Effects of acute isometric resistance exercise on cervicomedullary motor evoked potentials.

Cervicomedullary motor evoked potentials (CMEPs) in relaxed biceps brachii have been reported to facilitate after acute isometric exercise of the elbow flexors. This facilitation, which reflects either enhanced corticospinal transmission or increased motoneurone excitability, has only been documented in the limb posture used during exercise. In Experiment 1, we tested if these spinal changes "transfer" to a second posture. Fourteen individuals completed 12 sets of high-force isometric contractions of the elbow flexors with the forearm pronated. Before and after exercise, biceps CMEPs were acquired with the forearm either pronated or supinated. CMEPs in pronation and supination were facilitated after exercise, indicating transfer (57.5 ± 55.5% and 53.9 ± 54.9%, respectively; mean ± SD). In Experiment 2, we examined if exercise posture influences the effect that exercise has on CMEPs. A different sample of 14 individuals performed isometric exercise in 2 sessions. In one, exercise was performed in supination. In the other, exercise was performed in pronation. Exercise intensity and volume were the same as in Experiment 1, as were participant characteristics. CMEPs were unchanged after exercise in supination (13.6 ± 31.2%) and pronation (7.7 ± 41.5%). The absence of an effect differs from the finding of Experiment 1. Thus, effects of acute isometric resistance exercise on corticospinal transmission and/or motoneurone excitability are not as consistent as previously thought. When exercise induces this spinal change, the effect is not specific to the posture used for exercise. However, the change does not always occur, and the reasons for this remain unknown.

High proportion of extrapulmonary tuberculosis in a low prevalence setting: a retrospective cohort study.

OBJECTIVES: The proportion of extrapulmonary tuberculosis (EPTB) cases in the United States (US) has been rising due to a slower rate of decline in EPTB compared to pulmonary tuberculosis (PTB). The purpose of this study was to characterise the clinical and treatment differences between EPTB and PTB patients, and identify patient factors associated with EPTB. STUDY DESIGN: We performed a retrospective cohort study of active tuberculosis (TB) cases treated at the Baltimore City Health Department between 2008 and 2013. METHODS: We categorised patients as having 'only PTB' (infection in the lung parenchyma), 'EPTB/PTB' (infection in the lung and an additional site), and 'only EPTB' (infection not involving the lung). Pearson's chi-squared tests were used to evaluate categorical variables and compare clinical and demographic differences between only PTB, only EPTB, and EPTB/PTB patients. Student t-tests and one-way analysis of variance tests were utilised to assess continuous variables and to compare treatment differences. RESULTS: One hundred and sixty-three patients were treated for TB; 39.3% had some form of EPTB (either EPTB/PTB or only EPTB). There was no difference found between EPTB, PTB, and EPTB/PTB patients with respect to HIV status, gender, race, foreign-born status, or mean age. Patients with only EPTB were less likely than patients with some form of PTB (only PTB or EPTB/PTB) to present with cough (30.4% vs 61.5%; P < 0.001), night sweats (10.9% vs 39.3%; P < 0.001), and weight loss (28.3% vs 47.9%; P = 0.023). Patients with some form of EPTB were also more likely to be hospitalised postdiagnosis compared to patients with only PTB (39.1% vs 20.2%; P = 0.009), and to have longer mean durations of treatment (37.9 weeks [SD = 11.1] vs 31.8 weeks [SD = 8.1]; P < 0.001). CONCLUSIONS: EPTB patients present with atypical symptoms, undergo prolonged treatment, and experience increased hospitalisations. In order to improve diagnostic algorithms and treatment modalities, EPTB must be further characterised.

An unusual case of extensive self-inflicted cement burn.

Cement is a fine powder used to bind sand and stones into a matrix of concrete, making up the world's most frequently used building material in the construction industry. First described by Ramazzini in his book "De Morbis Artificia Diatriba" in 1700, the effect of cement on the skin was presumed to be due to contact dermatitis. The first cement burns case was published by Rowe and Williams in 1963. Cement handling has been found to be responsible for many cases of occupational burns (generally full-thickness) usually affecting a limited TBSA, rarely greater than 5%, with localization especially in the lower limbs. We describe an unusual case of a self-inflicted cement burn involving 75% TBSA. A 28-yr-old building worker attempted suicide by jumping into a cement mixer in a truck. Upon arrival at our burn centre, clinical examination revealed extensive burn (75% TBSA - 40% full-thickness) involving face, back, abdomen, upper limbs and circumferentially lower limbs, sparing the hands and feet. The patient was sedated, mechanically ventilated, and subjected to escharotomy of the lower limbs in the emergency room. The following day, the deep burns in the lower limbs were excised down to the fascia and covered with meshed allografts. Owing to probable intestinal and skin absorption of cement, metal toxicity was suspected and dialysis and forced diuresis were therefore initiated on day 3. The patient's clinical conditions gradually worsened and he died on day 13 from the multi-organ failure syndrome.

