Publications by authors named "Stefano Palma"

36 Publications

Online Videos as a Source of Physiotherapy Exercise Tutorials for Patients with Lumbar Disc Herniation-A Quality Assessment.

Int J Environ Res Public Health 2021 05 28;18(11). Epub 2021 May 28.

Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria.

During the last few decades the prevalence of lumbar disc herniation has been increasing constantly, thereby imposing a significant socioeconomic burden. Physiotherapy plays a crucial role in both surgical and conservative treatment of lumbar disc herniation, consequently the current COVID-19 pandemic with concomitant lockdowns has led to a shortage of physiotherapeutical care. In the light of these recent events publicly available physiotherapy tutorials may be a useful tool to address this problem. The main aim of this study was to assess the quality of online physiotherapy exercise tutorials for lumbar disc herniation. With YouTube being a widely known and used platform we screened 240 of the most viewed videos. A total of 76 videos met the inclusion criteria and were statistically analyzed. The videos were assessed using Global Quality Score, DISCERN Score and JAMA benchmark criteria and in regard to their applicability. They displayed a wide range of views (44,969 to 5,448,717), likes (66 to 155,079) and dislikes (6 to 2339). The videos were assessed using Global Quality Score, DISCERN Score and JAMA benchmark criteria and in regard to their applicability. Neither the number of "Views", "Likes", nor "Dislikes" was found to have a significant association with any of the quality measures used in this study. : Overall quality grade was determined as "moderate". Based on the data examined in this study, the use of YouTube videos as a source of therapy advice for lumbar spine disc herniation cannot be recommended universally.
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http://dx.doi.org/10.3390/ijerph18115815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8198219PMC
May 2021

Paraneoplastic ganglioradiculoneuritis in a cat with a plasma cell tumour.

JFMS Open Rep 2021 Jan-Jun;7(1):20551169211003806. Epub 2021 Mar 31.

Southfields Veterinary Specialists, Laindon, UK.

Case Summary: An 8-year-old neutered female domestic longhair cat was presented for investigation of a 48 h history of lethargy and pelvic limb ataxia. MRI of the spinal cord and vertebral column (C1 to sacrum) and brain was unremarkable. Lumbar cerebrospinal fluid analysis revealed pleocytosis and increased protein concentration. Thoracic radiographs and abdominal ultrasound were unremarkable. Anti-inflammatory doses of prednisolone were administered. Clinical deterioration occurred over the following 2 days, with the development of lower motor neuron deficits in both thoracic limbs. On repetition of the MRI, bilateral enlargement, T2-weighted hyperintensity, and marked contrast enhancement of the C7, C8 and T1 nerve roots, spinal nerves and brachial plexuses were observed. Infectious disease testing was negative. An immune-mediated inflammatory process was suspected and immunosuppressive doses of prednisolone were commenced. The clinical signs improved transiently, but marked deterioration occurred after 2 weeks. The patient was euthanased and a post-mortem examination was performed. A lymphocytic inflammatory infiltrate was detected in the C7, C8 and T1 nerve roots and dorsal root ganglia, and neoplastic plasma cells were identified in multiple organs. A diagnosis of non-cutaneous extramedullary plasmacytoma with multiorgan involvement and paraneoplastic ganglioradiculoneuritis was reached.

Relevance And Novel Information: Paraneoplastic ganglioradiculoneuritis in association with a plasma cell neoplasia has not been previously reported in the cat and should be considered as a differential diagnosis for cats with clinical or imaging evidence of an inflammatory process affecting the nerve roots, spinal nerves or brachial plexuses.
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http://dx.doi.org/10.1177/20551169211003806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020407PMC
March 2021

Review on Canine Oral Melanoma: An Undervalued Authentic Genetic Model of Human Oral Melanoma?

Vet Pathol 2021 Sep 9;58(5):881-889. Epub 2021 Mar 9.

11661Animal Health Trust, Newmarket, Suffolk, UK.

Oral melanoma (OM) is a highly aggressive tumor of the oral cavity in humans and dogs. Here we review the phenotypic similarities between the disease in these 2 species as the basis for the view that canine OM is a good model for the corresponding human disease. Utility of the "canine model" has likely been hindered by a paucity of information about the extent of the molecular genetic similarities between human and canine OMs. Current knowledge of the somatic alterations that underpin human tumorigenesis and metastatic progression is relatively limited, primarily due to the rarity of the disease in humans and consequent lack of opportunity for large-scale molecular analysis. The molecular genetic comparisons between human and canine OMs that have been completed indicate some overlap between the somatic mutation profiles of canine OMs and a subset of human OMs. However, further comparative studies featuring, in particular, larger numbers of human OMs are required to provide substantive evidence that canine OMs share mechanisms of tumorigenesis with at least a subset of human OMs. Future molecular genetic investigations of both human and canine OMs should investigate how primary tumors develop a metastatic gene expression signature and the genetic and epigenetic alterations specific to metastatic sites. Such studies may identify genetic alterations and pathways specific to the metastatic disease which could be targetable by new drugs.
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http://dx.doi.org/10.1177/0300985821996658DOI Listing
September 2021

Airborne human papillomavirus (HPV) transmission risk during ablation procedures: A systematic review and meta-analysis.

Environ Res 2021 01 9;192:110437. Epub 2020 Nov 9.

Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria. Electronic address:

Background: Human Papillomavirus (HPV) is associated with development of oropharyngeal cancer. Aim of this review was to assess airborne transmission risk of infectious particles from HPV lesions to airway mucosa of medical staff during established ablation procedures.

Methods: A systematic review of human and animal studies, published before 09/2020, relevant to airborne HPV transmission. Controlled studies reporting prevalence of HPV-associated upper airway (nasal/oral/pharyngeal) disease in staff performing ablation procedures (laser, loop electrosurgical excision [LEEP], cryosurgery) on HPV lesions were included in meta-analysis. Additionally, we aimed for a comprehensive systematic overview of studies regarding occupational risk of airborne HPV transmission and safety measures during ablation procedures.

