Differences in muscle endurance and recovery between fallers and nonfallers, and between young and older women.

BACKGROUND: Significant morbidity and mortality are associated with falls in older adults. We tested the hypothesis that older women with a history of falls demonstrate decreased muscle endurance and longer recovery times following fatiguing exercise. METHODS: We evaluated dynamic endurance and recoverability of the quadriceps femoris of 29 young women (YW) (M age = 21.7), 26 older women with a history of falls (FA) (M age = 73.3), and 27 older women with no history of falls (NF) (M age = 71.2) using an isokinetic dynamometer. Subjects performed repeated maximal concentric knee extensions until the force output of two consecutive repetitions fell below 50% of their maximal voluntary contraction (MVC). Recovery was defined as the time required for the return of force output > or = 80% MVC for 2 consecutive repetitions, within a set consisting of 3 maximal contractions. One minute rest was allowed between sets. We collected electromyographic (EMG) data from the quadriceps during all testing to evaluate spectral shifts. RESULTS: ANOVA with a post-hoc Bonferroni-Dunn test revealed time to fatigue was significantly faster in FA than YW (p < .02) and in FA than NF (p < .05), but not different between YW and NF. Time to recovery was significantly slower in FA than YW (p = .01), but not different between YW and NF, or between FA and NF, EMG median frequency power shift (from the beginning to the end of the test) was significantly less in FA (p < .001) than either YW (p < .002) or NF (p < .05). CONCLUSIONS: Older women with a history of falls demonstrate decreased muscular endurance compared to YW and NF, and increased time to recover from fatiguing exercise when compared to young women.

Nutrition and athletes.

Athletes differ from nonathletes in their nutritional requirements. Proper determination of nutritional needs in athletes requires knowledge of the athlete's body-fat composition and daily caloric expenditure. A balanced diet for athletes consists of 60 percent of calories from carbohydrates, 15 percent from protein and 25 percent from fat. Other important considerations include adequate intake of minerals and fluids.

Ankle injuries. Tips from sports medicine physicians.

In dealing with an ankle sprain, worrisome features are few but important to recognize. A "pop" heard or felt at the time of injury, a prolonged course, or a history of several previous injuries are all of concern. Medial tenderness on palpation, positive results on a squeeze test, or markedly positive results on stress testing are also indicators of severe injuries, which may require referral for treatment. Stress testing by an experienced clinician is appropriate for chronic or severe cases. Otherwise, treatment of the acute, uncomplicated ankle injury is straightforward, focusing on early mobilization, rehabilitation, and protection.

Prescribing behaviors of family physicians in the treatment of osteoarthritis.

BACKGROUND: Patients with osteoarthritis are frequently managed by family physicians. New evidence suggests that nonsteroidal anti-inflammatory drugs (NSAIDs) are no more effective than simple analgesics for treating osteoarthritis. The purpose of this study was to characterize the pharmacologic prescribing practices of family physicians for treatment of osteoarthritis. METHODS: One hundred eleven Indian family physicians were asked to provide their initial treatment recommendations for a hypothetical patient who had uncomplicated osteoarthritis. Responses were analyzed and subsequently validated by an audit of actual cases managed by family physicians. RESULTS: The response rate was 78%. Of those responding, 97% chose NSAIDs as their first line of therapy. Physicians were more than twice as likely to use anti-inflammatory doses of these agents as they were to use analgesic doses. There were no significant differences between the results of the written simulation and the actual case audit (P = .4216). CONCLUSIONS: Family physicians generally treat osteoarthritis with NSAIDs, and they prescribe anti-inflammatory doses more than twice as often as analgesic doses. An audit of the actual practice behaviors of family physicians corroborated this prescribing pattern. This prescribing behavior may be inappropriate given evidence that simple analgesics are as effective as NSAIDs.

Neurofibromatosis type 1: a case report and review of the literature.

Neurofibromatosis is the most common single-gene disorder of the nervous system. The chromosomal defects for at least two forms of neurofibromatosis have been delineated and mapped to chromosomes 17 (type 1) and 22 (type 2). The clinical course for either type of neurofibromatosis is unpredictable, and serious neurologic and systemic manifestations frequently arise in patients with this disorder. A 66-year-old woman presented with rapidly progressive myelopathy requiring operative decompression of the spinal canal to preserve function of the lower extremities. It is important to recognize the characteristics of neurofibromatosis and understand the natural history of this condition. Conservative treatment is the rule, treating new manifestations as they arise.

Factors affecting compliance with screening sigmoidoscopy.

BACKGROUND: A retrospective, qualitative study in a university setting was undertaken to better understand factors influencing patient compliance with screening sigmoidoscopy. METHODS: Individuals who completed screening sigmoidoscopy were interviewed to learn about the physician-patient relationship, general knowledge of cancer, family experience with cancer, exposure to the media, and specific reasons why sigmoidoscopy was completed. RESULTS: Respondents reported that their physician's recommendation had a strong positive influence on their decision to have sigmoidoscopic screening, as did their family and personal experiences with cancer. In all cases, the patients stated that they would not have had a sigmoidoscopy without the recommendation of their physician. Respondents were little influenced by exposure to the media or by famous personalities. CONCLUSIONS: The importance of the physician's recommendation for the patient to have sigmoidoscopy and demonstration of concern with early cancer detection may represent the primary motivating factors in completion of screening sigmoidoscopy.

Computed tomography in progressive multifocal leukoencephalopathy.

An area of decreased density found with computed tomography corresponded to confluent demyelinative lesions in the brain of a patient with progressive multifocal leukoencephalopathy. Failure of the CT scan to enhance with contrast material together with the clinical picture may enable clinicians to diagnose this subacutely progressive viral demyelinative brain disorder.

Acute posterior multifocal placoid pigment epitheliopathy.

Thirteen cases of acute posterior multifocal placoid pigment epitheliopathy occurred in young adults or older children. In ten there was a characteristic, possibly infectious syndrome that preceded the onset of ocular manifestations by a few weeks. One patient developed cerebrospinal fluid lymphocytosis and a cerebral vasculitis coincident with the ocular changes. Extensive evaluations for viral and other infectious etiologies in this and other cases were unrevealing. An inflammatory reaction was observed in the anterior chambers of most patients, and cells were noted in the anterior vitreous bodies of a few patients. In one instance a serous detachment of the retina occurred adjacent to the optic disk. Our findings and others support the conclusion that the fundus lesions resulted from a multifocal choroiditis primarily involving the choriocapillaris and affecting the pigment epithelium and retina secondarily. The data also suggested that the choroiditis may be associated with a more widespread vasculitis occurring as an immune reaction to an earlier systemic infection.