The results concerning the efficacy of the multidisciplinary treatment are in accordance with former meta-analyses. Surprisingly, the findings suggest that the presented traditional orthopedic treatment was inherently very effective. The implications of these findings are discussed with respect to the benefit of additional psychologic interventions and the benefit of aftercare approaches for chronic pain patients.

The clinical value of high-resolution real-time sonography for the diagnosis of acute and complicated colonic diverticulitis was prospectively studied in 130 consecutive patients with abdominal complaints, because of which the disease entered into differential consideration. The results of ultrasound investigation were compared with those of clinical examination on admission. Regarding history and initial clinical evaluation, diverticulitis was graded as "highly suspected" in 19 (36.5 percent) out of a total of 52 patients with later proven colonic diverticulitis (prevalence 40 percent), as "possible but equivocal" in 24 (46.2 percent), and as "very unlikely" in the remaining nine (17.3 percent) patients. Ultrasonography enabled the diagnosis of diverticulitis with an overall accuracy of 97.7 percent, a sensitivity of 98.1 percent, and a specificity of 97.5 percent. The predictive values of positive and negative ultrasound examinations were 96.2 percent and 98.5 percent, respectively. The echomorphologic features of acute diverticulitis include visualization of a colon segment presenting with local tenderness on gradual compression, which showed hypoechogenic thickening of the wall and a targetlike appearance in transverse view due to inflammatory changes and muscular thickening. Sonographic signs of peridiverticulitis (hyperechoic halo) were found in 96 percent of patients, echogenic diverticula in 86 percent. Twelve (92 percent) of 13 abdominal abscesses were detected on initial ultrasound examination and could be treated by percutaneous drainage in seven cases, while six required surgical intervention. These results indicate that high-resolution sonography with graded compression is highly sensitive and specific for the imaging diagnoses of acute colonic diverticulitis and complicating abscess.

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Zusammenfassung. Zur Erfassung von Selbstwirksamkeitserwartungen bei Personen mit chronischen Schmerzen wird der Fragebogen zur Erfassung der schmerzspezifischen Selbstwirksamkeit (FESS), eine Adaptation des Pain Self-Efficacy Questionnaire (PSEQ) ( Nicholas, 2007 ), vorgestellt. Im Gegensatz zu anderen Selbstwirksamkeitsmaßen berücksichtigt dieser bei der Einschätzung von Selbstwirksamkeitserwartungen die vorliegenden Schmerzen. In einer obe von N = 363 Patienten (vorwiegend mit Rückenschmerzen) einer orthopädischen Rehabilitationsklinik wurden die psychometrischen Eigenschaften des FESS überprüft. Das Cronbachs Alpha der Gesamtskala liegt bei α = .93. Die einfaktorielle Struktur ließ sich faktorenanalytisch belegen. Hinweise auf die konvergente Validität des FESS liefert besonders die hohe Korrelation zur schmerzbedingten Beeinträchtigung („disability”) (PDI). Hinsichtlich der Konstruktvalidität zeigen sich für den spezifischen FESS und ein allgemeines Selbstwirksamkeitsmaß (SWE) teilweise unterschiedliche Korrelationen zu zentralen Kriteriumsvariablen des Schmerzgeschehens. Regressionsanalysen zeigen den prädiktiven Nutzen des FESS. Somit scheint der FESS ein gutes Instrument zur Status- und Veränderungsmessung in der klinischen Praxis sowie zur Evaluation von Therapieerfolgen in der Schmerzforschung zu sein.

BackgroundSudden limb paresis is a common problem in White Leghorn flocks, affecting about 1% of the chicken population before achievement of sexual maturity. Previously, a similar clinical syndrome has been reported as being caused by inflammatory demyelination of peripheral nerve fibres. Here, we investigated in detail the immunopathology of this paretic syndrome and its possible resemblance to human neuropathies.MethodsNeurologically affected chickens and control animals from one single flock underwent clinical and neuropathological examination. Peripheral nervous system (PNS) alterations were characterised using standard morphological techniques, including nerve fibre teasing and transmission electron microscopy. Infiltrating cells were phenotyped immunohistologically and quantified by flow cytometry. The cytokine expression pattern was assessed by quantitative real-time PCR (qRT-PCR). These investigations were accomplished by MHC genotyping and a PCR screen for Marek's disease virus (MDV).ResultsSpontaneous paresis of White Leghorns is caused by cell-mediated, inflammatory demyelination affecting multiple cranial and spinal nerves and nerve roots with a proximodistal tapering. Clinical manifestation coincides with the employment of humoral immune mechanisms, enrolling plasma cell recruitment, deposition of myelin-bound IgG and antibody-dependent macrophageal myelin-stripping. Disease development was significantly linked to a 539 bp microsatellite in MHC locus LEI0258. An aetiological role for MDV was excluded.ConclusionsThe paretic phase of avian inflammatory demyelinating polyradiculoneuritis immunobiologically resembles the late-acute disease stages of human acute inflammatory demyelinating polyneuropathy, and is characterised by a Th1-to-Th2 shift.