Showing papers by "St Thomas' Hospital published in 1989"
TL;DR: It is concluded that growth hormone has a role in the regulation of body composition in adults, probably through its anabolic and lipolytic actions.
Abstract: In a double-blind, placebo-controlled trial, we studied the effects of six months of growth hormone replacement in 24 adults with growth hormone deficiency. Most of the patients had acquired growth hormone deficiency during adulthood as a consequence of treatment for pituitary tumors, and all were receiving appropriate thyroid, adrenal, and gonadal hormone replacement. The daily dose of recombinant human growth hormone (rhGH) was 0.07 U per kilogram of body weight, given subcutaneously at bedtime. The mean (+/- SE) plasma concentration of insulin-like growth factor I increased from 0.41 +/- 0.05 to 1.53 +/- 0.16 U per liter during rhGH treatment. Treatment with rhGH had no effect on body weight. The mean lean body mass, however, increased by 5.5 +/- 1.1 kg (P less than 0.0001), and the fat mass decreased by 5.7 +/- 0.9 kg (P less than 0.0001) in the group treated with growth hormone; neither changed significantly in the placebo group. The basal metabolic rate, measured at base line and after one and six months of rhGH administration, increased significantly; the respective values were 32.4 +/- 1.4, 37.2 +/- 2.2, and 34.4 +/- 1.6 kcal per kilogram of lean body mass per day (P less than 0.001 for both comparisons). Fasting plasma cholesterol levels were lower (P less than 0.05) in the rhGH-treated group than in the placebo group, whereas plasma triglyceride values were similar in the two groups throughout the study. We conclude that growth hormone has a role in the regulation of body composition in adults, probably through its anabolic and lipolytic actions.
1,411 citations
TL;DR: The group of patients presented appears to be closely related, but distinctly separate from SLE, with a history of deep vein thromboses and a family history of SLE or a familial clotting tendency in a minority.
972 citations
TL;DR: Strokes were often multiple and were followed by multi-infarct dementia in nine patients and 10 patients in whom the presence of antiphospholipid antibodies was the major and often the sole immunologic disturbance present, and all patients with any of these conditions who present with vascular events should be screened for these antibodies.
322 citations
TL;DR: Rashes soon after surfacing were related to shunts but late rashes were not, and in divers who had neurological symptoms within 30 minutes of surfacing the prevalence of shunt was significantly higher.
275 citations
TL;DR: Measurement problems associated with hydrophone damage and the uncertainties in the hydrophone calibration at high pressures are discussed and an estimate of the total uncertainty in the absolute measurements of the spatial-peak temporal-peak positive pressure is given as +/- 36%.
Abstract: A survey of the pressures and intensities generated by different commercial extracorporeal shock wave (ESWL) lithotripters is reported. The lithotripters included in the survey are the Dornier HM3, Wolf Piezolith 2200 and 2300, Siemens Lithostar, Technomed Sonolith 2000 and 3000, and EDAP LT-01. Measurements were made using a polyvinylidene difluoride (PVdF) membrane hydrophone in water. The zero crossing frequency of one complete cycle of the focused pulse from ESWL equipment is in the range 0.1 to 1 MHz. Spatial-peak temporal-peak positive and negative pressures up to 114 MPa and 10 MPa, respectively, have been measured and the rise times of the positive pressure half cycle at maximum output settings are 30 ns or less. The mean spatial-peak temporal-average intensity of the lithotripters is 5.0 × 10 2 W m −2 when operated at a pulse repetition frequency of 1 Hz. The spatial-peak pulse-average intensity ranges from 6.6 × 10 7 to 1.24 × 10 9 W m −2 . The estimated acoustic energy in a single pulse (at the focus) at the maximum output setting of the lithotripters varies from 2.0 × 10 −3 J to about 9.0 × 10 −2 J. The beam area in the focal plane varies by a factor of 100 on different lithotripters and the temporal-peak pressure at the position of the skin at the entry point of the beam by a factor of 30. Measurement problems associated with hydrophone damage and the uncertainties in the hydrophone calibration at high pressures are discussed and an estimate of the total uncertainty in the absolute measurements of the spatial-peak temporal-peak positive pressure is given as ±36%.
