Magnetic resonance imaging in the a literature review.

To determine the indications for magnetic resonance imaging (MRI) in the evaluation of individuals with carpal tunnel syndrome (CTS). a critical review of the literature was undertaken. Among the studies reviewed, a lack of uniformity in MRI equipment and techniques, conflicting sensitivity and specificity of imaging criteria for median nerve compression, and a paucity of normative data were noted. Based on this review, we conclude that MRI is not a useful tool for large-scale population screening, and is unhelpful as a routine preoperative study MRI is useful for confirmed CTS with persistent postoperative findings and in cases m which anatomic anomalies are suspected preoperative!)'. The use of MRI for guiding treatment deosions in individuals with clinical signs and symptoms of CTS but with normal electrodiagnostic studies remains undetermined.

A prospective study of peripheral nerve lesions occurring in traumatic brain-injured patients.

The purpose of this study was to determine the frequency and severity of peripheral nerve lesions occurring in patients with traumatic brain injury. A prospective study of 132 patients was conducted. Patients fulfilling research criteria (flaccidity, areflexia, abnormal motor patterns) underwent neurodiagnostic examination. Fifteen electromyograph/NCV studies were performed, yielding positive findings in 13 patients (10%); 3 patients were found to have preventable lesions. Many patients had permanent impairment or attendant complications from the peripheral nerve injury that adversely affected eventual recovery.

Team treatment. Does a specialized unit improve team performance?

The treatment of inpatients in a contiguous hospital area designated the Arthritis Rehabilitation Unit (ARU) as opposed to the treatment of patients on units discretely spaced throughout the hospital was studied by means of independent retrospective audit of randomly chosen charts with the primary diagnosis of rheumatoid arthritis. Three time periods were considered: T-1 (2 months to 0 months prior to the beginning of the ARU), T-2 (0 months to 5 months of operation of the ARU), T-3 (after 18 to 24 months of operation of the ARU). At T-1 only seven charts were reviewed; ten charts were reviewed at T-2 and T-3. The frequency of fulfillment to audit criteria was calculated as the arithmetic mean. No weighting or preference was given to any of the items. P values were calculated utilizing the Mann-Whitney U test for nonparametric measures. The criteria by which the charts were reviewed were developed through the Delphi method of opinion convergence. Criteria were generated using the principle of optimal medical care. The categories included initial evaluation, treatment plan, outcomes and discharge plan. T-1 compared to T-3 yielded results in overall percentage of effectiveness of: physician, 81 v 90 (NS): nurse, 42 v 60 (P 0.043); occupational therapy, 62 v 58 (NS); physical therapy, 69 v 78 (NS); and social worker, 17 v 88 (P less than 0.001) Geographic isolation of arthritis rehabilitation patients improved measured aspects of their care but not uniformly throughout the rehabilitation team.

Late effects of poliomyelitis.

Muscular atrophy and decreased functional abilities are recognized as late complications of poliomyelitis. This study sought to more clearly define late-onset, postpolio muscular weakness--age of onset, symptoms, and severity--and to determine whether people might benefit from environmental modification, respiratory aids, and orthoses. A total of 183 postpolio patients were examined by a physician and completed a questionnaire on their ambulatory status and related musculoskeletal and respiratory symptoms. Of those participating in the study, 154 claimed to be experiencing late deterioration in strength. The syndrome included decreased endurance, more limited ambulation, and increased weakness in the previously affected limb/s. For those describing late-onset weakness, average ages were determined for the onset of polio (8.3 years), the onset of postpolio muscular weakness (42.3 years), and the latent period of stable functioning (34.8 years). Patients claimed to have experienced a new, lower level of strength for an average of 4.7 years. All 33 patients who had undergone muscle transfer surgery were experiencing late-onset weakness in that extremity. Fasciculations (51%) and long-bone fractures secondary to falls (21%) were common sleep disturbances occurred frequently (31%) even in those without prior bulbar involvement. Upper motor neuron signs were present in only one case. Bracing was rare (16%) and the braces used were usually old. The subjects did not report a steadily or rapidly progressive decline, but rather described a steplike decrement with long plateaus. The population described losses in strength that had significant bearing on functional status and general health.(ABSTRACT TRUNCATED AT 250 WORDS)

Release of neutral proteinases from mononuclear phagocytes and synovial cells in response to cartilaginous wear particles in vitro.

Cartilaginous wear particles were retrieved from synovial fluid aspirates of human diarthrodial joints and added to cultures of human or murine mononuclear phagocytes or human synovial cells. In each case, addition of the wear particles elevated the production of proteinases active at neutral pH against collage, gelatin, azocasein and the synthetic pentapeptide phenylazobenzyloxycarbonyl-L-Pro-L-Leu-Gly-L-Pro-D-Arg. Synovial cells secreted more than five times as much collagenase as the same number of the other cells. All types of cell secreted significant quantities of enzymes active against the noncollagenous substrates. Mild treatment of the spent media with trypsin stimulated all of these eurmymic activities. The spent culture media of synovial cells which had been exposed to cartilaginous wear particles released hydroxyproline and glycosaminoglycan from powdered cartilage, indicating the production of enzymes which degrade both the collagen and proteoglycan of th cartilaginous matrix. Cultures of mononuclear phagocytes, in contrast, while solubilizing chondroitin sulphate from cartilage, released very little hydroxyproline. The ability of wear particles to elicit these effects suggests a role for them in the pathogenesis of osteoarthritis and other types of joint deterioration.