The utility of normative foot floor angle data in assessing toe-walking

Initial heel contact is an important attribute of gait, and failure to complete the heel rocker reduces gait stability. One common goal in treating toe-walking is to restore heel strike and prevent or reduce early heel rise. Foot floor angle (FFA) is a measure of toe-walking that is valuable for quantifying foot orientation at initial contact when using ankle dorsiflexion angle alone is misleading. However, no age-standardized FFA norms exist for clinical evaluation. Our objectives were to: (1) obtain normative FFA in typically developing children; and (2) examine its utility in the example of toe-walking secondary to unilateral cerebral palsy. Gait kinematics were acquired and FFA trajectories computed for 80 typically developing children (4-18 years). They were also obtained retrospectively from 11 children with toe-walking secondary to unilateral cerebral palsy (4-10 years), before and after operative intervention, and compared to 40 age-matched, typically developing children. FFA at initial contact was significantly different (P<.001) between pre-surgery toe-walking (-14.7±9.7°; mean±standard deviation) and typical gait (18.7±2.8°). Following operative lengthening of the gastrocnemius-soleus complex on the affected side, FFA at initial contact (-0.9±5.3°) was significantly improved (P<.001). Furthermore, several cases were identified for which the sole use of ankle dorsiflexion angle to capture toe-walking is misleading. The assessment of FFA is a simple method for providing valuable quantitative information to clinicians regarding foot orientation during gait. The demonstrated limitations of using ankle dorsiflexion angle alone to estimate foot orientation further emphasize the utility of FFA in assessing toe-walking.

A Low Power Wireless Data Acquisition Device to Monitor Gait Patterns for Children With Toe Walking During Daily Activities

Clinical gait analysis is the accepted “gold standard” for evaluating an individual’s walking pattern. However, in certain conditions such as idiopathic toe walking (ITW), the degree of voluntary control that a subject may elicit upon their walking pattern in a gait laboratory may not truly reflect their gait during daily activities. Therefore, a battery-powered, wireless data acquisition system was developed to record daily walking patterns to assist in the assessment of treatment outcomes in this patient population. The device was developed to be small (30×50×12 mm3), light-weight (15 g), easy to install, reliable, and consumed little power. It could be mounted across the laces of the shoe, while forces and walking activities were recorded to investigate the percentage of toe walking during the assessment. Laboratory tests were performed and preliminary clinical trials at a gait laboratory were done on six normal gait walkers. These volunteers also try to walk on their toes to simulate the toe walking at the gait laboratory. The system was able to track the gait pattern and determine the percentage of toe walking relative to normal gait. Three boys and one girl were diagnosed with ITW then participated into this study. A total of 4 sets thirty-three 10 min data sessions (5.5 h) were collected outside the laboratory. The results showed that the test subjects walked on their toes 70±4% of the total walking time, which was higher than that they performed 64±5% at the gait laboratory. This preliminary study shows promising results that the system should be able to use for clinical assessment and evaluation of children with ITW.

Effect of lower limb massage on electromyography and force production of the knee extensors

OBJECTIVE

To evaluate the effect of massage on force production and neuromuscular recruitment.

METHODS

Ten healthy male subjects performed isokinetic concentric contractions on the knee extensors at speeds of 60, 120, 180, and 240 degrees /s. These contractions were performed before and after a 30 minute intervention of either rest in the supine position or lower limb massage. Electromyography (EMG) and force data were captured during the contractions.

RESULTS

The change in isokinetic mean force due to the intervention showed a significant decrease (p<0.05) at 60 degrees /s and a trend for a decrease (p = 0.08) at 120 degrees /s as a result of massage compared with passive rest. However, there were no corresponding differences in any of the EMG data. A reduction in force production was shown at 60 degrees /s with no corresponding alteration in neuromuscular activity.

CONCLUSIONS

The results suggests that motor unit recruitment and muscle fibre conduction velocity are not responsible for the observed reductions in force. Although experimental confirmation is necessary, a possible explanation is that massage induced force loss by influencing "muscle architecture". However, it is possible that the differences were only found at 60 degrees /s because it was the first contraction after massage. Therefore muscle tension and architecture after massage and the duration of any massage effect need to be examined.

Massage provision by physiotherapists at major athletics events between 1987 and 1998

BACKGROUND

The equivocal findings in the literature on efficacy of massage makes it difficult to assess the requirement for, or justify the use of, specialist massage personnel at major athletics events. However, the use of massage by athletes during training and competition remains popular.