238 citations
TL;DR: Nurses screened for carriage of epidemic methicillin-resistant Staphylococcus aureus immediately before and after duty periods in which they solely attended six patients widely colonized with two EMRSA strains distinguishable by plasmid analysis may explain some of the difficulties in controlling E MRSA.
Abstract: Twenty-six nurses were repeatedly screened for carriage of epidemic methicillin-resistant Staphylococcus aureus (EMRSA) immediately before and after duty periods in which they solely attended six patients widely colonized with two EMRSA strains distinguishable by plasmid analysis. EMRSA carriage was detected in 13 nurses. Three EMRSA carriage patterns emerged: transient carriage in 12 nurses, when the EMRSA was isolated from noses or fingers of nurses after duty but was gone before their next day's duty; short-term nasal carriage, seen on occasion in 4 of these 12 nurses, when EMRSA carriage was detected on two consecutive screens; and persistent nasal carriage, seen in 1 nurse only, when the EMRSA was seen on more than two consecutive occasions. All but one of these incidents of carriage could be explained by close patient, rather than environmental, exposure and occurred despite an intensive control programme. Transient or short-term carriage in nurses probably resulted in transfer of the EMRSA between patients. Staff decontamination should be considered following a period of cohort nursing of EMRSA patients, especially if staff members are shortly to nurse unaffected patients. Our findings may explain some of the difficulties in controlling EMRSA.
233 citations
TL;DR: Results indicate that platelet alpha-granule Fg can be derived from the circulating plasma pool and that Fg uptake can occur in both platelets and MKs.
Abstract: The origin of platelet alpha-granule fibrinogen (Fg), whether from endogeneous synthesis or exogeneous derivation, remains unknown. Although Fg biosynthesis by megakaryocytes (MK) has been suggested, recent studies have demonstrated that certain alpha-granular proteins originate primarily from plasma. To study the origin of alpha-granule Fg, platelet-associated Fg was measured by ELISA and Western blotting, and localized by immunofluorescence and immunoelectron microscopy in a patient with symptomatic congenital afibrinogenemia before and after replacement therapy with cryoprecipitate. alpha-Granule Fg was detected in the majority of platelets as early as 24 h postinfusion, suggesting that direct platelet uptake was occurring. Platelet Fg reached a maximum value of 42.5% of normal values at 3 d postinfusion and was localized in the alpha-granules, while plasma levels followed a typical half-life profile. Significant alpha-granule Fg was still detectable at 13 d postinfusion, with plasma Fg virtually absent. Studies on cultured CFU-MKs from the patient also confirmed that MKs can incorporate exogeneous Fg into alpha-granules. These results indicate that platelet alpha-granule Fg can be derived from the circulating plasma pool and that Fg uptake can occur in both platelets and MKs.
208 citations
TL;DR: It is concluded that the spread of a small volume of solution after paravertebral injection is imprecise and unpredictable and should be regarded as hazardous and interpreted with extreme caution.
Abstract: The spread of solution after a standardized paravertebral injection was studied to determine the precision and predictability of paravertebral spread. The spread of 5 ml of a solution of radiological contrast medium (sodium iothala-mate) and local anesthetic mixture after 45 (34 thoracic, 11 lumbar)
157 citations
TL;DR: The effect of cold and/or a raised partial pressure of oxygen was examined in eleven people with no demonstrable cardiac abnormality but who had pulmonary oedema when scuba diving or surface swimming, and in ten normal divers, finding that stimuli induced pathological vasoconstriction in the pulmonary Oedema group.
153 citations
TL;DR: The finding of selective dynamic fusimotor activation during unpredictably imposed and resisted stretches and evidence for powerful, often transient activation of dynamic efferents has now been obtained for three additional motor paradigms, clearly support the concept of flexible central control.
