MRI evaluation of topical heat and static stretching as therapeutic modalities for the treatment of eccentric exercise-induced muscle damage.

The aim of this study was to monitor the effects of topical heat and/or static stretch treatments on the recovery of muscle damage by eccentric exercise. For this purpose, 32 untrained male subjects performed intense eccentric knee extension exercise, followed by 2 weeks of treatment (heat, stretch, heat plus stretch) or no treatment (control, n=8/group). Isometric strength testing, pain ratings, and multi-echo magnetic resonance imaging of the thigh were performed before and at 2, 3, 4, 8, and 15 days following the exercise. Increased T2 relaxation time, muscle swelling, pain ratings, and strength loss confirmed significant muscle damage during the post-exercise period. Pain ratings and muscle volume recovered to baseline by 15 days, although muscle strength remained lower [77 (4) vs. 95 (3) kg pre-exercise, mean (SE)] and T2 values higher [32.2 (0.8) vs. 28.6 (0.2) ms pre-exercise]. Our results indicate that heat and/or static stretching does not consistently reduce soreness, swelling or muscle damage. The practical implication of our findings is that clinicians should be aware that prescribing heat and/or static stretching following intense eccentric or unaccustomed exercise will not enhance the recovery of damaged muscles.

Biarticular and monoarticular muscle activation and injury in human quadriceps muscle.

We hypothesized that activation of the quadriceps femoris muscle group during eccentric exercise is related to the increase in magnitude of several markers of muscle injury that developed during the next week. Fourteen male subjects performed six to eight sets of five to ten repetitions of single-leg eccentric-only seated knee extension exercise. Magnetic resonance (MR) images were collected before and immediately after exercise and on days 2-4 and 6 after eccentric exercise. Changes in maximal voluntary contraction (MVC), perceived soreness, muscle volume and muscle transverse relaxation of water protons (T2) were determined for the quadriceps femoris muscle group each day. Changes in muscle volume and T2 were determined every day for each muscle [vastus lateralis (VL), vastus medialis (VM), vastus intermedius (VI), rectus femoris (RF)] of the quadriceps femoris group. Post-exercise T2 was greater than pre-exercise T2 (P < 0.05) for all muscles. The acute deltaT2 (Post-Pre) was similar (P>0.05) among VL, VM, VI, and RF [5.5 (0.3) ms], suggesting that the four muscles were equally activated during eccentric exercise. In the week after eccentric exercise, subjects experienced delayed-onset muscle soreness (DOMS) and all muscles demonstrated a delayed increase in T2 above pre-exercise values (P < 0.05), suggesting that muscle injury had occurred. For the quadriceps femoris muscle group, there was no correlation between acute deltaT2 and delayed (peak T2 during days 2, 3, 4, 6 minus pre-exercise T2) deltaT2 (r=0.04, P>0.05). Similar results were obtained when VL, VM, VI and RF were examined separately. Of the four muscles in quadriceps femoris, the biarticular RF experienced greater muscle injury [delayed deltaT2= 15.2 (2.0) ms] compared to the three monoarticular vasti muscles [delayed deltaT2 = 7.7 (1.3) ms; P< 0.05]. We propose that the disproportionate muscle injury to RF resulted from an ineffective transfer of torque from the knee to hip joint during seated eccentric knee extension exercise, thus causing RF to dissipate greater energy than normal. We conclude that in humans, muscle activation is not a unique determinant of muscle injury.

Effect of aerobic capacity on the T(2) increase in exercised skeletal muscle.

