Faculty of Medicine

Raadiosageduslik ablatsioon (RFA, radiofrequency ablation) on vaheinvasiivne ravimeetod, mille puhul piltdiagnostika kontrolli all viiakse kasvajakoldesse RFA elektrood, mille kaudu juhitakse koldesse raadiosageduslik elektrivool. Viimane kutsub esile koe lokaalse termokoagulatsiooni, mille tulemusel tekib kudedes nekroos. Seda ravimeetodit on edukalt rakendatud neerukasvajate lokaalseks raviks Pohja-Eesti Regionaalhaiglas alates 2006. a juunist. Artikli eesmargiks on tutvustada RFAd kui perspektiivset meetodit neerukasvajate ravis ja anda ulevaade esimestest ravitulemustest Pohja-Eesti Regionaalhaiglas tehtud protseduuride pohjal. Eesti Arst 2007; 86 (11): 881–887

The purpose of this study was to analyse subjective self-evaluation of musculoskeletal discomfort conducted by female production assembly workers. Thirty-seven female assembly workers aged 20-54 years participated in this study, whereas 35 of them were right-handed. Discomfort in neck, shoulder, upper back, upper arm, low back, forearm, wrist, hips, thigh, knees, lower legs and heels was subjectively evaluated by Cornell Musculoskeletal Discomfort Questionnaire. The results indicated that female assembly workers felt most work-related discomfort in the neck (44%), lower back (19.7%) and in the right wrist (15%). Discomfort was less pronounced in the right knee (0.01%), left upper arm (0.04%) and left hip buttocks (0.1%). In conclusion, this study indicated that subjective discomfort sensed by female production assembly workers was higher in the neck, lower back, right shoulder and the right wrist. According to the study results, further research is needed on the relationship between musculoskeletal discomfort and its influence on the quality of assembly work.

Hallux Valgus (HV) (also Hallux abducto valgus) is a common deformity of the foot, which causes pain, inflammation and decreased joint mobility in the big toe. There are no universally accepted protocol for treating advanced phase HV, corrective surgery seems to be the most common direction of curing advanced HV deformation. The purpose of this study was to assess the effects of twomonth home exercise programme (HEP) on joint mobility and pain of the first metatarsophalangeal joint (MTP-joint) in women with advanced phase HV deformation. Seven women with mean age 55.6±2.9 years with advanced phase HV deformation (first MTP-joint angle more than 20 degrees) participated in the study. Foot pain in different conditions was assessed with modified Foot Function Index's (FFI) pain subscale before and after HEP. Passive range of motion (PROM) of flexion and extension of the first MTP-joint was measured before and after HEP using a standard mechanical goniometer. A significant increase (p<0.001) in the passive extension of the first MTP-joint was noted after HEP compared with the joint mobility before HEP, also passive flexion increased considerably but no significant difference was noted (p>0.05). Foot pain score decreased significantly (p<0.05) after HEP. In conclusion, in advanced phase HV two-month HEP was an effective therapeutic approach for increasing first MTP-joint mobility and reducing foot pain.

The aim of the study was to investigate the effect of 8-week home exercise programme (HEP) on thigh muscle tone in patients with knee joint osteoarthritis (OA) before total knee arthroplasty (TKA). Fifteen female patients with knee joint OA aged 50-74 years who were scheduled to TKA participated in the study before and after 8-week HEP. Muscle tone (frequency of muscle oscillation), elasticity (logarithmic decrement of muscle damped oscillations) and stiffness of rectus femoris, vastus medialis and vastus lateralis muscles were measured using hand-held myotonometer Myoton 3. Self-reported assessment of knee joint function and pain was performed using Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). Significant (p<0.05) decrease in muscle tone and stiffness of vastus lateralis muscle was noted after HEP, but no change was observed in elasticity of the muscle. Also no significant difference was found in rectus femoris and vastus lateralis muscles in either tone, elasticity or stiffness. As a result of 8-week HEP, pain intensity in knee joint decreased, whereas self-reported function of knee joint by WOMAC did not improve significantly. Preoperative performance of HEP is recommended for improvement of surrounding knee joint muscle function.