Abstract: A refined version of an experimental iterative simulation method is described, which was used to infer, from chronic spindle afferent recordings, type and time course of static and dynamic fusimotor activation during a variety of voluntary movements. When used to estimate overall fusimotor drive (without distinction between static and dynamic action) the method provides unique solutions. However, when generating independent γs and γd activation profiles, the solutions no longer are strictly unique. Yet the boundary conditions imposed by the type specific characteristics of γ−action nevertheless permit detection of powerful activation, especially of dynamic efferents. Extending the finding of selective dynamic fusimotor activation during unpredictably imposed and resisted stretches, evidence for powerful, often transient activation of dynamic efferents has now been obtained for three additional motor paradigms. First, initiation of walking was accompanied by mixed fusimotor action. Static drive was stepped up and then maintained, whereas dynamic drive declined after an initial abrupt peak. Second, corrective balancing on a narrow walk beam was characterized by largely maintained static background drive, whilst dynamic activation profiles often exhibited powerful surges or transients, when the animal crouched to regain balance. These preceded subsequent EMG bursts during the stretch phase of crouching by about 300 ms. Third, preparation for landing from rapid lowering featured prominent and possibly selective activation of dynamic fusimotor neurones, which peaked while the animal was in mid-air and declined upon landing, and which preceded the sharp onset of EMG after landing by several hundred milliseconds. In all cases the fusimotor activation profiles were unrelated to the parent muscle EMG and difficult to reconcile with the notion of α−γ linkage or coactivation. These findings then clearly support the concept of flexible central control, particularly of dynamic γ−motoneurones during certain motor tasks.
133 citations
TL;DR: By means of two different IgM-capture assays, enterovirus-specific IgM responses were shown in 9 of 14 patients with chronic relapsing pericarditis, suggesting persistent enterov virus infection, particularly coxsackie B virus infection.
TL;DR: The nature of the time course of susceptibility to ischaemia- induced VF compared with that of reperfusion-induced VF raises the possibility that the reperfusions-inducedVF may be clinically relevant as a cause of sudden death only when ischaemic-induced vF is suppressed, a finding which has not been reported previously.
TL;DR: It is suggested that clinical examination by an experienced examiner is the most accurate way to determine cruciate ligament integrity and that in many cases, confi dence in clinical diagnosis was improved by instru mented confirmation.
Abstract: A prospective study was performed on 50 patients who were thought or suspected to have cruciate ligament tears. Each patient had a clinical examination preoperatively and under anesthesia and instrumented examination using the MedMetric KT-1000 arthrometer, Stryker knee laxity tester, and Genucom knee analysis. The diagnosis was confirmed by arthrotomy or arthroscopy. Thirty had acute knee injuries (within 2 weeks), 9 had subacute (2 weeks to 3 months), and 11 had chronic injuries. The surgical findings demonstrated that five had other maladies, but no cruciate ligament tears. Two had a partial ACL tear, and the remaining 43 patients had at least one cruciate tear. The preoperative clinical examination for cruciate ligament integrity was completely correct in 92%, correct but incomplete in 6%, and incorrect in 2%. Examination under anesthesia was correct in 98%, the KT-1000 was correct in 75% (involved knee minus noninvolved knee was greater than or equal to 3 mm laxity equal to ACL tear), the Stryker was correct in 75%, and Genucom in 70%. The average laxity of those with ACL tears was 4.4 mm with the KT-1000, 4.6 mm with the Stryker, and 2.0 mm with the Genucom. The methods of testing with the Stryker and the KT-1000 are similar and the laxity recorded in patients with a torn ACL were almost identical. However, the KT-1000 can be used to identify the quadriceps neutral position and therefore more accurately determine PCL instability. The Genucom has the most versatility, but the laxity recorded in patients with a torn ACL was significantly lower than the other devices.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: Isolated rat hearts were subjected to regional ischemia and reperfusion and Superoxide dismutase exerted a reduced but nonetheless significant antifibrillatory effect, the dose-response characteristics describing an asymmetric U-shaped curve.
