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Biomedical subjects

Richard Crevenna

Publications and source records attributed to Richard Crevenna.

28 records · Page 2Linked to original sources
PubMed2003

Aerobic exercise as additive palliative treatment for a patient with advanced hepatocellular cancer.

Aerobic exercise is known to improve biopsychosocial outcomes in cancer patients. Currently, exercise is not regarded as a quality-of-life intervention for patients with advanced cancer. The aim of this case study was to determine the feasibility and effects of an aerobic exercise programme for a patient with advanced hepatocellular cancer. After written informed consent, a 55-year-old male patient with advanced hepatocellular carcinoma participated in an aerobic exercise programme of precise intensity, duration and frequency, consisting of ergometer cycling 2 times a week, carried out for a period of 6 weeks. Exercise testing and a 6-min walk were performed, and the patient's quality of life was assessed. The feasibility, safety and beneficial effects of the programme were proven for this patient. At the end of the exercise programme, peak work capacity had increased by 20.3%. The patient has experienced an improvement in physical performance, which was underlined by the 6-min walk. Quality of life has been improved (physical functioning, vitality, mental health, role functioning/emotional, social functioning). Knowledge about the benefits of aerobic exercise for patients suffering from advanced cancer is not yet widespread. Nevertheless, aerobic exercise initiated and executed with appropriate care may serve as a useful additional means of palliative treatment in some patients with advanced cancer.

Carcinoma, Hepatocellular↗
PubMed2003

[Splints in occupational therapy of the hand in an Austrian central hospital--current status].

Ergotherapeutic splinting is essential in the treatment of diseases, injuries and innate deformities of the hand. However due to its high material and staff costs, a definitely diagnosed indication is a prequisite for prescription. A retrospective study was performed using the Krankenhausinformationssystem (KIS) to establish the total number of hand splints prescribed by the Department of Physical Medicine and Rehabilitation of the General Hospital of Vienna from 1/1992 until 8/1998, as well as referring doctors/departments and diagnoses leading to referral were recorded and descriptively evaluated. The total number of patients was 1972. 1236 (63%) of the cases were referred by surgical departments/branches, 410 (20%) by internal departments, 151 (8%) by the neurological department and 175 (9%) by other departments. The diagnosis leading to referral were rheumatoid arthropathies (542 = 26%), peripheral nerve lesions (458 = 22%), tendon lesions (201 = 10%), Dupuytren' contractures after surgery (184 = 8%), degenerative joint diseases (82 = 4%), conditions after fractures (55 = 2.5%), patients after amputations (50 = 2.3%), disorders of the central nervous system (53 = 2.5%), focus removals (40 = 2%) and tendovagintis (35 = 1.7%). The remaining 19% were referred due to surgical repositionings, soft tissue injuries, local infections and various other diagnoses. The majority of ergotherapeutic splintings was prescribed due to forms of rheumatic or rheumatoid diseases, peripheral nerve lesions as well as hand surgery. In this study documenting the clinical practice of a medical center was primarily aimed at providing the basis for further discussion of both factual and economic aspects of future developments in splinting.

Academic Medical Centers↗
PubMed2003

Cancer rehabilitation: particularly with aspects on physical impairments.

Cancer can cause multiple impairments, activity limitations and participation restrictions. According to individual case findings and needs, rehabilitation treatment is varied. The review mainly focuses on specific problems. Because of functional deficits cancer patients suffer from persistent emotional and social distress and a reduced quality of life (QOL). QOL encompasses at least the four dimensions of physical, emotional, social and cognitive function, which may be positively influenced by physical exercise. Physical exercise also has been shown to prevent or minimise inactivity/ disuse problems and to reduce fatigue. The management of sexuality dysfunction has to begin with a thorough history taking and a consequent sexuality counselling. The goals of rehabilitation procedures under palliative care are not only to control physical pain but also to help with mental, social and spiritual pain, together with other symptoms. Rehabilitation problems in head and neck cancer, sexuality, lung cancer, prostate cancer, breast cancer and lymphedema can be improved by rehabilitation. The review mainly focuses on impairment and activity limitation. Social, psychological and vocational aspects are left aside in this review.

Breast Neoplasms↗
PubMed2002

Pulsed magnetic field therapy for osteoarthritis of the knee--a double-blind sham-controlled trial.

