Optimal methods for shoulder tendon palpation: a cadaver study.

BACKGROUND AND PURPOSE: Physical therapists often must either palpate tendons of the shoulder or, as part of treatment, apply forces to those tendons. Many methods have been suggested for minimizing the amount of soft tissue that overlies these tendons, but no data have been presented to justify the use of any approach. The purpose of this study was to evaluate methods described in the literature by use of cadaver models. SUBJECTS: Twenty-four shoulders from 12 cadavers of individuals aged 55 to 92 years were dissected. METHODS: Shoulders were placed in the positions described in the literature, and the positions in which the tendons were maximally exposed (ie, had the least overlying tissue) were noted. RESULTS: Positions were found in which tendons were maximally exposed. CONCLUSION AND DISCUSSION. Positions described in the literature for optimizing the exposure of shoulder tendons are not always optimal, and palpation and treatment may be improved by using positions determined by research such as those suggested in this report.

Teaching human anatomy in physical therapy education in the United States: a survey.

BACKGROUND AND PURPOSE: The purpose of this study was to determine how human anatomy was being taught in physical therapy programs in the United States. SUBJECTS: Faculty in 103 physical therapy programs participated in the study. METHODS: A six-page questionnaire, which was mailed to 145 physical therapy programs, contained five sections: demographics, human gross anatomy--present and future, administration/cost, human anatomy textbooks, and human gross anatomy content areas. RESULTS: Anatomy was a laboratory-intensive course, with dissection being the primary laboratory teaching method. Use of prosected specimens, various audiovisuals, and computer-assisted instruction was also documented. Half of those teaching anatomy had a degree in physical therapy, and 65.6% of these educators were doctorally prepared. When comparing anatomy courses taught by physical therapy faculty and non-physical therapy faculty, differences existed between the two groups with respect to course content and clinical applicability. The most significant difference in content area emphasis was noted in the thoracic area. CONCLUSION AND DISCUSSION: Differences noted in course-content emphasis demonstrate the necessity for physical therapy faculty to communicate with non-physical therapy faculty teaching human anatomy about course content. Although the survey results have indicated that numerous texts are in use, the value placed on clinical applicability remains a significant consideration.

Quincke's disease: nonhereditary angioneurotic edema of the uvula.

We report two cases of Quincke's disease, an isolated form of angioneurotic edema involving the uvula that is induced by several factors, including foods, drugs, and inhalants. Although Quincke's disease has prominent oral manifestations, it has only rarely been described in the dental literature. The rapid onset and progression of the disorder, combined with the risk of respiratory compromise, may result in a serious medial emergency. Clinical manifestations include a nonerythematous swollen uvula, fullness in the throat, and signs of airway obstruction. A hereditary form of angioneurotic edema is associated with a biochemical defect; this must be differentiated from nonhereditary, localized forms such as Quincke's disease to determine appropriate treatment and predict prognosis. Clinical features and laboratory tests can distinguish hereditary angioneurotic edema from the nonhereditary form.

Combined use of labetalol and nifedipine in controlling the cardiovascular response from ECT.

Serious cardiac complications have been reported to occur in elderly depressed patients during a course of electroconvulsive therapy (ECT). As a result, cardiac medications are being used more often to dampen the cardiovascular response that occurs during an ECT treatment. Specifically, labetalol (a mixed alpha- and beta-blocker) has been shown to effectively control the heart rate during ECT. However, on occasion, patients may still exhibit sustained elevations of blood pressure during ECT when receiving labetalol. The optimum clinical management of these patients is unclear. The authors report on the safety and efficacy of combining nifedipine with labetalol to control blood pressure during ECT in ten elderly patients whose blood pressures were not adequately controlled by labetalol alone. No adverse effects were noted, nor did nifedipine appear to shorten seizure duration.

ECT-induced interictal delirium in patients with a history of a CVA.