OBJECTIVES

To quantify the amount of their time that physiotherapists devote to massage treatment at major athletics events in an attempt to determine the importance of this treatment modality, and to examine whether the use of massage at athletics events is changing over time.

METHODS

Data recorded by the head team physiotherapist from 12 major athletics events (national and international events) between 1987 and 1998 were examined. For each event, the data included: total number of treatments administered by the physiotherapist, the treatment modalities used, and the number of attendances for treatment. The amount of massage provided was expressed as a percentage of the total number of treatments for each athletic event, and the pattern of change in use of massage treatment over time was evaluated.

RESULTS

The percentage of time spent providing massage treatment ranged from 24.0% to 52.2% of the total number of treatments made. The overall median percentage of total treatments in the form of massage was 45.2%. No significant increase or decrease in the use of massage as a treatment modality was observed between 1987 and 1998 in the athletics events examined (p = 0.95).

CONCLUSIONS

A significant proportion of physiotherapists' time is devoted to the delivery of massage treatment at athletics events. The demand for massage treatment has been steady over the time period, in the events for which data are available, indicating a consistent use of this treatment modality. Given the popularity of massage among athletes, consideration should be given to the use of specialist sports massage staff at major athletics events. Furthermore, it would seem prudent to further investigate the efficacy of the treatment.

Effects of leg massage on recovery from high intensity cycling exercise

BACKGROUND

The effect of massage on recovery from high intensity exercise is debatable. Many studies on massage suffer from methodological flaws such as poor standardisation of previous exercise, lack of dietary control, and inappropriate massage duration.

OBJECTIVE

To examine the effects of leg massage compared with passive recovery on lactate clearance, muscular power output, and fatigue characteristics after repeated high intensity cycling exercise, with the conditions before the intervention controlled and standardised.

METHODS

Nine male games players participated. They attended the laboratory on two occasions one week apart and at the same time of day. Dietary intake and activity were replicated for the two preceding days on each occasion. After baseline measurement of heart rate and blood lactate concentration, subjects performed a standardised warm up on the cycle ergometer. This was followed by six standardised 30 second high intensity exercise bouts, interspersed with 30 seconds of active recovery. After five minutes of active recovery and either 20 minutes of leg massage or supine passive rest, subjects performed a second standardised warm up and a 30 second Wingate test. Capillary blood samples were drawn at intervals, and heart rate, peak power, mean power, and fatigue index were recorded.

RESULTS

There were no significant differences in mean power during the initial high intensity exercise bouts (p = 0.92). No main effect of massage was observed on blood lactate concentration between trials (p = 0.82) or heart rate (p = 0.81). There was no difference in the maximum power (p = 0.75) or mean power (p = 0.66) in the subsequent Wingate test, but a significantly lower fatigue index was observed in the massage trial (p = 0.04; mean (SD) fatigue index 30.2 (4.1)% v 34.2 (3.3)%).

CONCLUSIONS

No measurable physiological effects of leg massage compared with passive recovery were observed on recovery from high intensity exercise, but the subsequent effect on fatigue index warrants further investigation.

The road to success: A review of 1000 axillary brachial plexus blocks

The authors present their experience of > 1000 axillary brachial plexus blocks performed over 13 years (1990-2002). Using a technique that involves the location of individual nerves with a nerve stimulator, the overall success rate was 97.9%, ranging from 89.7% in 1990 to 98.4% in 1998. There have been no failures, defined as the need for conversion to general anaesthesia, in the last 500 blocks. Supplementary nerve blocks at the elbow were performed in 22.2% of patients. The first author, trained and supervised by the second author, achieved similar success rates in half the time taken by the second author. The authors conclude that technique and experience are the keys to success, but that high success rates can be achieved in a short time if anaesthetists are trained by experts in regional anaesthesia.

Neurodevelopmental outcome of young pediatric intensive care survivors of serious brain injury

OBJECTIVES

To determine the number of children with severe brain injury due to closed head injury or hypoxic-ischemic encephalopathy as a proportion of all admissions of children <3 yrs of age in the regional pediatric intensive care unit; to determine the outcome of these children at >6 mos postinjury; and to explore the relationship of outcome measures to predictors of outcome obtained within the first 24 hrs after brain injury.

DESIGN

Prospective, descriptive outcome study of an inception cohort.

RESULTS

Neonatal and Infant Follow-up Clinic, Glenrose Rehabilitation Hospital, Edmonton, Canada.

