Objective. To study the use of combined photopheresis and psoralen-ultraviolet A irradiation (PUVA) in the treatment of psoriatic arthritis.Methods. Eight patients with psoriasis and seronegative arthritis received photopheresis for 12 weeks, followed by photopheresis plus PUVA for another 12 weeks. Clinical and laboratory examinations were performed every 3 months for up to 1 year after therapy.Results. Four patients experienced a marked improvement of joint symptoms that lasted for 212 months post-therapy (74% decrease in the Ritchie articular index; P < 0.01). Prior to therapy, these patients had a higher CD4CD8 ratio than the poor responders. Only minor laboratory changes occurred.Concluswn. A more extensive trial of photopheresis plus PUVA in psoriatic arthritis is warranted.
The effects of a shortened post-operative mobilization programme following flexor tendon repair in zone 2 in the hand were examined in a prospective, randomized study. 91 digits in 82 patients were included in the study. All injured tendons were repaired within 24 hours and all patients were subjected to the same mobilization programme during the first 6 weeks using a passive flexion-active extension régime. After 6 weeks the patients were randomized into two groups; in group A full activity was allowed after 8 weeks while in group B unrestricted use of the injured hand was not allowed until 10 weeks after the tendon repair. Functional results were compared using the Louisville, Tsuge and Buck-Gramcko assessment systems. Grip-strength was measured 16 weeks after repair, subjective assessment of hand function was recorded on a visual analogue scale, and absence from work was registered. No significant differences were observed between the groups regarding functional results, rupture rates, grip strength or subjective assessment, but absence from work was reduced by 2.1 weeks with the shorter mobilization programme. Using the described régime, full activity can be encouraged 8 weeks after flexor tendon repair in zone 2 of the hand without adverse effects on functional results or increased risk of rupture of the repair.
The results following primary and delayed primary repair in zone 2 flexor tendon injuries were evaluated in 85 fingers of 79 patients using immediate controlled mobilization post-operatively. In 31 patients a conventional Kleinert technique was used. In the remaining 48 patients a modified technique was used with rubber band traction to all fingers instead of only to the injured one. Also a shorter dorsal splint was used in order to secure extension of the PIP and DIP joints. The results were improved and the time of treatment was reduced.
Between 95% and 100% had answered these questions. The table of questions where the patients should use their own words in describing the connections between symptoms and actions was between 75% and 100%. The majority of answers could be accepted as ''correct'', but some of the answers revealed both wrong answers, misunderstandings or that the patient mixed different kinds of information given. Example: ''What are you going to do if your breathing worsens'' ''Relax and take it easy'' ''Have small meals about 4-5 times daily. This is also good for my diabetes. Not smoke. Get enough rest during the day. Avoid rapid movements or heavy work'' ''Use more pillows in bed (sit upright)'' ''Relax some more. My breathing is quite well''. (This question got 16 answers, 10 was accepted as ''correct''.) Conclusion: A majority of patients attending the heart failure clinic feel that their knowledge has increased and they feel more secure. A questionnaire which allows the patient to use his own words while explaining the relationship between symptoms and actions to be taken to avoid decompensation, shows that there are some misunderstandings and wrong answers. This confers with results found in other studies. It will always be a challenge to manage to adapt the information individually to avoid misunderstandings.
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