Comprehensive elements of a physiotherapy exercise programme in haemophilia--a global perspective.

SUMMARY: Exercise programmes for people with haemophilia are usually designed and implemented to help manage the recovery after a haemarthrosis or a muscle bleed, or as a tool to help prevent bleeding episodes from occurring. In this article, we have identified individual components of exercise that are often applied as separate entities, but may also need to be implemented in concert for optimized impact. Although it may be necessary on occasion to bias an exercise programme towards one component over the others, it is important to recognize that the various elements of exercise are not mutually exclusive. Decreased flexibility, strength and proprioception, will result in an impairment of balance and a loss of function. Programme design should whenever possible be guided by proven methodology in terms of how each component is incorporated, and more specifically how long to perform the exercise for and how many repetitions should be performed. We recognize, however, that this is not always possible and that there is significant value in drawing from the experience of clinicians with specialized training in the management of haemophilia. In this study, both perspectives are presented, providing reference-based reviews of the mechanics of the various elements of exercise as well as the expert opinions of the authors. Research that has been completed using patients with conditions other than haemophilia may or may not have a direct application with the bleeding disorders population, but the programme design based on principles of tissue healing in addition to disease specific knowledge should be encouraged.

Familial occurrence of oligodendroglial tumours.

Two non-identical brothers were diagnosed with anaplastic oligoastrocytoma within 4 months of each other and a maternal grandmother was diagnosed with oligodendroglioma 21 years previously. Familial clustering of oligodendrogliomas is rare.

Treatment of subtotally resected intracranial plasma cell granuloma with steroids: a case report.

Primary intracranial plasma cell granuloma (PCG) is a rare form of inflammatory pseudotumour often characterized by non-neoplastic proliferation of plasma cells. The following case indicates a potential role for steroid therapy after subtotal resection.

Detection of cathepsin S cysteine protease in human brain tumour microdialysates in vivo.

Microdialysis enables the chemistry of extracellular fluid in body tissues to be measured. Extracellular proteases such as the cysteine protease, cathepsin S (CatS), are thought to facilitate astrocytoma invasion. Microdialysates obtained from human brain tumours in vivo were subjected to cathepsin S activity and ELISA assays. Cathepsin S ELISA expression was detected in five out of 10 tumour microdialysates, while activity was detected in five out of 11 tumour microdialysates. Cathepsin S expression was also detected in microdialysate from the normal brain control although no activity was found in the same sample. While some refinements to the technique are necessary, the authors demonstrate the feasibility and safety of microdialysis in human astrocytomas in vivo. Characterisation of the extracellular environment of brain tumours in vivo using microdialysis may be a useful tool to identify the protease profile of brain tumours.

Isolated conjugate gaze palsy after frontal lobe tumour surgery.

Isolated conjugate gaze palsy following unilateral frontal lobe surgery is uncommon. When it does occur, usually it recovers within hours. We report a case of isolated conjugate gaze palsy which persisted for four weeks post-operatively before recovery commenced.

Delayed post-surgical development of dural arteriovenous fistula after cervical meningocele repair.

A 34-year-old female patient presented with an intracranial subarachnoid hemorrhage and was found to have a dural arteriovenous fistula at the site of previous cervical meningocele repair. Subsequent occlusion was achieved with endovascular embolization. To our knowledge, the phenomenon of the development of a spinal dural fistula at the site of a meningocele repair has not been recorded before.

Dinosaurs, dragons, and dwarfs: the evolution of maximal body size.

Among local faunas, the maximum body size and taxonomic affiliation of the top terrestrial vertebrate vary greatly. Does this variation reflect how food requirements differ between trophic levels (herbivores vs. carnivores) and with taxonomic affiliation (mammals and birds vs. reptiles)? We gathered data on the body size and food requirements of the top terrestrial herbivores and carnivores, over the past 65,000 years, from oceanic islands and continents. The body mass of the top species was found to increase with increasing land area, with a slope similar to that of the relation between body mass and home range area, suggesting that maximum body size is determined by the number of home ranges that can fit into a given land area. For a given land area, the body size of the top species decreased in the sequence: ectothermic herbivore > endothermic herbivore > ectothermic carnivore > endothermic carnivore. When we converted body mass to food requirements, the food consumption of a top herbivore was about 8 times that of a top carnivore, in accord with the factor expected from the trophic pyramid. Although top ectotherms were heavier than top endotherms at a given trophic level, lower metabolic rates per gram of body mass in ectotherms resulted in endotherms and ectotherms having the same food consumption. These patterns explain the size of the largest-ever extinct mammal, but the size of the largest dinosaurs exceeds that predicted from land areas and remains unexplained.

Sildenafil (Viagra)-induced spontaneous intracerebral haemorrhage.

Sildenafil (Viagra) has been developed as a drug to help male impotence. It has a direct effect on the vasculature of the corpus cavernosum. A case of spontaneous intracerebral haemorrhage (ICH) following the illicit use of Viagra is reported. A discussion of drug-induced ICH is included.