Earlier works have documented a high incidence of affective disorders in patients with a history of a cerebrovascular accident (CVA). In general, electroconvulsive therapy (ECT) has been reported to be effective in treating depressed patients with a history of CVA. Recent works have shown that preexisting structural brain changes may predispose patients to develop interictal ECT-induced delirium. However, the incidence of ECT-induced interictal delirium in patients with a history of CVA has not been directly studied. In this pilot study, the authors examined the incidence of ECT-induced interictal delirium in 14 depressed CVA patients compared with 14 elderly depressed controls (without a history of CVA). Interestingly, the overall incidence of delirium was identical in both groups (28.5%). However, consistent with previous works, some patients who had had a recent CVA involving the caudate nucleus appeared more likely to develop delirium. Thirteen of the 14 depressed CVA patients (92%) showed a moderate to significant improvement in their depressive symptoms from ECT. None of the patients developed significant cardiac complications during ECT.

Multiple sclerosis and ECT: possible value of gadolinium-enhanced magnetic resonance scans for identifying high-risk patients.

Electroconvulsive therapy (ECT) has been used effectively in treating depressed patients with multiple sclerosis (MS). However, several reports have observed that some patients with MS may suffer neurological deterioration during ECT. The authors describe the outcomes of 3 depressed patients with MS who were treated with ECT. Consistent with previous works, ECT effectively treated the psychiatric symptoms; however, 1 patient deteriorated neurologically during ECT. The brain MRI findings and clinical courses of all 3 patients are discussed, along with the possible value of gadolinium-contrast MRI scans for identifying high-risk patients.

Simultaneous major depression and panic disorder: treatment with electroconvulsive therapy.

BACKGROUND: Major depression and panic disorder commonly occur together. Patients with simultaneous depression and panic disorder may have a higher lifetime rate of suicide attempts and an overall worse prognosis than patients with either depression or panic disorder alone. In addition, preliminary work suggests that some of these patients may not respond satisfactorily to antidepressants. In this report, we describe the clinical courses of eight consecutive patients with simultaneous major depression and panic disorder who were referred for ECT at our institution. METHOD: Eight consecutive patients who met DSM-III-R criteria for simultaneous major depression and panic disorder received ECT. All eight patients were evaluated by a structured clinical interview and the patients' major depression and panic disorder were evaluated with a 7-point Clinical Global Impressions severity rating scale. RESULTS: Before ECT was begun, each subject's panic disorder and depression were rated as at least markedly ill. After receiving ECT, all eight showed improvement in their depression. In addition, none of the eight patients reported having a panic attack from the time of their fourth ECT treatment until discharge. CONCLUSION: In this report, eight consecutive patients with simultaneous major depression and panic disorder improved with ECT. Further work is required which examines the potential utility of ECT in treating these patients.

The Characterization of a Piston Displacement-Type Flowmeter Calibration Facility and the Calibration and Use of Pulsed Output Type Flowmeters.

Critical measurement performance of fluid flowmeters requires proper and quantified verification data. These data should be generated using calibration and traceability techniques established for these verification purposes. In these calibration techniques, the calibration facility should be well-characterized and its components and performance properly traced to pertinent higher standards. The use of this calibrator to calibrate flowmeters should be appropriately established and the manner in which the calibrated flowmeter is used should be specified in accord with the conditions of the calibration. These three steps: 1) characterizing the calibration facility itself, 2) using the characterized facility to calibrate a flowmeter, and 3) using the calibrated flowmeter to make a measurement are described and the pertinent equations are given for an encoded-stroke, piston displacement-type calibrator and a pulsed output flowmeter. It is concluded that, given these equations and proper instrumentation of this type of calibrator, very high levels of performance can be attained and, in turn, these can be used to achieve high fluid flow rate measurement accuracy with pulsed output flowmeters.

Determining therapeutic efficacy in recurrent herpes labialis by lesion size analysis.