PATIENTS

Of a cohort of 53 children of <3 yrs of age (4% of pediatric intensive care unit admissions, 1995-1998) admitted for severe acquired brain injury (Glasgow Coma Score, <or=8), 12 (23%) died, three (6%) were lost to follow-up, and 38 (71%) survived and received multidisciplinary outcome assessments.

MEASUREMENTS AND MAIN RESULTS

Of 50 children with known outcome, 23 (46%) had a good recovery on the Glasgow Outcome Scale; however, only eight (16%) of these had average or above scores on both the mental and motor developmental indices of the Bayley Scales of Infant Development-II at 18-36 mos of age. Acute injury predictors of adverse outcome were apnea at scene, bolus epinephrine given for resuscitation, pupils nonreactive, arterial pH <or=7.2, and Glasgow Coma Score of 3. For 38 survivors, sensitivity and specificity from predictors for the Glasgow Outcome Scale were 73% and 83% respectively; for mental scores, 86% and 93%; for motor scores, 75% and 89%.

CONCLUSIONS

Of children of <3 yrs of age identified by a Glasgow Coma Score of <or=8 after acute brain injury, >80% have adverse outcome of death, disability, or mental or motor developmental scores below average. A Glasgow Outcome Scale of 5 overestimates good recovery. Universal registry and follow-up of these children are needed.

McLeod neuroacanthocytosis: genotype and phenotype

McLeod syndrome is caused by mutations of XK, an X-chromosomal gene of unknown function. Originally defined as a peculiar Kell blood group variant, the disease affects multiple organs, including the nervous system, but is certainly underdiagnosed. We analyzed the mutations and clinical findings of 22 affected men, aged 27 to 72 years. Fifteen different XK mutations were found, nine of which were novel, including the one of the eponymous case McLeod. Their common result is predicted absence or truncation of the XK protein. All patients showed elevated levels of muscle creatine phosphokinase, but clinical myopathy was less common. A peripheral neuropathy with areflexia was found in all but 2 patients. The central nervous system was affected in 15 patients, as obvious from the occurrence of seizures, cognitive impairment, psychopathology, and choreatic movements. Neuroimaging emphasized the particular involvement of the basal ganglia, which was also detected in 1 asymptomatic young patient. Most features develop with age, mainly after the fourth decade. The resemblance of McLeod syndrome with Huntington's disease and with autosomal recessive chorea-acanthocytosis suggests that the corresponding proteins--XK, huntingtin, and chorein--might belong to a common pathway, the dysfunction of which causes degeneration of the basal ganglia.

Genetic immunization with the region encoding the alpha-helical domain of PspA elicits protective immunity against Streptococcus pneumoniae

Pneumococcal surface protein A (PspA) is a pneumococcal virulence factor capable of eliciting protection against pneumococcal infection in mice. Previous studies have demonstrated that the protection is antibody mediated. Here we examined the ability of pspA to elicit a protective immune response following genetic immunization of mice. Mice were immunized by intramuscular injections with a eukaryotic expression vector encoding the alpha-helical domain of PspA/Rx1. Immunization induced a PspA-specific serum antibody response, and immunized mice survived pneumococcal challenge. Survival and antibody responses occurred in a dose-dependent manner, the highest survival rates being seen with doses of 10 microg or greater. The ability of genetic immunization to elicit cross-protection was demonstrated by the survival of immunized mice challenged with pneumococcal strains differing in capsule and PspA types. Also, immunized mice were protected from intravenous and intratracheal challenges with pneumococci. Similar to the results seen with immunization with PspA, the survival of mice genetically immunized with pspA was antibody mediated. There was no decline in the level of protection 7 months after immunization. These results support the use of genetic immunization to elicit protective immune responses against extracellular pathogens.

Childhood morbidity after severe traumatic brain injury: Increased detection with the Multiattribute Health Status Classification

