Effects of different frequencies of loading on healing in partial rupture of the Achilles tendon in a rat model.

Objective: To determine the histological effects of different frequencies of loading in a healing Achilles tendon following partial rupture. Design: Experimental laboratory study. Setting: University of Zimbabwe, Department of Physiology, Animal house. Subjects: Sixty female Sprague-Dawley rats. Intervention: Partial tenotomies of the right Achilles tendon were performed surgically. From day 1 post operatively, the animals were allocated to treadmill running at different frequencies (once (OD), two (BD), three (TDS) and four (QID) times daily) up to 21 days. Histological sides of the tendons were made at days 7,14 and 21 and interpreted by a blinded pathologist. Main outcome measures: Collagen fibre orientation, inflammatory cell populations, fibroblast morphology and neoangiogenesis were observed and scored using the Grande Biomechanical Histological Correlation Score. Results: Mean weight was 209.67g ±30.14. The best and worst arrangements of collagen were in the QID group (73%) and OD group (46.7%) respectively. These differences were not statistically significant (p=0.487). The BD group had the most mature fibroblast nuclei and the QID tendons had the least mature (p=0.577). Inflammatory cell populations were independent of loading frequency (p=0.132). Conclusion: Changing the frequency of the same type of loading in a healing tendon does not have an effect on the healing process in partially ruptured Achilles tendons during the inflammatory and proliferative phases.

Glucose tolerance study in low and normal birth weight young adults.

Objective: To determine blood glucose levels by conducting an oral glucose tolerance test in low and normal birth weight young black adults. Design: Acase control study was done. Seventy students in the College of Health Sciences who had neonatal clinic cards as proof of birth weight were recruited into the study. Blood glucose levels were measured before, during and after the oral glucose tolerance test. Setting: Department of Physiology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe. Main Outcome Measures and Results: A total of 70 young adult participants, 47(67%) females and 23(33%)males with mean age 20.28±0.19 years were recruited. 30 had Low Birth Weight (LBW, 21 females and 9 males) and 40 had Normal Birth Weight (NBW,26 females and 14 males).LBW individuals had significantly elevated (p<0.05) mean blood glucose levels at 30minutes(9.41±0.91 for LBW and 7.24±0.28 for NBW, p=0.029) and 60 minutes (9.22±0.75 for LBW and 7.57±0.36 for NBW, p=0.035) after the oral glucose tolerance test. Oral glucose tolerance testing detected 1case of type II diabetes (LBW individual), 13cases of impaired glucose tolerance (9 LBW and 4 NBW individuals)and 1 case of impaired fasting glucose (LBW individual).LBW was associated with an odds ratio of 3.1 for impaired glucose tolerance and it was statistically significant, p<0.05 (p=0.027). Conclusion: Low birth weight was associated with glucose intolerance and significantly higher mean blood glucose levels at 30 and 60 minutes after glucose loading in young adults.

Comparison of the systolic blood pressure of the upper and lower limbs in young adults.

INTRODUCTION: The anatomical structural origin of the left and right subclavian arteries is different. Could this difference translate into differences in blood pressure measurements? This was the question to be answered by this study. The experiments were done in the Department of Physiology at University of Zimbabwe-College of Health Sciences. METHODOLOGY: A Dinamap (CRITIKON, TAMPA, FL 33634), automated, oscillation-based machine was used to take blood pressure measurements on the arms and ankles of 112 subjects, 23 females and 89 males, aged 19-25, recruited between 0800 to 1600 hours on Monday to Friday of the week for 2 months. A towel was used for blindfolding subjects. RESULTS: The mean systolic blood pressures (SBPs) were, right arm 121, left arm 117, right leg 152 and left leg 154 with the subjects sitting. The right arm systolic blood pressure (SBP) readings were higher in 62.1% of the subjects with a mean difference +/- S.E of (4.15 +/- 0.848). The right calf SBP readings were lower in 63.0% of the subjects with a mean difference +/- S.E of (3.44 +/- 2.29). Blinded subjects had lower SBP in 63.0% of the subjects with a mean difference +/- S.E of (2.06 +/- 0.779). The first was greater than the second sequential SBP readings in 81.5% of the subjects' right arm and was reduced to 59% by blindfolding the subjects, and the left was 67.2%. On the ankle pressure it was 67.2% left and 63.0% right. CONCLUSION: Clinicians should be aware that the right arm systolic blood pressure is higher than the left in most people. Also that it is different in the legs whereby the left ankle pressure is higher than the right ankle pressure.