The aim of the present study was to investigate the gait and muscle strength characteristics in total knee arthroplasty (TKA) patients with patellofemoral pain syndrome (PFPS) before and six months after surgery. Eight patients (4 men and 4 women) aged 58-77 years with PFPS following unilateral TKA who had primary degenerative knee OA participated in the study before and six months after reoperation. In patients was registered the active range of motion (AROM) of knee extension and flexion, hip abduction and adduction. Isometric maximal voluntary contraction (IMVC) force of knee flexors, extensors, abductors and adductors was measured and gait kinematic characteristics and kinetic characteristics of knee joint were recorded. Knee flexion AROM in the involved leg was significantly lower (p<0.05) as compared to the uninvolved leg pre-and post-surgery. The patients had greater (p<0.05) hip abduction AROM and significant increase (31%, p<0.05) of IMVC force of the involved legʼs hip abductors postoperatively as compared before surgery. Six months after surgery H. Gapeyeva et al. a significant (p<0.05) improvement of gait spatiotemporal characteristics (increase of swing time and stride length (p<0.05), together with decrease of stance time and cadence, as well increase of stride length) was noted in the involved leg. In TKA patients 6 months after reoperation due to PFPS the knee joint function in involved leg was significantly improved and the positive changes in gait with comfortable velocity took place as compared before surgery.

Hip muscle weakness is an often-occurring condition after displaced fractures of the proximal femur in older patients. The aim of this study was to compare hip muscle strength and pain in elderly female patients after proximal femoral fracture. Nine female patients (mean±SD of 71.4±3.9 yrs) participated in this study. Knee extensor, hip abductor and adductor muscle strength was evaluated with handheld dynamometer Lafayette (USA) during the first week of postoperative stay in hospital, and 6 months postfracture with fractured and nonfractured leg. Pain was assessed using a visual analogue scale. A week after the operation knee extensor, hip abductor and adductor muscle isometric muscle strength for the fractured leg was decreased (p<0.05) by 50.7%, 55.6% and 38.8%, respectively, compared to the nonfractured limb. At 6-month follow-up, hip muscle strength increased significantly (p < 0.05) in both the fractured and nonfractured leg. Hip muscle strength for the fractured leg was significantly lower (p<0.05) compared with the nonfractured leg 6 months after surgery. Pain score was significantly (p<0.05) higher during the first postoperative week as compared to 6 months follow-up. It was concluded that voluntary maximal isometric forcegenerating capacity of knee and hip muscles for the fractured leg was markedly increased 1 week and 6 months postoperatively. Isometric Changes in hip muscle strength after proximal femoral fracture 81 force-generating capacity for the fractured leg was significantly improved by 6 months follow-up.

The purpose of this study was to compare postural control and vertical jumping performance characteristics in adolescent and adult male basketball players. Forty nine male basketball players participated in this study. They were distributed into three groups: (1) young adolescents (YA; with mean age 15.4±0.7 yrs), (2) old adolescents (OA; 17.9±1.2 yrs), and (3) adults (AD; 25.9±3.7 yrs). Static standing balance during bi-and unipedal standing and vertical jumping characteristics were measured on a force platform. AD basketball players had significantly (p<0.05) higher vertical jumping height and power development per unit of body mass as compared to YA and OA group; OA group outperformed YA group as well. Static standing stability was better in AD group than YA and OA group. There were no significant differences between YA and OA groups in static standing balance test. Age and sports participation were significantly (p<0.05) positively correlated with vertical jumping height and power. Anthropometrical characteristics and sports participation were all significantly (p<0.05) negatively correlated with centre of pressure trace length during bi-and unipedal standing. No significant correlation was observed between balance and vertical jumping characteristics. It was concluded that in male basketball players the improvement in vertical jumping performance and static standing balance during bipedal stance are influenced by sports participation 90 T. Jallai et al. and maturation, whereas static standing balance during unipedal stance is not affected by aforementioned factors.