BACKGROUND AND METHODS: Pulsed magnetic field therapy is frequently used to treat the symptoms of osteoarthritis, although its efficacy has not been proven. We conducted a randomized, double-blind comparison of pulsed magnetic field and sham therapy in patients with symptomatic osteoarthritis of the knee. Patients were assigned to receive 84 sessions, each with a duration of 30 minutes, of either pulsed magnetic field or sham treatment. Patients administered the treatment on their own at home, twice a day for six weeks. RESULTS: According to a sample size estimation, 36 consecutive patients were enrolled. 34 patients completed the study, two of whom had to be excluded from the statistical analysis, as they had not applied the PMF sufficiently. Thus, 15 verum and 17 sham-treated patients were enrolled in the statistical analysis. After six weeks of treatment the WOMAC Osteoarthritis Index was reduced in the pulsed magnetic field-group from 84.1 (+/- 45.1) to 49.7 (+/- 31.6), and from 73.7 (+/- 43.3) to 66.9 (+/- 52.9) in the sham-treated group (p = 0.03). The following secondary parameters improved in the pulsed magnetic field group more than they did in the sham group: gait speed at fast walking [+6.0 meters per minute (1.6 to 10.4) vs. -3.2 (-8.5 to 2.2)], stride length at fast walking [+6.9 cm (0.2 to 13.7) vs. -2.9 (-8.8 to 2.9)], and acceleration time in the isokinetic dynamometry strength tests [-7.0% (-15.2 to 1.3) vs. 10.1% (-0.3 to 20.6)]. CONCLUSION: In patients with symptomatic osteoarthritis of the knee, PMF treatment can reduce impairment in activities of daily life and improve knee function.

Aged↗
PubMed2002

Sleep attacks in patients taking dopamine agonists: review.

OBJECTIVES: To assess the evidence for the existence and prevalence of sleep attacks in patients taking dopamine agonists for Parkinson's disease, the type of drugs implicated, and strategies for prevention and treatment. DESIGN: Review of publications between July 1999 and May 2001 in which sleep attacks or narcoleptic-like attacks were discussed in patients with Parkinson's disease. RESULTS: 124 patients with sleep events were found in 20 publications. Overall, 6.6% of patients taking dopamine agonists who attended movement disorder centres had sleep events. Men were over-represented. Sleep events occurred at both high and low doses of the drugs, with different durations of treatment (0-20 years), and with or without preceding signs of tiredness. Sleep attacks are a class effect, having been found in patients taking the following dopamine agonists: levodopa (monotherapy in 8 patients), ergot agonists (apomorphine in 2 patients, bromocriptine in 13, cabergoline in 1, lisuride or piribedil in 23, pergolide in 5,) and non-ergot agonists (pramipexole in 32, ropinirole in 38). Reports suggest two distinct types of events: those of sudden onset without warning and those of slow onset with prodrome drowsiness. CONCLUSION: Insufficient data are available to provide effective guidelines for prevention and treatment of sleep events in patients taking dopamine agonists for Parkinson's disease. Prospective population based studies are needed to provide this information.

Adult↗
PubMed2002

[Optimizing electrotherapy--a comparative study of 3 different currents].

Neuromuscular electrical stimulation can be used to increase strength of skeletal muscle. In neuromuscular electrical stimulation of innervated skeletal muscle, the application of the highest possible intensities of electricity is an important determinant of therapeutic success with regard to strength training. The therapeutic goal of "strengthening muscles" is opposed to the side effect of discomfort through the application of electricity. The aim of the present study was to compare three forms of electric current with respect to subjective tolerance and maximum achievable muscular strength. Twenty-nine healthy male volunteers were included in a single-blind study in which three forms of electric current were applied in a randomized fashion. The following types were compared: a short monophasic form, a biphasic form that was twice as long in terms of impulse duration, and a long monophasic form with an equal impulse duration than tht of the biphasic form and with an impulse form that corresponded to the short monophasic current. Stimulation was administered via surface electrodes placed on the knee extensors in the lower extremity on the right side. The intensity of the current was increased to the individual limit of tolerance or to a maximum of 100 mA. The main target parameter used to determine the success of treatment was the maximum electrically induced strength as a percentage of maximal voluntary contraction. The short monophasic form of electricity was associated with much less discomfort than the long monophasic and biphasic forms (p < 0.0001, p = 0.0062). Furthermore, the biphasic form was better tolerated (and therefore had a larger therapeutic range of application) than the long monophasic form (p = 0.041). The biphasic and long monophasic forms produced higher values for maximum electrically induced strength than did the short monophasic form (p = 0.0001, p = 0.0010). To summarize: the biphasic form had a larger range of therapeutic application than the long monophasic form. Furthermore, the biphasic form produced 40% more electrically induced strength than the short monophasic one. It may be concluded that, in terms of therapeutic application, the biphasic form of electric current is superior to the monophasic forms described in the present study.

