Clinical evaluation of the bionic glove.

OBJECTIVE: Clinical evaluation of the Bionic Glove, a prototype of a new functional electrical stimulation device designed to improve the function of the paralyzed hand after spinal cord injury. PATIENTS: Twelve people with spinal cord injury at C5-C7 who had used the device 6 months or more. SETTING: Measurements were made at the Institute "Dr Miroslav Zotovic" in Belgrade as a part of a multicenter clinical trial. METHODS: Measures include Upper Extremity Function Test, Functional Independence Measure, and Quadriplegia Index of Function. RESULTS: The daily use of a Bionic Glove had two major effects: (1) increasing the power grasp; and (2) increasing the range of movements. Active force was significantly greater than passive tenodesis force, as shown in other studies. Most manual tasks improved significantly with the use of the assistive system, as judged by the time needed to complete a task or the subject's qualitative ratings of a task difficulty. Most subjects who retained some dexterity without the assistive system hesitated to use the assistive system to manipulate small objects. CONCLUSION: The Bionic Glove can significantly improve independence in people with C5-C7 spinal cord injury if their initial Functional Independence Measure and Quadriplegia Index of Function scores are 20% to 50% of the maximum values.

Prostaglandin synthesis inhibitors potentiate the antihypertensive effect of heparin in spontaneously hypertensive rats.

We have shown that heparin lowers blood pressure significantly in hypertensive rats. This study was initiated to examine whether prostaglandin (PG) mediates the antihypertensive action of heparin. To this end, the effect of three different PG synthesis inhibitors (indomethacin, aspirin, meclofenamate) on the cardiovascular and renal actions of heparin was studied in spontaneously hypertensive rats (SHR). During 4 weeks of treatment, heparin reduced blood pressure significantly (P less than 0.01) in SHR. This was accompanied by significant decrements in hematocrit and total peripheral resistance but a significant increment in cardiac output. All of the PG inhibitors used significantly potentiated the antihypertensive effect of heparin and further reduced blood pressure by about 20%. Although heparin alone increased plasma renin activity, heparin and PG inhibitors together prevented this effect. When compared with heparin-treated rats, SHR treated with heparin and PG inhibitors combined had significantly (p less than 0.05 to 0.01) lower plasma aldosterone levels. These levels, however, were not different from SHR treated with PG inhibitors alone. Like blood pressures, the renal histopathologic lesions in SHR treated with heparin or heparin and PG inhibitors combined were significantly less severe than those in untreated SHR or SHR treated with PG inhibitors alone. Finally, captopril was shown to potentiate the effect of heparin. In conclusion, the antihypertensive effect of heparin does not appear to be PG mediated, but may be related to the structural changes in renal arterioles, inhibition of angiotensin-converting enzyme, or both.

Methioninemia and myopathy: a new disorder.

A 7 1/2-year-old girl with hypermethioninemia, myopathy, and mental deficiency (IQ = 65) is described. The increased methionine was not associated with deficiency of methionine adenosyltransferase, which was normal or increased in liver, muscle, erythrocytes, and cultured fibroblasts. Methionyl-tRNA synthetase in fibroblasts was normal. The hypermethioninemia and a concurrently increased blood S-adenosylmethionine declined on a diet low in methionine. There was a diffuse, symmetrical, moderate proximal muscle weakness, but muscle atrophy was not discernible, and the deep tendon reflexes were hypoactive but obtainable. Electromyographic abnormalities were not detected. Electron microscopy of muscle revealed 3 to 6 small myelin figures in the region of the I band in nearly every fiber, with occasional myelin figures at other sites also. These myelin figures were more numerous and smaller than those seen accompanying nonspecific myopathies and may reflect a more specific pathological change. Electron microscopy of liver revealed three nonspecific lesions in all hepatocytes: (1) numerous megamitochondria with crystalloid deposit in the matrix; (2) increased numbers of small vesicles of smooth endoplasmic reticulum; and (3) loss of plasma membrane microvilli, with extensive bleb formation and shedding of cytoplasm into Disse's space.