A method of measuring finger force with the Kin-Com dynamometer.

The purpose of this study was to determine whether the force of a finger could be measured with a new system based on an attachment to the Kin-Com dynamometer, and to define the reproducibility of the finger force measurement. Eleven male subjects (age, 27.6 +/- 6.12 years) took part. All were free of orthopedic problems in the tested hand. Mean forces of the index and little finger for concentric and eccentric motion were measured using the new system. Overall coefficients of variation (OCVs) were calculated as an index of reproducibility. The reproducibility of force curves was considered good when an OCV was less than 20%. The OCVs for mean force of the index finger and for eccentric motion of the little finger were less than the 20% standard, at 10.7 and 14.0, respectively. The OCV for concentric motion of the little finger was greater than 20%. The findings suggest that measurement of finger force is feasible with the new Kin-Com attachment.

Efficacy of steroid hormone in solution for intracranial irrigation during aneurysmal surgery for prevention of the vasospasm syndrome.

A series of 55 patients with ruptured cerebral aneurysms were treated with moderate removal of subarachnoid clot followed by intracranial irrigation with pH 8.0 Hartmann solution containing 1 mg/ml of methylpredonisolone sodium succinate after the aneurysmal clipping during early (before day 3) operation. Six (11%) of the 55 patients suffered vasospasm syndrome postoperatively. The clinical results are significantly better than a series of 68 patients operated on and treated before day 3 by intracranial irrigation with Hartmann solution (pH 8.0) only. The possible preventive effect of direct intracranial administration of steroid hormone is discussed.

[Plasma PAI-1 levels in patients with various tumors with or without metastasis].

Recently, much interest has focussed on fibrinolysis in malignant tumors. In our previous study, we showed that t-PA antigen was significantly increased in plasma from patients with malignant tumors with metastasis. In our present study, we measured plasminogen activator inhibitor-1 (PAI-1) levels in plasmas from patients with various tumors. PAI-1 antigen was measured by means of enzyme immuno assay in plasma from 64 consecutive patients with a variety of malignant tumors. Patients were subdivided into two groups, one with (n = 47) and without (n = 17) metastasis. In the group with metastasis except for lung cancer, PAI-1 antigen level was increased compared to age-matched control subjects, while in the group without metastasis, PAI-1 antigen level was normal.

Cerebral microthrombosis in symptomatic cerebral vasospasm--a quantitative histological study in autopsy cases.

A comparative investigation of the pathogenetic factor in symptomatic cerebral vasospasm was made by quantitative histological and clinical studies in four patients who died immediately of symptomatic cerebral vasospasm (Cases 1-4) and in two who died without fatal cerebral vasospasm (Cases 5 and 6). Histological examination of the brain from Cases 1 and 2 found many white and fibrin microthrombi together with ischemic and infarctic changes in the territories of spastic arteries, which corresponded to the low-density areas (LDAs) observed on computed tomographic (CT) scans and the typical neurological symptoms. In Case 3, who had suffered severe vasospasms in bilateral anterior cerebral and middle cerebral arteries, bilateral LDAs were observed on CT scans and multiple fibrin thrombi were seen diffusely throughout the brain. In Case 4, extensive bilateral LDAs (lt greater than rt) were observed on CT scans, and multiple microthrombi were seen diffusely but predominantly in the left cerebral hemisphere. Only in Case 3 the possible complication of disseminated intravascular coagulation could not be ruled out. Only negligible thrombi were observed in Cases 5 and 6, whose immediate cause of death was considered to be acute hydrocephalus and aneurysmal rerupture, respectively. Distributions of microthrombi were significantly greater in the regions clinically identified to have been ischemic or infarctic.

The Valsalva maneuver: a test of autonomic nervous system function in pregnancy.

Four hundred forty-two studies of the Valsalva maneuver were performed on 282 pregnant subjects and 37 nonpregnant female control subjects. A fetal monitor was used for graphic presentation of the subject's beat-to-beat heart rate changes. The Valsalva ratio was calculated, defined as maximum tachycardia divided by maximum bradycardia during a Valsalva maneuver. The data from the studies on pregnant subjects were grouped according to weeks of gestation: less than 13, 13 to 16, 17 to 20, 21 to 24, 25 to 28, 29 to 32, 33 to 36, and greater than 36. The mean Valsalva ratio for control subjects is higher than the mean for every gestation group, and there is a definite downward trend in the means for each successive gestation group through 29 to 32 weeks. The tendency for pregnant women to have an "abnormal" Valsalva ratio (that is, less than 1.5) also appears to be related to gestation. This exploratory study demonstrates that the Valsalva ratio is sensitive to physiologic changes associated with pregnancy. This test might have use as a noninvasive indicator of certain types of abnormalities associated with pregnancy.

Use of toluidine blue for documentation of traumatic intercourse.

Forty-four women were examined for evidence of traumatic intercourse. Toluidine blue dye was employed as an objective adjunct in the evaluation because of its sensitivity for exposed superficial nuclei. Seventy percent of nulliparas and 40% of the total number of patients examined within 48 hours after complaint of sexual assault demonstrated toluidine blue-positive lacerations. Only 1 of 22 patients presenting after consenting intercourse demonstrated toluidine blue-positive lacerations. This new use of toluidine blue may prove of value in examining of the victim of sexual assault because of the dye's ability, independent of the examiner's skill, to indicate injury in collection of evidence for court proceedings.

Action of cortisol introduced into the supraoptic nucleus, on vasopressin release and antidiuresis during hypertonic saline infusion in conscious rhesus monkeys.

In human subjects cortisol raises the osmotic threshold for vasopressin release. The presumption that this results from a direct inhibitory action of cortisol on osmotically stimulated vasopressin release has been tested in conscious rhesus monkeys. Preparatory surgical procedures included chronic bladder catheterization, placement of cannulae in the right atrium, the left jugular vein and the stomach and stereotaxic insertion of metal cannulae in both supraoptic nuclei. The osmotic threshold for vasopressin release was defined as the plasma osmolality at the beginning of the 3 min urine sample in which free water clearance first fell by greater than 2 SD below the mean control level, in response to 5% saline infusion during constant hydration. Compared with control substances (0.9% saline solution or 11-deoxycortisol crystals), cortisol solution or crystals introduced into both supraoptic nuclei significantly lowered the plasma osmolality during the water-induced pre-saline diuresis, so that a larger amount of 5% NaCl infusion was required to reach the osmotic threshold. Thus, cortisol introduced into the supraoptic nuclei prolonged the duration of 5% saline infusion needed to reach the osmotic threshold, and raised the increment in plasma osmolality needed to reach the threshold but cortisol did not significantly raise the absolute level of the threshold.

Maternal transport: behind the drama.

Despite a lack of proof that overall perinatal outcome is improved, physicians and patients participate in a growing regional maternal transport program in a community hospital setting. Over the course of 3 1/2 years, 129 patients were transferred from 23 institutions. Maternal transport and the changes which result in the interactions of the physicians are compared to traditional referral systems. Obstacles and guidelines for minimizing them are discussed.

Impact of intensive newborn care on neonatal mortality in a community hospital.

Development of a Perinatal Center delivering Level 3 intensive care in a community hospital is described. The inborn neonatal mortality at the hospital in which the Center is located, as well as that of the 13 surrounding counties, has diminished more rapidly than the state neonatal mortality. This has coincided with an almost constant delivery rate, increased proportion of staff patients, relatively constant rate of low birth weight, and declining total perinatal mortality. Our experience suggests that appropriately trained and motivated people, not equipment or geographic location, represent the key factor in the development of such a center.