Awareness of disabilities in stroke rehabilitation--a clinical trial.

PURPOSE: To investigate the frequency of unawareness of disabilities after stroke during the rehabilitation stage, the relationship of unawareness with neuroanatomical variables, and the impact of unawareness on functional outcomes. METHOD: Sixty consecutive patients (36 with right, 24 with left hemisphere damage) admitted to rehabilitation hospital with a first, single, unilateral stroke were evaluated at admission, discharge and at 1-year post onset of stroke. Unawareness of disabilities was operationally defined as the discrepancy between therapist and patient's rating on the motor scale of the functional independence measure (FIM). Functional outcomes included FIM, instrumental activities of daily living (IADL) scale, activity card sort (ACS) and safety rating scale. RESULTS: Unawareness of disabilities was found in 44/60 patients at admission and 24/57 at discharge. There was no significant difference between the hemisphere groups in the frequency of unawareness at both times. Discharge unawareness in the right hemisphere group was significantly associated with lesions in the frontal and temporal lobes, and with lesion size. Unawareness in the left hemisphere damaged group was not associated with any neuroanatomical variables. A negative impact of unawareness at admission on functional outcomes was not found, but it was found that unawareness at discharge was a negative predictor of activity level (ACS score) at follow up, after controlling for the severity of initial disability level. CONCLUSIONS: Unawareness of disabilities is a significant issue in stroke rehabilitation. Unawareness that persists to discharge from rehabilitation correlates with neuroanatomical variables in right hemisphere damaged patients, and is a negative predictor for some rehabilitation outcomes at follow-up.

Poison exposure in children before Passover.

BACKGROUND: Extensive cleaning of homes in Israel before Passover may result in increased exposure of children to cleaning substances. OBJECTIVES: To evaluate the potential danger of Passover cleaning to children, and to study the risk factors in order to identify areas for prevention. METHODS: All cases of poison exposure in Jewish and Arab children under the age of 15 years reported to the Israel Poison Information Center during 1990-95 (n = 5,583) were analyzed for the 6 weeks before and 6 weeks after Passover. Poison exposures in Jewish children < 15 years old were studied in seven pediatric emergency rooms for the 2 weeks before and 6 weeks after Passover (n = 123). RESULTS: The IPIC data showed a highly significant 38% increase in the average weekly poison exposure rate for the 2 weeks before Passover compared with the remaining 10 weeks. Data recorded by the pediatric emergency rooms showed a twofold increase in cleaning substance poisoning during the 2 weeks before Passover compared with the following 6 weeks. The rise in exposures to cleaning substances was observed among children from secular, religious and ultra-orthodox families. In these exposures, the substance was found in open containers in 70% of cases. CONCLUSIONS: The extensive cleaning of homes among Jewish families in preparation for Passover poses the danger to young children of cleaning substance poisoning. Increasing public awareness, closer observation of children, and keeping these substances in closed containers should increase children's safety during this annual cleaning.

A step to a uniform definition and interpretation of the suspension effect.

Experimental results for potentials obtained from measurements in suspension galvanic cells, both conventional and of some new configurations, analysed on the basis of their detailed schemes, support the new SE concept advanced in recent years. The SE is found to be the sum of two effects, one due to the interaction of particles with the solid indicator electrode, resulting in an irreversible mixed potential, and the other due to the outflow of the solution from the salt bridge tip of the reference electrode into the suspension, causing an 'anomalous liquid junction potential'. No thermodynamically founded pIon value can be obtained from potential measurements of suspension galvanic cells. Instead of the current SE definitions, that seem unsuitable, an operational definition of SE is proposed, which is suggested to be considered as a starting point for the new formulation of the definition and the interpretation of the SE.

A prospective randomized trial of Filgrastim (r-metHuG-CSF) given at different times after unrelated bone marrow transplantation.

A study was done to compare treatment with Filgrastim (r-metHuG-CSF) given at three different times after unrelated bone marrow transplantation (BMT). Sixty-nine patients grafted with HLA-A, -B and -DR-compatible unrelated bone marrow were randomized to Filgrastim (5 microg/kg/day) starting on day 0 (n = 23), day +5 (n = 23) or day +10 (n = 23) after BMT. No significant differences were detected in hematological recovery, days with fever, days on antibiotics, incidence of bacteremia or need for erythrocyte, platelet and granulocyte transfusions between the three groups. Patients given Filgrastim starting on day 0, day +5 or day +10, respectively, reached an absolute neutrophil count (ANC) >0.5 x 109/l on a median of 17, 16 and 16 days after BMT. Starting Filgrastim treatment on day +10, rather than on day 0, reduced the costs of Filgrastim by $1060, with no significant change in the median number of days-to-hospital discharge in the three Filgrastim-treated groups. The incidences of acute and chronic GVHD, transplantation-related mortality, relapse, leukemia-free survival and patient survival (PS) were similar in all groups.