Results: A total of n = 30 original studies report outcomes related to HPV transmission risk in medical staff conducting ablation procedures. HPV DNA detection in ablation smoke (n = 7), matching HPV genotypes on ablated HPV lesions and face/airways of medical staff after ablation (n = 2), and evidence for infectivity of papillomavirus in ablation smoke (n = 3, animal models only) were reported. Three case reports describe occupational HPV disease of upper airway mucosa. Three controlled studies assessed warts (in CO laser-users only); when pooling all controls (general population, non-laser users), nasal/oral/pharyngeal lesion sites were more common amongst laser-users (OR = 5.75; 95%CI[1.55, 21.38]; p < .001).

Discussion: Airborne HPV dispersal with matching "high-risk" HPV-genotypes in airways of medical staff after ablations (LEEP and CO-laser) and cases of HPV-associated upper airways neoplasms based on exposure to laser and LEEP smoke are documented. Upper airway mucosa is a more common anatomical site for warts in CO laser users compared to controls. Simple safety measures greatly reduce HPV contamination and transmission risk.
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http://dx.doi.org/10.1016/j.envres.2020.110437DOI Listing
January 2021

High-intensity interval training in the prehabilitation of cancer patients-a systematic review and meta-analysis.

Support Care Cancer 2021 Apr 26;29(4):1781-1794. Epub 2020 Oct 26.

Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.

Purpose: To evaluate the impact of high-intensity interval training (HIIT) on health-related outcome parameters in the prehabilitation of patients diagnosed with cancer.

Methods: A systematic review and meta-analysis of comparative studies on HIIT in cancer prehabilitation conducted by screening standard databases from their inception to March 30, 2020. Outcomes of interest included cardiorespiratory fitness, feasibility, safety, clinical, and patient-reported outcomes.

Results: Of the 855 identified studies, 8 articles met the inclusion criteria (7 randomized, 1 non-randomized controlled trial) with a total of 896 patients. The study protocols were heterogeneous, but the methodological quality ranged from good to high according to PEDro scale. Meta-analysis revealed a significant improvement of peak oxygen consumption (VOpeak) achieved with HIIT compared to usual care. Furthermore, HIIT was feasible and safe, showing low risk of adverse events and positive effects on health-related outcomes in prehabilitative settings.

Conclusion: In the phase of prehabilitation, HIIT has potential health benefits in patients diagnosed with cancer and is feasible and safe to perform. Nonetheless, larger randomized controlled trials focusing on long-term effects (such as cancer recurrence or survival rates) are missing, to underline the potential relevance of HIIT for cancer patients.
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http://dx.doi.org/10.1007/s00520-020-05834-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892520PMC
April 2021

Effects of a structured exercise program on physical performance and function, quality of life and work ability of physically active breast cancer survivors : A retrospective data analysis.

Wien Klin Wochenschr 2021 Jan 22;133(1-2):1-5. Epub 2020 Sep 22.

Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Background: Purpose of this retrospective data analysis was to depict the effects of a structured off-season conditioning program with breast cancer survivors competing in dragon boat paddling.

Methods: In this study 10 breast cancer survivors (mean age 52.0 ± 5.4 years) who had finished the primary cancer treatment and who were paddlers of the Vienna Pink Dragon self-help group underwent a structured 10-week exercise program as part of their routine supportive treatment. Upper extremity strength, endurance capacity, shoulder flexibility, quality of life and work ability were assessed at baseline and after completion of the exercise program.

Results: Out of 10 patients 8 completed more than 80% of the exercise sessions. A multivariate analysis of variance (MANOVA) of the pooled exercise effects showed a very large effect size (Η = 0.982); however, the change from baseline to follow-up was non-significant (p = 0.363). In the European Organisation for Research and Treatment of Cancer Quality of Life of Cancer Patients Questionnaire (EORTC QLQ-C30) the exercise program led to a significant improvement of body image (p = 0.02) and less arm symptoms in the affected arm (p = 0.04).

Conclusion: A structured and well-planned exercise intervention program can have a large effect on the physical performance of pretrained breast cancer survivors. Moreover, it can increase the body image and decrease the arm symptoms in this population.
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http://dx.doi.org/10.1007/s00508-020-01739-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7840644PMC
January 2021

infection associated with granulomatous eosinophilic myositis in a horse.

J Vet Diagn Invest 2020 Jul;32(4):611-615

Department of Veterinary Medicine, University of Perugia, Perugia, Italy (Veronesi, Morganti, Lepri).

The only species currently known to inhabit the fibers of skeletal and cardiac muscles in horses are , and . We describe herein the invasion of myofibers in a horse by , a sheep-specific species with low virulence in the original host. A hunter gelding was referred to a veterinary surgeon in Newmarket (UK). The anamnestic data reported that the horse had an initial history of swelling of the right forelimb with fluid on the front of the carpus and edema spreading up the forearm. Subsequently, 2 firm lumps were found on the left pectoral muscle adjacent to the axilla of the left forelimb. Histologic examination of biopsies from the lumps revealed multifocal granulomatous eosinophilic myositis associated with intact and degenerate encysted parasites, consistent with spp. Based on amplification and DNA sequencing of the 18S rRNA gene obtained from formalin-fixed, paraffin-embedded tissue blocks, was identified. The presence of sarcocysts in equine skeletal muscles has been considered an incidental finding, and there are only sporadic associated reports of myositis. Our finding suggests that some spp. have a wider intermediate host range than believed previously, and that of other species (not considered horse-associated) can invade the muscle fibers of equids, leading to myositis.
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http://dx.doi.org/10.1177/1040638720935847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7438657PMC
July 2020

Effects of resistance exercise in prostate cancer patients : A systematic review update as of March 2020.

Wien Klin Wochenschr 2020 Aug 17;132(15-16):452-463. Epub 2020 Jul 17.

Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Purpose: The aim of this systematic review is to provide an update on the effects of resistance exercise (RE) in patients with prostate cancer (PCa), with special attention to the effects on sexual health.

Methods: A systematic search of the literature was conducted in March 2020 using the databases PubMed, MEDLINE, EMBASE, SCOPUS and the Cochrane Library. Only randomized, controlled trials published after 31 December 2016 were included in this update. Additionally, articles from current and previous reviews were utilized to provide a brief summary of the effects on sexual health.

Results: A total of 10 articles met the inclusion criteria, of which 5 were identified as independent studies. The remaining five articles presented additional data for studies, which have already been included. The identified studies further strengthened the evidence for positive effects on muscle strength, body composition and physical function. Positive effects on bone mineral density were apparent only when RE was combined with impact training. One article reported an improvement in fatigue and health-related quality of life. Only one study examined the effects of RE in isolation and three articles indicated positive effects of exercise on sexual health.

Conclusion: Recent evidence supports the use of RE in PCa patient rehabilitation as a countermeasure for treatment side effects. Further research is necessary to ascertain the optimal delivery methods and illuminate the effects on health-related quality of life (HRQOL), fatigue and sexual health.
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http://dx.doi.org/10.1007/s00508-020-01713-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445198PMC
August 2020

Can reminders improve adherence to regular physical activity and exercise recommendations in people over 60 years old? : A randomized controlled study.

Wien Klin Wochenschr 2021 Jun 26;133(11-12):620-624. Epub 2020 Jun 26.

Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.

Purpose: The purpose of the study was to investigate whether additional reminders could enhance adherence to a 12-week program consisting of regular physical activity.

Methods: The study collective consisted of pensioners insured with the Austrian Insurance Fund for Civil or Public Servants. They were made aware of our program through the public service union. The subjects were randomized to an intervention group (group A) that received reminders and to a control group (group B) that did not receive such notifications. Adherence to physical activity was assessed by the use of diaries.

Results: Group A performed 96 min more moderate intensity regular physical activity per week than group B (group A median 269 min, r = 0-1560 min; group B median 173 min, r = 0-2700 min). The Mann-Whitney U-test showed no significant differences (p = 0.080) between the study groups. There was no difference in muscle strengthening activity (group A: median: 2, r = 0-13 sessions; group B: median: 2, r = 0-20 sessions).

Conclusion: The major positive observation was that both the experimental and control group participants exceeded the recommended level of physical activity. Nevertheless, there were some differences concerning the minutes of physical activity performed in favor of the intervention group.
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http://dx.doi.org/10.1007/s00508-020-01699-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7318722PMC
June 2021

Resistance exercise and breast cancer-related lymphedema-a systematic review update and meta-analysis.

Support Care Cancer 2020 Aug 15;28(8):3593-3603. Epub 2020 May 15.

Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Background: The purpose of this systematic review update and meta-analysis was to analyze resistance exercise (RE) intervention trials in breast cancer survivors (BCS) regarding their effect on breast cancer-related lymphedema (BCRL) status and upper and lower extremity strength.

Methods: Systematic literature search was conducted utilizing PubMed, MEDLINE, and Embase databases. Any exercise intervention studies-both randomized controlled and uncontrolled-which assessed the effects of RE on BCRL in BCS in at least one intervention group published between 1966 and 31st January 2020 were included. Included articles were analyzed regarding their level of evidence and their methodological quality using respective tools for randomized and nonrandomized trials of the Cochrane collaboration. Meta-analysis for bioimpedance spectroscopy (BIS) values as well as upper and lower extremity strength was conducted.

Results: Altogether, 29 studies were included in the systematic review. Results of six studies with altogether twelve RE intervention groups could be pooled for meta-analysis of the BCRL. A significant reduction of BCRL after RE was seen in BIS values (95% CI - 1.10 [- 2.19, - 0.01] L-Dex score). Furthermore, strength results of six studies could be pooled and meta-analysis showed significant improvements of muscular strength in the upper and lower extremities (95% CI 8.96 [3.42, 14.51] kg and 95% CI 23.42 [11.95, 34.88] kg, respectively).

Conclusion: RE does not have a systematic negative effect on BCRL and, on the contrary, potentially decreases it.
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http://dx.doi.org/10.1007/s00520-020-05521-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316683PMC
August 2020

What Is Your Diagnosis?

J Am Vet Med Assoc 2020 May;256(10):1101-1104

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http://dx.doi.org/10.2460/javma.256.10.1101DOI Listing
May 2020

Functional outcome after recurrent patellar dislocation : Comparison of two surgical techniques-Medial patellofemoral ligament reconstruction (MPFL) vs. Elmslie Trillat procedure.

Wien Klin Wochenschr 2019 Dec 11;131(23-24):614-619. Epub 2019 Nov 11.

Department of Orthopedics and Traumatology, Clinical Division of Traumatology, Medical University of Vienna, Vienna, Austria.

Background: There is no final consensus regarding the ideal surgical technique for the treatment of patellar dislocation. The aim of this retrospective pilot study was to describe muscle strength, body composition, self-reported physical performance, and pain in male patients after patellar dislocation treatment with two different surgical techniques: medial patellofemoral ligament (MPFL) reconstruction vs. the Elmslie-Trillat procedure.

Methods: Isokinetic testing of knee extensor muscles was performed using a Biodex System 3 pro dynamometer at an angular velocity of 60°/s. Body composition was measured with bioelectrical impedance analysis (Nutribox). Self-reported physical performance and pain were assessed by the SF-36 subscales of physical functioning, role physical and bodily pain. The outcome variables of peak torque normalized to participant's body mass (Nm/kg), lean body mass, phase angle, self-reported physical performance, and pain were compared between the study groups.

Results: Of the 12 included male patients, 6 had been treated with MPFL reconstruction (age: median = 33 years, range = 18-38 years; BMI: median = 26 kg/m, range = 23-29) and 6 with the Elmslie-Trillat procedure (age: median = 26 years, range = 19-32 years; BMI: median = 23 kg/m, range = 19-28). No statistically significant differences were found between the groups in any outcome parameter of muscle strength, body composition, self-reported physical performance, or pain.