The aim of this study was to investigate knee pain and postural stability in women with knee osteoarthritis (OA), who used postoperative home exercise program (HEP) with balance exercises. 14 women with knee OA in stage III-IV (aged 48-70 years) participated in this study before and 6 months after unilateral total knee arthroplasty (TKA). All patients performed HEP during 6 months after unilateral TKA. Data of patients was compared with healthy age-matched women (controls, n=10). Postural stability characteristics (centre of pressure (COP) displacement in the anterior-posterior (AP) and mediolateral (ML) direction, COP sway equivalent radius and area) during 30 s bipedal standing (eyes open) were recorded on two dynamographic force plates. Pain in knee joint was estimated with visual-analogue scale. COP displacement in AP direction of the operated and non-operated leg was greater (p<0.05) in women with knee OA before and 6 months after TKA compared to the controls. Knee joint pain in the operated leg reduced 70% after TKA. TKA together with HEP has an important role in preserving postural stability and reducing knee joint pain in women with III-IV stage gonarthrosis.

The aim of this study was to compare the isometric force production capacity of the leg extensor muscles in 9-12-year-old children with spastic diplegia (SD; 11 girls and 10 boys) and age-and gendermatched nondisabled children (11 girls and 10 boys). Isometric maximal voluntary contraction force of the leg extensor muscles was measured during unilateral and bilateral contractions (leg press exercise) using custom-made dynamometric chair. Children with SD had significantly (p<0.05) lower isometric maximal force during bilateral and unilateral contractions compared with healthy children. Bilateral strength deficit did not differ significantly in children with and without SD. No significant correlations between isometric force characteristics of the leg extensor muscles and anthropometric parameters were observed in children with SD. These results indicated that in children with SD, isometric voluntary force-generating capacity of the leg extensor muscles during bilateral and unilateral contractions is markedly reduced, whereas bilateral strength deficit is not differ compared with age-and gender-matched healthy children.

The aim of this study was to evaluate subjectively and objectively neuromuscular fatigue in female painters before and after a working day. The subjects (n=11) were female painters aged 22-60 years. The subjects completed a questionnaire and gave a subjective evaluation on muscle fatigue sensation in hands, trunk, back and lower limbs according to Borg's Category Ratio (CR-10) scale. Thereafter they performed 3-minute test of painting a wall, in the course of which the electromyographical (EMG) power spectral median frequency (MF) slope for biceps brachii, trapezius, deltoid and infraspinatus muscles was measured. The results indicated a significant change in the subjective muscle fatigue sensation in hands by 40%, lower limbs by 54% and trunk by 57% after the working day, compared to the beginning of the working day. EMG power spectral MF slope of the measured muscles did not differ significantly during the 3-minute wall coloring test before and after working day. It was concluded that subjective muscle fatigue sensation in hands, lower limbs and trunk was higher after the working day whereas it was less pronounced in the back. Muscle fatigue evaluated objectively by MF slope of EMG power spectrum from biceps brachii, trepezius, deltoid and infraspinatus muscles was not evident during the wall coloring test before and after the working day.

We studied the effect of impaction of fresh cancellous bone or demineralized bone matrix (DBM) around cancellous screws in 25 cadaver femoral heads. The bone mineral content (BMC) of femoral heads was measured to determine if greater relative increase in holding power will be achieved by impaction-grafting, as the BMC of the specimen decreases. A 60% (p < 0.001) relative increase in the pull-out force was achieved by impaction-grafting with DBM, compared to non-grafted controls. The augmenting effect of fresh cancellous bone graft and DBM did not differ significantly. The relative improvement in holding power was not inversely correlated to femoral head BMC, but was inversely related to the pullout resistance of non-grafted control screws. These findings suggest that impaction-grafting provides significantly better hold of cancellous screws in femoral heads.

