Isolated peritoneal donor-related plasmacytoma 3 years after liver transplantation: a case report

Organ transplantation carries a risk of disease transmission from donor to recipient, primarily infection or malignancy. Although donors are thoroughly screened, donor-related malignancies are reported to occur in 0.01% of solid organ transplants. Plasma cell neoplasm, to the best of our knowledge, has not been reported as a donor-transmitted malignancy in liver transplantation. We describe a liver transplant from a donor with unrecognized plasmacytoma requiring retransplantation. Three years after the first transplant a single peritoneal mass was detected on surveillance imaging and radically excised; HLA phenotyping confirmed the mass to be an isolated extra-medullary plasmacytoma of chimeric donor and recipient origin.

A retrospective analysis of Terlipressin infusion in patients with refractory hypotension after cardiac surgery

AIM

The aim of this retrospective study was to evaluate the effectiveness of Terlipressin in the treatment of severe hypotension in cardiosurgical patients and to assess the differences between the groups of survivors and nonsurvivors.

METHODS

The study population was 27 patients who developed hypotension after cardiac surgery.

RESULTS

All surviving patients developed refractory hypotension early after extracorporeal circulation. Of the 9 nonsurvivors, 3 also experienced postcardiotomy hypotension, while the remaining 6 developed severe hypotension during sepsis. Terlipressin given continuously significantly increased the mean arterial pressure and reduced the heart rate in both groups. Norepinephrine requirements decreased significantly among survivors only. The mean pulmonary artery pressure and pulmonary capillary wedge pressure levels remained unchanged or increased insignificantly, while several liver markers in the survivor group significantly increased.

CONCLUSION

Terlipressin given continuously is a potent vasopressor in patients with norepinephrine-resistant postcardiotomy hypotension; however, Terlipressin treatment failed in patients who developed refractory hypotension during sepsis. We cannot recommend this therapy in such patients as it proved to be hemodynamicaly ineffective and may even worsen the circulatory situation.

Spinal posture during stooped walking under vertical space constraints

STUDY DESIGN

Simultaneous spine kinematic variables in sewage workers were quantified using a two-dimensional video-based gait analysis system.

OBJECTIVES

To identify patterns of spinal posture in a population of sewage workers pushing waste matter through tunnels while walking stooped under various height constraints.

SUMMARY OF BACKGROUND DATA

Working with stooped postures is one of several occupational risk factors that have been associated with spinal disorders. However, the specific changes in spinal posture during stooped walking under various height constraints have not been documented.

METHODS

A video-based gait analysis system was used to measure spinal posture in 22 sewage workers. Angles of the cervical, thoracic, and lumbar spine in the sagittal plane were assessed during walking with five levels of height constraint, from upright walking to stooped walking under a headroom restriction of 105 cm. Correlations among gait parameters, demographic data, and clinical results were determined. Linear regression analysis was performed to examine which variables have the largest impact on the posture resulting from a given vertical height constraint when age and body height are held constant.

RESULTS

Mean angular values changed significantly with increasing headroom restrictions, with increases in cervical and thoracic extension as well as lumbar flexion. The cervical and thoracic angles were best correlated with height constraint, followed by lumbar angle and stride length. The inverse relation between cervical and thoracic angle during upright walking increased with increasing vertical space constraints, whereas the relation between the thoracic and lumbar angles decreased. Subjects with decreased abdominal muscle strength adopted a significantly more kyphotic thoracic posture when walking under headroom constraints than subjects with normal abdominal muscle strength.

CONCLUSIONS

Combined walking and pushing under vertical space constraints was associated not only with the expected increased flexion of the lumbar spine, but also with greater extension (i.e., reduced kyphosis) of the thoracic spine.

Spinal troubles in sewage workers: epidemiological data and work disability due to low back pain

OBJECTIVES

To determine the prevalence of spinal troubles (i.e., neck, upper back and low back pain) in a population of sewage workers, and to establish the effect of sociodemographic, work-related, physical, and psychosocial factors on the reported work disability due to low back pain (LBP) during the previous 12 months.

METHODS

Data from 255 sewage workers were obtained by standardized questionnaire, structured interview, and standardized physical examination. Data on the prevalence of neck, upper back and low back pain were obtained with the use of the Nordic Questionnaire. The level of disability was assessed from a modified Low-Back Outcome Scale. Work history included physical factors and job perception based on a modified Work APGAR Score. Other questionnaires recorded the psychosocial aspects of the work environment. In addition, we compared the risk factors between sewage workers who had been prevented from doing their normal work, at any time during the preceding 12 months, as a result of LBP (n = 92), and those without any history of work disability during the previous 12 months (n = 157).

RESULTS

The 12-month prevalence rates of neck, upper back and low back pain were 52.4%, 54.8%, and 72.8%, respectively. The prevalence of spinal troubles increased with age. Work disability during the preceding 12 months due to LBP was significantly positively associated with age, disability, the weekly duration of stooping and lifting 5 years previously and higher abnormal illness-behavior scores (odds ratio between 1.26 and 0.94). Moreover, when adjusted for age, the results showed that the subjects in the work disability group were more likely to report higher pain intensities, decreased participation in sports activities, higher levels of physical impairment, the belief that their LBP was related to the physical demands of their job, and a lack of drive (P < 0.05).

CONCLUSIONS

This study revealed a high incidence of spinal troubles among sewage workers. In a multidisciplinary approach, we demonstrated that not one factor alone but a combination of sociodemographic, work-related and psychosocial factors have shown associations with work disabilities due to LBP. Additional studies evaluating the relative importance of individual risk factors are warranted.

Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial

OBJECTIVE

To assess the effect of a combined exercise and motivation program on the compliance and level of disability of patients with chronic and recurrent low back pain.

