Arthrogenic quadriceps inhibition and rehabilitation of patients with extensive traumatic knee injuries

1. The relationship between joint damage, quadriceps weakness and arthrogenic muscle inhibition was investigated in eight patients who had sustained extensive traumatic knee injury. Isometric and isokinetic quadriceps and hamstring voluntary strength, and quadriceps arthrogenic muscle inhibition during isometric contractions, were measured before and after 4 weeks (approximately 100 h) of intensive rehabilitation. 2. Compared with the uninjured leg, before rehabilitation the injured leg had larger amounts of quadriceps arthrogenic muscle inhibition (P < 0.025), quadriceps (P < 0.0001) and hamstring (P < 0.0001) weakness and severe functional joint instability. There was a negative correlation between the amount of arthrogenic muscle inhibition and quadriceps voluntary contraction force (P < 0.025). 3. After rehabilitation in the injured leg there were small hamstring strength increases (P < 0.05-0.025), but no overall significant quadricep strength increase. Arthrogenic muscle inhibition was statistically unchanged. Severe functional joint instability was still reported by all patients. 4. Previous studies have shown that minimal joint damage evokes relatively less arthrogenic muscle inhibition that does not impede rehabilitation. These data indicate that greater joint damage is associated with greater arthrogenic muscle inhibition, quadriceps weakness and joint instability. Furthermore, intensive rehabilitation had little affect on either quadriceps arthrogenic muscle inhibition or atrophy.

Sylvian fissure asymmetries in monozygotic twins: a test of laterality in schizophrenia

To address prior reports that schizophrenia is associated with loss of normal brain asymmetry and that it might be linked to a defect of a gene controlling cerebral lateralization, we measured on three-dimensional cortical renderings from magnetic resonance imaging (MRI) scans the lengths and angles of the sylvian fissures in 10 normal monozygotic (MZ) twin pairs (n = 10 pairs) and in 10 MZ pairs discordant for schizophrenia (n = 10 pairs). We confirmed in both sets of twins the expected normal asymmetries of length and angle of the sylvian fissure. We also confirmed that the length asymmetry occurs solely in the region of the planum temporale. In the discordant twins, affected and unaffected twins did not differ in asymmetry measures, thus failing to support an association between illness per se and diminished asymmetry. Moreover, the discordant twins as a group did not differ from the normal twins as a group, thus failing to confirm the hypothesis of a genetic association with abnormal asymmetry. The implications of variations in methodology and patient samples are discussed.

Effects of doxazosin and hydrochlorothiazide on lipid levels in Korean patients with essential hypertension

Because none of the major studies used to document adverse or beneficial metabolic effects of antihypertensive drugs were made of non-Western patients with a non-Western diet, we compared doxazosin and hydrochlorothiazide in Korean patients receiving a Korean diet to determine if one regimen is superior to the other in terms of efficacy, adverse metabolic effects, or both. The randomized, double-blind, parallel study of Korean hypertensive patients compared the effects of oral doxazosin (mean +/- SD dose, 10.3 +/- 6.3 mg/day) and oral hydrochlorothiazide (44.0 + 11.0 mg/day) on blood pressure (BP) and lipid metabolism. The results of 48 patients treated for 20 weeks are reported here. Systolic (p < 0.001) and diastolic (p < 0.001) BP (SBP, DBP) were significantly lower in both groups at the end of the treatment period. Doxazosin significantly increased high-density-lipoprotein (HDL) cholesterol from a baseline of 1.10 +/- 0.31 to 1.27 +/- 0.30 mM (p < 0.05) and HDL/total cholesterol from 0.25 +/- 0.1 to 0.28 +/- 0.1 mM (p < 0.01). Hydrochlorothiazide significantly increased triglyceride from a baseline of 1.63 +/- 0.71 to 2.02 +/- 0.87 mM (p < 0.05). In contrast to Western studies, hydrochlorothiazide demonstrated no adverse effect on total, low-density-lipoprotein (LDL), or HDL cholesterol, or on HDL/total cholesterol. Indeed, HDL cholesterol was increased by 0.16 mM (p < 0.01). As in Western patients, doxazosin is effective for treatment of essential hypertension in Koreans and has no adverse effects but some beneficial effects on lipids.(ABSTRACT TRUNCATED AT 250 WORDS)

Three-dimensional surface rendering in MRI morphometry: a study of the planum temporale

OBJECTIVE

The emergence of methodologies for accurately rendering cortical surfaces suggests possible quantitative applications of surface rendering to morphometry of the cerebral cortex. We examined this novel use of surface renderings in a study of the planum temporale, a neuroanatomical structure exhibiting well-documented normal asymmetry previously visible only in postmortem studies.

