Upper extremity nerve transfers for acute flaccid myelitis: a systematic literature review.

BACKGROUND: Acute flaccid myelitis (AFM) is a rare disease that commonly affects young children. AFM's pathophysiology involves loss of lower motor neurons following a viral infection and induces acute asymmetric flaccid paralysis most commonly in the upper extremities. Nerve transfers have emerged as a treatment option for these patients with permanent motor deficits. OBJECTIVE: To summarize the literature and report safety and efficacy outcomes following nerve transfers for recovery of shoulder abduction and external rotation, and elbow flexion and extension in pediatric patients with AFM. Recovery of at least antigravity function was defined as a successful outcome. This systematic review was performed according to the PRISMA guidelines. The PubMed, Embase and Cochrane databases were utilized. RESULTS: Five studies comprising 44 patients (median age 2.95 years; 71% male), and 93 upper extremity nerve transfers were included. Thirty-eight patients received 65 nerve transfer procedures aiming for recovery of shoulder abduction and/or external rotation with a transfer to the axillary and/or suprascapular nerve. The recovery of shoulder abduction and external rotation was achieved in 40.7% (n = 11/27) and 60% (n = 6/10) of patients, respectively. Time from injury to surgery showed an inverse relationship with the odds for successful recovery (OR: 0.81; 95% CI: 0.64-1.02; p = 0.07); however, statistical significance was not reached. Successful recovery of elbow flexion with a transfer to the musculocutaneous was reported at a rate of 92.3% (n = 12/13). Successful re-innervation of the radial nerve with recovery of elbow extension was found in 75% (n = 6/8) of patients. No complications were reported. CONCLUSIONS: Upper extremity nerve transfers appear to be promising and safe for AFM patients. Shoulder abduction is the most challenging upper extremity function to recover. Further studies are warranted to identify whether nerve transfers are associated with superior outcomes when performed earlier.

Sputum and pulmonary function in asthma.

STUDY OBJECTIVE: To assess the relevance of sputum production to pulmonary function, in particular, persistent obstruction in patients with a primary clinical diagnosis of asthma. DESIGN: Cross-sectional study of all patients currently followed up in secondary care in a defined locality. SETTING: National Health Service and private clinics in north-east England. PATIENTS: All attenders, aged 18 years or older, with asthma, confirmed by reversibility of peak expiratory flow (PEF) by > or =15% and to > or =200 L/min. INTERVENTIONS: Pro forma history. Pulmonary function at attendance. Assessment of best function according to protocol. Measurement of actual FEV1, FVC, and PEF at attendance. MEASUREMENTS AND RESULTS: We studied 772 subjects; 387 (50%) were male; mean age was 55 years; atopic, 51%; current smokers, 11.5%; ex-smokers, 36%; and never smokers, 52.5%. Best pulmonary function was lower in chronic sputum producers (PEF, 83.2 vs 95.8; FVC, 67.9 vs 81.7% predicted). Chronic sputum production and its negative relationship with best function was strongly associated with smoking. There was little relationship between chronic sputum and persistent obstruction in nonsmokers. There were no univariate associations between sputum during attacks, or its color, and pulmonary function, but after allowing for demographic factors, including smoking, green sputum was associated with persistent obstruction. There was little relationship between sputum and actual/best function at attendance. CONCLUSIONS: Chronic sputum production is associated with persistent obstruction principally in those who have smoked, suggesting that the association reflects smoking rather than asthma. There is no interaction with atopy. After allowance for cigarette smoking, there is an association between green sputum production during exacerbations and persistent obstruction. Green sputum during relapse in asthma may indicate inflammation that is relevant to prognosis.

Detection and spectrophotometric determination of copper(III) with p-anisidine.

Copper(III) solutions are found to give an instantaneous stable pink-coloured product with 0.2% aqueous p-anisidine in the presence of 0.03N acetic acid. The wavelength of maximum absorption is 533 nm and obeys Beer's law up to 0.89408 g copper(III). It is also recommended as a spot test for copper(III).

Tuberculin skin testing: present status.

The incidence of tuberculosis is on the rise, with a reported 18% increase between 1985 and 1992. There is every reason to think that this trend will continue in the 1990s. Expectedly, there is a renewed interest in early detection and prevention of this potentially life threatening disease. Tuberculin skin testing remains a valuable diagnostic tool for the detection, control, and elimination of tuberculosis. It involves the intracutaneous injection of culture extracts of tubercle bacilli as a classic example of delayed hypersensitivity reaction. Despite proper technique and interpretation of the test, its usefulness is limited by cross-reaction caused by other mycobacterial antigens. False-negative reaction is a common confounding problem. It is therefore important to interpret the test based on the overall clinical context of the individual being tested. This article aims to review the basic immunology, proper technique, interpretation, and indication for the test.

Steroid-induced bone disease. Conflicting views of respiratory and bone physicians.

Physician members of the Thoracic Society and the Bone and Tooth Society were circularised about their views on the prophylaxis, screening and treatment for steroid osteoporosis. Bone physicians were more active than respiratory physicians in screening and prophylaxis and were more likely to favour bone densitometry in assessment and bisphosphonates in treatment. Further studies are required to establish the value of prophylactic agents in steroid osteoporosis but meanwhile respiratory physicians should appreciate the value of the relatively simple technique of bone densitometry in assessment and consider whether they should be more active in prophylaxis.

Infection in exacerbations of asthma: views of different groups of practitioners.

A questionnaire designed to elucidate views on the frequency of infection in asthma and its management was circulated to general practitioners, general physicians, paediatricians and respiratory physicians in the north of England. On the whole, general practitioners agreed with the general physicians and paediatricians with respiratory physicians. The generalists, and to a lesser extent the specialists, tended to overestimate the risk of bacterial infection, which was perceived to be a particular risk following viral infection in intrinsic asthma. This resulted in more frequent prescription of antibiotics than is justified by the published evidence. There was a tendency for frequent prescribers of antibiotics to withhold corticosteroids. If prescribing habits are to be altered, education will have to be directed at those responsible for acute admissions to hospital as well as at general practitioners.

Vitamin nutritional status of women using oral contraceptive pills.

PIP: A comparative study was conducted to assess the biochemical effects of a low-estrogen combined OC (oral contraceptive). The focus of the study was on possible biochemical effects indicative of altered nutritional status. Both low and high income women on pills were compared with others not on pills. The groups were further divided according to the duration of OC usage. Blood hemoglobin, serum Vitamin A, plasma ascorbic acid, folic acid, riboflavin, and aspartate transaminase levels were measured. Higher income women had better measures on all the indices than the low income women, indicating a better initial nutritional status. Deficiencies increased with duration of use. Results of the study show that OCs reduce the vitamin nutritional level in women. For poor women on OCs, special nutrition intervention programs should be instituted.^ieng

Determination of thiourea and some of its organic derivatives with sodium vanadate, hexacyanoferrate(III), Cerium(IV) sulphate, manganese(III) and manganese(IV).

The determination of thiourea and some of its organic derivatives with sodium vanadate, hexacyanoferrate(III), cerium(IV) sulphate, manganese(III) and manganese(IV) is described. A mixture of iodate and iodide is used as catalyst. Ferroin, N-phenylanthranilic acid and p-ethoxychrysoidine can be used as indicators.