Conclusions: The results of the present pilot study revealed that MPFL reconstruction shows equal results to the Elmslie-Trillat procedure, with respect to isokinetic knee muscle strength, body composition, self-reported physical performance and pain in male patients suffering from recurrent patellar dislocation.
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http://dx.doi.org/10.1007/s00508-019-01570-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6908566PMC
December 2019

Automatic force plate contact detection protocol for computerized gait analysis.

Gait Posture 2020 01 30;75:63-65. Epub 2019 Sep 30.

Medical University of Vienna, Department of Physical Medicine, Rehabilitation and Occupational Medicine, Währinger Gürtel 18-22, 1090 Vienna, Austria. Electronic address:

Background: The usability and evaluability of a computerized gait analysis requires correct force plate foot contact, with the force measuring plates embedded in the ground, in order to obtain kinetic data.

Research Question: This article describes a technical development that facilitates the process flow of computerized gait analysis. Software has been developed that automatically recognizes, counts and documents the correct force plate foot contacts METHODS: A software program has been developed. Programming was done in Microsoft® C# using the ViconDatastreemSDK.dotNet® Dynamic Link Library (DLL) developed by Vicon®. The program queries the positions of the foot markers and the electrical signals of the force plates.

Results And Significance: The program, which runs parallel to the Vicon® data acquisition software, simultaneously displays the information about the correct force plate foot contacts in a graphical user interface (GUI). After the measurement, an automatically generated protocol of the evaluable walks is available in tabular form.
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http://dx.doi.org/10.1016/j.gaitpost.2019.09.028DOI Listing
January 2020

Disseminated Langerhans cell histiocytosis presenting as oesophageal disease in a cat.

JFMS Open Rep 2019 Jul-Dec;5(2):2055116919874902. Epub 2019 Sep 19.

Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK.

Case Summary: An 11-year-old female spayed domestic shorthair cat was referred with a 2-month history of ptyalism, hyporexia and weight loss. Physical examination revealed reduced body condition score (2/9) and decreased skin turgor. Laboratory abnormalities included mild erythrocytosis, elevated creatine kinase, hypercobalaminaemia and hypofolataemia. CT of the head and abdominal ultrasonography were within normal limits. Gastroesophagoscopy revealed mucosal ulceration and possible stenosis of the distal oesophagus. Thoracic radiographs and iodine oesophagram showed a soft tissue opacity in the caudodorsal thorax compatible with a parietal oesophageal mass causing luminal stenosis or an extra-parietal mass causing ventral displacement and compression of the oesophagus. Pulmonary nodules were observed in the cranial lung lobes. CT of the thorax confirmed the oesophageal origin of the mass and the presence of pulmonary nodules scattered throughout the lung parenchyma. The patient was euthanased given the imaging findings and perceived guarded prognosis. Post-mortem examination revealed multifocal nodular lesions affecting the oesophagus, lungs, kidneys and pancreas. Histopathological examination identified atypical round cells characterised by eosinophilic cytoplasm and pale nuclei with prominent nuclear grooves, compatible with neoplastic histiocytic cells. Immunohistochemistry revealed strong expression for CD18, Iba-1 and vimentin. Transmission electron microscopy demonstrated intracytoplasmic organelles consistent with Birkbeck granules of Langerhans cell origin in lesional histiocytes. These findings were compatible with a diagnosis of disseminated Langerhans cell histiocytosis.

Relevance And Novel Information: To our knowledge, this is the first report of disseminated Langerhans cell histiocytosis with oesophageal involvement in a cat.
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http://dx.doi.org/10.1177/2055116919874902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753522PMC
September 2019

Typical aspects in the rehabilitation of cancer patients suffering from metastatic bone disease or multiple myeloma.

Wien Klin Wochenschr 2019 Nov 2;131(21-22):567-575. Epub 2019 Jul 2.

Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.

Background: The aim of this study was to present a practical concept focusing on typical aspects of regular physical activity, exercise and physical modalities for patients suffering from metastatic bone disease or multiple myeloma.

Methods: A narrative review of the relevant scientific literature and presentation of clinical experiences.

Results: In cancer patients with metastatic bone disease or multiple myeloma, pain is treated in an interdisciplinary and multimodal setting by using medication, radiotherapy and physical medical modalities (e.g. transcutaneous electrical nerve stimulation); however, modalities increasing local blood flow, such as ultrasound therapy, thermotherapy, massage, various electrotherapy options, are not performed at the site of the tumor. For physical activity and exercise, a suitable indication of the static and dynamic capacity of the affected skeletal structures is essential. This process includes strategies to maintain and improve mobility and independence. Individually tailored and adapted physical activity and exercise concepts (programs) within a multidisciplinary and interdisciplinary setting (tumor board) are used to manage the condition and bone load-bearing capacity of the patient. Typical clinical features and complications, such as pathological fractures in patients suffering from metastatic bone disease and additionally hypercalcemia, monoclonal gammopathy with bone marrow aplasia and risk of renal failure in patients with multiple myeloma have to be considered when planning supportive strategies and rehabilitation.

Conclusion: In order to ensure the safety and effectiveness of regular physical activity, exercise, and physical modalities in patients with metastatic bone disease or multiple myeloma, typical contraindications and considerations should be noted.
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http://dx.doi.org/10.1007/s00508-019-1524-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6851044PMC
November 2019

Role of physical medicine for cancer rehabilitation and return to work under the premise of the "Wiedereingliederungsteilzeitgesetz".

Wien Klin Wochenschr 2019 Oct 13;131(19-20):455-461. Epub 2019 May 13.

Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.

Background: With the intention of enabling people a phased return to work after long-term sick leave the so-called "Wiedereingliederungsteilzeitgesetz" (WIETZ) was implemented in Austria on 1 July 2017.