MATERIALS AND METHODS

With the aid of three-dimensional renderings of the supratemporal cortex, the area of the planum temporal was analyzed in the volume MRIs of seven normal, strongly right-handed males.

RESULTS

In comparison with areas derived from conventional measurements of serial MRI sections, planum temporale areas derived from supratemporal surface renderings offered far greater interrater reliability, and presumably improved validity as reflected by more consistent evidence of the anticipated planum asymmetry.

CONCLUSION

Morphometry of the supratemporal cortex is enhanced by the use of three-dimensional surface renderings. Application of surface-rendering techniques to morphometry of other cortical regions is discussed.

Measurement of brain activity with bolus administration of contrast agent and gradient-echo MR imaging

This study was performed to measure changes in cerebral blood volume (CBV) associated with visual activation by use of bolus administration of contrast agent and conventional, clinically configured magnetic resonance (MR) hardware and software. Fast gradient-recalled acquisition in the steady state technique was used to study five healthy subjects during visual activation and a control dark state. MR images were obtained every 2.048 seconds for 2 minutes. A bolus of gadopentetate dimeglumine was injected during visual stimulation and darkness. Cine images produced from the series of rapid images clearly depicted arterial, capillary, and venous phases. Analysis of serial concentration maps derived from the rapid images revealed expected differences between the relative CBV of gray matter and that of white matter, as well as significantly increased relative CBV in calcarine cortex during visual activation versus the control state (mean increase, 15.24%; range, 6.41%-27.78%; P < .05). These results confirm those reported in echo-planar imaging studies and demonstrate that brain function can be assessed with the bolus method by means of MR imaging hardware and software with conventional clinical configurations.

The usefulness of echocardiography in the surgical management of infants with congenital heart disease

Between January 1988 and August 1991, at The Children's Heart Center, Atlanta, 83 infants with congenital heart defects were diagnosed by echocardiography and underwent surgery without cardiac catheterization. The diagnostic categories included 46 infants with left heart obstructive lesions, 19 infants with cyanotic heart lesions, and 18 infants with miscellaneous lesions. Forty-five infants (55%) underwent surgery under cardiopulmonary bypass. There were three errors in diagnosis, yielding a diagnostic accuracy of 95%. Many infants with congenital heart disease can be accurately and completely diagnosed by echocardiography and can safely undergo surgery without cardiac catheterization.

A comparison of xenon-133 and xenon-127 for the determination of regional cerebral blood flow measured by dynamic SPECT

Phantom studies and cerebral blood flow (CBF) measurements in 11 normal subjects at rest were performed by single photon emission tomography (SPECT) with Xe-133 (16 mm full-width at half-maximum [FWHM] collimation) and Xe-127 (16 mm, 12 mm, and 9 mm FWHM collimation). The phantom results clearly illustrated the feasibility of Xe-127 studies and the advantage of Xe-127 over Xe-133 for equivalent patient dose exposures. CBF values obtained with Xe-127 were comparable to those of Xe-133 for the 16 mm collimator, although higher flow values were found with the better resolution, probably because of reduced partial volume effects. The correlations between the various groups of examinations were high, except for the Xe-133 and Xe-127 16 mm collimator groups. Xe-127 allows a considerable increase in the resolution of the images, while exposing the patient to a lower radiation dose. Potential limitations because of higher energy penetrating photons from Xe-127 were not observed in this specially shielded equipment.

Effect of phenylpropanolamine hydrochloride on blood pressure in Korean patients with hypertension controlled by hydrochlorothiazide

The effect of 10 oral doses of phenylpropanolamine hydrochloride 25 mg four times a day on blood pressure and heart rate in Korean patients with hypertension controlled by hydrochlorothiazide was studied. A randomized, placebo-controlled, crossover, double-blind study design was used. Twenty Korean patients with mild hypertension controlled by hydrochlorothiazide were recruited from an ambulatory-care clinic. Blood pressure and heart rate were measured in triplicate before treatment, after a five-day washout period between phases of treatment, and two hours after the last dose in each phase of treatment. Eighteen patients completed both phases of treatment, and one patient completed only the placebo phase. Mean baseline values for systolic and diastolic blood pressures and heart rate before the placebo phase did not significantly differ from mean baseline values before the phenylpropanolamine phase. Comparison of mean baseline values for systolic and diastolic blood pressures and heart rate with mean after-treatment values showed no clinically relevant or statistically significant changes for the 19 patients who completed the placebo phase or the 18 patients who completed the phenylpropanolamine phase. There was no significant difference between the mean change in systolic blood pressure, diastolic blood pressure, or heart rate when the phenylpropanolamine phase was compared with the placebo phase. Phenylpropanolamine hydrochloride 25 mg p.o. four times a day (total, 10 doses) given to Korean patients with hypertension controlled by hydrochlorothiazide did not affect blood pressure or heart rate according to single-point outcome measurements.