OBJECTIVES: Study 1: To determine the interrater agreement on the Multiattribute Health Status Classification (MAHSC) for brain-injured children. Study 2: To determine the outcome of severe childhood traumatic brain injury (TBI) by comparing three measures: MAHSC, Functional Independence Measures (FIM/WeeFIM), and the Glasgow Outcome Scale. Designs: Study 1: Clinic recruitment of parents of patients. Study 2: Surveillance follow-up of an inception cohort. Settings: Study 1: The Brain Injury Clinic, Glenrose Rehabilitation Hospital, Edmonton, Canada. Study 2: Pediatric Intensive Care Unit, University of Alberta Hospital. PATIENTS: Study 1: Two physiatrists and parents of 50 children (5-18 yrs, 54% boys) independently completed the survey. Study 2: From a cohort of 51 patients (3-17 yrs, 69% boys, 6 deaths) consecutively admitted to the pediatric intensive care unit in 1995 and 1996 with severe TBI (Glasgow Coma Score </= 8 within the first 24 hrs postinjury), parents of all survivors (71% boys) completed outcome measures at 6-12 months postinjury. MEASUREMENTS AND MAIN RESULTS: Study 1: The interrater agreement exceeded 70% for attributes of sensation, mobility, cognition, self-care, and general health. Study 2: Of 45 survivors, 34 (76%) had a "good recovery" on the Glasgow Outcome Scale, 16 (36%) had normal scores on the FIM/WeeFIM, and only 8 (18%) had normal attributes on the MAHSC. Correlations of measures were Glasgow Outcome Scale and MAHSC, -.73; Glasgow Outcome Scale and FIM/WeeFIM,.64; and MAHSC and FIM/WeeFIM, -.63. Sensitivity and specificity from acute injury predictors for the Glasgow Outcome Scale were 88% and 91%, respectively; for MAHSC 75% and 70%; and for FIM/WeeFIM 63% and 75%. CONCLUSIONS: The MAHSC has a high interrater reliability after brain injury and is a useful parent-report surveillance tool to audit outcome after severe TBI. It identified problems not addressed by the Glasgow Outcome Scale or FIM/WeeFIM. Most children with severe TBI have adverse outcomes.

Early motor development of breech- and cephalic-presenting infants

OBJECTIVE

This study was conducted to determine whether breech-presenting infants have a different pattern of early neuromotor development than cephalic-presenting infants--regardless of mode of delivery-thus explaining both the failure to assume cephalic version at the end of gestation and the higher rates of childhood motor impairments associated with breech presentation.

METHODS

Ninety morphologically normal, term, breech-presenting singletons with birthweights greater than 2,500 g were paired with a similar cephalic-presenting infant, matched for gender and mode of delivery (n = 180; 100 delivered abdominally and 80 delivered vaginally). Data on neurological status (Neurological Assessment of the Preterm and Full-term Newborn Infant) and motor performance (Alberta Infant Motor Scale, Peabody Developmental Motor Scales, and age of walking) were collected prospectively over the first 18 months of life. This study was designed with a power of .80 to detect a "medium" effect size for motor development using the Alberta Infant Motor Scale. The data were analyzed using analysis of variance techniques.

RESULTS

Breech-presenting infants had minor transient differences compared with cephalic-presenting infants. First, they had more open popliteal angles at birth (P < .001). Second, they had significantly lower motor scores at 6 weeks than the normative sample (P < .001). At 18 months, three infants were diagnosed with neurological problems, all of whom were delivered electively in the cesarean-breech group.

CONCLUSION

As a group, breech-presenting infants do not have a persistent, inherently different pattern of motor development than cephalic-presenting infants. Mode of delivery did not explain the excess neuromotor impairment detected in the subgroup of breech infants.

Relationship between serotype A encapsulation and a 40-kDa lipoprotein in Pasteurella multocida

Eleven serotype A encapsulated and nonencapsulated strains of Pasteurella multocida were examined with regard to lipoprotein content. Relative amounts of an approximately 40-kDa lipoprotein (Plp-40) were found to correlate directly with the degree of encapsulation in that heavily encapsulated strains exhibited the greatest amounts, while nonencapsulated strains possessed little or no Plp-40.

The practical use of axillary brachial plexus block for hand surgery

A retrospective study of 178 patients undergoing axillary brachial plexus block (ABPB) for hand surgery used information gathered by a computer-aided anaesthetic record keeping system. The practical use of local techniques to augment the block meant that only two of the 178 patients required a general anaesthetic, giving a success rate of 98.8%. There were no significant complications.

The use of Bier's block for day case surgery

With the increasing popularity of day case surgery it is important to ensure that safe and appropriate techniques are being used. We retrospectively reviewed a large series of 732 patients who underwent planned day case hand surgery under intravenous regional anaesthesia (modified Bier's block) over a 5-year period. We found a modified Bier's block to be ideally suited to day case surgery with no deaths, minimal morbidity and a success rate in excess of 98%.

