Bronchoscopic management of bronchopleural fistula.

In recent years successful bronchoscopic management of bronchopleural fistulas (BPFs) by locating its site and then blocking the leaking segment with any of the several agents available has gained recognition. It is now considered as an alternate mode of management of BPF. Here we present a case of non-resolving pneumothorax that was managed successfully using bronchoscopic glue (cyanoacrylate glue) instillation.

Extramedullary paraspinal hematopoiesis in hereditary spherocytosis.

Hereditary spherocytosis (HS) is a common inherited hemolytic anemia due to red cell membrane defects. Extramedullary hematopoiesis is a compensatory response to insufficient bone marrow blood cell production. The preferred sites of extramedullary hematopoietic involvement are the spleen, liver and lymph nodes; but in HS, the posterior paravertebral mediastinum is also commonly involved. We report a case of a 50-year-old male who presented to us in respiratory distress and with bilateral paravertebral posterior mediastinal masses, which on trucut biopsy were found to be extra-hematopoietic masses; and the patient was found to have hereditary spherocytosis.

Neurite extension from rod bipolar cells in retinal cell and explant cultures.

One of the key requirements for the success of a subretinal prosthesis or photoreceptor transplant is the formation of an effective interface with the remaining neural retina. An optimal interface would be one where specific and highly efficient contacts were made with retinal neurons, presumably bipolar cells. Although the properties of neurite (particularly axonal) outgrowth have been extensively studied in retinal ganglion cells, comparatively little work has been done with other retinal neurons. The goal of the present research is to explore the survival and neurite outgrowth properties of a specific type of retinal cell, the rod bipolar cell (RBC), using in vitro culture preparations. RBCs are the most numerous of the several classes of bipolar cells in mammals, and would be a likely target of stimulation by any subretinal implant. We report here that RBCs in short term culture--as isolated cells or within retinal explants--extend their dendrites, and that these are often decorated with varicosities and smaller spine-like extensions. This response is similar to remodeling of RBCs observed in cat models of retinal detachment, and suggests it might be possible to manipulate RBCs with appropriate growth and guidance cues to form an optimal interface with subretinal devices or transplants.

The psychopharmacology of hallucinogens.

Hallucinogenic drugs have been inhaled, ingested, worshipped, and reviled since prehistory. With the purification and synthesis of bontanical preparations and the ensuing discovery of chemically unique agents, hope was raised regarding their therapeutic potential, but this hope has been clouded by an epidemic of abuse and an inventory of adverse effects. This review examines aspects of that controversy, including the history of hallucinogens, epidemiology of current hallucinogen abuse, the association of LSD use with prolonged psychoses and hallucinogen persisting perception disorder, and the efforts to demonstrate the drug's therapeutic efficacy. Human subject ramifications in hallucinogen experimentation are discussed. Future lines of research are suggested in human, animal, and tissue culture paradigms.

Physical therapy modalities for wound management.

As part of a multidisciplinary team approach to the management of chronic wounds, physical therapists can add certain physical modalities to the care plan. Whirlpool, electrical stimulation, ultrasound, low-energy laser and compression therapy are physical therapy modalities that have been used to enhance wound healing. All of these modalities are used as adjunct treatments that, when appropriate, may help shorten the length of treatment and reduce patient suffering. Because the efficacy of some of these modalities remains to be established in controlled clinical trials, conventional wound care continues to be an important part of the team approach.

High-voltage galvanic stimulation on wound healing in guinea pigs: longer-term effects.

The purpose of this investigation was to determine the effects of high-voltage stimulation (HVS) on wound tensile strength properties and wound closure (histology). Eighteen mature guinea pigs with full-thickness incisions were treated with HVS for 45 minutes daily for 2 weeks; 9 animals were studied after the 14 days of treatment and the remaining 9 were studied 2 weeks later. Five animals (10 wounds) served as controls at each time period. After 2 or 4 weeks, treated and untreated skin was harvested, tested to failure, and prepared for histological examination. Two-week-treated and control wounds had comparable values for peak force to failure, elongation, and energy absorbed to failure. Epithelialization was more advanced in treated animals at 14 days (p < .05). There was a trend (p = .068) toward stronger wounds in 4-week-treated animals (maximum load to failure), but not differences were observed between controls and treated groups for elongation or energy absorbed to failure. Dermal healing appeared to be more advanced in treated animals at 30 days. Although peak force to failure was almost 500g higher for treated guinea pigs after 2 weeks of treatment and more than 700g higher than controls after 4 weeks, mean data were highly variable, so the hypothesis that HVS augments wound strength could not be accepted. It is difficult, however, not to assign clinical significance to the findings.

Electromyographic analysis of neck muscle fatigue in patients with osteoarthritis of the cervical spine.