Methods: To explore the overall awareness about the WIETZ and the value of physical modalities together with further supporting measures in return to work of cancer survivors, a survey by using a self-constructed questionnaire was performed in 30 experts 6 months after the WIETZ came into force.

Results: The awareness of Austrian specialists regarding the WIETZ seems to be excellent. Regarding expert opinions, return to work in cancer survivors is notable hampered in workplaces with great physical stress even in times of the WIETZ, whereas for professions in offices and banks it is easier to return to work, with and without WIETZ. The highest impact on return to work seems to be due to exercise, as an intervention of the field of physical medicine and rehabilitation to improve sensorimotor functions and to increase endurance capacity as well as muscular strength.

Conclusion: Early information about cancer rehabilitation and the WIETZ seems to be necessary to facilitate return to work of cancer survivors. Furthermore, exercise interventions seem to be the most important measures from the field of physical medicine and rehabilitation.
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http://dx.doi.org/10.1007/s00508-019-1504-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795628PMC
October 2019

Gait analysis and body composition after treatment of quadriceps tendon ruptures showed equal results independent of suture anchor or transosseus repair technique used: a pilot study.

Disabil Rehabil 2020 12 8;42(26):3833-3837. Epub 2019 May 8.

Department of Orthopaedics and Trauma Surgery, Division of Trauma-Surgery, Medical University of Vienna, Vienna, Austria.

Suture anchor repair is a fairly new surgical technique for quadriceps tendon ruptures. It is supposed to be superior to the standard transosseus sutures because of biomechanical superiority and - due to a less invasive surgery - earlier rehabilitation onset. This study focused on analyzing functionality of the quadriceps muscle during gait as well as body composition between a suture anchor and a transosseus suture repair group and is the first study that undertook systematic gait analyses in this patient population. Seventeen patients who underwent either suture anchor (9 subjects) or transosseus suture repair surgery (8 subjects) at two different trauma surgery centers between 2010 and 2015 were included. Gait analysis was performed with a three dimensional motion capture system (Vicon) and body composition was assessed with bioelectrical impedance analysis (Nutribox). Parametrical statistical analyses were conducted using independent -tests. No statistically significant differences were found in any outcome parameter of gait analysis or body composition measurement. Suture anchor repair shows equal results to transosseus suture repair technique regarding gait quality and body composition.Implications for rehabilitationIn a long term follow-up suture anchor repair shows similar results to the transosseus suture technique regarding body composition and musculus quadriceps function in gait.Without the implementation of an appropriate rehabilitation protocol incorporating the earlier load-carrying capacity, early biomechanical advantages of suture anchor technique over transosseus sutures might vanish over time.The decision which surgery technique might be best for the individual patient, should not be based on the expectation that suture anchor repair alone without considering appropriate rehabilitation would lead to long term functional advantages over transosseus suture technique.
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http://dx.doi.org/10.1080/09638288.2019.1611951DOI Listing
December 2020

Inter- and Intraobserver Agreement of Canine and Feline Nervous System Tumors.

Vet Pathol 2019 05 20;56(3):342-349. Epub 2019 Jan 20.

5 Vetsuisse Faculty, University of Bern, Bern, Switzerland.

In routine diagnostic activity, pathologists may be confronted with nervous system tumors. The lack of clinical information, economic restrictions for additional testing, and the lack of expertise in neuropathology may render the diagnosis challenging. The goals of this study were to assess the agreement in diagnosing nervous system tumors in domestic carnivores among 4 board-certified surgical pathologists without particular expertise in neuropathology and a neuropathologist expert, and to investigate the utility of special stains frequently used in routine diagnostic laboratories. Forty-six tumors (7 cats, 38 dogs, and 1 unknown carnivore) were retrieved and 1 hematoxylin and eosin-stained slide per tumor was selected. Diagnoses (tumor type and subtype) were formulated based on histological features and available clinical information. Confidence in the diagnosis was also scored. Subsequently, a panel of histochemical and immunohistochemical stains (Gordon Sweet silver stain and immunohistochemistry for AE1/AE3, vimentin, glial fibrillary acid protein, S100, neuron-specific enolase and neurofilament) was evaluated by the pathologists, who either confirmed or changed their original diagnoses. Intraobserver and interobserver agreement and confidence in relation to diagnosis before and after analysis of special stains were assessed. The use of special stains increased the complete agreement among surgical pathologists, with regard to tumor type, from 63% to 74%. Cases with a high confidence score had a higher interobserver agreement than cases with a low confidence score. These results suggest that pathologists without expertise in neuropathology agree in the diagnosis of most nervous system tumors, and special stains available in most laboratories only slightly increase this agreement.
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http://dx.doi.org/10.1177/0300985818824952DOI Listing
May 2019

Resistance exercise and breast cancer related lymphedema - a systematic review update.

Disabil Rehabil 2020 01 13;42(1):26-35. Epub 2019 Jan 13.

Department of Physical Medicine Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria.

Purpose of this systematic review update was analyzing resistance exercise (RE) intervention trials in breast cancer survivors (BCS) regarding their effect on breast cancer-related lymphedema (BCRL) status. Articles published until 31 September 2017 were included. A systematic literature search was conducted utilizing PubMed, MEDLINE, and EMBASE databases. Included articles were analyzed regarding their level of evidence and their methodological quality using the Cochrane risk of bias tool. Altogether, 23 articles could be included of which 16 were independent RE intervention studies and seven additional articles. Lymphedema assessment was so heterogeneous that conduction of a thorough meta-analysis regarding lymphedema status was still impossible. In all but one study, which reported a small but methodologically weak increase in arm volume, no negative effects of RE on BCRL was recorded. RE seems to be a safe exercise intervention for BCS and not to be harmful concerning the risk of lymphedema. Lymphedema assessment methods that allow for a qualitative analysis of arm tissue composition should be favored.Implications for rehabilitationBreast cancer-related lymphedema affects a considerable proportion of breast cancer patients and is debilitating on the physical, functional, social, and psychological domain.At the current time breast cancer related lymphedema is incurable but well manageable by a number of physical therapy modalities, especially complete decongestive therapy (CDT).One of the encouraging treatment methods is resistance exercise.
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http://dx.doi.org/10.1080/09638288.2018.1514663DOI Listing
January 2020

Identification of molecular genetic contributants to canine cutaneous mast cell tumour metastasis by global gene expression analysis.

