Intermittent compression for the treatment of the oedematous hand in hemiplegic stroke: a randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of intermittent pneumatic compression in treating oedema in the hemiplegic hand of stroke patients. DESIGN: Single-blind randomized control trial. SETTING: acute and rehabilitation elderly care wards in a teaching district. SUBJECTS: 37 Subjects with a first ever hemisphere stroke were randomized to treatment with standard physiotherapy either alone or combined with intermittent pneumatic compression. MAIN OUTCOME MEASURES: The effect of treatment on oedema was assessed using measures of the hand volume of the hemiplegic hand. The impact on function was assessed using the motricity index. RESULTS: The treated group showed no change in the mean stroke hand volume. In the control group the mean stroke hand volume decreased by 3.2 ml. There was no statistically significant difference between the groups. The median scores for the motricity index increased for both groups but there was no significant difference between the groups and any improvement in motor function was independent of any treatment effects. CONCLUSION: Intermittent pneumatic compression at the prescribed pressure and duration of this study is not an effective treatment for the oedematous stroke hand.

Caring for Older People. Public transport.

Most older people are mobile and able to use public transport without any problems. Those who are hard of hearing or have poor vision and those with mobility problems need not be deterred from using public transport. Though the design and provision of suitable buses, taxis, and trains is not always optimum, many now have imaginative features to help older passengers. Travel by air and sea needs extra planning for disabled elderly people, but helpful advice is available and much can be done to enable even the most disabled traveller to make long journeys confidently and in comfort.

Recurrent Guillain-Barré syndrome: lightning does strike twice.

Recurrent Guillain-Barré syndrome following a long asymptomatic interval is very rare. Forty-nine cases are reviewed from the literature, their common features are noted and conclusions are drawn. Thus it can be seen that, with Guillain-Barré syndrome, lightning can indeed strike twice.

The use of deaf-aid communicators in a Salford Hospital: a failure of communication?

It is estimated that 7.5 million adults in the UK have varying degrees of hearing loss. People with hearing deficits often feel isolated, neglected and can be mistakenly labelled as confused. Responding to this need, ten deaf-aid communicators were purchased for our elderly-care wards. It however became apparent that the aids were being under-used, and to test this observation a survey of ten elderly-care wards was undertaken. Fifty-six nurses were questioned about their knowledge and use of the communicators. Only 32% knew the communicators were on their ward. Of these 32%, only 61% knew where the aids were kept and only five nurses had ever used the communicators. Only one original, functioning communicator was found and over 50% of the machines could not be recovered. The possible reasons for the failure of this initiative are discussed and lessons drawn. Similar surveys in other hospitals and general practice would be useful to determine the level of service offered to patients with hearing impairments and to provide a basis for future audit.

The cold hemiplegic arm.

BACKGROUND AND PURPOSE: Vasomotor changes occur in the arm after hemiplegic stroke. Previous studies have provided conflicting results, with most showing an increase in skin temperature of the hemiplegic arm. However, a number of patients complain of distressing coldness of the hemiplegic arm. METHODS: Eleven patients with symptomatic coldness and 10 patients with hemiplegia but no coldness were recruited. The severity of the symptom of coldness was compared by questionnaire with other common symptoms after stroke. A thermographic camera was used to record the finger skin temperature response to cold stress. Blood flow to both hands was also measured simultaneously by means of two plethysmographs. In all patients there were no symptoms in the unaffected arm, and this was used as a control. RESULTS: The symptom of coldness rated highly compared with other symptoms. In the symptomatic group the finger temperature on the hemiplegic side was lower at rest (median difference at rest, 0.65 degrees C; P < .0001) and at all times after cold stress. In the asymptomatic group the fingers on the hemiplegic side were colder at rest and after initial cooling (median temperature difference, 0.2 degrees C) but at no other time. Hand blood flow on the hemiplegic side was also decreased in the symptomatic group by 35%. This was not seen in the asymptomatic group. CONCLUSIONS: Coldness of the hand may be a severe and distressing symptom in some patients after hemiplegia. Symptomatic patients have lower finger skin temperatures at rest and after standard cold stress. These symptomatic patients also had reduced blood flow to the hemiplegic hand.

Fatal diltiazem overdose: report of four cases and review of the literature.

Four fatal cases of diltiazem overdose are described and compared with previously published cases. Clinical sequelae include all grades of heart block, hypotension and ultimately death. Management includes gastric lavage and oral administration of activated charcoal at presentation. Further symptomatic treatment with inotropic agents and temporary cardiac pacing may be required. If these measures are successful, recovery occurs within 36 hours in uncomplicated cases. Toxicological data have been reviewed but currently drug levels can only offer a retrospective analysis of the severity of overdoses. As the use and risk of abuse of diltiazem increases, these reports serve to highlight the possible hazards and to alert physicians to what must be regarded as a dangerous and potentially lethal drug in overdosage.