Abstract: Isolated rat hearts (n = 15 per group) were subjected to regional ischemia (10 min) and reperfusion. Superoxide dismutase (SOD; 8 X 10(3), 2 X 10(4), 4 X 10(4), 6 X 10(4), 8 X 10(4), 1.2 X 10(5), or 1.6 X 10(5) IU/l) given early (i.e., throughout the experiment) reduced the incidence of reperfusion-induced ventricular fibrillation (VF), the dose-response characteristics describing an asymmetric U-shaped curve. The optimal dose of SOD (8 X 10(4) IU/l) reduced VF incidence from its control value of 87 to 27% (P less than 0.05). Given late (i.e., 2 min before reperfusion), this dose of SOD exerted a reduced but nonetheless significant antifibrillatory effect. Early administration of catalase (1 X 10(3), 1 X 10(4), 2.5 X 10(4), 5 X 10(4), 1 X 10(5), 1.5 X 10(5), or 1 X 10(6) IU/l) reduced VF incidence in a linear dose-dependent manner, from its control value of 87 to 7% with 1 X 10(6) IU/l (P less than 0.05). Late administration of this dose reduced VF incidence from its control value of 87 to 27% (P less than 0.05). Allopurinol (0.07, 0.15, 0.37, 0.73, 1.10, or 1.47 mM added to the perfusate throughout the experiment) significantly reduced VF incidence over a wide range of doses, but low and high doses were ineffective. Pretreatment with allopurinol (0, 0.01, 0.02, 0.05, 0.10, 0.20, or 0.50 g.kg-1.day-1 per os 48, 24, and 1 h before study) reduced VF incidence from its control value of 93 to less than 50% at several doses.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: By using this technique, it is found that the elevation of intracellular Ca2+ concentration directly augmented Ca2-channel currents in isolated cardiac muscle cells from both frog and guinea pig and may work through a similar pathway, involving phosphorylation of a regulatoryCa2+-channel protein.
Abstract: THE entry of calcium ions into cells through voltage-activated Ca2+ channels in the plasma membrane triggers many important cellular processes. The activity of these channels is regulated by several hormones and neuretransmitters, as well as intracellular messengers such as Ca2+ itself (for examples, see refs 1–9). In cardiac muscle, myoplasmic Ca2+ has been proposed to potentiate Ca2+ influx1,7–9, although a direct effect of Ca2+ on these channels has not yet been demonstrated. Photosensitive 'caged-Ca2+ molecules such as nitr-5, however, provide powerful tools for investigating possible regulatory roles of Ca2+ on the functioning of Ca2+ channels10,11. Because its affinity for Ca2+ is reduced by irradiation, nitr-5 can be loaded into cells and induced to release Ca2+ with a flash of light10. By using this technique we found that the elevation of intracellular Ca2+ concentration directly augmented Ca2+-channel currents in isolated cardiac muscle cells from both frog and guinea pig. The time course of the current potentiation was similar to that seen with β-adrenergic stimulation. Thus Ca2+ may work through a similar pathway, involving phosphorylation of a regulatory Ca2+-channel protein. This mechanism is probably important for the accumulation of Ca2+ and the amplification of the contractile response in cardiac muscle, and may have a role in other excitable cells.
TL;DR: Software is developed which allows for digitizing afferent firing, muscle length and electromyogram (EMG) activity, and to align segments for averaging by choosing one or more reference points in the step cycle, to build up a quantitative "look-up-chart" of the ensemble afferent and efferent profiles in the cat step cycle.
Abstract: Analysis of the control of movement in tasks such as stepping is severely restricted by the lack of quantitative data on the ensemble activity of afferents in the numerous muscles involved. We have started to build up a quantitative “look-up-chart” of the ensemble afferent and efferent profiles in the cat step cycle. To this end, we have developed software which allows us to digitize afferent firing, muscle length and electromyogram (EMG) activity, and to align segments for averaging by choosing one or more reference points in the step cycle. The ensemble firing of triceps surae la afferents showed lower than expected mean and peak rates, whereas triceps group II and Ib afferents were more active than predicted. There were small but significant transients in Ia firing at foot-off and touch-down which could not be explained in terms of origin-to-insertion length alone. They were most likely caused by propagated mechanical transients or tendon compliance effects giving rise to small differences between the origin-to-insertion length and the intramuscular length “seen” by spindles. Net ensemble Ia rates, based on previous estimates of spindle populations, probably exceed 25 kilo-impulses/second (ki.p.s.) in some muscles. Inputs as large as this are likely to contribute significantly to reflex control.