Modern management of head injuries.

Management of the head-injured patient is designed to prevent secondary injury and to provide the neurosurgeon with a live patient who has some hope of recovery. This review sets out the background essentials for the non-neurosurgeon dealing with the initial care of a head-injured patient.

New ages for the last Australian megafauna: continent-wide extinction about 46,000 years ago.

All Australian land mammals, reptiles, and birds weighing more than 100 kilograms, and six of the seven genera with a body mass of 45 to 100 kilograms, perished in the late Quaternary. The timing and causes of these extinctions remain uncertain. We report burial ages for megafauna from 28 sites and infer extinction across the continent around 46,400 years ago (95% confidence interval, 51,200 to 39,800 years ago). Our results rule out extreme aridity at the Last Glacial Maximum as the cause of extinction, but not other climatic impacts; a "blitzkrieg" model of human-induced extinction; or an extended period of anthropogenic ecosystem disruption.

Cranioplasty: why throw the bone flap out?

Patients who undergo decompressive craniectomy for intracranial hypertension often require interval cranioplasty. Many cranioplasty agents are currently in use. The authors suggest that storage of the patient's own bone flap in the subcutaneous tissue of the abdominal wall, is a safe, efficacious and cost-effective alternative to use of synthetic cranioplasty materials.

1999 salary survey. Is this the future of your bonus?

As pay trends go, one executive's bonus can be another's bane. Asked what they like about their compensation programs, health care execs and trustees say they're satisfied with the base salaries paid to their top people, but not with their bonus plans, especially for meeting long-term goals like stronger credit ratings and asset positions.

Combination growth hormone and estrogen increase bone mineralization in girls with Turner syndrome.

Turner syndrome is characterized by osteopenia and impaired skeletal growth. Neither feature is normalized by current modes of hormone therapy. The purpose of this study was to determine whether GH would increase protein anabolism and provide additional benefit to a regimen of estrogen replacement on calcium metabolism in girls and women with Turner syndrome. Using stable isotopes of calcium and leucine, we determined calcium absorption, urinary calcium loss, calcium retention, deposition into bone, leucine rate of appearance from protein, leucine incorporation into protein, and leucine oxidation in seven girls (10-17 y of age) and four adult females (16-34 y of age) with Turner syndrome, before and after 3 mo of GH treatment. All adults were treated with estrogen (ethinyl estradiol, 50 micrograms/d) and progesterone before and throughout the study. Three girls received no estrogen, and four girls were treated with low-dose estrogen (ethinyl estradiol, 5 micrograms/d) in combination with GH. The addition of estrogen to GH treatment resulted in a significant increase in calcium absorption and deposition in girls. GH did not affect calcium kinetics in adults already receiving estrogen/progesterone replacement therapy, nor did GH alone affect calcium kinetics in girls, and neither GH nor estrogen affected protein metabolism. These data suggest that the addition of low-dose estrogen to a regimen of GH improves bone deposition and calcium metabolism in girls with Turner syndrome and that estrogen is facultative for GH effects on bone.

Managing nursing assets: a primer on maximizing investment in people.

Nurse managers require critical competencies and skills to thrive in today's turbulent health care environment. A nurse manager's relationship with nursing staff is the primary variable that can reduce nursing turnover and improve unit morale in a variety of measurable ways. Self-confidence is the cornerstone competency required for the nurse manager's success. Nurse managers set the context for the delivery of patient services. To do so effectively, a working partnership with finance and human resources is required. Both functions can provide essential information for real time decision making, including variance analysis, flexible budgets, absenteeism rating, turnover rate, and innovative compensation programs.

A tribosphenic mammal from the Mesozoic of Australia.

A small, well-preserved dentary of a tribosphenic mammal with the most posterior premolar and all three molars in place has been found in Aptian (Early Cretaceous) rocks of southeastern Australia. In most respects, dental and mandibular anatomy of the specimen is similar to that of primitive placental mammals. With the possible exception of a single tooth reported as Eocene in age, terrestrial placentals are otherwise unknown in Australia until the Pliocene. This possible Australian placental is similar in age to Prokennalestes from the late Aptian/early Albian Khoboor Beds of Mongolia, the oldest currently accepted member of the infraclass Placentalia.

Dynamic pay strategies for the changing health care environment.

In the rush to adapt to the rapidly shifting health care environment, organizations have spent thousands of hours and dollars changing structures, processes, and jobs. Largely overlooked have been compensation strategies, which if used effectively are critical drivers of the change process. This article details the following issues: the evolution of new health care work cultures and the need for compensation strategies that are aligned with these new cultures; dynamic reward and recognition strategies, including team- and competency-based pay, and their application in the health care environment; and the changing role of the nurse manager in developing, implementing, and administering dynamic reward programs.