Le ciment est une poudre fine utilisée pour lier le sable et les pierres dans une matrice de béton qui constitue le matériau de construction le plus utilisé au monde dans l'industrie de la construction. Décrit pour la première fois par Ramazzini dans son livre "De Morbis Artificia Diatriba" en 1700, l'effet du ciment sur la peau était attribué à une dermatite de contact. La première description d'un cas de brûlure due au ciment a été publiée par Rowe et Williams en 1963. La maniement du ciment a été jugé responsable de nombreux cas de brûlures professionnelles (généralement de toute épaisseur) qui intéressent en général une surface corporelle totale (SCT) limitée, rarement plus de 5%, avec une localisation surtout dans les membres inférieurs. Les Auteurs décrivent un cas peu commun de brûlure auto-infligée par ciment dans 75% de la SCT. Un ouvrier de 28 ans a tenté de se suicider en sautant dans la bétonnière d'un camion. À l'arrivée au centre des brûlés, l'examen clinique a révélé des brûlures dans 75% de la SCT (40% de toute épaisseur) qui intéressaient le visage, le dos, l'abdomen, et les membres supérieurs et inférieurs en circonférence, avec exclusion des mains et des pieds. Le patient a été mis sous sédation et ventilation mécanique et soumis à escarrotomie des membres inférieurs dans la salle d'urgence. Le lendemain, les brûlures profondes des membres inférieurs ont été excisées jusqu'au fascia et couvertes d'allogreffes en filet. L'absorption intestinale et cutanée du ciment a suggéré une toxicité métallique et pour cette raison la dialyse et la diurèse forcée ont été effectuées au troisième jour. Les conditions cliniques du patient se sont aggravées progressivement et il est mort le jour 13 à cause du syndrome de défaillance multi-organique.

Purpura fulminans in meningococcal septicaemia in an adult: a case report.

Purpura fulminans is a rare and severe complication of meningococcal septicaemia. It presents as a petechial rash spreading rapidly in extent and depth, evolving into full-thickness skin necrosis. The condition is extremely uncommon in the adult population. We report the case of a 28-yr-old man with extensive meningococcal-related skin necrosis. The initial diagnosis was made and first treatment given in the emergency department of a local hospital, from where after 12 days he was transferred to our hospital. Our approach was based on the continuation of intensive treatment and on staged aggressive debridement. Temporary alloplastic skin grafts were used to prepare the wound bed and the wounds were closed with autologous skin grafts. The patient survived but subsequently, owing to chronic skin ulceration and scar instability, he underwent late bilateral below-the-knee amputation.The patient returned to normal deambulation with an orthopaedic prosthesis 18 months after the onset of meningococcal septicaemia.

Efficient and predictable recovery of viruses from water by small scale ultrafiltration systems.

Current methods to concentrate viruses from large volumes of water are prone to inconsistent results and are costly and complex procedurally. Ultrafiltration can utilize size exclusion rather than adsorption and (or) elution to concentrate viruses and, therefore, may offer greater flexibility in developing methods that can provide more consistent recoveries among different viruses and widely varying water conditions. Two small scale ultrafiltration systems (hollow fiber and tangential flow) were tested with a virus suspended in 2 L of reagent grade, tap, ground, or surface water. Three model viruses were used (bacteriophages PP7 and T1 and poliovirus) to compare and characterize the recovery of viruses with the two ultrafiltration systems. Pretreatment of the ultrafilters with blocking agents and the use of elution agents can serve to prevent viral adsorption to the filter surface or to elute bound virus and keep viral agents suspended in the retentate. The use of a blocking and elution step concentrated viruses (>60% recovery) from widely varying water qualities, including surface water, such that a single method can be used to efficiently concentrate viruses from all of the water types tested. Both ultrafiltration systems appear to be able to efficiently recover viruses; however, the hollow fiber systems provided slightly better results in the 2-L volumes tested.

Dealing with hostility: a war of words.

If security officers can be provided with more understanding of why people act the way they do, the training needed to respond to those actions, and the verbal and physical skills needed in almost all situations, injuries will be reduced and security forces will be able to deal with hostility and win "the war of words," says the author.

The first six years' experience with the Pathology Residents' In-Service Examination, 1983-1988.

Data derived from the 1983-1988 administrations of the American Society of Clinical Pathology Residents In-Service Examination (PRISE) are presented. Data indicate an increase in participation by U.S. and Canadian pathology residency training programs (from 55% in 1983 to approximately 90% in 1988). Demographic data reflect an increase in the proportion of foreign medical graduates (from 24.8% in 1983 to 32.8% in 1988) in U.S. training programs with concomitant decrease in proportion of U.S. medical graduates (from 74.8% to 61.5%, respectively). Canadian residents comprise approximately 5% of the test population. Response surveys from residents and program directors indicate a high degree of satisfaction with the PRISE. In 1988 40.6% of all program directors thought that the PRISE satisfied their objectives very well, and 56% thought that objectives were met satisfactorily. For residents the corresponding rates were 21.2% and 70.7%. Trends in resident group performance in each subspecialty area of pathology, and the implications for residency training are discussed.

Diaphyseal lengthening for brachymetatarsia.

The authors present a case report of brachymetatarsia. The literature is reviewed, various surgical treatments are discussed, and the preferred surgical procedure that relieved symptoms and achieved cosmetic approval is described.

Peliosis hepatis after long-term androgen therapy.

Peliosis hepatis is a recognized, but rare, complication of androgen replacement therapy. We herein report such a complication with necropsy study of the liver so involved.