PLoS One 2018 19;13(12):e0208026. Epub 2018 Dec 19.

Animal Health Trust, Newmarket, Suffolk, United Kingdom.

Cutaneous mast cell tumours are one of the most common canine cancers. Approximately 25% of the tumours metastasise. Activating c-kit mutations are present in about 20% of tumours, but metastases occur in the absence of mutations. Tumour metastasis is associated with significantly diminished survival in spite of adjuvant chemotherapy. Available prognostic tests do not reliably predict whether a tumour will metastasise. In this study we compared the global expression profiles of 20 primary cutaneous mast cell tumours that metastasised with those of 20 primary tumours that did not metastasise. The objective was to identify genes associated with mast cell tumour metastatic progression that may represent targets for therapeutic intervention and biomarkers for prediction of tumour metastasis. Canine Gene 1.1 ST Arrays were employed for genome-wide expression analysis of formalin-fixed, paraffin-embedded biopsies of mast cell tumours borne by dogs that either died due to confirmed mast cell tumour metastasis, or were still alive more than 1000 days post-surgery. Decreased gene expression in the metastasising tumours appears to be associated with a loss of cell polarity, reduced cell-cell and cell-ECM adhesion, and increased cell deformability and motility. Dysregulated gene expression may also promote extracellular matrix and base membrane degradation, suppression of cell cycle arrest and apoptosis, and angiogenesis. Down-regulation of gene expression in the metastasising tumours may be achieved at least in part by small nucleolar RNA-derived RNA and microRNA-effected gene silencing. Employing cross-validation, a linear discriminant analysis-based classifier featuring 19 genes that displayed two-fold differences in expression between metastasising and non-metastasising tumours was estimated to classify metastasising and non-metastasising tumours with accuracies of 90-100% and 70-100%, respectively. The differential expression of 9 of the discriminator genes was confirmed by quantitative reverse transcription-PCR.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208026PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300220PMC
June 2019

Impact of supportive therapy modalities on heart rate variability in cancer patients - a systematic review.

Disabil Rehabil 2020 01 4;42(1):36-43. Epub 2018 Dec 4.

Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria.

To systematically review literature for interventional studies and their impact on autonomic dysfunction assessed by heart rate variability in cancer patients. Research was conducted using the databases Medline/Pubmed, Scopus, and Web of science from their inception to October 2017. Original articles with an interventional design that reported changes in at least one heart rate variability parameter as outcome parameter were included and described. Ten studies were identified as eligible for subsequent analysis. The main application field in oncological therapy setting was music therapy intervention, Traditional Chinese Medicine related treatments, exercise interventions, relaxation, and myofascial release techniques. Breast cancer was the most frequently described single cancer entity. Heart rate variability recording was performed with standard electrocardiography devices or wearable heart rate monitors, within a time range between 5 and 20 min and a sampling rate varying from 200 to 1000 Hz. No adverse events were reported in all studies. Supportive therapy modalities may have the potential to enhance vegetative functioning. In this context, heart rate variability analysis appears to be an easily applicable and safe method to evaluate cancer related autonomic dysfunction. More large prospective multicentre randomised controlled trials are needed.Implication for rehabilitationMost cancer patients face autonomic dysfunction due to the disease itself the applied treatments or combination of both.HRV measurement is an easy and safe method to asses autonomic dysfunction.Supportive treatments targeting on an elevation of the vagal tone and autonomic balance in general might have beneficial effects for cancer patients.
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http://dx.doi.org/10.1080/09638288.2018.1514664DOI Listing
January 2020

Clinical outcomes after treatment of quadriceps tendon ruptures show equal results independent of suture anchor or transosseus repair technique used - A pilot study.

PLoS One 2018 19;13(3):e0194376. Epub 2018 Mar 19.

Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.

Biomechanical studies have shown the use of suture anchors (SA) to be superior to the traditional transosseous sutures (TS) in the repair of quadriceps tendon rupture (QTR). This study aimed to analyze and compare the functional outcomes of patients treated for quadriceps tendon ruptures using suture anchors or transosseous sutures. Patients having undergone suture anchor repair or transosseous suture repair for quadriceps tendon rupture between 2010 and 2015 at one of the two participating hospitals were included. Patients from site A underwent TS repair (TS group) while patients from site B underwent SA repair (SA group). Exclusion criteria included previous or concomitant injuries of the involved knee, penetrating injuries and pre-existing neurological conditions. Clinical outcome was assessed by subjective scores (Lysholm and Tegner Scores, International Knee Documentation Committee (IKDC) Score, Visual Analog Scale (VAS) for pain), quadriceps isokinetic strength testing, Insall-Salvati Index (ISI), and physical examination. Non-parametrical statistical analysis was conducted using the Mann-Whitney U test. Twenty-seven patients were included in the study of which 17 patients (63%) were available for follow-up (SA group: 9, TS group: 8). All patients were male with a mean age of 62.7 (SD: 8.8) and 57.9 (SD: 12.7) years for the SA group and TS group, respectively. The groups did not differ in terms of demographic characteristics. No clinically significant differences were identified between the two groups. There were no re-ruptures in either group. Treatment of quadriceps tendon rupture using suture anchors provides a clinically valid alternative treatment to the gold-standard transosseous suture repair.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0194376PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858832PMC
July 2018

Congenital fiber-type disproportion in an ambulatory rehabilitation setting : A case report.

Wien Med Wochenschr 2018 Oct 25;168(13-14):367-373. Epub 2017 Jul 25.

Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.

Congenital fiber-type disproportion is a rare condition, histologically characterized by a relative type 1 fiber hypotrophy. The main clinical feature is mild-to-severe muscle weakness. In this report, we present the case of a 21-year-old patient with congenital fiber-type disproportion in an outpatient rehabilitative setting to evaluate the feasibility and results of an assessment battery, including bioimpedance analysis (BIA), dynamometry, 3D gait analysis, 6‑min walk test (6MWT), and the timed up and go test (TUG). The patient had a notable decrease in all functional scores. BIA: lean body mass, 38.4 kg (50.2 ± 5.3), body fat, 1.6% (12.4 ± 4.4); hand dynamometry: 18.5 kg left/20.0 kg right (44.8 ± 6.6); walking speed, 58 cm/s (122.7 ± 11.1), step length, 43.0 cm (61.6 ± 3.5); 6MWT: 478.5 m (638 ± 44); TUG: 9.4 s (8.1 ± 1.0). No adverse events were reported. The tests used were easily applicable in clinical routine and well tolerated by our patient.
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http://dx.doi.org/10.1007/s10354-017-0580-4DOI Listing
October 2018

Safety and function of a prototype microprocessor-controlled knee prosthesis for low active transfemoral amputees switching from a mechanic knee prosthesis: a pilot study.

Disabil Rehabil Assist Technol 2018 02 11;13(2):157-165. Epub 2017 Apr 11.

a Department of Physical Medicine, Rehabilitation and Occupational Medicine , Medical University of Vienna, General Hospital of Vienna , Vienna , Austria.

Purpose: Aim of this pilot study was to assess safety and functioning of a microprocessor-controlled knee prosthesis (MPK) after a short familiarization time and no structured physical therapy.

Materials And Methods: Five elderly, low-active transfemoral amputees who were fitted with a standard non-microprocessor controlled knee prosthesis (NMPK) performed a baseline measurement consisting of a 3 D gait analysis, functional tests and questionnaires. The first follow-up consisted of the same test procedure and was performed with the MPK after 4 to 6 weeks of familiarization. After being refitted to their standard NMPK again, the subjects undertook the second follow-up which consisted of solely questionnaires 4 weeks later.

Results: Questionnaires and functional tests showed an increase in the perception of safety. Moreover, gait analysis revealed more physiologic knee and hip extension/flexion patterns when using the MPK.

Conclusion: Our results showed that although the Genium with Cenior-Leg ruleset-MPK (GCL-MPK) might help to improve several safety-related outcomes as well as gait biomechanics the functional potential of the GCL-MPK may have been limited without specific training and a sufficient acclimation period. Implications for Rehabilitation Elderly transfemoral amputees are often limited in their activity by safety issues as well as insufficient functioning regarding the non microprocessor-controlled knee prostheses (NMPK), thing that could be eliminated with the use of suitable microprocessor-controlled prostheses (MPK). The safety and functioning of a prototype MPK (GCL-MPK) specifically designed for the needs of older and low-active transfemoral amputees was assessed in this pilot study. The GCL-MPK showed indicators of increased safety and more natural walking patterns in older and low-active transfemoral amputees in comparison to the standard NMPK already after a short acclimatisation time and no structured physical therapy. Regarding functional performance it seems as if providing older and low-active transfemoral amputees with the GCL-MPK alone without prescribing structured prosthesis training might be insufficient to achieve improvements over the standard NMPKs.
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http://dx.doi.org/10.1080/17483107.2017.1300344DOI Listing
February 2018

IMAGING DIAGNOSIS-ULTRASONOGRAPHIC APPEARANCE OF SKELETAL MUSCLE METASTASES IN A DOG WITH HEMANGIOSARCOMA.

Vet Radiol Ultrasound 2017 Nov 4;58(6):E64-E67. Epub 2016 Oct 4.

Dipartimento di Scienze Medico Veterinarie, University of Parma, Italy.

A 13-year-old spayed female German shepherd dog was presented for acute onset of lethargy, anorexia, and disseminated erythematous skin lesions. Thoracic radiographs and abdominal ultrasonographic findings were consistent with metastatic hemangiosarcoma. Multiple, ill-defined, irregularly shaped hypoechoic nodules were also detected within the thoracic and abdominal wall. Hemangiosarcoma metastases to the skeletal muscle were confirmed based on histopathological examination. Multivisceral involvement was also confirmed by necropsy. Metastatic neoplasia should be considered as a differential diagnosis for dogs with ill-defined, irregular, hypoechoic, intramuscular nodules.
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http://dx.doi.org/10.1111/vru.12432DOI Listing
November 2017

Intensive ultrasound treatment in acute calcific periarthritis of the wrist: a case report.

Wien Klin Wochenschr 2015 Aug 2;127(15-16):649-51. Epub 2015 Jul 2.

Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria,

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http://dx.doi.org/10.1007/s00508-015-0813-8DOI Listing
August 2015

Evaluation of contact lens multipurpose solutions on bacterial biofilm development.

Eye Contact Lens 2015 May;41(3):177-82

Department of Public Health and Infectious Diseases (M.A., A.C., G.L.S., R.P., M.T., L.S.), Sapienza University, Rome, Italy; and Department of Experimental and Clinical Sciences (S.P.), G. D'Annunzio University, Chieti, Italy.

Objectives: No sooner are contact lenses (CLs) inserted into the eyes than lipids, proteins, and glycoproteins rapidly accumulate on their surface, thus favoring the adhesion of commensal bacteria and biofilm formation. Infections may be caused by the proliferation of indigenous flora or other opportunistic pathogens. Our purpose was to evaluate the activity and the capacity of different CL solutions to interfere with the mechanisms of biofilm formation and stability and use of a system to study dynamically biofilm development.

