Biotolerant and haemodynamic effects of copolymerization with acrylic acid on Dacron arterial prostheses

The biotolerant and haemodynamic effects of three types of woven polyethylene terephthalate (Dacron) arterial prostheses were compared. Two of these were unmodified, one low, one high porosity; and the third was the latter type radiation graft copolymerized with 5% acrylic acid. The prostheses were implanted as aorto-aortic bypass grafts, in dogs, for periods ranging from three to seventeen months. The copolymerized prosthesis exhibited the smallest rise in circumferential elastance from the 'as supplied' state, as well as a significantly slower pulse wave velocity, a significantly thinner internal lining, and a markedly lower longitudinal impedance. Of the unmodified prostheses, the low porosity graft had a significantly greater circumferential elastance, the poorest handling characteristics, and a tendency for pseudo intimal detachment. It was concluded that, although there was little difference between the two unmodified prostheses, the low porosity one had little to recommend it for use in small calibre bypass grafting. Copolymerization with acrylic acid produced better haemotolerant and haemodynamic results as well as surface properties which appeared to discourage fibrin and platelet adherence, and promote a more complete and organised pseudointima.

Multiple sclerosis: Part II. Common functional problems and rehabilitation

Cognitive impairments, often unrecognized in multiple sclerosis, include memory loss, new learning problems, denial and depression. Spasticity and incoordination of the oropharyngeal and respiratory muscles create functional problems with speech and swallowing. Genitourinary problems include sexual dysfunction and neurogenic bladder. Specific measures can be used to alleviate these problems.

Multiple sclerosis: Part I. Common physical disabilities and rehabilitation

Rehabilitation of the multiple sclerosis patient must be individualized because of the varied manifestations and fluctuating course of the disease. The activity schedule must be modified to compensate for muscle weakness and fatigability. Spasticity and the preventable complication of joint contractures may be treated with joint ranging, medications, motor-point blocks and surgical intervention. Mobility problems, such as foot drop, may be improved with an ankle-foot orthosis, but ultimately a patient may require a wheelchair. Measures to prevent pressure sores include position change, pressure release, incontinence management and special equipment.

Optokinetic nystagmus and upper extremity dressing independence after stroke

Right hemisphere brain-damaged stroke patients demonstrate a variety of neurologic deficits which seem to impair their ability to regain self-care independence. Visual perceptual and visual search disorders have been implicated with persistent functional deficits. The objective of this study was to measure the extent to which defects of optokinetic nystagmus (OKN), an ocular movement reflex, may be associated with inability to regain independent function. Eighteen right hemisphere brain-damaged stroke patients suffering similar sensory-motor deficits were followed up from admission as they underwent self-care training in a comprehensive stroke rehabilitation center. Ten subjects demonstrated unilateral absence of OKN and eight subjects demonstrated bilaterally intact responses upon admission. Upper extremity (UE) dressing independence was used as an indicator of functional skill level at admission, during treatment, and at discharge. Subjects with unilateral loss of OKN were significantly less independent at admission and at discharge when compared to subjects with intact OKN. Although both groups of patients made statistically significant gains in UE dressing, those with defective OKN had a 40% greater inpatient length of stay and were more likely to be discharged to a nursing home or needed care by a significant other after rehabilitation.

Stroke rehabilitation: Part II. Recovery and complications

Return of neurologic function after a stroke tends to be complete within six months after the insult. Initial flaccidity is superseded by spasticity, which is most prominent distally. Movements initially occur in synergistic patterns. Return of voluntary movements begins proximally in the lower extremity. In the upper extremity, proximal recovery usually occurs first, but finger movement occasionally is the earliest sign. Proper positioning and early, passive range-of-motion exercises help to avoid complications.

Stroke rehabilitation: part I. Cognitive deficits and prediction of outcome

In many cases, the family physician will set the tone for rehabilitation of the stroke patient. It is imperative that the physician understand the recovery process, as well as the nature, benefits and limitations of rehabilitation. Since there are no precise predictors of individual outcome, no patient should be excluded from rehabilitation unless he is too ill or too cognitively devastated to participate.

Something new: a radiology policies and procedures outline guide

The American Hospital Radiology Administrators Midwest Region Education Committee felt the need for a guide to assist radiology administrators in developing departmental policies and procedures unique to their own institutions. The outline guide was undertaken as the education project for the committee of 1980/81. The completed guide was presented at the April, 1981 Midwest regional meeting. This article is presented to you to introduce the outline guide and also emphasize the importance of the development of a comprehensive policy and procedure manual for improved radiology management.