Lead contamination of UK dusts and soils and implications for childhood exposure: An overview of the work of the Environmental Geochemistry Research Group, Imperial College, London, England 1981-1992

Over the course of the last decade, research conducted by the Imperial College Environmental Geochemistry Research Group has focused on the nature and effects of lead in UK dusts and soils. An initial nationwide reconnaissance survey demonstrated that approximately 10% of the population is exposed to lead levels in excess of 2,000 μg g(-1) in house-hold dust. Subsequent exposure studies revealed that for 2 year old children in the UK urban environment, approximately 50% of lead intake was from dust ingested as a result of hand-to-mouth activity. Follow-up computer controlled scanning electron microscopy (CCSEM) analysis of urban household dust and particulate material wiped from children's hands showed that important sources of dust lead include lead-based paint, road dust and soils. CCSEM identification of specific soil lead tracer particles (from minewaste contaminated soils) in dusts and on children's hands further documented the important role of soil as a source of exposure. Speciation studies of soil lead of this origin indicated that the form of the lead, which is largely influenced by the soil environment, is the primary control on bioavailability. It appears that although lead of minewaste origin may be present at elevated levels in dusts and soils, it does not necessarily contribute to elevated blood lead levels when the lead is present in relatively insoluble form.

A new low-frequency red cell antigen, 'SARAH'

There are more than 100 low-frequency antigens (LFAs) which have been given International Society of Blood Transfusion (ISBT) numbers as members of systems, collections or the 700 series. In addition, there are a number of well-known (to reference laboratories) unpublished LFAs. The presence of an LFA was suspected when 2 sera were found to react with a single example of K homozygous cells. Anti-K reacting with K homozygotes was eliminated on testing with other KK cells. Testing of the reactive cell with antibodies to known LFAs and the reactive sera with cells known to carry LFAs failed to identify the specificity. A study on the family of the cell donor showed inheritance of the antigen in two generations. Further testing, which included immunoblotting and RFLPs, was carried out in Australia, the UK, Canada and the USA. By March 1993 all published LFAs had been excluded, and an application was made to the ISBT to have the antigen, SARAH, assigned a 700 series number. In April the number 700.052 was provisionally designated for this new antigen.

Apportioning the sources of lead in house dusts in the London borough of Richmond, England

The sources of particulate lead in houses in the London Borough of Richmond, England have been investigated using automated scanning electron microscopy in conjunction with energy dispersive X-ray spectroscopy. Compositional and size information was collected on lead-bearing particles from density and size fractionated floor dusts from 16 residences of various ages. A classification scheme based on the analysis of different types of lead source particles was used to categorize the house dust particles as either auto exhaust, road dust, garden soil, paint, high temperature process emissions, lead of common origin or miscellaneous lead-bearing. Classification results based on both populations of particles and estimated particle volumes suggest that paint, road dust and garden soil are the major contributors of particulate lead to the Richmond households. The primary contributing source in the 64-1000-microm size range of the house dusts appears to be paint. In the 0-64-microm size fraction of the dusts paint, road dust and garden soil all make significant contributions. Variations in the contributions made by the major sources appear to be unrelated to the age of the homes.

Early development of the chick embryo

The ultrastructure of the early chick embryo was investigated, using scanning (SEM) and transmission electron microscopy (TEM). Eggs were obtained from the shell gland by injecting hens intravenously with a synthetic prostaglandin or arginine vasopressin. Embryos were examined during late cleavage (stages IV-VI, Eyal-Giladi and Kochav, '76), formation of the area pellucida (stages VII-XI), and formation of the hypoblast (stages X-XIV). SEM highlighted the reduction in cell number at the underside of the embryo during formation of the area pellucida although it became apparent that the thickness of the embryo is not reduced to a single layer of cells at stage X. In addition, blastomeres at the perimeter of embryos (stages V-VI) project filopodial extensions onto a smooth membrane that separates the sub-embryonic cavity from the yolk. During hypoblast formation, epiblast cells generate stellate projections at their basal aspect, thus providing a meshwork for the advancing secondary hypoblast cells. By stage XII the epiblast was one cell thick and reminiscent of a columnar epithelium when viewed transversely. Cells of the deep portion of the posterior marginal zone were distinguished morphologically in the stage XII embryo by their many cell surface projections and ruffled appearance. Blastomeres at the perimeter of stage V-VI embryos projected filopodial extensions onto a smooth membrane which separates the sub-embryonic cavity from the yolk. This membrane is presumed to be confluent with the cytolemma. Evidence is presented demonstrating the presence of intracellular membrane-bound droplets which are hypothesised to contain sub-embryonic fluid.

