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BACKGROUND: Rehabilitation is currently the preferred first-line treatment for thoracic outlet syndrome (TOS). When physiotherapy fails, the next treatment option is usually surgery - a complex procedure with potential complications. OBJECTIVE: We sought to establish whether an intensive, multidisciplinary, day-hospital-based rehabilitation programme could reduce the symptoms of TOS after the failure of private-practice physiotherapy and before surgery was considered. METHODS: We performed a retrospective, single-centre study of 63 TOS patients admitted to our day hospital for 3 weeks (15 therapy sessions) between 2003 and 2014. The data were extracted from hospital records or gathered in a phone interview. RESULTS: Immediately after discharge, the observed improvements in hand function were related to lifting a load, reaching a high shelf, sweeping the floor, cleaning windows, and combing hair. Three months after the end of the intensive rehabilitation program, 80% of the patients reported a reduction in their symptoms. Forty-one of the 63 patients were subsequently contacted by phone. The mean time interval between the end of the rehabilitation programme and the phone interview was 4.5 years (median: 3.5 years; range: 1-12 years). Twenty-seven patients (66%) reported a worsening in hand function, and 25% had undergone surgery. Twenty-three patients had kept the same job, 7 had changed jobs after retraining, 4 had stopped working before the programme but were able to return to work afterwards (including one patient in a part-time job), 4 had not returned to work, and 3 received disability benefits. CONCLUSION: An intensive, multidisciplinary, hospital-based rehabilitation programme was associated with improvements in the great majority of patients with TOS - even after private-practice physiotherapy had failed.

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OBJECTIVE: Normative data on gait is essential for clinical practice - especially in children whose gait pattern changes over time. Sets of normative gait data in healthy children vary significantly from one country to another. We decided to generate a specific reference database of gait parameters for French children. METHOD: Three hundred and eighty-two children (228 boys and 154 girls, aged between 6 and 12) were asked to walk as naturally as possible and at a self-selected speed on a GAITRite track. Velocity, step count, cadence, step time, step length, cycle time, stride length, base width, swing time, stance time, single support time and double support time were recorded. Parameters were analyzed by age group, height group and BMI. RESULTS: Velocity, step and stride length increased regularly with advancing age and height. Cadence decreased with height. All temporal parameters (except for double support) differed significantly (P<0.05) when comparing the 6-year-old group or the 7-year-old group with the 9-year-old group and older groups. A small number of temporal parameters (cadence, step time, cycle time and stance time) differed significantly when comparing 7-year-olds and 8-year-olds. Temporal parameters appeared rise in proportion height from 110 cm to 130 cm and then reached a plateau. Overweight was associated with a longer stance time and more double support. CONCLUSION: The gait pattern in French children aged between 6 and 12 differs from those recorded elsewhere in the world; although gait parameters appear to change in much the same way with age worldwide, our values (even when normalized) are different. Our local database should be of value in French studies of childhood gait disorders. Given that gait patterns do not appear to mature by the age of 12, it would be valuable to study gait patterns in a population of teenagers.

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UNLABELLED: Rehabilitation care and physical exercise are known to constitute an effective treatment for chronic peripheral arterial occlusive disease (PAOD) at the intermittent claudication (IC) stage. Improvements in functional capacities and quality of life have been reported in the literature. We decided to assess the effects of hospital-based exercise training on muscle strength and endurance for the ankle plantar and dorsal flexors in this pathology. PATIENTS AND METHODS: This prospective study included 31 subjects with chronic peripheral arterial occlusive disease (PAOD) and IC who followed a 4-week rehabilitation program featuring walking sessions, selective muscle strengthening, general physical exercise and therapeutic patient education. An isokinetic assessment of ankle plantar and dorsal flexors strength was conducted on the first and last days of the program. We also studied the concentric contractions at the angular velocity of 30°/s and 120°/s for muscle strength and at 180°/s for muscle fatigue. We also measured the walking distance for each patient. RESULTS: Walking distance improved by 246%. At baseline, the isokinetic assessment revealed severe muscle weakness (mainly of the plantar flexors). The only isokinetic parameter that improved during the rehabilitation program was the peak torque for plantar flexors at 120°/s. CONCLUSION: All patients presented with severe weakness and fatigability of the ankle plantar and dorsal flexors. Our program dramatically improved walking distance but not muscle strength and endurance.

