Influence of Preoperative and Postoperative Pelvic Floor Muscle Training (PFMT) Compared With Postoperative PFMT on Urinary Incontinence After Radical Prostatectomy: A Randomized Controlled Trial.
Influence of Preoperative and Postoperative Pelvic Floor Muscle Training (PFMT) Compared with Postoperative PFMT on Urinary Incontinence After Radical Prostatectomy: A Randomized Controlled Trial.
Filed under: Rehab Centers
Eur Urol. 2013 Jan 21;
Geraerts I, Van Poppel H, Devoogdt N, Joniau S, Van Cleynenbreugel B, De Groef A, Van Kampen M
BACKGROUND: The efficacy of preoperative pelvic floor muscle training (PFMT) for urinary incontinence (UI) after open radical prostatectomy (ORP) and robot-assisted laparoscopic radical prostatectomy (RARP) is still unclear. OBJECTIVE: To determine whether patients with additional preoperative PFMT regain urinary continence earlier than patients with only postoperative PFMT after ORP and RARP. DESIGN, SETTING, AND PARTICIPANTS: A randomized controlled trial enrolled 180 men who planned to undergo ORP/RARP. INTERVENTION: The experimental group (E, n=91) started PFMT 3 wk before surgery and continued after surgery. The control group (C, n=89) started PFMT after catheter removal. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary end point was time to continence. Patients measured urine loss daily (24-h pad test) until total continence (three consecutive days of 0g of urine loss) was achieved. Secondary end points were 1-h pad test, visual analog scale (VAS), International Prostate Symptom Score (IPSS), and quality of life (King’s Health Questionnaire [KHQ]). Kaplan-Meier analysis and Cox regression with correction for two strata (age and type of surgery) compared time and continence. The Fisher exact test was applied for the 1-h pad test and VAS; the Mann-Whitney U test was applied for IPSS and KHQ. RESULTS AND LIMITATIONS: Patients with additional preoperative PFMT had no shorter duration of postoperative UI compared with patients with only postoperative PFMT (p=0.878). Median time to continence was 30 and 31 d, and median amount of first-day incontinence was 108g and 124g for groups E and C, respectively. Cox regression did not indicate a significant difference between groups E and C (p=0.773; hazard ratio: 1.047 [0.768-1.425]). The 1-h pad test, VAS, and IPSS were comparable between both groups. However, “incontinence impact” (KHQ) was in favor of group E at 3 mo and 6 mo after surgery. CONCLUSIONS: Three preoperative sessions of PFMT did not improve postoperative duration of incontinence. TRIAL REGISTRATION: Netherlands Trial Register No. NTR 1953.
HubMed – rehab
Neurologic diseases of the central nervous system with pathophysiologically relevant autoantibodies – Perspectives for immunoadsorption.
Filed under: Rehab Centers
Atheroscler Suppl. 2013 Jan; 14(1): 161-5
Klingel R, Heibges A, Fassbender C
Immediate antibody elimination, pulsed induction of antibody redistribution, and immunomodulation are major forces of efficacy of therapeutic apheresis (i.e. plasma exchange [PE] or immunoadsorption [IA]) for autoimmune neurologic disorders. Therapeutic apheresis can offer rapid response for severe acute neurologic symptoms, and stable rehabilitation in long-term clinical courses being refractory to drug based strategies or complicated by drug side effects. PE or IA in these situations must be considered as part of multimodal or escalating immune treatment strategies in combination or in competition with intravenously administered immunoglobulins (ivIg), corticosteroids, the full spectrum of immunosuppressive drugs, and bioengineered antibodies. Selective IA is increasingly replacing PE due to its superior safety profile and increasing knowledge on pathogenic relevance of autoantibodies. Recent experiences in autoimmune diseases of the central nervous system, e.g. multiple sclerosis, neuromyelitis optica, and autoimmune encephalitis confirmed this concept.
HubMed – rehab
The temporal association between changes in primary sensory cortex and corticomotor output during muscle pain.
Filed under: Rehab Centers
Neuroscience. 2013 Jan 25;
Schabrun SM, Jones E, Kloster J, Hodges PW
Background : Integration of information between multiple cortical regions is thought to underpin the experience of pain. Yet studies tend to focus on pain related changes in discrete cortical regions. Although altered processing in primary motor (M1) and sensory cortex (S1) is implicated in pain, the temporal relationship between these regions is unknown and may provide insight into the interaction between them. Methods: We used recordings of somatosensory evoked potentials (SEPs) and transcranial magnetic stimulation (TMS) to investigate the temporal relationship between altered excitability of primary sensory cortex and corticomotor output during and after muscle pain induced by hypertonic saline infusion into the right first dorsal interosseous (FDI). SEPs and motor evoked potentials (MEPs) were recorded in twelve healthy individuals. Results: Participants reported an average pain intensity of 5.4 (0.5) on a 10 cm visual analogue scale. The area of the N(20)-P(25)-N(33) complex of the SEP was reduced during and after pain, but MEP amplitudes were suppressed only after pain had resolved. Conclusions: Our data show that pain reduces sensory processing before motor output is altered. This temporal dispersion, coupled with the lack of correlation between pain-induced changes in S1 and M1 excitability, imply either that independent processes are involved, or that reduced excitability of S1 during acute experimental muscle pain mediates latent reductions in motor output via processes that are non-linear and potentially involve activation of a wider brain network.
HubMed – rehab
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