Putting teeth into pay-for-performance programs

Although performance-based evaluation and salary systems are common among healthcare organizations, most facilities have not adopted rank-and-file variable compensation plans. One option, gain sharing, may draw increasing attention in health care because it is designed to reward employees based on financial performance, productivity, and quality measures--addressing some prominent concerns in the industry.

The effect of amphetamine on regional cerebral blood flow during cognitive activation in schizophrenia

To explore the role of monoamines on cerebral function during specific prefrontal cognitive activation, we conducted a double-blind placebo-controlled crossover study of the effects of 0.25 mg/kg oral dextroamphetamine on regional cerebral blood flow (rCBF) as determined by 133Xe dynamic single-photon emission-computed tomography (SPECT) during performance of the Wisconsin Card Sorting Test (WCST) and a sensorimotor control task. Ten patients with chronic schizophrenia who had been stabilized for at least 6 weeks on 0.4 mg/kg haloperidol participated. Amphetamine produced a modest, nonsignificant, task-independent, global reduction in rCBF. However, the effect of amphetamine on task-dependent activation of rCBF (i.e., WCST minus control task) was striking. Whereas on placebo no significant activation of rCBF was seen during the WCST compared with the control task, on amphetamine significant activation of the left dorsolateral prefrontal cortex (DLPFC) occurred (p = 0.0006). Both the mean number of correct responses and the mean conceptual level increased (p less than 0.05) with amphetamine relative to placebo. In addition, with amphetamine, but not with placebo, a significant correlation (p = -0.71; p less than 0.05) emerged between activation of DLPFC rCBF and performance of the WCST task. These findings are consistent with animal models in which mesocortical catecholaminergic activity modulates and enhances the signal-to-noise ratio of evoked cortical activity.

Crevice corrosion products of dental amalgam

The objective of this study was to determine the in vitro corrosion products that resulted from crevice corrosion of low- and high-copper dental amalgams. Specimens were potentiostatically polarized in a chloride-containing electrolyte while set against a PTFE surface to form a crevice. After 16 h, corrosion products were examined by light microscopy, SEM, EDS, and XRD. Analysis showed the presence of three previously reported products [Sn4(OH)6Cl2, SnO, and Cu2O] and a new product, CuCl, which formed on high-copper, gamma 2-free amalgams. Thermodynamic considerations show that CuCl is stable for the reported in vivo potentials of amalgam restorations and the high acidity and high chloride ion concentration associated with crevice corrosion.

Hamster cheek-pouch testing of dental soft polymers

The hamster cheek pouch provides a suitable model system for the mucous-membrane irritation testing of dental materials. Poor retention of materials or difficulties in histopathological interpretation caused by surgical artifacts have been reported in published techniques. We describe a new "pouch-in-pouch" technique for mucous membrane irritation tests. The retention rate of polymer discs was 97% and 87% at 14 and 35 days, respectively. Clear differentiation was obtained between the tissue reaction to the test materials and the surgical procedure. Polymer discs containing dibutyltin diacetate (DBTD) or dibutyl phthalate (DBP) as plasticizer resulted in epithelial changes, including epithelial atypia, early papillomas, and areas resembling dysplasia. The potentially pre-malignant nature of these changes requires further investigation.

Detection of protein C deficiency during oral anticoagulant therapy--use of the protein C:factor VII ratio

Laboratory diagnosis of protein C deficiency is complicated by the fact that many patients referred for investigation are already being treated with oral anticoagulants. Protein C and factor VII have similar half lives and by using the protein C:factor VII ratio we hoped to be able to detect protein C deficiency in patients receiving oral anticoagulants. We have studied activity levels of protein C and factor VII to produce protein C:factor VII activity ratios in 105 patients receiving oral anticoagulants, 42 normal subjects, and nine patients with known inherited protein C deficiency. The mean ratios for these groups were 1.38, 1.12 and 0.63 respectively. In patients receiving oral anticoagulants, the protein C level showed a poor correlation with the international normalized ratio (INR) value. Reference ranges for protein C at different levels of anticoagulation were therefore considered unsuitable for the identification of inherited protein C deficiency. Five patients with inherited protein C deficiency were studied with and without oral anticoagulation; their protein C:factor VII ratios remained relatively unchanged, despite alterations in the level of the individual proteins. These results suggest that measurement of the protein C:factor VII ratio may help to identify patients with inherited protein C deficiency whilst on oral anticoagulants.