Intermittent pneumatic compression to prevent proximal deep venous thrombosis during and after total hip replacement. A prospective, randomized study of compression alone, compression and aspirin, and compression and low-dose warfarin

A prospective, randomized study of the effectiveness of intraoperative and postoperative use of intermittent pneumatic compression, alone or in combination with oral administration of either aspirin or low-dose warfarin, was done of a consecutive series of patients who had a total hip replacement and were more than thirty-nine years old. All patients began walking by the third postoperative day. One hundred and ninety-six patients who had 217 total hip arthroplasties were included. Twenty-eight per cent of the procedures were revisions of a previous total hip replacement or of an endoprosthesis, and the remainder were primary arthroplasties. Patients were randomized as to the type of prophylaxis that they received: intermittent pneumatic compression alone, seventy-six hips; intermittent pneumatic compression and aspirin, seventy-two hips; or intermittent pneumatic compression and low-dose warfarin, sixty-nine hips. Before discharge from the hospital, and at an average of seven days after the operation, all patients were evaluated for the presence of proximal deep-vein thrombosis with either venography on the side of the operation or with bilateral venous ultrasonography. The relative frequency with which thrombosis occurred in a proximal vein was not significantly different in the three groups; the over-all relative frequency was 10 per cent. Intermittent compression during and after the operation effectively reduces the rate of proximal-vein thrombosis after total hip replacement. With the number of patients in our study, the effectiveness of this technique could not be shown to be augmented by oral administration of either aspirin or low-dose warfarin.

Assessment of clinical significance of anti-Ge in an untransfused man

A 19-year-old, untransfused Melanesian man from Papua New Guinea was admitted to the hospital for repair of an atrial septal defect. His serum contained an alloantibody that reacted strongly on the indirect antiglobulin test and was identified as anti-Ge. Gerbich-negative blood was transfused following urgent surgery. A 51Cr red cell survival study performed 2 weeks after surgery yielded zero survival of Gerbich-positive cells after 24 hours. A monocyte-driven, antibody-dependent, cell-mediated cytotoxicity assay performed on both pretransfusion and posttransfusion serum samples and on concentrated serum showed less than 1 percent specific lysis of Gerbich-positive cells. This did not correlate with the indication of clinical significance predicted by the 51Cr study. Red cell adherence and phagocytosis, not evident in a monocyte monolayer assay using native serum, were demonstrable in 16 percent of monocytes by the use of concentrated serum.

Use of autologous blood in total hip replacement. A comprehensive program

We evaluated the effectiveness of a comprehensive program for the use of autologous blood in reduction of the need for transfusion of homologous blood in total hip replacement in a prospective study of a consecutive series of patients. Transfusion of homologous blood was minimized through transfusion of preoperatively deposited autologous blood, intraoperative and postoperative salvage of washed red blood cells, and use of the clinical condition of the patient as the sole criterion for transfusion of non-autologous blood, regardless of the hematocrit. The cases of 143 patients who had had 154 primary total hip replacements were studied. One hundred and forty-three procedures were done on patients who had not been prevented from donating blood for medical reasons, and 93 per cent of these 143 procedures were performed with the availability of one to five units of preoperatively deposited autologous blood. The patients predeposited an average of 2.6 units of blood for each procedure. Ninety-two per cent of the procedures for which autologous blood had been predeposited were performed without transfusion of homologous blood. In the entire group of patients, almost 90 per cent of the transfused blood was autologous blood. Intraoperative salvage of red blood cells was successful in 148 procedures, and salvage was continued in the recovery room for all of these patients. An average of 408 milliliters of red blood cells was saved and reinfused, and this was 28 per cent of the average total loss of blood (1435 milliliters) for this series of procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Lead exposure in young children from dust and soil in the United Kingdom

A survey of metals in United Kingdom dusts and soils has confirmed widespread lead contamination with a geometric mean value for lead in surface (0-5 cm) garden soils of 266 micrograms/g and in housedusts of 561 micrograms/g (excluding old mining areas). A subsequent detailed survey of 97 householders in Birmingham with 2-year-old children showed dust lead loading in the home environment to be an important predictor of blood lead concentrations in young children, when both variables fell within the normal range for the U.K. The total estimated lead uptake by the young child was 36 micrograms/day of which 1 microgram was by inhalation and 35 micrograms by ingestion.

