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Recently, ultrasound tissue characterization ( UTC) was introduced as a reliable method for quantification of tendon structure. Despite increasing publications on the use of UTC, it is striking that there is a lack of normative data in active adolescents. Therefore, the aim of this study was to provide normative values of the Achilles tendon as quantified by UTC. Seventy physiotherapy students (26 male and 44 female students) with no history of Achilles tendon injuries were recruited. The Achilles tendons were scanned with UTC to characterize tendon structure. This study demonstrated that Achilles tendons of active, healthy adolescents contained 54.6% echo type I, 42.8% echo type II, 2.2% echo type III, and 0.3% echo type IV at midportion. The comparison between insertion and midportion of the tendon showed more echo type II at insertion ( P < 0.001). Furthermore, female tendons contained significantly more echo type II, in both insertion and midportion compared with male tendons ( P = 0.004 and P = 0.003, respectively). The results of this study, with respect to the MDC (minimum detectable change), highlight differences in the UTC echopattern in the normal population (sex and regional location), which are important considerations for future studies. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the vascular response of the Achilles tendon as indicated by power Doppler activity during a military training program of 6 weeks. 49 male military recruits (98 tendons) volunteered for this study. Before and during the military training program, the Achilles tendons were screened with gray-scale ultrasonography and power Doppler US. Reactive tendinopathies of the Achilles tendons were registered by means of a clinical examination, VAS-scores and VISA-A scores. The US examination, the clinical examination, VAS- scores and VISA-A scores showed that 13/98 tendons developed a reactive tendinopathy. 3 of these 13 symptomatic tendons showed intra- tendinous Doppler activity. In these tendons, pain was always present before the vascular response of the Achilles tendon. Both pain and hypervascularisation remained visible till the end of the basic military training. In 5 asymptomatic tendons with no structural changes of the tendon, a vascular response was seen during one single measurement. It can be hypothesized that there is no relationship between the vascular response of the Achilles tendon and the pain in a reactive tendinopathy. In a reactive tendinopathy, other pain mechanisms must be investigated in future research. [ABSTRACT FROM AUTHOR]

The pathogenesis of heterotopic ossification is still unclear and the preventive therapies are usually insufficient. The present study was designed to investigate the possible preventive effect of free radical scavengers on the development of experimentally induced heterotopic ossification in a rabbit model and to compare free radical scavengers with indomethacin to determine whether they act synergistically. A standard immobilization-manipulation model was used to induce heterotopical ossification in the hind legs of 40 1-year-old female New Zealand albino rabbits. The animals were divided into four groups and received daily either placebo, a free radical scavenger cocktail [allopurinol and N-acetylcysteine (A/A)], indomethacin or the combination of A/A and indomethacin in a randomized double-blind fashion. Every 4 days an X-ray was taken and the thickness and length of new bone formation was measured at the thigh. A marked statistically significant difference was found between the four groups. In the groups that received A/A, either alone or combined with indomethacin, an inhibition of bone growth, both in thickness and in length was demonstrated. In this experimental model free radical scavengers had a superior inhibitory effect on heterotopic ossification than indomethacin. Free radicals could play an important role in the pathogenesis of heterotopic ossification. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:267-272, 2007 [ABSTRACT FROM AUTHOR]

The problem of urinary retention after hysterectomy for benign disease is extensively evaluated by authors from Ghent. Their interesting results show that it is associated with the de-afferentiation of the bladder wall and with Fowler's syndrome. These findings help our understanding of a troublesome condition. Further work is reported into the use of the tension-free vaginal tape procedure, particularly into its positive effect on quality of life. Another study reported here found that in patients with BOO associated with BPH, there is a focal compromise of the blood-urine permeability barrier, with an increase in expression of inducible nitric oxide synthase. Objective To detect prospectively neurogenic damage in patients with urinary retention responding to sacral nerve stimulation (SNS) after hysterectomy for benign disease. Patients and methods From August 1995 to February 2002, 13 of 15 patients (mean age 43 years, sd 7) with urine retention for a mean (sd, range) of 25 (22, 6–240) months after hysterectomy for benign disease, were prospectively evaluated and treated with SNS. They were assessed using urodynamics at baseline and during the test stimulation. Sensory evoked potentials (SEPs), electrical sensory threshold (EST) measurements of the pudendal nerve, bladder neck and the bladder (2 Hz, 0–300 V), and needle electromyography of the external urethral sphincter (EUS) were undertaken in all patients. Results De-afferentiation (EST ≥ 200 V) was limited to the bladder in four of the 13 patients and extended to the bladder neck in one other, and was matched by no response at the SEP. Relative ESTs of the bladder neck correlated inversely with residual urine (r = - 0.76, P = 0.01, x = 546, fx = 1.22) and bladder capacity (r = - 0.77, P = 0.01, x = 611, fx = 1.26) at diagnosis. Complex repetitive discharges and decelerating bursts of the EUS were seen in these five patients. Unilateral SNS was applied in 10 patients (bilateral in... [ABSTRACT FROM AUTHOR]

