Clinical Function Parameters Research Articles

Stress, Stressverarbeitung und kraniomandibuläre Dysfunktionen - eine Longitudinalstudie

Stress is widely accepted as an etiologic factor of craniomandibular disorders (CMD). There is, however, a lack of studies evaluating the significance of interindividual differences of stress and coping for the development of CMD. 99 volunteers (33 male, 66 female) were observed over a period of 24 months. The clinical examination at the beginning and end of the observation time were carried out according to the protocol of the Research Diagnostic Criteria for Temporomandibular Disorders (Dworkin 1992). Data concerning stress and general body complaints were evaluated twice by questionnaires, and data on coping methods were collected at the beginning of the study. Stress, coping methods and general body complaints correlate with clinical functional parameters. Stress and body complaints proved to be significant predictors via linear regression analyses. Stress and general somatic complaints are predictors of the development of craniomandibular disorders.

Evaluation of controller medication efficiency in patients with moderate and severe uncontrolled asthma

Evaluation of efficiency of controller medication (combination of fluticasone propionate and Salmeterol) in 40 patients (age from 18 to 65 years) with moderate (n = 15) and severe (phenotype brittle n = 10, asthma with fixed obstruction n = 15) uncontrolled asthma was evaluated in open prospective trial. It was observed, that all patients with moderate asthma achieved control criteria (GINA, 2006) to 12th week of treatment with combination of fluticasone propionate and Salmeterol. Improvement of clinical-functional indexes was observed in patients with severe asthma to 24th week of therapy. 5 patients with brittle asthma achieved controlled and partly controlled asthma to 24th week therapy. Controlled asthma was not reach through the patients with fixed obstruction asthma, whereas increase of clinical-functional parameters was observed, usage of inhaled combined therapy allowed us to reduce oral steroids dose in 4 patients of this group.

Myocardial scar and insulin resistance predict cardiovascular events in severe ischaemic myocardial dysfunction: a perfusion–metabolism positron emission tomography study

Clinical outcome can be predicted by metabolism-perfusion positron emission tomography (PET) in patients with severe ischaemic left ventricular dysfunction. This study determined whether the amount of viable or non-viable myocardium detected with a PET scan or clinical-functional parameters might predict cardiovascular events. All patients had previous myocardial infarction (>6 months previously) and left ventricular ejection fraction (LVEF) <40%. Metabolism-perfusion PET, echocardiogram and coronary angiography were provided. All subjects underwent short euglycaemic-hyperinsulinaemic clamp before the metabolism study. The dysfunctioning segment was defined as hibernating myocardium when metabolism was normal-moderately reduced with impaired perfusion (mismatch flow-metabolism). Cardiac death, hospital admission for myocardial infarction or heart failure were considered cardiovascular events. Ninety-three patients (71 males, aged 64.2 years) were studied. The LVEF was 30.2+/-7.7%; 48 (51.6%) suffered an anterior myocardial infarction. Fifty-three (54.1%) subjects were treated with coronary revascularization; all had optimal medical therapy. Cardiovascular events occurred in 20/93 patients at 1-year follow-up (event group). Age (P=0.7), diabetes mellitus (P=0.6) and rate of coronary revascularization (P=0.3) were not different in the two groups. Patients who experienced cardiovascular events had larger non-viable myocardium (5.8+/-2.7 vs. 4.1+/-2.6, P=0.01), lower metabolic rate glucose (1.3+/-0.6 vs. 1.7+/-0.7 ml . kg . min, P=0.04) but similar hibernating myocardium (1.6+/-1.6 vs. 1.7+/-2, P=0.8) and baseline LVEF (28.1+/-4.8 vs. 30.7+/-8.3%, P=0.08). Having more then five non-viable segments and a metabolic rate for glucose of <0.9 mg . kg . min predicted a worse prognosis (P=0.04, log rank, 3.89; and P=0.004, log rank, 8.1, respectively). Non-viable myocardium revealed with PET predicts mid-term clinical prognosis. Insulin resistance seems to influence the outcome.

łGradation of sideropneumoconiosis.

Pathological-anatomical analyses of biopsy and autopsy samples of 43 men with anamnestically established occupational exposure to welding fumes showed in 38 specimens (88%) characteristic alterations of varying degrees of sidero pneumokonioses. Based on recurrent histological findings of increase and activation of iron storing macrophages (siderophages) and varying degrees of fibrosis, sidero pneumokonioses are classified into three grades. Intraindividually and also toporegionally different degrees may well be present. Based on morphological criteria of the three grades, seven samples were classified as grade I, 21 specimens as grade II, and 10 samples as grade III. The results show that exposure to welding fumes may well cause pulmonary alterations reaching an impairment level, depending on length, extent and special circumstances of the respective exposure. In cases of so-called welders lungs, an obliging statement in an expert's opinion on the degree of functional impairment, however, can only be given when histological findings, detailed information on the occupational history and clinical functional parameters are combined.