Trends in cancer pain management.

BACKGROUND: Pain is a prevalent symptom in cancer patients, affecting up to 50% of patients undergoing active cancer treatment and up to 90% of those with advanced disease. Although adequate relief can be achieved in the majority of cancer patients, pain is often treated inadequately in traditional settings and sometimes even under the management of more specialised units. In this review the authors use their experience and that of others to review the evaluation and diagnosis of pain syndromes and the principles of management. This is in keeping with increasing recognition by bodies such as the World Health Organisation and other governmental agencies who have recognised the importance of pain management as part of routine cancer care. Conducting a comprehensive assessment, competently providing analgesic drugs, and communicating with the patient and family allow effective management of pain in the cancer patient.

Neuropathic pain--from mice to men.

The past decade has seen great progress in understanding the syndrome of neuropathic pain, its causes and in finding new drugs that promise great benefit. For example, an early outcome of the research has been the observation that the new drugs do not blunt normal pain sensation--a pattern beginning to find explanation through the realisation that neural pain circuits rewire themselves, both anatomically and biochemically, after nerve injury. In this article, we discuss a case of a known diabetic patient with intractable pain and the course of management provided by the use of novel tools and devices coming to the fore in this rapidly expanding specialty.

Lung function, blood gases, pH and serum electrolytes of small-scale miners exposed to chrome ore dust on the Great Dyke in Zimbabwe.

We measured and compared lung function indices and some blood parameters (gases, electrolytes, glucose, pH, red cell indices) of 54 male small-scale miners (SSM) chronically exposed to chrome ore dust to those of 50 nonmining control subjects (NMC) and 46 large-scale chrome miners (LSM) who had taken internationally recommended precautionary measures (secondary control). The respirable dust level in the SSM environment (6.0 +/- 0.5 mg/m3) was significantly higher (P < 0.001) than in the NMC and LSM environments (0.3 +/- 0.1 mg/m3 and 0.5 +/- 0.3 mg/m3, respectively). There were no significant differences in neither dust levels nor lung function status between NMC and LSM environments. The values of FVC, FEV1, PEFR and FEV1% of the SSM were 3.5 +/- 0.09 l, 2.61 +/- 0. 09 l, 6.07 +/- 0.36 l/second and 76.19 +/- 2.36%, respectively. These values were significantly lower than those of NMC (P < 0.01, respectively). However, the blood parameters of the SSM and NMC were not significantly different. The results are indicative of both restrictive and obstructive ventilatory defects in the SSM which may be attributed exposure to chrome ore dust in the environment. Associated risk factors appear to be advancing age, prolonged exposure to chrome ore dust and acid base disturbance.

Pain: friend or foe.

Pain, the most urgent of symptoms usually signals the presence of potential or on-going injury to tissue which requires attention. The warning that pain provides is, therefore, a good thing and in a way friendly. When pain continues or resumes after the healing process of injury is complete, it is no longer signalling on-going tissue damage but becomes a disease in its own right. That, in essence, is the presentation of most chronic pain syndromes referred to Pain Clinics for investigation and treatment.

The need for a regular comprehensive health surveillance on industrial workers.

The movement of people during some of their daily occupations and activities releases an amount of dust into the air. Even dust that has settled on floors and flat surfaces is made airborne by air currents. Of greater concern is the dusty environment caused by the operations within the workplace, such as handling of dusty materials, machining, cutting, drilling, milling, rock blastic and pounding. Fortunately, a lot of the dust is harmless except when present in high concentrations when it can cause some discomfort. At such levels it is termed 'nuisance dust'. However, some form of dusts are distinctly harmful, giving rise to impairment of lung function and pneumoconiosis (dust-induced changes in the lung).