The aim of this study was to investigate motor performance and haptic object recognition (HOR) in 5-year-old boys with minor to moderate specific impairment of expressive language (expressive-SLI). Methods: Twenty-eight boys with expressive-SLI and 26 boys with typical language development as controls were recruited from ordinary kindergartens. An assessment of the voluntary isometric force production and relaxation capacity of the leg extensor muscles, manual dexterity, ball skills, balance and HOR was performed and the results were compared with those for age-matched control group. Results: Reaction times to voluntary contraction and relaxation of the leg extensor muscles as well as manual dexterity did not differ significantly in the measured groups. Boys with expressive-SLI demonstrated poorer results in ball skills (p < 0.01), balance (p < 0.01), less leg extensors strength (p < 0.05) and made considerably more (p < 0.001) errors in haptic perception test when compared to controls. Conclusions: Deviations in gross-motor performance and haptic perception are very common in children with minor to moderate expressive-SLI, being embodied especially in less muscle strength of lower extremities, poorer ball skills, balance and HOR.

Background and aims: This study ex amined the effect of recreational physical activity on the contractile properties of skeletal muscles in middle aged vs young women. Methods: A total 74 young (20 29-year-old) and middle-aged (45-54-year-old) women participated. The subjects were distributed into four groups: 1) young recreationally physically active (RPA) (n=19), 2) young recreationally physically non-active (RPN) (n=21), 3) middle-aged RPA (n=23) and 4) mid dle-aged RPN (n=16). RPA women exercised regular ly in groups of recreational gymnastics 2-3 times per week. Isometric twitch of the plantarflexor muscles was evoked by supramaximal electrical stimulation of the tibial nerve in resting and post-activation potentia tion state. Results: A greater resting twitch maximal rate of force development (RFD), and potentiated twitch peak force (PF) and maximal rate of relaxation (RR) were observed in the young RPA women com pared with the two middle-aged women groups. In young RPN women, these characteristics were greater than in the middle-aged RPN women, whereas they did not differ significantly when compared with the middle aged RPA women. A shorter resting and potentiated twitch contraction time, and a greater potentiated twitch maximal RFD were found in the young com pared with the middle-aged groups. There were no significant differences in twitch characteristics be tween RPA and RPN women of similar age. Conclu sions: The recreational gymnastic type of physical activity did not have a marked effect on twitch con tractile properties in young and middle-aged women. A reduced speed of isometric twitch contraction was found in middle-aged women, which was more pro nounced in the post-activation potentiation state.

This study examined lower limb performance in older sedentary patients with Parkinson's disease (PD). Methods: Fourteen female patients with mild to moderate PD and 12 age-matched controls were included in this study. The force preparation and production of the knee extensor muscles during maximal isometric contraction were measured by dynamometric chair. Two force plates were used to measure the chair rising performance. Results: PD patients had longer visual reaction time during performing maximal isometric contraction, and lower maximal isometric force (MF) and rate of force development of the knee extensor muscles compared with controls. However, MF relative to body weight (BW) did not differ significantly in PD patients and controls. A longer chair rising time and lower maximal rate of vertical ground reaction force (VGRF) development while rising from a chair were found in PD patients compared with controls. No significant differences in maximal VGRF, and the sum of maximal VGRF of the right and left legs relative to the BW while rising from a chair were observed between the groups. In PD patients, chair rising time correlated negatively with MF of the knee extensor muscles. PD subjects also showed a positive correlation between the BW-related maximal VGRF while rising from a chair and MF of the knee extensor muscles relative to BW. Conclusions: These data suggest that subjects with PD are more deficient in the regulation of force-time parameters, rather than simply in force production of the knee extensor muscles.