Median frequency parameters of myoelectric signals were studied in 25 patients with osteoarthritis of the cervical spine and in 25 normal subjects. The median frequency parameters included initial median frequency and slope of the median frequency during 20%, 50%, 80%, and 100% of maximum voluntary contractions (MVC). The subjects performed sustained, isometric constant-force contractions of forward and backward bend of the cervical spine. The median frequency signals were obtained from the anterior (sternocleidomastoid) and posterior (upper trapezius) neck muscles. The results showed that at moderate and high forces (i.e., 50%, 80%, and 100% MVC) the anterior neck muscles in patients with osteoarthritis of the cervical spine fatigued faster than those of normal subjects. The posterior neck muscles in patients fatigued faster compared to normal subjects at high force levels (i.e., 80% and 100% MVC). This indicates a higher fatigue of the anterior and posterior neck muscles associated with arthritic changes of the cervical spine. Rehabilitation programs must consider these muscular changes to obtain optimal outcomes.

Total hip replacement in patients with osteoarthritis of the hip: improvement in pain and functional status.

A simple, self-rating questionnaire was developed to assess the clinical outcome related to pain and function after total hip replacement surgery followed by physical therapy. Twenty-two patients, 57 to 86 years of age, with osteoarthritis of the hip who underwent total hip replacement surgery and received physical therapy following surgery, participated in the study. A questionnaire consisting of 11 items was developed to ascertain the level of pain, functional ability and the assistive ambulatory device used to perform selected activities of daily living. A maximum cumulative score of 55 points was possible. The functional categories monitored included: sitting, standing, sleeping, functional walking, distance walking, stair climbing, sitting/standing from a toilet seat, driving, and sexual activities. The questionnaires were completed preoperatively, and postoperatively at 3 and 6 months. The results showed an overall improvement of 56% at 3 months and 64% at 6 months after surgery. Twenty of 22 patients obtained "excellent" results with total hip replacement surgery and follow-up physical therapy. Results of this study indicated that total hip replacement followed by physical therapy decreases joint pain and improves function in patients with osteoarthritis of the hip.

Hydrocortisone and exercise effects on articular cartilage in rats.

The combined effects of hydrocortisone and running exercise on articular cartilage were assessed in female Sprague-Dawley rats. Animals were divided into three groups: 12 control (C), 12 who received an injection of 0.1 mL hydrocortisone once a week for three weeks (HC), and 12 rats who received three weekly injections of hydrocortisone and ran twice daily for six weeks (HC + run). Previous study revealed that rats that ran on a treadmill for three to 12 months did not have articular cartilage that was different from controls and thus a fourth group of rats, runners only, was not included in this analysis. At sacrifice, both knees were examined, photographed, and subsequently decalcified, then sectioned at 6 mu and stained. HC + run rats had significant more surface degeneration on femoral cartilage than HC or C rats. Eight of 12 HC + run rats displayed fibrotic invasion and/or subchondral bone replacement of degenerated articular cartilage, a feature not seen in HC or C rats. Cross-sections from HC + run rats displayed areas of cell death, and loss of matrix staining. Results suggest that, in rats, running exercise combined with intraarticular injections of hydrocortisone is more detrimental to articular cartilage than hydrocortisone or running alone.

The biology of wound healing.

Wound healing is a complex biological process. A thorough knowledge of normal wound healing is of utmost importance for the clinicians who are involved in the care of patients with open wounds. It is imperative for every clinician who is involved in wound care to know the process which prevents, minimizes and eliminates those factors which adversely affect wound healing.

Changes in fatigue characteristics of cervical paraspinal muscles with posture.

The median frequency of the myoelectric signal of the cervical paraspinal muscles was studied in 28 normal subjects in prone and sitting positions. Median frequency parameters (initial median frequency and slope of the median frequency) of the myoelectric spectrum were monitored during sustained isometric neck extensions at 20%, 50%, 80%, and 100% of maximum voluntary contractions. Force output of 100% maximum voluntary contractions was also measured in the prone and sitting positions. Reliability of the median frequency parameters for repeated trials at various force levels was computed. There were significant differences (P less than 0.05) in the median frequency parameters between the prone and sitting positions, and there was significantly higher 100% maximum voluntary contractions force production in the prone position than in the sitting position (P less than 0.05). There were also high reliability estimates for the median frequency parameters in both test positions. The cervical paraspinal muscles may use different strategies of recruiting motor units during force production in various postures of the neck. It therefore is necessary to standardize the testing procedures before the median frequency parameters can be considered objectively to measure the muscle function in the neck.

Paralysis of the trapezius: a case report.

A patient was referred to physical therapy for exercises to the right shoulder secondary to a peripheral nerve injury involving the spinal accessory nerve. A treatment program was designed to accommodate for lack of upward scapula rotation, which is necessary for elevation of the upper extremity above shoulder level. During the course of two and a half years of care, a variety of associated problems were encountered. There was no apparent nerve regeneration, and the patient was left with limited mobility of the affected upper extremity.

Median frequency of the myoelectric signal in cervical paraspinal muscles.