Blood preservation 42: improvement of ascorbate's ability to maintain 2,3-DPG with inosine

Inosine and ascorbate have been shown to maintain normal 2,3-DPG levels during three to four weeks of blood storage. With the introduction of CPD-adenine, which allows five weeks of storage, the desire for 2,3-DPG maintenance may receive new emphasis. Red blood cell 2,3-DPG remained at normal or higher levels for six weeks whenever 10 or 15 mM inosine and 10 mM vitamin C (L-ascorbate) or D-ascorbate were present in the CPD-adenine preservative. Provision by inosine of a five-carbon sugar for 2,3-DPG synthesis, bypassing the rate-limiting phosphofructokinase reaction, may allow NADH oxidation by ascorbate to provide an increased supply of substrate for the Rappoport-Luebering shunt, thus affecting the net increase and maintenance of 2,3-DPG.

Blood preservation 35. Red cell 2,3-DPG and ATP maintained by DHA-ascorbate-phosphate

DHA (dihydroxyacetone, 60 mM) with ascorbic acid (d-ascorbate, 10 mM) kept 2,3-DPG concentrations above normal for six weeks. Levels of 2,3-DPG were below normal after four weeks with DHA alone and after two weeks with DHA-ascorbate-phosphate. As in previous studies, high phosphate concentrations decreased 2,3-DPG maintenance. ATP maintenance was best achieved with the following (in order of performance): DHA-phosphate (20 mM); DHA-phosphate (10 mM); the control, CPD-adenine preservative; Phosphate 20 mM; and DHA. DHA with ascorbate provides normal 2,3-DPG for six weeks. The adverse effects of DHA and DHA with ascorbate on ATP levels are modified by 10 mM phosphate.

Blood preservation. XLIII. Studies on the ascorbate mechanisms of maintaining red cell 2,3-DPG

Our previous experiments on the mechanisms of ascorbate's effect on the red blood cell failed to show an effect of iodoacetate (IA), a sulfydryl inhibitor. In this study, in contrast to the previous, iodoacetate (85 micromolar) was seen to prevent continued red blood cell metabolism. During the first weeks there was an absence of a continual fall in pH; ATP levels were depressed below half normal; and 2,3-DPG levels fell to very low values within the first week. ATP was best maintained in the control preservative and next best maintained, at adequate levels, with ascorbate, 5 mM, with and without glutathione, 5 mM. 2,3-DPG levels were well maintained with ascorbate and ascorbate with glutathione. Poor ATP maintenance and rapid decreases in 2,3-DPG were observed with iodoacetate, IA plus ascorbate, and IA plus ascorbate and glutathione.

Head and neck cancer, a rehabilitation approach

Survival from head and neck cancer is not uncommon. However, treatment is often radical and may compromise the patient's appearance, function, and quality of life. The most common modalities of treatment, employed either singly or in combination, are chemotherapy, radiation, and surgery. Each treatment modality involves unique complications and compromises, many of which are amenable to rehabilitation techniques. A role of the occupational therapist on a cancer rehabilitation team is described and an overview of the therapeutic procedures for the evaluation and treatment of common problems recognized in these patients is presented. The material is derived both from clinical experience of the rehabilitation team and from a literature review employed in developing the rehabilitation program.

Skin conductance conditioning with dyshidrotic eczema patients

Thirty-three patients with dyshidrotic eczema were trained either to decrease or to increase the electrical conductivity of the skin. Skin conductance has been found to be related to epidermal water content as well as emotional variables, both of which have suggested links to eczema. Subjects trained to decrease skin conductance showed clinical improvement more often than the controls who were trained in the opposite direction. They also showed a significant decrease in measured conductance and anxiety. The controls showed increased anxiety and no significant changes in skin conductance level.

The radiological features of lymphangioma-like Kaposi's sarcoma. A case report

A case of lymphangioma-like Kaposi's sarcoma is described, together with the lymphangiographic and arteriographic features. Persistent pleural effusions developed, for which a cause is postulated.

Amyotrophic lateral sclerosis: comprehensive management

The cause of amyotrophic lateral sclerosis remains unknown, and no curative treatment is available. From a rehabilitation perspective, however, comprehensive management and symptomatic treatment can minimize complications, increase function and improve the patient's quality of life. Quinine, diazepam (Valium) and phenytoin (Dilantin) may relieve muscle cramps, and orthoses may permit greater participation in daily activities. Problems with respiration and swallowing may require surgical procedures and the use of feeding tubes. Decisions regarding surgical intervention must be made in the context of the patient's overall status.

Low back pain as the presenting symptom of renal artery aneurysm. A case report

Hypertension of recent onset in a 29-year-old woman was associated with low pain radiating to the right groin. Angiography showed the presence of a large aneurysm of the right renal artery. Resection of the aneurysm and nephrectomy cured the hypertension.

The radiological features of alcoholic ulcero-osteolytic neuropathy in Blacks

The radiological features in the bones and the angiographic changes in the vessels of the lower limbs of 15 chronic alcoholic men are discussed. The distal arteries demonstrate the features of neovascularization. Infective and resorptive changes in the bones of the forefeet are described. These features are related to chronic infection or to the toxic effects of the alcohol.