B-mode ultrasound scanning in the detection of proximal venous thrombosis after total hip replacement

A prospective study of the accuracy of real-time B-mode ultrasonography in detecting deep venous thrombosis in the femoral and popliteal veins of the lower extremity was conducted on a consecutive series of patients who had had a total hip replacement. Ascending venography was used as a diagnostic standard. One hundred and forty-three patients had ultrasound studies of both lower extremities and a venographic study of the operatively treated lower extremity at an average of 7.6 days postoperatively. The two tests were done within twenty-four hours of each other. Both ultrasonography and venography were done on 152 extremities. Two paired studies were excluded from the analysis of results because the ultrasound scans could not be interpreted. In 131 extremities, both diagnostic tests were negative for proximal thrombosis. Eight extremities had isolated thrombosis of a vein in the calf that was detected only by venography. In nineteen extremities, old or fresh thrombosis was diagnosed by venography. In four extremities, an old thrombosis of the superficial femoral vein was detected by both studies. In four of the extremities that had a new thrombus in the common femoral vein and in nine that had a new thrombus in the superficial femoral vein, abnormal findings on ultrasound scans correlated with those on venograms. There were two false-negative ultrasound scans and one false-negative venogram. The sensitivity, specificity, and accuracy of ultrasonography were 89, 100, and 99 per cent for the diagnosis of thrombosis of the proximal veins of the lower limb and 63, 100, and 93 per cent for the diagnosis of thrombosis when the entire venous system of the limb was included.(ABSTRACT TRUNCATED AT 250 WORDS)

Lead intake and blood lead in two-year-old U.K. urban children

A comprehensive study of a group of 2-year-old urban children (n = 97), designed to provide quantitative information simultaneously for lead intakes via all identified pathways, has been carried out in Birmingham (U.K.). Results showed that for children whose blood levels and exposure to environmental lead were within the normal range for the U.K., blood lead concentration was significantly related to a combination of house dust lead loading and an overall rate of touching objects, to water lead concentration and to the parents' smoking habits. On the basis of assumptions used by the Royal Commission on Environmental Pollution (RCEP), the estimated average total uptake of lead was 36 micrograms day-1; of this, 97% was from ingestion from dust, food and water and only 3% from inhalation.

Early prognosis for ambulation of neonatal intensive care survivors with cerebral palsy

The ambulatory status of 74 neonatal intensive care unit survivors with cerebral palsy, excluding those with central nervous system malformations and syndromes, was assessed at eight years of age. Detailed examinations were completed at two and eight years of age; of the 47 who were sitting by two years, 46 became ambulatory, and a total of 47 of the 74 children became ambulatory. The clinical type of cerebral palsy at two years of age related significantly to eight-year ambulation. However, between two and eight years the diagnosis was changed for 18 children. At two years of age the tonic labyrinthine, asymmetrical and symmetrical tonic neck and Moro reflexes related significantly to ambulation; in five of 27 children not walking, these reflexes were absent by two years of age. Foot placement and/or parachute reactions at two years were found in more than one-third of children not walking. Multivariate analysis determined that age at sitting explained 91 per cent of the variance in ambulation. No other variables, combined with sitting, increased this prediction.

Effect of lysine-8-vasopressin on retention and retrieval of a discrimination reward task in the rat

The effect of vasopressin on memory of a brightness discrimination reward task was investigated in 20 male Sprague-Dawley rats. Two measures of retention were used: resistance to extinction and savings scores on a reacquisition task given 45 days after the completion of extinction training. The effect of the peptide on both memory consolidation and retrieval was assessed. There were two major findings: (a) The peptide enhanced memory consolidation of the task whether measured after a short time interval (6 days) or after a long time interval (45 days after completion of extinction training) using a measure of trials to relearn the task, and (b) the peptide had no effect on memory retrieval. These results were compared to those of other studies designed to access memory consolidation and retrieval on appetitive tasks. The mechanisms of the peptide's effect on memory was briefly discussed with respect to three theories on the subject. This study extends the vasopressin research on memory consolidation by suggesting that it pertains to appetitive as well as to aversive tasks.

Air lead concentrations in Birmingham, England - a comparison between levels inside and outside inner-city homes

Air lead concentrations were monitored for seven consecutive days at two locations inside and one location immediately outside 97 houses in inner-city Birmingham. Concentrations in the bedroom and playroom were similar to each other, but usually lower than those found outdoors. The mean internal air lead concentration was 0.26 μg/m(3) (n=1206) and the mean external concentration, 0.43 μg/m(3) (n=605). The mean of the individual internal:external ratios was 0.61 and similar to others cited in the literature. The study indicates that, in the absence of any major internal sources of lead, the mean external air lead concentration is a good predictor of the mean air internal air lead concentration.