The aim of the study was to report our results of sacral nerve stimulation in patients with pelvic pain after failed conservative treatment. From 1992 to August 1998 we treated 111 patients (40 males, 71 females, ages 46 ± 16 years) with chronic pelvic pain. All patients with causal treatment were excluded from this study. Pelvic floor training, transcutaneous electrical nerve stimulation (TENS) and intrarectal or intravaginal electrostimulation were applied and sacral nerve stimulation was used for therapy-resistant pain. The outcome of conservative treatment and sacral nerve stimulation (VAS <3/10; >50% pain relief) was related to symptoms of voiding dysfunction and dyschezia, and urodynamic proof of dysfunctional voiding, not to the pain localization or treatment modality. Outcome was inversely related to neuropathic pain. When conservative treatment failed, a test stimulation of the S3 root was effective in 16/26 patients, and 11 patients were implanted successfully with a follow-up of 36 ± 8 months. So far no late failures have been seen. A longer test stimulation is needed in patients with pelvic pain because of a higher incidence of initial false positive tests. Our conclusion is that sacral nerve stimulation is effective in the treatment of therapy-resistant pelvic pain syndromes linked to pelvic floor dysfunction. [ABSTRACT FROM AUTHOR]

. The aim of this study was to investigate the effects of low intensity laser therapy (LILT) on the conduction characteristics of peripheral sensory nerve. Fifteen healthy subjects participated in this experiment. Six points on the sural nerve of the left leg were irradiated with an 830 nm GaAlAs laser with different parameters. All 15 subjects received at random one of the following treatments: an average power of 400 mW at a dose of 1.5 J per point (7.65 J/cm2) (treatment A); an average power of 140 mW and a dose of 1.0 J per point (5.1 J/cm2) (treatment B); an average power of 30 mW, 0.5 J per point (2.55 J/cm2) (treatment C) and to evaluate possible placebo effects in a fourth moment, no power was given (sham). The influence of skin temperature on conduction characteristics of peripheral nerve was taken into account by using correction factors for conductance velocity (1.47 m/s per °C) and negative peak latency (0.2 ms per °C) to a reference temperature of 32°C. One way analysis of variation with repeated measurements of the data collected within 15 min postirradiation showed a significant decrease in conduction velocity and increase in negative peak latency in treatment B. Those results could explain possible laser-mediated pain relief. [ABSTRACT FROM AUTHOR]

Voiding dysfunction is defined as impaired bladder emptying, and presents with a mixture of lower urinary tract symptoms. Dysfunctional voiding is a condition in which there is a lack of coordination between the sphincter and detrusor during emptying in a patient without overt uropathy or neuropathy. Assessment of voiding dysfunction is important in women and girls in the prevention and treatment of urinary incontinence, retention, urinary tract infection and subsequent kidney damage. Accurate diagnosis is essential in order to select the correct treatment. Screening can be done by history-taking: symptom scores can help to guide the screening. More objective measures are uroflowmetry, ultrasonography and videourodynamics. The latter is the gold standard for the diagnosis of voiding dysfunction and consists of simultaneous registration of pressure in the bladder and rectum and external sphincter behavior, either by electromyographic recording of pelvic floor activity or by pressure recording at the external sphincter, during the whole bladder cycle of filling and emptying. On fluoroscopy the bladder can be visualized throughout the filling and emptying phase. In dysfunctional voiding, hypertonicity and instability of the external urethral sphincter during filling cystometry and impaired external sphincter relaxation during emptying are pathognomonic findings. Pressure–flow analysis reveals no obstruction and the detrusor contractility is low. [ABSTRACT FROM AUTHOR]