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Till now almost nothing has been published about normal liquor findings in spinal cord tumours. Out of 503 cases there were normal findings of total proteins and cells in 30 cases (6 per cent). A connection with the severity of the compression-syndrome was not evident. Nevertheless liquor examinations are important in diseases of the medulla spinalis. This is especially useful in the differential diagnostical demarcation of inflammable spinal cord diseases, accompanying reactions or bleedings into the spinal channel.

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Diagnosis, long-term management and family investigations of Wilson's disease are provided by selected clinical institutions in the GDR. From 187 patients detected since 1949, 111 are alive. In spite of the principal effectiveness of penicillamine treatment, confirmed by the disappearance of most of the central nervous system symptoms and successful professional rehabilitation of many patients, insufficient therapeutic discipline, psychosocial disturbances and penicillamine side-effects forcing its substitution by zinc or triethylenetetramine dihydrochloride in 14 cases need our further attention.

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Current methods of diagnosing psychological performance, which are primarily status-oriented, are inadequate to permit satisfactory differentiation between brain-organically and neurotically induced performance disturbances. We therefore attempted to contribute to the solution of this problem by adopting a new psychodiagnostic approach (measurement of intraindividual variability) and using multi-point measurements with the aid of attentiveness tests. The fact that 80 to 90% of 254 neurotic and brain-damaged subjects could be correctly diagnosed in the way indicates that the new approach to performance diagnosis is suitable for clinical use.

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Specific "reference areas" were derived from relationships between the proteins prealbumin, albumin, alpha 1-acid glycoprotein, alpha 2-macroglobulin, total transferrin, IgG, IgA, IgM, and the corresponding total protein in normal lumbar CSF samples. The procedure for calculating the boundary lines of these reference areas was carried out on the basis of double standard deviations in subgroups with total protein differences of 50 ml/l within the whole range of 150-400 ml/l CSF. The resulting biochemical data, hydrodynamic radii of the individual proteins investigated, and van Deurs' and Koehler's morphological findings on the existence of pores in the barrier-forming tight junctions of the choroid plexus epithelium could be surprisingly well correlated with one another, although these morphological findings were obtained in choroid plexus of the rat brain. The correlation allowed the conclusion that proteins undergo ultrafiltration via a pattern of tight junction pores with various diameters. However, the molecular mechanism seems to include an additional facilitating component.

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Investigation of the long-term stability of psychological efficiency standards using a frequently applied intelligence test (Hawie -verbalpart). The test value distribution of two representative random tests of adults (from the beginning of 1950 in the FRG and from 1980 to 1983 in the GDR) was investigated and a comparison made together. Significant efficiency differences between the two random tests indicate defective long-term stability of test standards and the necessity to restandardize after 20 to 30 years. Because of significant differences between the old and new standard values and the high percentage of errors (26%), in classifying intelligence when applying the old standard values, the application of the new standards in the clinical diagnosis of intelligence is to be recommended.

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In 32 patients the times of retinal passage were determined in 112 examinations immediately after cerebrovascular insult and following in daily intervals. In this case after the insult a significant change of the retinal haemodynamics could be observed: the bolus-tension time and the time V2 showed a continuous deterioration of the blood supply of the retina possibly parallel to the cerebral haemodynamics. Furthermore it was shown that the initial prolongation of the arm-retina-times over 17 seconds refers to serve cerebral lesions with poor prognosis. It seems that the method described is not suitable for the preliminary diagnosis of extracranial vascular processes: In acute extracranial vascular occlusion we found equality of the sides of the inflow of dye as well as differences of the sides of more than 30 seconds in free extracranial vascular lumina.

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In 15 patients with renal insufficiency at the stage of the compensated retention and 13 patients of the chronic haemodialysis programe no relations between clinical findings, maximum motor nerve conduction speed (peroneal nerve, median nerve), visually evaluated EEG and actual metabolic parameters could be statistically secured. During haemodialysis either an increase of the EEG changes increased or the findings remained constant.

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