The increase in nuclear magnetic resonance transverse relaxation time (T(2)) of muscle water measured by magnetic resonance imaging after exercise has been correlated with work rate in human subjects. This study compared the T(2) increase in thigh muscles of trained (cycling VO(2 max) = 54.4 +/- 2.7 ml O(2). kg(-1). min(-1), mean +/- SE, n = 8, 4 female) vs. sedentary (31.7 +/- 0.9 ml O(2). kg(-1). min(-1), n = 8, 4 female) subjects after cycling exercise for 6 min at 50 and 90% of the subjects' individually determined VO(2 max). There was no significant difference between groups in the T(2) increase measured in quadriceps muscles within 3 min after the exercises, despite the fact that the absolute work rates were 60% higher in the trained group (253 +/- 15 vs. 159 +/- 21 W for the 90% exercise). In both groups, the increase in T(2) of vastus muscles was twofold greater after the 90% exercise than after the 50% exercise. The recovery of T(2) after the 90% exercise was significantly faster in vastus muscles of the trained compared with the sedentary group (mean recovery half-time 11.9 +/- 1.2 vs. 23.3 +/- 3.7 min). The results show that the increase in muscle T(2) varies with work rate relative to muscle maximum aerobic power, not with absolute work rate.

Synthetic antifibrinolytics are not associated with an increased incidence of baffle fenestration closure after the modified Fontan procedure.

OBJECTIVE: To determine if the lysine analog antifibrinolytic agents, epsilon-aminocaproic acid and tranexamic acid, are associated with early closure of the baffle fenestration after the modified Fontan procedure. DESIGN: Retrospective chart review. SETTING: University hospital. PARTICIPANTS: Seventy-four successive patients underwent the modified Fontan procedure. Three patients received aprotinin and were excluded. A total of 71 patients were analyzed. INTERVENTIONS: Charts were examined for variables known to be associated with baffle fenestration closure in the modified Fontan procedure. MEASUREMENTS AND MAIN RESULTS: Occurrence of baffle fenestration closure, oxygen saturation, central venous pressure, left atrial pressure, transpulmonary gradient, chest tube drainage volume, chest tube drainage duration, intensive care unit (ICU) duration, and total inpatient duration were compared between the 33 patients who received antifibrinolytics and the 38 patients who did not. One patient of 71 had baffle fenestration closure in the first 48 hours after surgery. Oxygen saturation, central venous pressure, left atrial pressure, transpulmonary gradient, chest tube drainage volume, chest tube drainage duration, days in ICU, and total inpatient duration were not significantly different between the two groups. CONCLUSIONS: Use of epsilon-aminocaproic acid and tranexamic acid is not associated with early baffle fenestration closure after the modified Fontan procedure. It is concluded that these agents can be used without increasing the risk of spontaneous baffle fenestration closure.

Preparation of ethanol-enriched, bicarbonate-based hemodialysates.

We describe a method to produce bicarbonate-based dialysates containing approximately 100 mg/dl ethanol by introducing the alcohol into one of the dialysate concentrate solutions geared for the production of bicarbonate-based dialysates.

The efficacy of tranexamic acid versus placebo in decreasing blood loss in pediatric patients undergoing repeat cardiac surgery.

The antifibrinolytic drug, tranexamic acid, decreases blood loss in adult patients undergoing cardiac surgery. However, its efficacy has not been extensively studied in children. Using a prospective, randomized, double-blind study design, we examined 41 children undergoing repeat sternotomy for repair of congenital heart defects. After induction of anesthesia and prior to skin incision, patients received either tranexamic acid (100 mg/kg, followed by 10 mg.kg-1.h-1) or saline placebo. At the onset of cardiopulmonary bypass, a second bolus of tranexamic acid (100 mg/kg) or placebo was administered. Total blood loss and transfusion requirements during the period from protamine administration until 24 h after admission to the intensive care unit were recorded. Children who were treated with tranexamic acid had 24% less total blood loss (26 +/- 7 vs 34 +/- 17 mL/kg) compared with children who received placebo (univariate analysis P = 0.03 and multivariate analysis P < 0.01). Additionally, the total transfusion requirements, total donor unit exposure, and financial cost of blood components were less in the tranexamic acid group. In conclusion, tranexamic acid can reduce perioperative blood loss in children undergoing repeat cardiac surgery.

The influence of cardiopulmonary bypass on ionized magnesium in neonates, infants, and children undergoing repair of congenital heart lesions.

