Exercise effect with the wheelchair aerobic fitness trainer on conditioning and metabolic function in disabled persons: a pilot study.

OBJECTIVE: To determine the effect of exercise with the wheelchair aerobic fitness trainer (WAFT) on anthropometric indices, conditioning, and endocrine and metabolic parameters in persons with lower extremity disability. DESIGN: Exercise sessions with the WAFT lasted 20 to 30 minutes for two to three sessions. SETTING: Tertiary-care Veterans Administration medical center. PARTICIPANTS: Twelve subjects (3 with quadriplegia, 7 with paraplegia, 1 with cerebrovascular accident, 1 with bilateral above-knee amputation). MAIN OUTCOME MEASURES: Anthropometric indices (heart rate, blood pressure, weight, oxygen utilization, body mass index, upper arm and abdominal circumference, arm power) and endocrine and metabolic parameters (fasting serum glucose, lipids, and thyroid function) were determined before and after 10 weeks of exercise with the WAFT. RESULTS: All patients noted improved feelings of well-being after training. Mean resting heart rate, upper arm fat area, and fasting serum cholesterol level decreased significantly. Peak oxygen consumption, midarm circumference, and free thyroxine index increased significantly with training. CONCLUSIONS: WAFT improves quality of life, conditioning, and endocrine-metabolic parameters in disabled persons.

Epidural spinal cord stimulation for the control of spasticity in spinal cord injury patients lacks long-term efficacy and is not cost-effective.

Epidural spinal cord stimulation has been used to decrease spasticity and spasms in spinal cord injury patients. However, the long-term benefits of this procedure have not been determined. We therefore conducted a retrospective study of the possible long-term efficacy of the epidural spinal cord stimulator for the relief of symptoms. Seventeen patients were identified who had undergone implantation of an epidural spinal stimulator. The total number of implantations in these seventeen patients was 24, (seven patients had undergone a second implantation) costing a total of $566,400. In only one of the patients was the epidural stimulator providing symptomatic relief. The epidural spinal cord stimulator lacks long-term efficacy for the relief of spasticity and pain and is not cost effective.

Altering therapy of type II diabetes mellitus from insulin to tolazamide increases blood pressure in spite of weight loss.

In a retrospective study we investigated the effects of altering treatment of type II diabetes mellitus from insulin to tolazamide on weight and blood pressure. In 17 patients, weight decreased from 136 +/- 6 to 131 +/- 6% of ideal body weight (P = .01). Even though weight loss occurred, mean systolic blood pressure increased from 133 +/- 3 mm Hg to 142 +/- 4 mm Hg (P = .025). There was no difference in diastolic blood pressure on the two treatments (79 +/- 3 v 78 +/- 4 mm Hg). In an additional 10 patients whose treatment was changed from tolazamide to insulin, mean systolic blood pressure decreased from 136 +/- 1 to 124 +/- 2 mm Hg (P < .01). In spite of the potential benefits of reversal of insulin resistance and weight reduction, altering therapy of type II diabetes mellitus from insulin to tolazamide may increase blood pressure, thereby increasing cardiovascular risk.

Profound hypotension in a tetraplegic patient following angiotensin-converting enzyme inhibitor lisinopril. Case report.

We present the case of a 60 year old C6 complete tetraplegic patient who developed profound hypotension following initiation of the angiotensin-converting enzyme inhibitor lisinopril to control blood pressure. Other causes of hypotension, such as myocardial infarction and sepsis was ruled out. Inhibition of the renin-angiotensin-aldosterone system was the probable cause of hypotension. This case demonstrates the critical importance of the renin-angiotensin-aldosterone axis in the maintenance of blood pressure in tetraplegic patients, who may lack input from the brain to sympathetic neurons, and therefore have increased reliance on the renin-angiotensin-aldosterone axis for the maintenance of blood pressure. Angiotensin-converting enzyme inhibitors should be avoided in tetraplegic patients, unless other treatment modalities are ineffective.

A comparison of impression techniques for the CeraOne abutment.

PURPOSE: This study measured the accuracy of two impression techniques recommended by Noblepharma to be used with their CeraOne single tooth implant restoration. The first technique was to lute the impression transfer coping to the impression tray with autopolymerizing acrylic resin. The second was to leave the transfer coping free-standing in the impression material. MATERIALS AND METHODS: Thirty-five samples were made of a polyvinyl impression of the CeraOne transfer coping free-standing in the set impression material. Thirty-five samples were made of a polyvinyl impression of the CeraOne transfer coping luted to the impression tray with autopolymerizing acrylic resin. A jig was fabricated and used to record the spatial relations of the impressions and the transfer copings in reference to the jig. A light microscope was used to measure the distance between fixed markings on pressure sensitive paper, representing impression variations. RESULTS: The mean discrepancy in the horizontal plane for nonluted impressions was 0.094 mm, and for luted impressions, it was 0.275 mm. The mean discrepancy in the vertical plane for nonluted impressions was 0.154 mm, and for luted impressions, it was 0.192 mm. The differences found between the group with the luted impression tray and the group with the nonluted impression tray were found to be statistically significant. CONCLUSIONS: The more accurate of the two techniques is to transfer the impression coping without luting it to the impression tray.

Ibuprofen fails to increase plasma growth hormone levels in humans.

In eight healthy volunteers, basal and arginine-stimulated plasma glucose and growth hormone levels were determined during administration of a placebo and after 3 days of ibuprofen (800 mg four times daily). Ibuprofen had no significant effect on basal or stimulated plasma glucose or growth hormone levels. As is not the case with indomethacin, ibuprofen fails to increase basal and arginine-stimulated plasma growth hormone levels. This suggests that the effect of indomethacin on growth hormone secretion is due to a mechanism unrelated to inhibition of prostaglandin synthesis.