An in vivo and in vitro study of the loss of plasticizer from soft polymer-gel materials

Polymer-gel materials used as short-term denture soft linings are blended with plasticizers to lower the glass transition temperature (Tg). A lower Tg allows for greater polymer chain mobility, thus producing a more flexible material. The present work evaluated the loss of plasticizers due to leaching both in vivo and in vitro. Two commercial denture soft-lining materials (A and B) were tested. These were both poly(ethyl methacrylate) polymers, blended with alcohol and phthalate esters. A clinical study was conducted in which patients wore, sequentially, dentures bearing (on separate occasions) each of the two soft-polymer lining materials. The two materials A and B were randomly assigned for each of ten patients and were worn for 14 and 30 days, respectively. With one exception, patients wore dentures with both lining materials, for a total of 19 clinical evaluations. The plasticizer loss occurring during the clinical trial was determined by GC analysis from the initial and terminal day sampling of plasticizer content of the soft polymer-gel materials. The results of this analysis were compared with results obtained from an in vitro leachability study by use of sink conditions in water at 37 degrees C for the same two commercial soft polymers conducted over the same time periods of 14 and 30 days. The results indicated that a higher loss of plasticizer occurred in vivo, compared with the in vitro tests for 17 of the 19 clinical evaluations. The average plasticizer lost in vivo from material A at 14 days was 122 +/- 58 mg/g, and for material B at 30 days it was 33 +/- 27 mg/g.(ABSTRACT TRUNCATED AT 250 WORDS)

Chemical and molecular weight analyses of prosthodontic soft polymers

A number of studies have been made investigating the properties of dental prosthodontic soft polymer materials. In such materials, which are used as short-term denture soft liners, the polymer component is complexed with one or more plasticizers. This lowers the glass transition temperature, Tg, of the polymer by allowing greater chain mobility and produces a more flexible material. Little information is available relating to the polymer components of such soft-lining materials. The chemical composition and molecular-weight distribution of a polymer help to determine its ability to form a plasticized soft polymer-gel. In the present work, both pyrolysis depolymerization/gas chromatography (GC) and size exclusion chromatography (SEC) have been used to characterize 11 commercial polymer powders. By use of SEC and polymer standards having a narrow molecular-weight range, it has been possible for accurate molecular-weight distributions to be determined for all 11 powders. The peak molecular weights were found to be between 1.79 x 10(5) and 3.28 x 10(5). These values are above the molecular weight at which chain entanglement occurs. The polydispersity ratios (Mw/Mn) were between 2.09 and 4.48. Methacrylate polymers can be readily decomposed thermally to their constituent monomers, which, once recovered, can be analyzed by gas chromatography. The simple pyrolysis apparatus used in the present study was easily assembled and was capable of producing both qualitative and quantitative results. None of the commercial polymers analyzed gave methacrylate decomposition products with pendant chains greater than ethyl (-CH2-CH3). All of the commercial polymers successfully studied by the pyrolysis test method proved to be poly(ethyl [100-79%]/methyl [0-21%] methacrylate) polymers or co-polymers.

Gel strength and rate of gelation of soft polymers

A rheometer was used to characterize the gelation rate of six commercial short- to medium-term (chairside intra-oral gelation) denture soft-lining materials. Shear puncture force was measured from one to 60 days for six short- to medium-term materials as well as for three heat-cured (polymerizable) materials. The observed increase in puncture force with age of the specimen was considered to be a function of increased polymer chain entanglement and/or loss of plasticizer. Reduction in puncture force with age occurred for some materials as a result of hydration of the polymer gel. Rheometer setting time (gelation rate) and puncture force values for the intra-oral gelation materials were influenced by the quantity of ethyl alcohol present in the mixing liquid. In general, the higher the level of ethyl alcohol, the shorter the gelation time and the stronger the gel. The characterization of the properties may help develop improved prosthodontic treatment procedures, and allow better management of soft-tissue recovery following trauma.

In vivo fungal presence and growth on two resilient denture liners

To determine whether two intraoral-setting resilient denture liners supported the in vivo presence or growth of oral commensal fungi, the liners were randomly placed in the mandibular complete dentures of 14 patients. Cytologic smears were made from the liner surfaces at 1 hour and 1, 2, 7, 14 and 30 days after intraoral placement. Yeast forms were observed in six patient trials of material A and in two trials of material B. Hyphae were observed in only one patient trial of material A and in two trials of material B. When yeast forms and hyphae findings were combined and were considered as indicative of fungal presence or growth, the prevalence up to 30 days was seven for material A and four for material B. Statistical analysis revealed no significant difference in the prevalence of fungal presence or growth between the two resilient denture liners tested.