The purpose of this study was to measure the ionized magnesium (iMg) concentrations in children undergoing the correction of congenital heart defects. iMg levels were measured in 115 consecutive patients at five sample periods: prebypass, onset of bypass, during rewarming, immediately postbypass, and 1 h postbypass using an ion-selective electrode of the NOVA-CRT 8 (Nova Biomedical, Watham, MA). The incidence of dysrythmias was noted. Patients were divided into two groups: those who received Plegisol as the cardioplegic solution and those who did not. This study demonstrates that iMg decreases with the onset of cardiopulmonary bypass (CPB) in patients who weigh < 10 kg. In the Plegisol group, all subgroups of patients demonstrated statistically higher iMg during the rewarming phase of CPB, immediately post-CPB, and 1 h post-CPB, when compared with control values. The probability of dysrhythmias in the Plegisol group was almost twice that of the non-Plegisol group. However, this did not reach statistical significance (P = 0.22). The results of our study demonstrate that the use of CPB on pediatric patients produces alterations in the iMg. The changes differ depending on both patient weight and the use of a magnesium-containing cardioplegic solution, exemplified here by Plegisol. The role of these changes in iMg on dysrhythmias could not be further evaluated.

Speeds of action of single doses of formoterol and salbutamol compared with placebo in reversing methacholine-induced bronchoconstriction.

We compared the speeds of action of two doses of the long acting beta-agonist formoterol (12 micrograms and 24 micrograms) with those of salbutamol (400 micrograms) and placebo using a double-blind, randomized, cross-over study design in 16 asthmatic subjects. A methacholine test was used on four separate study days to produce a standardized degree of bronchoconstriction (a decrement in FEV1 > or = 20%) and one of the study medications as dry powder was administered immediately afterwards via an Aerolizer inhaler device. The speeds of recovery were estimated from measurements of FEV1 over the following 2-90 min. All active treatments produced significantly greater bronchodilation than placebo as early as 2 min after administration, and their peak effects within 10 min; and no significant differences were noted between them. Mean recovery times by 50% of the FEV1 decrement provoked by methacholine were significantly shorter for the active medications: 5.7 min (formoterol 24 micrograms), 6.4 min (salbutamol 400 micrograms), 10.2 min (formoterol 12 micrograms), and 53.1 min (placebo); the respective times for recovery by 80% being 18.0, 17.4, 22.1, and 83.3 min. We conclude that single doses of the dry powder formulations of all three active treatments produce rapid and effective bronchodilation. This conclusion should not, however, be extrapolated to the regular use of these medications, since differential down-regulation and tachyphylaxis may then exert an influence.

Tracheal extubation of children in the operating room after atrial septal defect repair as part of a clinical practice guideline.

Early tracheal extubation in the operating room after atrial septal defect (ASD) surgery was recommended as part of a clinical practice guideline (CPG) established in the Cardiovascular Program at the Children's Hospital, Boston, MA. This retrospective review was undertaken to determine whether this practice was efficient without compromising patient care. The charts and hospital charges for 102 patients undergoing secundum ASD or sinus venosus defect surgery between March 1992 and July 1994 were reviewed; 36 patients (Group I) had surgery prior to introduction of the CPG, and 66 patients were managed according to the CPG. Of the latter, 25 patients (Group II) were tracheally extubated in the operating room (OR) and 41 patients (Group III) were extubated in the cardiac intensive care unit (CICU). Patients in all three groups were similar with respect to height, weight, and surgical conditions including cardiopulmonary bypass time, lowest esophageal temperature, hematocrit, total OR time, and the time from completion of bypass to leaving the OR. Patients in Group II received significantly less fentanyl during anesthesia, were more likely to have a respiratory acidosis on admission to the CICU, and had an increased frequency of vomiting in the CICU. There was no difference in duration of CICU stay among groups. The length of hospital stay was reduced in Groups II and III after introduction of the CPGs, but was not influenced by tracheal extubation in the OR. There was no difference among groups in the hospital charges for OR, anesthesia and CICU time. However, when the combined hospital charges for services provided both in the OR and CICU were included, patients in Group II were charged significantly less, and this primarily reflects the absence of postoperative mechanical ventilation charges. Tracheal extubation in the OR after ASD surgery in children can result in lower patient charges without significantly compromising patient care.