Jumper’s knee or infrapatellar insertional tendinopathy is a condition primarily found in athletes between 18 and 25 years of age who are engaged in explosive running and jumping sports. It is caused by microtears or partial macrotears through the patellar tendon. Conservative treatment is used as the primary approach. If conservative measures are insufficient or fail to relieve the symptoms, surgery is indicated. The patellar tendon is incised and the hyaline inflammatory tissue is removed. Twenty-six patients have been studied retrospectively, with specific attention to postoperative resumption of sports and residual subjective and objective findings. They all completed a detailed questionnaire and subsequently underwent a physical and ultrasound examination. [ABSTRACT FROM AUTHOR]

From a questionnaire sent to 90 spinal cord injury (SCI) patients it is concluded that 58% of patients with a complete SCI above L2 suffer from constipation, defined as two or fewer bowel movements per week, or the use of aids such as laxatives, manual evacuation or enemas. Tetraplegic patients had the highest prevalence of constipation, while patients with low paraplegia were less prone to constipation. The use of anticholinergic drugs was found to predispose to constipation. Preserved rectal sensation did not influence the presence of constipation. Faecal incontinence was rare. Regular abdominal pain was present in one third of SCI patients and might be caused by an irritable bowel syndrome in 62% of these. [ABSTRACT FROM AUTHOR]

Constipation is a common problem in patients with spinal cord injury. The aim of this study is to analyze the role of pelvic floor dysfunction in the development of constipation.Twenty-five patients with clinically complete supraconal spinal cord injury were studied by means of colonic transit time, anal manometry, electrophysiologic testing, and sensory-evoked potentials.Sixteen patients had prolonged total and segmental colonic transit times (Group C), and nine patients had normal colonic transit times (Group NC). Basal pressure and anal pressure during coughing, Valsalva's maneuver, and rectal distention were diminished in all patients, but no differences were observed between Group C and Group NC. Rectal sensation was preserved in eight patients, but this was not related to the absence of constipation. In seven of these eight patients, somatosensory-evoked potentials could be recorded, which indicated an incomplete cord lesion. Synergic relaxation of the pelvic floor during straining was never observed; dyssynergia was seen in ten (7 in Group C and 3 in Group NC; P = not significant) patients. Associated peripheral nerve damage was present in 40 percent of patients but did not predispose these patients to constipation.Loss of rectal sensation, dyssynergic pelvic floor contraction during straining, associated peripheral nerve damage, and insufficient rise of intra-abdominal pressure could not be held responsible for constipation as a result of spinal cord injury. A prolongation of the colonic transit time is the most important mechanism, and therapy should be directed toward it. [ABSTRACT FROM AUTHOR]

Background The link between the hypervascularisation and the pain symptoms in a tendinopathy is still obscure. It can be hypothesised that it is important to take the stage of the tendinopathy into account. Objective The objective of this study was to evaluate the vascular response of the achilles tendon during a basic military training program of 6 weeks. Design A prospective study. Setting Officer cadets followed the same 6-week basic military training. This training mainly consists of running, roadwork, military tactical exercises, drills, shooting, marching with backpacks and some theoretical classes. Patients 49 male military recruits (98 tendons) volunteered for this study. The mean age was 18.3 years. None of the persons had a history of achilles tendon problems. Interventions Before and during the military training program, clinical symptoms, structural tendon changes and hypervascularisation were weekly screened. Main outcome measurements The achilles tendons were screened by gray – scale ultrasonography and power Doppler US. Reactive tendinopathies were registered by means of a clinical examination, VAS – scores and VISA – A scores. Results 13 of the 98 tendons developed a reactive tendinopathy. Three of these 13 symptomatic tendons showed intratendinous Doppler activity. In these tendons, pain was always present before the vascular response of the tendon. Both pain and hypervascularisation remained visible during till the end of the training program. In five asymptomatic tendons with no structural changes in the tendon, a vascular response was seen during one measurement. Conclusion To our knowledge, this is the first prospective study that looked at the development of hypervascularisation in a specified subpopulation, that is, reactive tendinopathy. The results of this study show that there is no link between the vascular response of the tendon and the pain sensation of the patient in this early stage of tendinopathy. Other pain mechanism should be investigated. [ABSTRACT FROM PUBLISHER]