Whiplash: assessing the validity of diagnostic tests in a cervical sensory disturbance.

OBJECTIVE: To determine the ability of two diagnostic tests that examine sensory disturbance in whiplash patients to discriminate between 'extreme' groups. BACKGROUND: The neuromuscular theories have been accepted as explanations of the symptoms after a whiplash injury. Dutch manual therapists often use the diagnostic tests under study to diagnose and treat sensory disturbances after such an injury. The validity of a test needs to be assessed before its efficacy as a treatment in whiplash patients can be tested. The aim of this study was to validate two diagnostic tests and to initiate further research on the efficacy of a treatment of a sensory disturbance in whiplash patients. METHOD: Twelve subjects with chronic symptoms (> 3 months) after a whiplash injury (patient group) and 18 subjects without any head or neck problems (control group) were studied. The tests under study were the extension test and the coordination test. All researchers were blind to the characteristics of the subjects. RESULTS: The extension test and the coordination test were able to discriminate adequately between subjects with symptoms after a whiplash injury (patients) and subjects without any head or neck complaints (control subjects). Patients clearly show a smaller degree of extension compared with the control subjects and an increase of extension movement with external fixation. The sensitivity as well as the specificity of the coordination test were good (both > .80). CONCLUSION: These diagnostic tests seemed to be valid instruments for discriminating between whiplash patients with symptoms and healthy people.

[Effect of alcoholic hyperlipoproteinemias on the deformability and viscosity of erythrocytes]. / Einfluss alkoholtoxischer Hyperlipoproteinämien auf die Verformbarkeit und Viskosität der Erythrozyten.

This pilot study set out to evaluate the influence of the metabolic disorder due to acute alcohol toxicity on red blood cell (RBC) deformability. RBC deformability was measured optoelectronically by microcomputer-assisted polymicroviscometry (filtrometry). Chronic alcoholic patients (n = 12) with transient haemolytic anaemia, jaundice and hyperlipoproteinaemia were studied during the acute and the remittent phase of alcoholic disease. RBC obtained from patients in the acute phase revealed a markedly impaired deformability as compared with RBC suspensions studied when the alcoholic symptoms had subsided. The study lends further support to the hypothesis that predominantly during acute alcohol toxicity patients experience a marked impairment of the adhesive and rheological properties of RBC, which may finally impair the peripheral microcirculation of the whole blood.

[Oral theophylline therapy for dyspnea]. / Orale Theophyllin-Medikation bei Dyspnoe.

With regard to special situations in severe dyspnea 10 patients with reversible airway obstruction were studied to verify the effect of oral and systemic application of 193,2 mg Theophyllinmonohydrat and 46,8 mg Aethylendiamin as customary in the trade injection fluid (Euphyllin) on blood levels. In comparison both medications are bioaquivalent . The oral application yields with duration serum concentrations of theophylline higher than 5 mg/l but less than the postulated therapeutic levels from 10--20 mg/l.

[Pathologic fluidity, glycohemoglobin and erythrocyte metabolism disorder in Fontaine II diabetic macroangiopathy]. / Pathologische Fluidität, Glykohämoglobin und Stoffwechselstörung der Erythrozyten bei diabetischer Makroangiopathie Fontaine II.

This pilot study set out to evaluate the influence of metabolic disorders due to diabetes mellitus on red blood cell (RBC) substrates, deformability and glycohaemoglobin (HbA1) levels. RBC deformability was measured optoelectronically by microcomputer-assisted polymicroviscometry (filtrometry) following separation of RBC into old (dense) and young (buoyant) fractions by means of density-layer centrifugation. 20 adult patients with type II diabetes mellitus associated with Fontaine II macroangiopathy underwent RBC investigations before and after diabetic therapy. Those RBC fractions containing older cells exhibited impaired metabolism, increased HbA1 levels and markedly altered deformability which significantly differed from values obtained from young RBC fractions. However, old RBC fractions only of patients treated for diabetes persistently displayed a slight increase in HbA1 levels associated with a still altered deformability, in contrast to the young RBC fractions which showed normal values again after diabetic treatment. The preliminary results suggest an adaptive alteration of RBC metabolism and function in diabetes, predominantly existing in old RBC, which still persists only in old RBC fractions after diabetic therapy. Thus, a prolonged pathologic effect of older RBC on the peripheral microcirculation may occur in diabetes, resulting in a further persistent maintenance of diabetic vascular disease.

Biorheological and metabolic dysfunctions of density-fractionated erythrocytes in diabetics with peripheral vascular disease.

Preliminary communications are presented about a serial study of biorheological and metabolic dysfunctions of density-fractionated erythrocytes (RBC) in diabetics with vaso-occlusive disorders. The study aimed at evaluating the influence of metabolic disorder due to diabetes mellitus on RBC substrates, deformability and glycohaemoglobin (HbA1) levels. The peak HbA1 level served to confirm the duration of serum metabolic disorder due to diabetic crisis. The rheological and metabolic changes of RBC were compared with serial estimations repeated on the same patients when asymptomatic concerning diabetes after insulin therapy. RBC deformability was measured optoelectronically by microcomputer-assisted polymicroviscometry (filtrometry) following separation of RBC into old (dense) and young (buoyant) fractions by means of density-layer centrifugation. 15 adult patients with diabetes mellitus typ II associated with macroangiopathy Fontaine II underwent RBC investigations before and after diabetic therapy. Those RBC fractions containing older cells disclosed an impaired metabolism, increased HbA1 levels and markedly altered deformability which significantly differed from values obtained from young RBC. But after insulin-therapy old RBC fractions only revealed persistently an increase of HbA1 levels and metabolic disorder associated with a still altered deformability, in contrast to young RBC which in again showed normal values. The preliminary results suggest an adaptable alteration of RBC metabolism and function in diabetes, predominantly existing in old RBC, but after insulin-therapy still persisting only in old (dense) fractions. Thus, a prolonged pathologic effect of older RBC occurred in diabetes probably resulting in a further persistent maintenance of diabetic vascular disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Cyclic nucleotide metabolism in experimental bronchial constriction in rabbits.

In anesthetized, spontaneously breathing rabbits, intratracheally administered isotonic saline, acetylcholine (Ach) and histamine (His) induced an increase of airway resistance up to 183, 571, and 312%, respectively, compared with untreated controls. This was accompanied by a decrease of the arterial pO2. Bilateral cervical vagotomy led to nearly complete inhibition of the saline- and Ach-induced bronchoconstriction, whereas the His effect was only reduced to 202%. Vagotomy did not improve the arterial pO2. While the bronchoconstrictive effects of isotonic saline and Ach revealed a significant linear correlation with the increased cGMP/cAMP ratio, His did not cause an alteration of the cGMP/cAMP ratio to a degree that corresponds to its bronchoconstrictive activity. These data indicate that (1) bronchoconstriction-inducing agents may act (a) by stimulation of the parasympathetic nerve or (b) by contracting smooth muscles directly; (2) alveolar ventilation is not regulated by the parasympathetic nerve, and (3) bronchoconstriction induced by parasympathetic stimulation is associated with or mediated by an increase of the cGMP/cAMP ratio.