Cocaine and metabolites in human graying hair: pigmentary relationship.

OBJECTIVE: To assess differences in the binding of cocaine, cocaethylene, and benzoylecgonine among pigmented and senile white hairs of the graying human cocaine abuser. DESIGN: A sheath of graying hair in the region around the apex of the head was gathered between the thumb and index finger then cut and removed about 2 mm proximal to the scalp. The graying hair was divided into pigmented and senile white of equal weights and lengths and then analyzed by gas chromatography/mass spectrometry chemical ionization. Twenty-nine such pairs were analyzed. SUBJECTS: Male cocaine abusers, ages 33-55 years hospitalized for substance abuse. Informed consent was obtained and confidentiality assured. MAIN OUTCOME MEASURES: Concentrations of cocaine, cocaethylene and benzoylecgonine in ng were assessed for each of 29 paired hair samples by gas chromatography/mass spectrometry chemical ionization. RESULTS: There were statistically significant differences between pigmented and senile white sections of paired samples. Cocaine (ng/mg hair, mean +/- SD) was 31.5 +/- 30.2 for pigmented hair vs 14.9 +/- 19.8 for senile white portions; (p < 0.0001). Cocaethylene (ng/mg hair, mean +/- SD) 3.22 +/- 5.0 (pigmented) vs 0.52 +/- 0.88 (senile white); (p < 0.0016). Benzoylecgonine (ng/mg hair, mean +/- SD) 5.1 +/- 5.3 (pigmented) vs 3.9 +/- 4.8 (senile white); (p < 0.005). CONCLUSION: Melaninated pigmented hair seems to bind more cocaine, cocaethylene and benzoylecgonine than white hair in the same subject.

The in vitro differential binding of benzoylecgonine to pigmented human hair samples.

Only fragmentary information on the relationship between hair pigmentation (melanin) and the cocaine/benzoylecgonine content of hair samples is available. The in vitro incorporation of benzoylecgonine into the shafts of black, brown, and blond samples of human hair was accomplished. Post digestion analysis and wash samples demonstrate the relative incorporated ions of benzoylecgonine to be black > brown > blond. Melanin content seems to be important. Lightly pigmented blond hairs may be less appropriate samples for benzoylecgonine and cocaine analysis.

Epidural anesthesia for postpartum tubal ligation using epidural catheters placed during labor.

STUDY OBJECTIVES: To evaluate the success of epidural anesthesia for postpartum tubal ligation using epidural catheters placed during labor and to determine whether patient characteristics, timing of surgery, or technical factors (e.g., length of epidural catheter inserted into the epidural space) influenced the success of subsequent epidural anesthesia. DESIGN: Retrospective study. SETTING: University hospital labor and delivery suite. PATIENTS: 90 consecutive women scheduled for postpartum tubal ligation using epidural catheters placed during labor. INTERVENTIONS: Epidural catheters were reinjected with 1.5% to 2% lidocaine with epinephrine 5 micrograms/ml or 2% to 3% 2-chloroprocaine immediately before surgery. MEASUREMENTS AND MAIN RESULTS: 74% of the women received satisfactory intraoperative anesthesia using in situ epidural catheters. Reinjecting the catheter within 4 hours of delivery was associated with a greater frequency of successful epidural anesthesia for tubal ligation (95% vs. 67%; p = 0.029). There was no significant difference between the two groups in the length of catheter inserted into the epidural space. CONCLUSIONS: Although other factors may influence the timing of postpartum tubal ligation after delivery, the success of epidural anesthesia for tubal ligation using in situ epidural catheters is greater if surgery is performed shortly after delivery.

Measurement of naloxone in plasma using high-performance liquid chromatography with electrochemical detection.