Methods: We evaluated the antibiofilm activity of three different multipurpose solutions (MPSs): Regard, Biotrue, and OPTI-FREE PureMoist on four bacterial species (Serratia marcescens, Pseudomonas aeruginosa, Staphylococcus epidermidis, and Staphylococcus aureus). Static biofilm assay was first performed to analyze the effect of MPSs. Dynamic assays were performed with the BioFlux system to analyze the effect of the OxyChlorite solution Regard on the biofilm formation.

Results: Our studies show that MPSs are able to completely inhibit biofilm formation of Staphylococcus species and of S. marcescens after only 4 hr of incubation. Moreover, a reduction of biofilm formation by Pseudomonas was noted. Best results on P. aeruginosa were obtained with Regard. Regard was also used for dynamic assay, revealing its ability to disaggregate the mature biofilm. Regard completely inhibited biofilm formation by S. epidermidis and slowed down biofilm development by P. aeruginosa.

Conclusions: Our findings indicate that the CL solutions tested were all able to reduce biofilm formation. Furthermore, the BioFlux system was proven to be useful for the evaluation of the effectiveness of CL solutions against microbial biofilm formation.
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http://dx.doi.org/10.1097/ICL.0000000000000105DOI Listing
May 2015

Comparison of 2- and 3-category histologic grading systems for predicting the presence of metastasis at the time of initial evaluation in dogs with cutaneous mast cell tumors: 386 cases (2009-2014).

J Am Vet Med Assoc 2015 Apr;246(7):765-9

Department of Veterinary Sciences and Public Health, Faculty of Veterinary Medicine, University of Milan, 20133 Milan, Italy.

Objective: To compare the Kiupel (2 categories) and Patnaik (3 categories) histologic grading systems for predicting the presence of metastasis at the time of initial examination in dogs with cutaneous mast cell tumors (MCTs).

Design: Retrospective case series.

Animals: 386 client-owned dogs with cutaneous MCTs.

Procedures: Medical records of dogs with newly diagnosed, histologically confirmed cutaneous MCTs that had undergone complete clinical staging were reviewed for clinical and histopathologic data.

Results: All Patnaik grade 1 MCTs (n = 52) were classified as Kiupel low-grade MCTs, and all Patnaik grade 3 MCTs (43) were classified as Kiupel high-grade MCTs. Of the 291 Patnaik grade 2 MCTs, 243 (83.5%) were classified as Kiupel low-grade tumors, and 48 (16.5%) were classified as Kiupel high-grade MCTs. Dogs with Patnaik grade 3 MCTs were significantly more likely to have metastases at the time of initial examination than were dogs with grade 1 or 2 MCTs (OR, 5.46), and dogs with Kiupel high-grade MCTs were significantly more likely to have metastases than were dogs with Kiupel low-grade MCTs (OR, 2.54). However, 3 of 52 (5.8%) dogs with Patnaik grade 1 tumors, 48 of 291 (16.5%) dogs with Patnaik grade 2 tumors, and 44 of 295 (14.9%) dogs with Kiupel low-grade tumors had metastatic disease.

Conclusions And Clinical Relevance: Findings indicated that in dogs with cutaneous MCTs, prognostication should not rely on histologic grade alone, regardless of grading system used, but should take into account results of clinical staging.
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http://dx.doi.org/10.2460/javma.246.7.765DOI Listing
April 2015

Nasal eucoleosis in a symptomatic dog from Italy.

Vet Parasitol 2013 Jul 1;195(1-2):187-91. Epub 2013 Feb 1.

Department of Biopathological and Hygiene of Animal and Food Productions, Section of Parasitology, Faculty of Veterinary Medicine, University of Perugia, Italy.

A dog with chronic muco-purulent nasal discharge, sneezing, reverse sneezing and impaired scenting ability was diagnosed as being affected by nasal eucoleosis based upon rhinoscopic evidence of Eucoleus boehmi in situ, identification of the adult parasites in nasal biopsies, and eggs in the faeces by light and scanning electron microscopy. The dog was successfully treated with a single administration of moxidectin. A second course of moxidectin was required for about 10 weeks after the first treatment, because clinical signs recurred due to a likely re-infection. This second administration, along with measures undertaken to prevent geo- and coprophagic pica, resolved the parasitism, as demonstrated by negative copromicroscopic and rhinoscopic examinations, and prevented reinfestation for the next 4 months. To the best of the authors' knowledge, this represents the first report describing a clinical case of nasal eucoleosis with a demonstration of the adult parasites in situ in a dog from Italy where, until recently, infestation of E. boehmi was only detected by a coprological examination. Veterinarians and parasitologists should be aware of the occurrence of canine infection with E. boehmi. They should include this parasite in the differential diagnoses for animals suffering from upper airway distress and look systematically for it during rhinoscopic and copromicroscopic examinations.
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http://dx.doi.org/10.1016/j.vetpar.2013.01.022DOI Listing
July 2013

Comparative spatiotemporal analysis of the intrathecal immune response in natural listeric rhombencephalitis of cattle and small ruminants.

Comp Immunol Microbiol Infect Dis 2012 Sep 24;35(5):429-41. Epub 2012 Apr 24.

Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, Switzerland.

This study examined the spatiotemporal immune response in listeric rhombencephalitis of ruminants in situ. Our data support the view that astrocytes facilitate the containment of infectious lesions. Results on the natural disease recapitulate observations in experimental rodent models and suggest that the mounted adaptive lymphocytic response of ruminants is effective in eliminating Listeria monocytogenes (LM). However, our data indicate earlier participation of the adaptive immune response, a stronger B lymphocyte contribution and a more protracted macrophage infiltration in the natural disease than it has been deduced from experimental models. Therefore, such models should be complemented by studies in natural host systems. Various macrophage and microglia subsets are involved in listeric rhombencephalitis and their differential contribution may account for species differences in clinical course and outcome of infection as might species differences in the B-cell response. Future functional ex vivo and in vitro studies are necessary to further investigate the findings obtained in the present study.
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http://dx.doi.org/10.1016/j.cimid.2012.03.009DOI Listing
September 2012
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