The ankle brachial index in chronic spinal cord injury: a pilot study.

BACKGROUND: Recent case reports implicate peripheral vascular disease (PVD) as an etiology for pressure ulcers (PU), failed myocutaneous flap surgeries, and amputation in spinal cord injury (SCI). Early detection of PVD is complicated by motor and sensory deficits in this population. The ankle-brachial index (ABI) is used to quantify PVD in the able-bodied population. We hypothesized that the ABI would be a useful screening tool for detecting PVD in patients with SCI. Differences in baseline blood pressure, as well as motor and sympathetic function, could potentially alter ABI, so values were studied in a sample of patients with SCI without risk factors or signs of PVD, and compared to those in able-bodied controls without PVD. METHODS: ABI values were measured in 15 healthy individuals with chronic complete SCI above the T6 level, who had no evidence for risk factors or physical findings of PVD, and compared with the values for a group of 10 able-bodied controls. RESULTS: No statistically significant difference in ABI was found between patients with SCI and the able-bodied comparison group. There was no statistically significant correlation between ABI and post-injury duration or incidence of PU. CONCLUSION: ABI may prove to be a useful screening device in individuals with SCI. Follow-up studies are needed to confirm these findings and to ascertain that the ABI correlates with presence and severity of PVD in patients with SCI who have risk factors and signs of PVD.

Clinical manifestations of hepatitis A: recent experience in a community teaching hospital.

A study of the clinical profile of 59 patients who presented with hepatitis A virus infection showed that dark urine, fatigue, gastrointestinal complaints, and fever were the most common presenting symptoms. The most frequent physical findings were hepatomegaly and jaundice. The mean presenting laboratory tests included total bilirubin of 5 mg/dL, alkaline phosphatase of 269 units/L, and serum aspartate aminotransferase and alanine aminotransferase levels of 1442 mIU/mL and 1952 mIU/mL, respectively. Atypical manifestations included relapse, cholestasis, rash, and arthralgia. Two patients presented with hepatitis A and concomitant type I autoimmune chronic hepatitis, and both required immunosuppressive therapy. Five patients who presented with hepatitis A were pregnant, and during follow-up, none of their infants developed elevated serum transaminase values or had detectable IgM anti-HAV antibody. All 59 patients experienced complete clinical and biochemical recovery within 6 months after onset of illness.