TL;DR: The results of this study support the concept that hyperkalemic crystalloid cardioplegic solutions cause vascular damage possibly involving the endothelium or its function, which may adversely affect vascular responsiveness.
TL;DR: The results provide evidence that reactive oxygen intermediates can rapidly induce eiectrophysiological changes and arrhythmias even in the absence of ischemia or reperfusion.
Abstract: The objective of this study was to determine whether reactive oxygen intermediates (e.g., singlet oxygen and the superoxide radical) can rapidly induce electrophysiological disturbances leading to the genesis of arrhythmias, even in the absence of ischemia and reperfusion. Rat hearts (n = 6 per group) were perfused aerobically at 37 degrees C for 10 minutes without rose bengal and for 5 minutes with rose bengal (250 nmol/l), during which time no changes in coronary flow or heart rate were observed. Hearts were then uniformly illuminated for 20 minutes with green light (530-590 nm) from 200 fiber optic cables. With light and without rose bengal, or vice versa, all hearts remained stable. However, in the illuminated rose bengal group, electrophysiological changes (inversion of the terminal portion of the T wave and an increase in Q-T interval) were observed within 11.8 +/- 2.1 seconds (i.e., less than 60 beats). All hearts exhibited ventricular premature beats (within 2.2 +/- 0.7 minutes) and ventricular tachycardia (within 2.8 +/- 0.7 minutes) before the occurrence of complete atrioventricular block (within 5.5 +/- 0.9 minutes). During the illumination period, coronary flow progressively fell in the rose bengal-perfused hearts from 11.6 +/- 0.5 ml/min to 2.0 +/- 0.4 ml/min (p less than 0.05 when compared with any control group). When a similar progressive reduction in coronary flow was mimicked (with or without rose bengal), no arrhythmias occurred.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: Oral azathioprine therapy is an effective and usually well tolerated treatment in chronic actinic dermatitis and the marked improvement in clinical status of actively treated patients led to early termination of the trial.
Abstract: Oral azathioprine was compared with placebo in a double-blind controlled trial of therapy in chronic actinic dermatitis (CAD), a rare eczematous photodermatosis. Eighteen severely affected patients were randomly allocated to azathioprine 50 mg t.d.s. or placebo over a 2-year period. Severity of itch and rash were assessed weekly by each patient on a visual analogue scale and overall clinical status monthly by a medical observer. Monitoring of patient ultraviolet radiation (UVR) exposure was undertaken throughout treatment by polysulphone film lapel-badge dosimetry. Five of 8 patients treated with azathioprine but none of 10 placebo patients achieved remission within 6 months. One patient could not tolerate treatment because of gastrointestinal effects. No haematological or hepatic abnormality was noted. The marked improvement in clinical status of actively treated patients (P less than 0.02, Fisher's exact test), led to early termination of the trial. Oral azathioprine therapy is an effective and usually well tolerated treatment in chronic actinic dermatitis.
TL;DR: Clinical and serological findings in 13 patients with myocardial infarction and antiphospholipid antibodies (the 'lupus anticoagulant', antibodies to cardiolipin, antibodies to phosphatidylethanolamine) and patients with SLE as defined by the revised 1982 criteria are presented.