A new sample preparation technique, solid-phase extraction employing the ion-pair reagent octyl sodium sulfate (OSS), was developed for the selective isolation of nanogram quantities of naloxone from human plasma. Plasma samples containing naloxone, OSS, buffer, and naltrexone (internal standard) were applied to octyldecylsilane (C18) cartridges, and the opiates were eluted with 100% methanol. An extraction efficiency of 90% was achieved. Extracts were then examined by reversed-phase high-performance liquid chromatography with electrochemical detection, with mobile phase composition adjusted to optimize separation and quantitation. An oxidizing potential of +0.93 V resulted in an assay sensitivity of 1.0 ng. Thus, plasma naloxone levels of ca. 20 ng/ml could be readily detected and quantified. The intra-assay coefficient of variation at plasma levels of 80 ng/ml was 7.2%. Plasma naloxone values obtained during a 5-h infusion of the drug (0.24 mg/min) in two normal human subjects were stable and reproducible. Thus, the method herein described is applicable to human studies employing naloxone infusion.

Polycystic ovaries are a common finding in untreated female to male transsexuals.

OBJECTIVE: We studied the pretreatment hormone profile and ovarian ultrasound appearance of female-to-male transsexuals. DESIGN: Female-to-male transsexuals who were seen in the local Gender Identity Clinic were examined after psychiatric assessment. RESULTS: Sixteen patients were assessed. Approximately 50% had symptoms and signs of the polycystic ovary syndrome (PCOS) and 15 had a pelvic ultrasound diagnosis of polycystic ovaries. The endocrine profiles of the patients were not markedly abnormal and were compatible with the diagnosis of PCOS. CONCLUSIONS: Polycystic ovaries and the polycystic ovary syndrome are a common finding in female-to-male transsexuals who have had no previous exposure to exogenous androgen therapy.

Retrospective serologic survey for the presence of feline immunodeficiency virus antibody: a comparison of ELISA and IFA techniques.

A total of 878 samples from the New York State Diagnostic Laboratory (NYSDL), dating from January 1984 to May 1987, were examined to detect antibodies to feline immunodeficiency virus (FIV). We used 2 screening methods; an indirect immunofluorescence assay (IFA) and an enzyme-linked immunosorbent assay (ELISA). Of these, 211 samples were from cats that tested negative for feline leukemia virus (FeLV) and exhibited disease signs consistent with immunodeficiency disease; 19 (9.0%) serum samples were determined to be positive. An additional 508 samples were from cats that tested FeLV-negative and were asymptomatic; 6 (1.2%) sera were determined to be positive. The final 159 samples were from FeLV-positive cats and included symptomatic and asymptomatic animals; this population of cats produced 6 (3.8%) positives. Additionally, 521 samples from the Cornell Feline Health Center (CFHC) serum bank, dating back to 1966, were tested to determine the earliest sample in which FIV antibodies could be detected. Five (2.7%) 1971 and 3 (3.3%) 1969 CFHC samples tested positive. The IFA for FIV antibody proved to be a sensitive (97.4%) and specific (100%) test. The ELISA also had high sensitivity (100%) and specificity (99.6%); however, the IFA proved to be more specific than the ELISA when assaying FeLV-positive cats.

Naloxone increases water and electrolyte excretion after water loading in patients with cirrhosis and ascites.

Endogenous opioids may be involved in the pathogenesis of ascites and edema in patients with liver cirrhosis. We administered the opioid antagonist naloxone (5 mg bolus followed by a 0.06 mg/min infusion) to eight male patients with alcoholic cirrhosis and ascites and to five healthy age- and sex-matched control subjects and determined the effects of naloxone on water and electrolyte excretion after a nonsustained water load (20 ml/kg). In comparison with saline vehicle infusion carried out in the same subjects, naloxone administration resulted in a 50% increase in urine output and creatinine clearance and twofold increases in sodium and potassium excretion in patients with cirrhosis. Fractional sodium and potassium excretion, minimal urinary osmolality, plasma vasopressin and aldosterone levels, arterial blood pressure, and heart rate were not affected by naloxone treatment. The diuretic effect of naloxone was not observed in control subjects. Plasma naloxone levels were about six times higher in patients with cirrhosis than in control subjects (probably because of impaired metabolism of the drug) but only a weak correlation was found between drug levels and the degree of diuresis observed. The diuretic effect of naloxone may be related to an increase in glomerular filtration rate, possibly in conjunction with altered tubular reabsorption.

