Chiropractic Care in a Patient With Hereditary Spastic Paraplegia and Chronic Pain.

Hereditary spastic paraplegia (HSP) is a rare neurodegenerative disorder, which is challenging to diagnose and is known to be associated with more than 73 genes. Neurodegenerative disorders are characterized by progressive spasticity and weakness of the lower limbs. Here, we report the case of a 13-year-old girl with a history of HSP who presented to a chiropractic clinic with chronic low back pain and rehabilitation for lower extremity weakness. She had been receiving non-steroidal anti-inflammatory drugs and baclofen for spasticity. Full-spine radiography revealed borderline acetabular dysplasia in the right hip. After nine months of chiropractic therapy, the patient reported reduced lower extremity spasticity and pain as well as improved strength and functionality. As non-invasive therapies have minimal side effects, chiropractic therapy can be used alongside or in combination with other treatments as an additional option for the long-term management of HSP.

A Flowmeter Technique to Exclude Internal Mammary Artery Anastomosis Error in an Arrested Heart.

The revision of an internal mammary artery graft anastomosis because of a technical error can be time-consuming and complicated and may lead to complications. Here, we describe the technical details and our early experience of using a standard transit-time flowmeter to exclude technical errors and facilitate rapid decision making for anastomosis revision in an arrested heart during aortic cross-clamping in the absence of ultrasound guidance.

Comparison of intensive and low-dose atorvastatin therapy in the reduction of carotid intimal-medial thickness in patients with coronary heart disease.

BACKGROUND: Intensive statin therapy has been shown to improve prognosis in patients with coronary heart disease (CHD). It is unknown whether such benefit is mediated through the reduction of atherosclerotic plaque burden. AIM: To examine the efficacy of high-dose atorvastatin in the reduction of carotid intimal-medial thickness (IMT) and inflammatory markers in patients with CHD. DESIGN: Randomised trial. SETTING: Single centre. PATIENTS: 112 patients with angiographic evidence of CHD. INTERVENTIONS: A high dose (80 mg daily) or low dose (10 mg daily) of atorvastatin was given for 26 weeks. MAIN OUTCOME MEASURES: Carotid IMT, C-reactive protein (CRP) and proinflammatory cytokine levels were assessed before and after therapy. RESULTS: The carotid IMT was reduced significantly in the high-dose group (left: mean (SD), 1.24 (0.48) vs 1.15 (0.35) mm, p = 0.02; right: 1.12 (0.41) vs 1.01 (0.26) mm, p = 0.01), but was unchanged in the low-dose group (left: 1.25 (0.55) vs 1.20 (0.51) mm, p = NS; right: 1.18 (0.54) vs 1.15 (0.41) mm, p = NS). The CRP levels were reduced only in the high-dose group (from 3.92 (6.59) to 1.35 (1.83) mg/l, p = 0.01), but not in the low-dose group (from 2.25 (1.84) to 3.36 (6.15) mg/l, p = NS). A modest correlation was observed between the changes in carotid IMT and CRP (r = 0.21, p = 0.03). CONCLUSIONS: In patients with CHD, intensive atorvastatin therapy results in regression of carotid atherosclerotic disease, which is associated with reduction in CRP levels. On the other hand, a low-dose regimen only prevents progression of the disease.