Pedal infectious disease associated with acquired immunodeficiency syndrome.

AIDS is a disease that quickly takes the lives of individuals of all ages and in all countries. Therefore, it is the responsibility of podiatrists to recognize the primary manifestations of this disease, to take the proper precautions to guard against the spread of this disease, to direct attention to areas in need of proper diagnosis, and to provide effective treatment to those with the disease and to those yet undetected.

Influence of exercise on a heart transplant patient.

A treadmill training protocol was implemented to examine the effects of a 12-week exercise program on the physiologic status of a patient who had a heart transplant in 1980. The patient was tested for exercise tolerance before programming, midway through the study, and immediately upon completing endurance training. Maximal METS levels achieved were 3.2 METS, 5.6 METS, and 6.3 METS, respectively. The subject began an anaerobic program consisting of 48 exercise sessions over a three-month period. Exercise sessions were interval in nature, walking at 2.5 mph, 0% grade, three repetitions, five minutes each and increasing to 3.0 mph, 2.5% grade, two repetitions, 15 minutes each. The patient improved from Class III (METS = 3.0), where less than ordinary physical activity causes fatigue, to Class I (METS = 6.5), where ordinary physical activity can be sustained without undue fatigue. These findings suggest that selected heart transplant patients may achieve up to 85% maximum oxygen consumption and maximum heart rate which demonstrates the need for endurance training programs in this population. This form of cardiovascular conditioning has enabled the participant to engage in higher levels of activities of daily living within the community.

Treadmill training program for a bilateral below-knee amputee patient with cardiopulmonary disease.

This study was undertaken to determine the degree of progress an elderly bilateral below-knee amputee with cardiopulmonary disease could achieve by endurance training on a treadmill. Aspects of medications, orthotic/prosthetic evaluation, and energy expenditure are discussed. The subject was a 63-year-old Class IV cardiac patient with combined restrictive-obstructive pulmonary disease of moderate severity. He had undergone a coronary artery bypass graft (two-vessel) followed by a bilateral below-knee amputation for an ascending dry gangrene. The initial ambulatory aerobic evaluation showed the patient achieving only 50% of predicted maximal heart rate and 20% of maximal oxygen consumption. An individualized daily training program started the patient walking at .5 mph, 0% elevation, for five repetitions at two minutes each. By the end of the six-month training program the workload reached 1.4 mph at 2.5% elevation, for 30 minutes of total external work. The final exercise test evaluation showed an overall increase in age-predicted maximal heart rate (90%) and oxygen consumption (55%). The patient improved from cardiac Class IV to Class II, and therapeutically from Class E (bed rest) to Class C (moderate exercise restriction). These findings suggest a need for endurance training programs for patients with cardiopulmonary disease hindered by additional physical disabilities. The program enabled the participant to engage in significantly higher levels of activity for daily living within the community.

Food and chemical sensitivity. Clinical and immunologic correlates.

Six allergic patients and six normal controls were studied serologically before and after provocative challenge with allergic substances. The patients showed impaired modulation of the immune system prior to challenge. The challenge blood changes in patients with adverse clinical responses were consistent with type 1 and/or type 3 immune responses. Normal controls showed no abnormal laboratory or clinical changes. The data support the hypothesis that an abnormal immune reaction develops in allergic patients who sustain an adverse clinical response to ingestion of foods or inhalation of chemicals to which they are sensitive.