Direct diagnosis of tuberculosis by computer assisted pattern recognition gas chromatographic analysis of sputum.

Chemical detection of tuberculosis (TB) products in sputum was attempted by using gas chromatographic analysis in conjunction with different pattern recognition computer models. For the chromatographic separations, we used a 2 mm x 1.8 m packed column and a 0.25 mm x 30 m fused silica capillary column to analyse the methylated glycosides and fatty acid methyl ester derivatives. Three computer pattern recognition methods were applied: error score, TB score and discriminant analysis. These methods predicted the presence of active TB most often in sputa of active TB patients and less so in those from inactive, suspected and non-TB patients, in that order. Although the best true positive of 75% was obtained from the TB score method and best true negative of 98% from discriminant analysis, the accompanying false positive and false negative results (36% and 50%, respectively) were unacceptable. The use of capillary column or fatty acid methyl ester derivatives of the samples did not improve on the predictive values of chromatograms obtained from the packed column on trimethylsilylglycosidic derivatives. Additional work is needed before this method can have a direct clinical application.

Identifying Mycobacterium tuberculosis cultures by gas-liquid chromatography and a computer-aided pattern recognition model.

A procedure that uses gas-liquid chromatography and a pattern recognition computer model was developed for distinguishing cultures of Mycobacterium tuberculosis from cultures of other mycobacteria, common bacteria, and fungi. In this procedure, a sample of a culture preparation is methanolyzed and trimethylsilylated sequentially and injected into a gas chromatograph equipped with a flame ionization detector. A pattern recognition procedure computes an error score by comparing the gas-liquid chromatography peak responses of a culture to those of a standard M. tuberculosis culture. Ten M. tuberculosis cultures were used in the development of the pattern recognition model. Computed error scores of 5 or less were established for identifying an M. tuberculosis culture. The method was evaluated with two sets of test samples, non-M. tuberculosis and M. tuberculosis cultures. Sample identification was correct for all 14 M. tuberculosis cultures (M. tuberculosis or non-M. tuberculosis), 45 fungal cultures, 94 bacterial cultures, and all but 1 of 18 cultures of mycobacteria other than tuberculosis (MOTT). The false prediction represented an isolate of M. fortuitum. For M. tuberculosis, fungal, bacterial, and MOTT cultures, the ranges of error scores were 1 to 5, 16 to 33, 13 to 34, and 4 to 26, respectively. Therefore, we have demonstrated that this diagnostic model can distinguish M. tuberculosis from non-M. tuberculosis cultures with a high degree of accuracy.

Effect of acute postinfusion lipemia and free fatty acids on myocardial contractility: assessment with radionuclide ventriculography.

Equilibrium gated radionuclide ventriculography was used to evaluate the effect of intravenous fat-emulsion overload and excess of free fatty acids (FFA) on left ventricular ejection fraction (LVEF) in 20 patients with and without coronary artery disease (CAD). Fifteen of these patients had normal (greater than 50%) baseline LVEF and 5 had low (less than 50%) baseline LVEF. From 100 to 150 ml of 20% artificial fat emulsion (Liposyn) was infused over 20-25 min. At the end of the infusion, triglyceridemia reached 820 +/- 220 mg% and left ventricular ejection fraction decreased from baseline 62 +/- 19% (mean +/- SD) to 58 +/- 16% (P less than 0.05, paired t-test). After completion of Liposyn infusion, 5,000 U of heparin was administered intravenously and monitoring of LVEF was continued. One and one-half hours following heparin administration, plasma FFA levels reached 3.7 + 2.0 mmol/l and LVEF rose to 69 +/- 19% (P less than 0.001, paired t-test). Our data indicate that acute intravenous fat overload can suppress and high pathophysiologic levels of FFA can increase LVEF. This effect is more uniform and statistically more reliable in patients with normal LVEF. The study failed to demonstrate any significant difference in the effect of this pharmacologic intervention between patients with and without CAD.