. Neurophysiologische Diagnostik der Immunneuropathien. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Claus D, Spitzer A. Magnetische Stimulation mit Doppelspulen - Methodik und Normalbefunde. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Claus D, Brenner P, Flügel D. Die Untersuchung der zentralen motorischen Leitungszeit zur unteren Extremität, Normalbefunde und methodische Anmerkungen. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Claus D. Analyse der Herzfrequenzvariabilität bei Polyneuropathien und akuten zerebralen Erkrankungen. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Claus D, Neundörfer B. Zur Untersuchung der peripheren und zentralen Nervenleitung bei der Ratte. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1061047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hinrichs H, Claus D. Methodenfortschritte in der neurologischen Funktionsdiagnostik. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-981684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tuin I, Voss U, Kang JS, Kessler K, Rüb U, Nolte D, Lochmüller H, Tinschert S, Claus D, Krakow K, Pflug B, Steinmetz H, Auburger G. Stages of sleep pathology in spinocerebellar ataxia type 2 (SCA2). Neurology 2007; 67:1966-72. [PMID: 17159102 DOI: 10.1212/01.wnl.0000247054.90322.14] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Autosomal dominant spinocerebellar ataxia type 2 (SCA2) bears clinical and neuropathologic similarities to sporadic multisystem atrophy (MSA) or Parkinson disease, in which sleep pathology is well documented. However, those clinical entities have a marked variability of the reported sleep disturbances, and their etiology is heterogeneous. In contrast, the study of SCA2 provides an opportunity to examine a molecularly homogeneous patient group, in which disease stages can be defined not only based on disease duration and ataxia scores, but also with regard to modulatory effects of mutation size. OBJECTIVE To examine the presence and progression of sleep pathology in SCA2. METHODS We analyzed eight patients with disease durations of 3 to 31 years, all with medium size SCA2 expansions (CAG 38 to 49), using clinical scores, sleep interviews, and video-polysomnography (VPSG) recordings. RESULTS Almost all patients reported good subjective sleep quality and negated incidents of REM behavior disorder (RBD). At early disease stages, however, REM without atonia in four patients' VPSG suggested subclinical RBD. This was accompanied by a consistent reduction of REM density. In three patients at later SCA2 stages, REM sleep was undetectable, whereas slow wave sleep (SWS) was markedly increased at the cost of light sleep. Periodic leg movements, apnea, or hypopnea were not prominent. CONCLUSIONS Progressive loss of dream recall in spinocerebellar ataxia type 2 was found and correlated with stages of REM more than non-REM pathology in video-polysomnography. These stages correspond to the progressive atrophy from the pons, nigrostriatal projection, and locus ceruleus to the thalamus.
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