DESIGN

A double-blind prospective randomized controlled trial.

SETTING

Physical therapy outpatient department, tertiary care.

PATIENTS

Ninety-three low back pain patients were randomly assigned to either a standard exercise program (n = 49) or a combined exercise and motivation program (n = 44).

INTERVENTIONS

Patients were prescribed 10 physical therapy sessions and were advised to continue exercising after treatment termination. The motivation program consisted of five compliance-enhancing interventions. Follow-up assessments were performed at 3 1/2 weeks, 4 months, and 12 months.

MAIN OUTCOME MEASURES

Disability (low back outcome score), pain intensity, physical impairment (modified Waddell score, fingertip-to-floor distance, abdominal muscle strength), working ability, motivation, and compliance.

RESULTS

The patients in the motivation group were significantly more likely to attend their exercise therapy appointments (p = .0005). Four and 12 months after study entry there was a significant difference in favor of the motivation group with regard to the disability score (p = .004) and pain intensity (p < or = .026). At 4 months, there was a significant advantage for the motivation group in the fingertip-to-floor distance (p = .01) and in abdominal muscle strength (p = .018). No significant differences were found in motivation scores, self-reported compliance with long-term exercise, and modified Waddell score. In terms of working ability, there was a trend favoring the combined exercise and motivation program.

CONCLUSION

The combined exercise and motivation program increased the rate of attendance at scheduled physical therapy sessions, ie, short-term compliance, and reduced disability and pain levels by the 12-month follow-up. However, there was no difference between the motivation and control groups with regard to long-term exercise compliance.

The effect of brochure use versus therapist teaching on patients performing therapeutic exercise and on changes in impairment status

BACKGROUND AND PURPOSE

The purpose of this study was to investigate whether the mode of teaching exercises (use of brochures versus therapist teaching) affects whether patients correctly perform the exercises and whether it affects changes in impairment.

SUBJECTS

Eighty-seven patients (33 women, 54 men) with neck pain and low back pain were examined. The average age was 48 years (SD = 12.7, range = 21-67).

METHODS

Two groups of patients were analyzed. The supervised (physical therapist-instructed) group (n = 47) exercised under the supervision of a physical therapist, whereas the brochure group (n = 40) received their instructions only from one of three brochures. A rating scale was used to assess the correctness of exercise performance. Muscle status was registered using a standardized procedure for determination of muscle force and length. Pain severity was determined by means of a visual analogue scale.

RESULTS

On the rating scale evaluating the correctness of exercise performance at follow-up, the patients in the supervised group performed better than the patients in the brochure group. In addition, there was a strong correlation between the quality of exercise performance and decrease in pain.

CONCLUSION AND DISCUSSION

Exercises learned only from a brochure without being monitored by a physical therapist were done properly by only about half of the patients and appeared to result in fewer improvements in impairments.

[Expression and course of the nail-patella syndrome in a family over 6 generations]

The younger generations of a Viennese family suffering from Patella-Nail-Syndrome were examined. Prominent features and frequency of symptoms were compared with the results of earlier examinations of this family. Differences and similarities were compared with the observations of other authors.

[Therapy of hirsutism with cyproterone acetate (author's transl)]

21 female patients with pronounced, predominantly idiopathic hirsutism were treated for six month wit preparation SH B 209 AB (Diane, Schering corp.) supplemented by 10 mg Cyproterone acetate between the 5th and 20th day of the menstrual cycle. The results of this therapy were clinically assessed as excellent in 5 patients, 11 patients showed a considerable, and 4 a moderate reduction of hirsutism, 1 patient showed no improvement. The results were quantified by measurement of hair thickness. In almost all cases a reduction was found, the mean value being 18,74%. No correlation could be found between therapeutic success and menstrual cycle anamnesis.

[Is chronic recurrent urticaria a psychosomatic disease?]

A random group of 37 patients with chronic recurrent urticaria, 26 female and 11 male, was subjected to multidimensional personality tests (Freiburg personality inventory, FPI, Freiburg aggression test, FAF) whereas, deviating from establishing standards, introversion, nervousness, psychosomatic disturbance were more pronounced in the urticaria group, the following traits in deviation from normal standards were not noted: depression, irritability, sociability, emotional instability, composure. Nevertheless, this group appeared to be less communicative, more inhibited, compliant, and less dominant and aggressive. Neither did they show signs of socially accepted expression of negative and annoyed emotions nor socially desirable signs of assertiveness. A high rate of coincidence with other psychosomatic disorders such as frequent headache (18/37), chronic gastritis (19 of 37) and ulcus duodeni (5 of 37) and migraineous headache (6 of 37) was also found in this group. In all cases explorable latent conflictive situations (frequent ambivalence) and negative childhood experience are further indicative of psychosomatic diseases.

[Psyche and skin (author's transl)]

The important psychological functions of the human skin - the skin functions as a border, contact and sense organ and as an organ of expression - as well as causalgenetic aspects of psychodermatology and the most important psychodermatological diseases are reported. Frequent psychosomatic dermatoses like chronic urticaria (bibliography), pruritus (case report, perioral dermatitis and alopecia areata (case reports) are described. In atopic dermatitis, psoriasis vulgaris and acne rosacea psychological factors are involved in addition to constitutional factors. Psychovegetative dermatoses can be due to situational problems (stress), but dermatologic symptoms may also have a mere appellant character (e.g. slight effluvium). Dermatologic symptoms may occur in connection with psychoses (e.g. parasitophobia). Psychic dermatologic symptoms may also arise secundary to severe chronic dermatoses. In psychoneurotic diseases such as dermatitis arterficialis skin is the target organ. Therapeutical aspects are considered.