Abstract: The clinical and serological findings in 13 patients with myocardial infarction and antiphospholipid antibodies (the 'lupus anticoagulant', antibodies to cardiolipin, antibodies to phosphatidylethanolamine (one patient] seen by our unit and other units from 1984 to 1989, are presented (eight males and five females, ages ranging from 20 to 52 years). Five suffered myocardial infarction before the age of 30; four of these five were in their early 20s. Other risk factors such as excessive smoking (greater than 20 cigarettes a day) (two patients), long-term treatment with steroid (one) and use of oral contraceptives (one) were present. One patient had demonstrated a plasminogen activator deficiency and one a deficiency of protein C. Two patients developed myocardial infarction six to eight weeks after warfarin was discontinued for recurrent deep vein thrombosis. Six patients had SLE as defined by the revised 1982 criteria, three suffered from 'lupus-like' disease, while four patients conformed to a 'primary' antiphospholipid syndrome.
TL;DR: A randomized double‐blind placebo controlled trial of colchicine in the treatment of 13 patients with delayed pressure urticaria and a modified method of pressure testing using a calibrated dermograph‐ometer has shown a pressure induced papular dose response curve.
Abstract: A randomized double-blind placebo controlled trial of colchicine in the treatment of 13 patients with delayed pressure urticaria enabled us to assess some of the variables in this disorder. We have modified a previously described method of pressure testing using a calibrated dermographometer and shown a pressure induced papular dose response curve. Assessment of disease activity was based on the number of pressure weals which occurred, the size of delayed pressure induced papules using a dermographometer calibrated at 9.75 x 10(5) pascals for five separate time periods on the back and estimations of erythrocyte sedimentation rate and the acute phase protein levels. We have been unable to show a therapeutic effect using colchicine 0.5 mg bd for I week.
TL;DR: The case for vaccination of all surgeons and medical students against hepatitis B is strengthened, as the surgeon was found to be a carrier of hepatitis B e antigen.
TL;DR: The effects on 31 normal subjects following exposure to sunbeds containing UVA lamps with minimal UVB emission have been compared in a double‐blind study with the effects on nine control subjects of a similar exposure course three times weekly for 4 weeks to sun beds emitting visible light.
Abstract: The effects on 31 normal subjects following exposure to sunbeds containing UVA lamps with minimal UVB emission have been compared in a double-blind study with the effects on nine control subjects of a similar exposure course three times weekly for 4 weeks to sunbeds emitting visible light. On previously untanned areas, all those subjects on active treatment developed a mild tan; in tanned areas they all developed a moderate tan, while all control subjects developed a minimal to mild tan. The mean protection factor against later UVB-induced erythema was 3.2 +/- 0.3 after the active course and 1.6 +/- 0.2 among the controls. Significantly more frequent adverse cutaneous effects for active subjects were pruritus, erythema, freckling, burning sensation, dryness and polymorphic light eruption. Cutaneous Langerhans cell numbers, and blood CD3+ (pan T-cell) and CD4+ (helper T-cell) lymphocyte subsets were reduced in both active and control groups. CD8+ (cytotoxic/suppressor T-cell) counts were similarly but not significantly reduced in both groups. Pityrosporum yeast counts were significantly reduced in both groups. The changes found in both groups seem attributable to small amounts of UVB emission from both active and control lamps.
TL;DR: It is suggested that fractured nasal bones may be reduced under local anaesthesia without detriment to the results, which represents a significant saving of hospital resources.
Abstract: This prospective study was designed to asses whether the results of reducing simple fractures of the nasal bones were different using local or general anaesthesia. Two consecutive groups of 50 patients had their fractures manipulated under (a) general, or (b) local anaesthesia. The results of reduction as assessed by the patients and surgeons were not significantly different between the 2 groups. The reoperation rate for nasal obstruction and external deformity was similar in the 2 groups. We suggest that fractured nasal bones may be reduced under local anaesthesia without detriment to the results. This represents a significant saving of hospital resources.
TL;DR: When reperfusion is elicited at the moment of peak susceptibility to arrhythmia, VF incidence is determined principally by occluded zone size, and flow of injury current between non-ischemic and reperfused tissue can be ruled out as a mechanism of arrhythmogenesis.
TL;DR: A pilot study to investigate the clinical use of an infrared diode laser in the treatment of a number of retinal vascular conditions and the implications of the development of this instrument in the context of its place in ophthalmic therapy are discussed.