Memory effect of pH glass electrodes in emulsions.

In the pH measurements of very viscous w/o emulsions, having a high electrical resistance, the "memory effect" of glass membrane is observed. Its dependencies on type of glass and on pretreatment conditions of electrode membrane, and its relation to the gel layer properties are presented. The results complement the findings of other authors.

Estimation of creatinine clearance without 24-hour urine collection--a useful guide during cisplatin therapy.

The validity of the Cockroft and Gault formula in monitoring renal function during cisplatin therapy was examined in 110 consecutive cancer patients. A good correlation between estimated creatinine clearance (ECC) and the standard measured creatinine clearance (MCC) was found both before and after the onset of cisplatin. The correlation was better in males (r = 0.78 prior to cisplatin and r = 0.79 after the initiation of cisplatin) than in females (r = 0.69 and r = 0.63 respectively). Obesity (> 125% of ideal body weight) had no major effect on the correlation between ECC and MCC. The presence of third-space body fluids, on the other hand, had an influence on the relations between ECC and MCC, particularly in females (r = 0.49). It is concluded that estimation of creatinine clearance, without the cumbersome collection of 24-h urine specimens, is accurate enough for the purpose of adjusting cisplatin dose. It should not be used in females with third-space body fluids.

Effect of swimming on prednisolone-induced osteoporosis in elderly rats.

We investigated the possible ameliorating and preventive effect of swimming on prednisolone-induced osteoporosis in elderly rats. A total of 48 female Sabra strain rats were randomly assigned to the following groups and treatments: (1) control (C), (2) swimming (S), (3) prednisolone-treated (CP), and (4) swimming + prednisolone (SP). An additional 8 rats were sacrificed and examined at the onset of the study. Groups C and S were sham injected; groups CP and SP were injected with prednisolone (Ultracorten), 80 mg/kg three times per week for 10 weeks. Groups S and SP swam 1 h daily, 5 days per week for 10 weeks. SP rats swam simultaneously with prednisolone administration. At the end of the swimming period, in vivo bone mineral content (BMC) measurements were performed on rat vertebrae L4-5 by single-photon absorptiometry. Later, the humerus and femur were removed for the following measurements: morphometric, bone density (BD) by Compton scattering technique, bone ion content by atomic absorption, and hydration fraction by proton magnetic resonance (PMR). We found that the humeral BD of S rats was greater by 14% for group S over C and 3% greater for group SP over CP (P less than 0.05). Vertebral BMC was higher by 15% in group S over C and 11% higher for group SP over CP (P less than 0.05). Femoral calcium (mg/g dry bone) ion content was higher by 5% in group S over C and 8% in group SP over CP group (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Semimicrotitration device for cholinesterase assay.

A semimicrotitration device for reaction volumes of 0.5 to 2 ml and effective stirring of reaction solution or suspension is described. The principal part of the device is a combined glass electrode functioning as a reaction vessel (combined "cup"-glass electrode). Characteristics of the device are small volumes and great reliability. Nonspecific cholinesterase activities measured in rat plasma and liver tissue homogenates and compared with the activities of the same tissue and plasma samples measured radiometrically and spectrophotometrically illustrate the applicability of the device. The method is best suited for kinetic studies with multiple substrates of esterases, either in the soluble form or in tissue homogenates.

A statistical examination of the accuracy of combining femoral length and biparietal diameter as an index of fetal gestational age.

The use of femur length (FL) and biparietal diameter (BPD) for estimation of gestational age (GA) was investigated using 1123 ultrasound measurements between the 14th and 41st week of gestation. Femur length was found to provide a more accurate index than BPD for the entire range of gestational age considered. If an interval of approximately +/- 2.5 weeks is considered 'satisfactory', the accuracy of FL past the 31st week is not sufficient to justify its use. Combining the FL and BPD measurements via the formula: GA = 9.565 + (0.0414) FL + (0.0024573) FL2 + (0.15209) BPD - (0.00015827) BPD2 provides an index of gestational age accurate to approximately +/- 2.5 weeks up to the 32nd week of gestation and accurate to approximately +/- 2.75 weeks up to the 34th week of gestation. This is the first time that combining FL and BPD in a statistically rigorous manner has been proposed as an index of gestational age, and we suggest that this combination be used as a routine tool in its assessment.

Estimating fetal age by ultrasound measurements: an example of multivariate calibration.

A problem in the estimation of gestational age by ultrasound measurement of fetal bone lengths (the femur length, F, and the biparietal diameter, BPD) is described. By means of multivariate calibration techniques, F and BPD are combined to give an index of gestational age which is significantly more accurate than existing indices based on F or BPD alone. A detailed description of the statistical analysis is given, ranging from the initial steps of data analysis and model choice to the final step of determining the index and its accuracy. A number of interesting aspects of multivariate calibration theory are illustrated.