Hypertension secondary to chlorpropamide with amelioration by changing to insulin.

A retrospective analysis of the records of 22 type II diabetics whose treatment had been changed from insulin to chlorpropamide was performed to investigate the relative effects of insulin and chlorpropamide on blood pressure. Although diastolic BP index was not significantly different between the treatments, systolic BP index was significantly higher on chlorpropamide than on insulin (141 +/- 3 v 135 +/- 3 mm Hg, P = .02). In 10 patients in whom insulin was reinstituted, systolic BP fell significantly (P < .005), suggesting that in type II diabetics chlorpropamide exerts a relative hypertensive effect in comparison to insulin.

Indomethacin increases plasma growth hormone levels in man.

In seven normal volunteers, the basal and arginine-stimulated levels of plasma growth hormone, glucose, glucagon, and free fatty acids and serum insulin was determined during placebo and during indomethacin 25 mg four times daily. Basal plasma growth hormone was higher during indomethacin (5.4 +/- 1 vs 1.7 +/- 2 ng/ml, p less than 0.005), as was the mean integrated response to intravenous arginine (40 +/- 14 vs 6 +/- 4 ng.min/ml, p less than 0.05). Despite lack of effect on plasma glucagon, indomethacin decreased the insulin response to arginine. The fall in free fatty acids during arginine infusion was decreased by indomethacin, which may in part be due to increased plasma growth hormone levels. In view of the many patients treated with indomethacin, the effect on growth hormone may be of clinical importance.

Insulin pump treatment of type I diabetes mellitus in a patient with C6 quadriplegia.

A 40-year-old patient with insulin-dependent (Type I) diabetes mellitus since childhood suffered a C6 spinal transection. Recurrent episodes of hypoglycemia resolved after the patient was placed on an insulin pump. The patient is able to set the insulin delivery rate and maintain the pump without assistance. Spinal cord injured patients may lack both the clinical symptoms of, and the ability to respond to, hypoglycemia. The mixing of NPH insulin and regular insulin requires fine motor skills; even with prefilled syringes, the quadriplegic person may have difficulty with subcutaneous injection. The use of an "open loop" insulin pump averts these problems and may provide better glucose control for selected spinal cord injury patients with Type I diabetes.

Modification of therapy from insulin to chlorpropamide decreases HDL cholesterol in patients with non-insulin-dependent diabetes mellitus.

In 27 patients with non-insulin-dependent diabetes mellitus, we determined fasting serum glucose, hemoglobin A1, body weight, serum triglycerides, cholesterol, low-density lipoprotein cholesterol (LDL-chol), high-density lipoprotein cholesterol (HDL-chol), and very-low-density lipoprotein cholesterol during treatment with insulin and several months after changing treatment to chlorpropamide. In five patients, diabetic control deteriorated to the point where insulin was reinitiated. In the remaining 22 patients, despite a significant decrease in weight (122 +/- 5 vs. 114 +/- 5% ideal body wt; P less than .025) on chlorpropamide, HDL-chol fell from 49 +/- 4 to 40 +/- 4 mg/dl (P less than .01) when therapy was modified from insulin to the sulfonylurea. There was a concomitant increase in LDL-chol:HDL-chol from 3.6 +/- 0.3 to 4.4 +/- 0.5 (P less than .05). In the 5 patients in whom insulin was reinstituted, HDL-chol increased to its previous level on insulin (P less than .05). Changing antidiabetic medication from insulin to sulfonylureas may alter the lipoproteins in a manner that increases cardiovascular risk.

Asymptomatic bacteriuria and hemoglobin A1.

We measured hemoglobin A1 (HbA1) and performed clean-catch urine cultures in 752 patients (411 men and 341 women) with non-insulin-dependent diabetes mellitus (NIDDM) attending an outpatient diabetes clinic. Prevalence of bacteriuria was significantly greater in diabetic women than in controls (9.1 vs. 5.0%, P less than .001) but not in diabetic men. Risk of bacteriuria was not related to level of HbA1 at the time of urine culture. However, mean duration of diabetes mellitus was significantly greater in diabetic women with bacteriuria than in those without infection (9.9 +/- 1.5 vs. 5.4 +/- 0.4 yr, P less than .025), and the prevalence of bacteriuria was significantly greater in patients with complications of long-standing diabetes mellitus than in those without complications (P less than .005).

Hemoglobin A1 correlates with the ratio of low-to high-density-lipoprotein cholesterol in normal weight type II diabetics.

Because cardiovascular risk correlates with serum low density lipoprotein (LDL) cholesterol and is inverse with high density lipoprotein (HDL) cholesterol, the LDL-HDL cholesterol ratio has been advocated as a sensitive index of relative cardiovascular risk. In 50 normal weight insulin-treated Type II diabetic subjects, mean LDL-HDL ratios were significantly higher than for controls. In diabetic women, the LDL-HDL cholesterol ratio correlated with hemoglobin A1 better than any of the lipids or lipoprotein cholesterol fractions. When 8 poorly controlled diabetics were treated with insulin, the LDL-HDL ratio changed more significantly than did its component fractions, and the fall in LDL-HDL ratio paralleled the fall in hemoglobin A1.

Phentolamine and the action of somatostatin in man.

The inhibition by somatostatin (SRIF) of basal and arginine-stimulated glucagon, insulin, and glucose levels was compared with that obtained when SRIF was preceded by alpha-adrenergic blockade with phentolamine. No noteworthy differences were observed, except that the characteristic rebound of insulin upon discontinuation of SRIF was significantly lower with phentolamine (P less than 0.01). These results indicate that inhibition of basal and arginine-stimulated glucagon and insulin secretion by SRIF in man is not mediated through activation by alpha-adrenergic receptors.