Objective measurements of the function of cervical paraspinal muscles (CPM) are lacking. Changes in the frequency spectrum of the myoelectric (ME) signal have been used in the limb muscles as an objective measurement of muscle function. Based on our previous investigational work on limb muscles, we attempted to measure parameters related to median frequency (MF) of the ME signal to measure localized muscle fatigue in cervical paraspinal muscles in 14 healthy subjects. The ME signals were recorded bilaterally using surface electrodes placed posteriorly at the C3 to C6 level. Sustained isometric neck extensions were performed at 20%, 50%, 80%, and 100% of maximum voluntary contractions (MVC). Initial median frequency (IMF) and slope of the MF during sustained isometric contraction were obtained by analyzing the ME signal using an IBM-XT computer, a laboratory interface system, and custom-designed software. The results indicated that the MF of the CPM behave somewhat differently from limb muscles, and that the CPM are less fatigable than limb muscles. The test-retest reliability, using our system, was found to be high, and data processing showed a variability of 4 to 8Hz. These results imply that neck muscles appear to behave differently at high and low force levels in response to daily functional demand. The MF measurements appear to be a useful objective technique for evaluating muscle function of cervical musculature.

Bed rest effect on extremity muscle torque in healthy men.

The purpose of this study was to assess the effect of bed rest on appendicular muscle torque. Fifteen healthy male volunteers between the ages of 21 and 54 participated in the study. The subjects were put on five weeks of strict horizontal bed rest. They were allowed to sit up for bowel movements only; however, no lower extremity weight-bearing was allowed. During bed rest, the subjects were required to ingest a fixed nutritionally adequate diet. Data for muscle torque were obtained using a Cybex II dynamometer, Upper Body Exercise Table (UBXT), and a data analysis computer (HUMAC). The subjects were tested on Cybex at the speed of 60 degrees/sec during the week before starting bed rest and the day after starting reambulation. The muscle groups tested were soleus, gastrocnemius-soleus, dorsiflexors, knee flexors, knee extensors, elbow flexors, and elbow extensors. The torque in all groups but elbow extensors was reduced by 24%, 26%, 8%, 8%, 19%, and 7%, respectively. Student's t-test for paired means demonstrated significant loss of torque in all muscle groups except elbow extensors (p less than 0.05). The results of this study suggest that a strengthening exercise program should be administered to these patients while they are on bed rest, and that the earliest possible attempt should be made to ambulate patients after prolonged bed rest to minimize the loss of muscle torque.

Calf muscle area and strength changes after five weeks of horizontal bed rest.

Nine male volunteers participated in a 10 week metabolic study in which subjects underwent 5 weeks of ambulatory control and 5 weeks of complete horizontal bed rest. Bed rest is a model commonly used to simulate space flight. The changes in muscle area and strength of the calf dorsiflexors and plantar flexors were measured before and after bed rest using magnetic resonance imaging (MRI) and a Cybex II dynamometer. The muscle area of the plantar flexors (gastrocnemius and soleus) decreased 12%, whereas the muscle area of the dorsiflexors was not significantly decreased. The maximal muscle strength of the plantar flexors decreased 26%; the muscle strength of the dorsiflexors was not significantly decreased. These results, which demonstrate differential muscle atrophy and a larger loss in strength relative to muscle area, have important implications in the development of exercise counter-measures to be implemented during space flight. The results also have implications for patients who have severe orthopaedic disorders and must be bed rested for long periods of time, and for persons who are voluntarily inactive (a large number of the elderly).

Wound management with whirlpool and infrared cold laser treatment. A clinical report.

Patients with open wounds are frequently referred to physical therapy for wound cleansing and enhancement of the healing process. The healing process in most open wounds, however, is very slow, especially in patients with diabetes mellitus and vascular insufficiency. The purpose of this clinical report is to describe a sterile whirlpool and cold laser treatment protocol used in one physical therapy department for patients with open wounds. The two patients described in this clinical report received infrared cold laser treatment and conventional sterile whirlpool baths with povidone-iodine solution. Clinical results showed well-granulated tissue and nearly complete healing of the open wounds in these two patients.

Effects of high voltage stimulation on cutaneous wound healing in rabbits.

The primary purpose of this study was to determine whether high voltage stimulation (HVS) enhances wound healing. Forty female rabbits were assigned to experimental or control groups and followed for four or seven days. We classified the groups as Exp4, Con4, Exp7, and Con7, respectively. Each animal was anesthetized, and a full-thickness incision, 3.5-cm long, was made on its back. After 24 hours, Exp4 and Exp7 rabbits received HVS with a negative polarity for two hours twice daily. Although tensile-strength values were 36% higher for Exp4 rabbits than for Con4 rabbits, no significant differences in tensile strength or percentage of wound closure existed between the two groups. After seven days, Con7 rabbits had a higher percentage of wound closure and significantly greater tensile-strength measures than Exp7 rabbits. Histologic examination of the wounds did not provide clear-cut evidence of differences between the experimental and control groups. Results suggest that 1) HVS did not significantly improve wound healing for Exp4 rabbits and 2) HVS as given, may have hampered the healing process for Exp7 rabbits.