The history of the Central African Journal of Medicine 1953 to 1999.

The Central African Journal of Medicine Company was founded in 1953 and registered in 1954 in accordance with the then existing company act. Its purpose was to assist medical personnel in central Africa find a place to publish the results of their research endeavours as well as an avenue to disseminate their clinical observation and updates. Since its first publication 46 years ago, to the present, the journal has attracted research papers from as far afield as Nigeria in West Africa, China, Hong Kong, the middle east and all the SADC states.

Human immunodeficiency virus and Guillain 'Barre' syndrome in intensive care unit patients.

Among 155 medical admissions to the intensive care unit during the period 1989 to 1990, 16 patients had Guillain-'Barre' Syndrome (GBS), five of whom were HIV positive. Out of the five cases, three had manifested herpes zoster and one had TB. The impact of HIV infection o GBS is discussed.

Misdiagnosis of aneurysms: a case report.

Three cases in which aneurysms were misdiagnosed to less serous lesions are described. Attention is drawn to the possibility of these errors whose consequences can be fatal. Some of the problems associated with the handling of an inadvertently opened aneurysm are discussed.

Neuroleptic malignant syndrome.

While on holiday in Zimbabwe, a forty-one year old woman with a long history of intermittent psychiatric illness developed what was diagnosed as neuroleptic malignant syndrome. She was admitted to the Intensive Care Unit of Harare Central Hospital and was treated successfully with bromocriptine and dantrolene.

Abdominal sepsis: the identification of a high risk subgroup using the APACHE II system in twenty-seven patients.

The outcome of 27 severely ill patients with intra-abdominal sepsis admitted to I.C.U. was studied. The APACHE II score was done on admission, at 24 hours and at 48 hours. It proved to be an accurate predictor of hospital survival in this group of patients and implications for management are discussed.

Use of a modified Doppler flow detector for percutaneous cannulation of the internal jugular vein.

To lessen the risks associated with cannulation of the internal jugular vein, a method to identify the contours of the carotid artery and internal jugular vein at the site of cannulation is proposed. This method uses a doppler flow detector equipped with an adjustable electronic filter which selectively enhances the sound component due either to the arterial or venous flow. This method has been applied clinically and was found to be useful in the identification of the vessels. Since doppler flow detectors are readily available in many hospitals and the required modification is simple, we hope that other institutions will find this technique useful in their clinical practice.

Assessment of immediate post-anaesthetic recovery in young children following intravenous morphine infusions, halothane, and isoflurane.

Within 15 minutes of terminating general anaesthesia, progressive recovery of consciousness, spontaneous ventilation and cough, and limb movements were assessed in 60 young children (age range 0-5 years, mean +/- SEM; 2.83 +/- 0.34; weight 13.86 +/- 0.41 kg). All patients were ASA physical status class I-III, received a standard intravenous induction (atropine 0.02 mg X kg-1, thiopental sodium 5 mg X kg-1, diazepam 0.2 mg X kg-1), were intubated with an orotracheal tube following the administration of metocurine, 0.4 mg X kg-1, and were maintained under general anaesthesia with nitrous oxide and oxygen in a 70:30 mixture administered by a T-piece circuit. They were ventilated mechanically to maintain normal blood-oxygen tension and normocarbia. The patients were assessed in three equal groups according to the anaesthetic supplement they received. Group I received intravenous infusions of morphine sulfate (loading dose 60 micrograms X kg-1 administered over 5 minutes followed by a continuous intravenous infusion of 2 micrograms X kg-1 X min-1. Patients in Groups II and III had 0.5 per cent halothane and 1.0 per cent isoflurane respectively added to the nitrous oxide/oxygen fresh gas mixture rather than morphine sulphate infusions. By the end of the study period, there was no significant difference in the degree of recovery between the morphine and the isoflurane groups but the patients in the halothane group had recovered to a lesser degree. Generally, the patients in the morphine group were awake but not crying, while those in the other two groups were less sedated.