We devised an experimental model for the analysis of therapeutic efficacy of topical medications for recurrent herpes labialis with a double-blind, placebo-controlled format. Rigid prestudy screening evaluations allowed the enrollment of a homogeneous starting population with characteristic herpetic reactivation in an early stage. Using precise measurements of lesion area for a 5-day period, we evaluated the effects of a novel medication containing tannic acid, which has demonstrated impressive inhibitory effects on herpes simplex virus in many recent studies, and salicylic acid, which has rapid absorption kinetics and substantial topical anti-inflammatory and keratin-disrupting properties. Using parametric and nonparametric tests, we studied differences in mean lesion size and used these measurements to evaluate objective and clinically applicable improvement criteria. Although there were no significant differences in mean lesion size at presentation (day 1) between the active medication and placebo groups, the former demonstrated significantly smaller lesions at days 2 through 5 (p less than 0.05). By day 5, 10 of 14 treated subjects showed improvement as defined by a 25% reduction in lesion size compared with day 1, in contrast to only 2 of 12 subjects in the placebo group (p = 0.0079, Fisher's Exact Test). This model can be employed in the evaluation of topical antiviral agents for herpes labialis in a healthy population, because it standardizes criteria for subject enrollment and provides objective and reproducible measurements of therapeutic efficacy.

Regional localization of RNA and protein metabolism in Schwann cells in vivo.

Schwann cells, which form and maintain extensive myelin sheaths, have the bulk of their lipid and protein synthesis restricted to the compact 'perinuclear' zone at the centre of the internode. Using teased fibre and quantitative electron microscopical autoradiography, we demonstrated that additional protein synthesis takes place in the lengthy processes of Schwann cell cytoplasm. This 'so-called' superficial cytoplasmic channel network forms a branching and anastomozing array that stretches between the perinuclear region and the distant paranodes. Protein synthesis apparently does not extend from this surface network into the Schmidt-Lanterman incisures or paranodal loops that circumscribe compact myelin. To maintain protein synthesis in these lengthy processes, Schwann cells transport a portion of their RNA along the superficial cytoplasmic channels at a rate (0.1 mm per day) that appears to be slightly lower than the transport rate reported for RNA along dendrites of hippocampal neurons in culture (0.5 mm per day). Nearly a week is required for labelled RNA to be transported from the Schwann cell nucleus to the paranodal terminals of the longer channels. The existence of this extended protein synthesis is not limited to myelinating Schwann cells. Schwann cell processes associated with small calibre axons also appear to synthesize some of their own proteins as the RNA needed to catalyze local translational events is transported into these processes.

Peripheral nerve axonal dwindling with concomitant myelin sheath hypertrophy in experimentally induced diabetes.

Axons of the peripheral nervous system (PNS) are reduced in caliber in response to the experimental diabetic state. The cause of this reduced axonal size is disputed. Various theories include (a) axonal dwindling, (b) inhibition of growth, and (c) shrinkage due to serum hyperosmolarity. This study was designed to directly address these conflicting theories and to provide additional information on the character of the peripheral neuropathy resulting from an experimentally induced diabetic state. Four weeks, 6 and 12 months after establishing a streptozotocin-induced diabetic condition in rats, a morphometric evaluation of randomly selected cross sections of myelinated nerve fibers in the common peroneal nerve was performed on diabetic and age and weight-matched control animals. A reduction in the cross-sectional area of axons with a concomitant increase in the width of myelin sheaths was detected following 6 months of exposure to the diabetic state. Axons in rats diabetic for 12 months showed smaller cross-sectional areas than those seen in rats diabetic for only 6 months; hence, a dwindling in axonal caliber had occurred during this period. These findings indicate the presence of an axonopathy, associated with a myelin sheath alteration in the common peroneal nerve of the chronically diabetic rat.

Peripheral neuropathy following prolonged exposure to streptozotocin-induced diabetes in rats: a teased nerve fiber study.

An experimental diabetic state was induced in rats by means of an injection of streptozotocin. A histological and histometric evaluation of randomly teased nerve fibers was applied to the common peroneal nerves of both diabetic and age- and weight-matched control rats. A long-term (6-12 months) exposure to the diabetic state was required for the demonstration of the following morphological changes: (1) splitting and notching of myelin sheaths, (2) decrease in the ratio of internodal length/internodal diameter, (3) widening of nodal gaps. This study showed that neurons of smaller caliber are preferentially affected after a prolonged period of the diabetic condition. Neurons of this size are representative of sensory and autonomic components, suggesting that the changes present in this model parallel the derangements of these constituents reported in the human diabetic with adult onset disease.