Abstract: A pilot study has been carried out to investigate the clinical use of an infrared diode laser in the treatment of a number of retinal vascular conditions. A hand-held device was employed initially and subsequently a further prototype was developed for use in conjunction with a standard slit lamp microscope. Thirty-three eyes in thirty patients were treated for conditions such as proliferative diabetic retinopathy, exudative retinopathy and branch and central retinal vein thrombosis. Regression of neovascularisation was observed in 13 of 16 eyes (81%) with proliferative diabetic retinopathy and in six of eight eyes (75%) with branch retinal vein occlusion. Four eyes were successfully treated for established or incipient rubeosis iridis following central vein thrombosis. Focal photocoagulation applied to five eyes for diabetic exudative maculopathy resulted in partial resorption of the exudates. These results are presented together with information on the ease of use of the laser and its reliability. The implications of the development of this instrument in the context of its place in ophthalmic therapy are discussed.
Journal Article•
TL;DR: A 43-year-old Caucasian man who, after a 10 year history of recurrent deep vein thromboses and pulmonary emboli, was found to have a "lupus anticoagulant" and marked elevation of antibodies to cardiolipin and biochemical investigations revealed the presence of Addison's disease is described.
Abstract: We describe a 43-year-old Caucasian man who, after a 10 year history of recurrent deep vein thromboses and pulmonary emboli, was found to have a "lupus anticoagulant" and marked elevation of antibodies to cardiolipin. He subsequently developed skin and buccal pigmentation and biochemical investigations revealed the presence of Addison's disease. The relationship of the Addison's disease to the recurrent thrombotic events in the presence of antibodies to phospholipids is discussed.
TL;DR: The optimal rehabilitation program included EMS and immobilization in flexion with early limited range of motion and CPM, which resulted in a significant reduction in the incidence of patellofemoral crepitation.
Abstract: Numerous postoperative therapies have been advocated for the rehabilitation of patients who have undergone ACL reconstruction. The effectiveness of these various methods, many of which are based on sound scientific principles, has yet to be documented. The purpose of this study was to determine the efficacy of five commonly used rehabilitation programs. Five groups of 20 patients, all of whom underwent the same method of ACL reconstruction, were compared in order to determine the effects of the following treatments (some in combination): transcutaneous electrical nerve stimulation (TENS), immobilization in flexion, immobilization in extension, electrical muscle stimulation (EMS), and continuous passive motion (CPM). Clinical evaluation, volumetric thigh measurements, instrumented varus-valgus stress testing, KT-1000 arthometer (Medmetric, San Diego, CA) measurements, and Cybex II (Cybex, Division of Lumex, Ronkonkoma, NY) muscle evaluation were used to examine the patients. TENS did not reduce the amount of pain medication required, nor was there improvement in any other clinically measurable parameter of performance. There was no clear difference in stability between those treated in extension and those treated in flexion; however, since three patients who were treated in extension required manipulation, there may be some advantage to treating patients with early limited range of motion in flexion. EMS did not reduce atrophy but it did minimize strength decrease during immobilization. EMS also resulted in significantly greater range of motion than those treated with extension or flexion with early limited motion. Compared to all groups, EMS patients had a significant reduction in the incidence of patellofemoral crepitation.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: A specially constructed scanning system, designed to access the raw echo data directly from the ultrasound transducer, and allow display and measurement of the echo signals on a computer, is described.
Abstract: Ultrasound imaging allows detection of pathologic change in muscle on the basis of increased strength of echoes. With current commercial equipment, however, there is no method of quantitation of the echoes representing muscle, and there is lack of uniformity in scanning methodology. We describe a specially constructed scanning system, designed to access the raw echo data directly from the ultrasound transducer, and allow display and measurement of the echo signals on a computer. In a study of 38 boys with Duchenne muscular dystrophy, aged 1 to 11 years, who had an ultrasound scan of the thigh muscle, 32 (84%) had abnormality on quantitation of the ultrasound echoes. The quantitative techniques we describe could easily be incorporated into the design of ultrasound scanners.