The aim of this study was to evaluate changes in neuromuscular fatigue characteristics in painters following the working day. The subjects (n = 10) were female painters aged 22-60 years. First the subjects completed a questionnaire and thereafter they performed before and after the working day a 3-minute test of wall painting, in the course of which the electromyographical (EMG) power spectral median frequency (MF) for biceps brachii, trapezius, deltoideus and infraspinatus muscles was measured. The results indicated an increase in subjectively evaluated muscle fatigue compared to the beginning of the working day, whereas the most burdened regions were the arms and shoulders. Objectively estimated muscle fatigue emerged before and after the working day when comparing EMG power spectral MF measured at the beginning and end of the wall painting test. However, this muscle fatigue, evaluated objectively by EMG power spectrum MF slope from biceps brachii, trapezius, deltoideus and infraspinatus muscles, did not differ significantly before and after the working day. This study revealed that painters used different manners of work, whereas the working tool was the same for everyone and no-one had customized it for herself. It is also important to emphasize that 82% of the workers had not been guided in terms of ergonomics. The results of this study can be used by specialists of ergonomics.

Innovation and technical change often do produce workplace pain [1]. Looked at from a medical perspective this is not a new phenomenon. As long ago as 1685 Giovanni Alfonso Borelli, the father of modern biomechanics stated: "muscular tensions inevitably have to be involved in holding posture"[2]. And in 1700 Bernardo Ramazzini, the father of occupational medicine observed about neck and shoulder complaints in clerks "Yet tis certain that in each City and Town vast Numbers of Persons earn their Bread by writing. The Diseases of Persons incident t o that Craft arise from three Causes: First, constant Sitting, secondly the perpetual Motion of the Hand in the same Manner, and thirdly, the Attention and Application of the Mind"[3]. These great minds came to these truths purely as a consequence of observing, palpating, and inspecting. In their day there were no tools for objective measurement. In recent times space medicine has given important insights into the significance and effect of gravity on the human musculoskeletal system, a number of devices have been developed to gain better understanding of how muscles function, and it has been established that sitting for long time is in itself a risk factor for developing neck pain.

The triangular capsular space between the insertion tendons of the Mm. supraspinatus and subscapularis-the "rotator interval", can be divided into lateral, medio-superior and medio-inferior parts. The lateral part of the capsule is strengthened by the "Lig. semicirculare humeri" and the anterior fibres of the M. supraspinatus tendon. The Ligg. coracohumerale and "coracoglenoidale" are the macroscopical elements of the medio-superior part. The medio-inferior part of the "rotator interval" is reinforced by the Ligg. glenohumeralia superius et medium. The key ligament of the "rotator interval" is the "Lig. semicirculare humeri". Laterally it ensures the insertion of the anterior fibres of the M. supraspinatus tendon above the Lig. transversum humeri and on the Tubercula majus et minus. Medially it is the place of attachment of the Lig. coracohumerale and oblique fibres of the Lig. glenohumerale superius. The "rotator interval" is not a weak capsular region but a complex network of macroscopically recognizable tendinous and ligamentous structures.

During the last 50-60 years, due to development of medical care and hygienically safe living conditions, the average life span of European citizens has substantially increased, with a rapid growth of the population older than 65 years. This trend places evergrowing medical and economical burden on society, as many of the older subjects suffer from age-related diseases and frailty. Coping with these problems requires not only appropriate medical treatment and social support but also extensive research in many fields of aging-from biology to sociology, with involvement of older people as the research subjects. This work anticipates development and application of ethical standards suited to dynamic advances in aging research. The aim of this review is to update the knowledge in ethical requirements toward recruitment of older research subjects, obtaining of informed consent, collection of biological samples, and use of stem cells in preclinical and clinical settings. It is concluded that application of adequate ethical platform markedly facilitates recruitment of older persons for participation in research. Currently, the basic ethical concepts are subjected to extensive discussion, with participation of all interested parties, in order to guarantee successful research on problems of human aging, protect older people from undesired interference, and afford their benefits through supporting innovations in research, therapy, and care. Keywords Ethical issues Á Human aging Á Recruitment of subjects Á Informed consent Á Tissue samples Á Stem cells Á Older population

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