The comparative economic performance of investor-owned chain and not-for-profit hospitals

We examined the differences in the economic performance of 80 matched pairs of investor-owned chain and not-for-profit hospitals in eight states during 1978 and 1980, and considered how their operating strategies might affect their relative success in a more price-conscious market. We found that total charges (adjusted for case mix) and net revenues per case were both significantly higher in the investor-owned chain hospitals, mainly because of higher charges for ancillary services; there were no significant differences between the two groups of hospitals in regard to patient-care costs per case (adjusted for case mix), but the investor-owned hospitals had significantly higher administrative overhead costs; investor-owned hospitals were more profitable; investor-owned hospitals had fewer employees per occupied bed but paid more per employee; investor-owned hospitals had funded more of their capital through debt and had significantly higher capital costs in proportion to their operating costs; and the two groups did not differ in patient mix, as measured by their Medicare case-mix indexes or the proportions of their patients covered by Medicare or Medicaid. We conclude that investor-owned chain hospitals generated higher profits through more aggressive pricing practices rather than operating efficiencies - a result not unexpected in view of past cost-based reimbursement policies. Recent changes in these policies are creating new pressures for cost control and moderation in charges, to which both types of hospitals must adapt. Neither type has a clear-cut advantage in the ability to make the necessary changes.

The influence of posture upon cardiovascular dynamics throughout pregnancy

Systemic blood pressure (measured with a zero-randomized sphyngmomanometer), stroke volume and heart-rate (measured with a Minnesota Impedance Cardiograph), hematocrit and their derivatives--cardiac output, pulse pressure, mean arterial blood pressure and peripheral vascular resistance, were assessed in 19 nonpregnant women of child-bearing age and in 27 patients who were examined at regular intervals on 12 to 15 occasions from 8 to 11 wk of pregnancy until 6-wk postpartum. Readings were made with the subjects in each of six positions: supine, reclining, left and right lateral, left and right tilt. The purpose of this paper is to compare the results of these different postures. Systolic and diastolic blood pressure readings were lowest in the left lateral and second lowest in the left tilt. We suggest that this reflects a hydrostatic pressure difference. Stroke volume and cardiac output were lowest in the right lateral and second lowest in the right tilt. Thus, the derived values of peripheral resistance were lowest when subjects were turned towards the left and highest when turned towards the right. The rank orders of values were maintained with impressive consistency between subjects (pregnant and nonpregnant) and throughout pregnancy, reaching levels of statistical significance in almost all instances. No evidence was found that aortocaval compression led to a change in the measured attributes of central cardiovascular dynamics. For the 'normal unembarrassed parturient' it is suggested that aortocaval compression is rapidly succeeded by a restablization of these attributes to their previous levels, reflecting the prompt establishment of a suitably diminished circulating blood volume within a reduced vascular capacity. It is nevertheless likely that aortocaval compression will interfere markedly with uteroplacental vascular dynamics and hence pose a hazard to the fetus.

A longitudinal study of cardiovascular dynamic changes throughout pregnancy

Systemic blood pressure (measured with a zero-randomized sphygmomanometer), stroke volume and heart-rate (measured with a Minnesota Impedance Cardiograph), hematocrit, and their derivatives -- cardiac output and peripheral vascular resistance--have been assessed in three groups of subjects. First, a control group of 19 nonpregnant women were matched for age and weight with the subjects in the second group, which consisted of 19 patients who were seen at regular intervals on 12 to 15 occasions from 8 to 11 wk of pregnancy until 6 wk postpartum. The third group consisted of 8 patients seen from before conception, throughout pregnancy and to several months postpartum. Readings were made with the subject in each of six positions: supine, reclining, left and right lateral, left and right tilt. This paper concerns the readings obtained in the left lateral position. The data showed that pulse rate rose throughout pregnancy. Stroke volume and cardiac output rose shortly after conception, the increase over the prepregnancy level being statistically significant by 12 wk. Thereafter both values fell throughout the rest of pregnancy and were below prepregnancy levels by about term, taking some weeks to regain the prepregnancy value. There were irregular fluctuations in the level of systolic blood pressure; diastolic blood pressure fell during the first 16 wk and then rose to reach almost the prepregnancy value by term. Peripheral resistance fell during the first trimester, then increased markedly throughout the remainder of pregnancy.

Child health revisited

Much discussion has taken place over the recently published mortality statistics for infants and young children. These statistics are critically examined and conclusions reached. Suggestions with regard to the improving of Child Health Services are made.

Anaphylactic reactions after use of CT 1341 (althesin)

Images