Adult↗
PubMed2002

Calcific trochanteric bursitis: resolution of calcifications and clinical remission with non-invasive treatment. A case report.

Calcific trochanteric bursitis, a common regional pain syndrome, is characterized by chronic, intermittent aching pain over the lateral aspect of the hip and limitation of function. Effective treatment is invasive, including infiltration therapy and surgical intervention. The therapeutic effects of conservative treatment modalities have not been proven. A 59-year-old woman presented at the department of physical medicine and rehabilitation with a 2-year history of pain in the right hip. She had been treated with several agents such as glucocorticoids and local anesthetics (via injection) for two years, but without success. Physical examination revealed the clinical diagnosis of bursitis trochanterica. Radiographic findings showed calcified rounded masses measuring about 1.5 cm in diameter around the greater trochanter; a calcific bursitis trochanterica was diagnosed. The patient presented for conservative treatment in order to avoid surgical intervention for removing the calcification and the bursal sac. A non-invasive treatment regimen including intensive pulsed ultrasound therapy, physiotherapy and iontophoresis was started. The conservative treatment led to a remission of both, symptoms as well as radiographic findings, which revealed complete resolution of calcifications. This case report shows that, in cases of calcific trochanteric bursitis (including those with extensive calcifications), a non-invasive conservative treatment regimen including intensive high-dosed pulsed ultrasound therapy should be attempted before more invasive treatment (injections, surgery) is considered.

Bursitis↗
PubMed2002

Hypertrophic osteoarthropathy caused by PGE1 in a patient with congestive heart failure during cardiac rehabilitation.

Continuous chronic drug infusion with PGE1 via a portable pump and neuromuscular electrical stimulation (NMES) help to improve the quality of life in patients with severe chronic heart failure waiting for a donor heart, as both treatments can be performed at home. We report a 56-year-old woman suffering from severe chronic heart failure, who was referred for a cardiac rehabilitation program because of progressive muscle weakness and weight loss. Due to her underlying heart disease she was unable to perform voluntary exercise. NMES of both knee extensor muscles was started. Under simultaneous chronic drug infusion with PGE1 via a portable pump the patient developed clinical signs of hypertrophic osteoarthropathy, which prevented her from continuing the rehabilitation program. X-ray examinations and bone scans concurred with the diagnosis of secondary hypertrophic osteoarthropathy. After the PGE1 dose had been reduced, the clinical signs of the osteoarthropathy resolved and the patient was able to continue the rehabilitation program with no difficulty. This case report underlines the importance of being aware of the potential side effects of modern cardiac drugs in the complex treatment of patients waiting for a donor heart.

Alprostadil↗
PubMed2002

Long-term outcome after treatment of temporomandibular joint osteoarthritis with exercise and manual therapy.

In a previous study, exercise and manual therapy demonstrated a 90% success rate in patients with osteoarthrosis of the temporomandibular joints in the short-term. The aim of this follow-up study was to assess the long-term effect of these treatment modalities. Seventeen patients were evaluated. All patients suffered from osteoarthrosis of the temporomandibular joints with pain in the temporomandibular joint at baseline and were treated successfully in a prior short-term study. The parameters were pain at rest and at chewing, impairment in daily life, and mouth opening. At follow-up, 11 patients (65%) experienced no pain and 13 patients (76%) had no pain at rest (Fisher's Exact Test: p<0.02). Thirteen patients (76%) had a normal incisal edge clearance, and ten patients (59%) felt no impairment due to the disease (Fisher's Exact Test: p=0.01). Thirteen patients (76%), who had been treated once successfully, have not needed treatment within the three years after cessation of their therapy. Exercise therapy is an effective tool to treat osteoarthrosis of the temporomandibular joints.

Activities of Daily Living↗