Examination of the neuromechanical factors contributing to golf swing performance.

This study investigated the relationship between a range of neuromechanical variables in the lower- and upper-body, and golf performance. Participants were assessed for individual muscle stiffness, vertical stiffness (Kvert), flexibility, power and maximal isometric strength. Furthermore, golf performance was determined by handicap and club head speed. Pearson's correlations quantified the relationships between neuromechanical variables and performance measures. Participants were also separated into relatively high club head speed (HC) and low club head speed (LC) groups and compared for physical characteristics. Club head speed showed positive relationships with Kvert and power and a negative relationship with hip mobility. The HC group exhibited superior Kvert and power, while strength and flexibility measures were not related to performance. Higher levels of lower-body stiffness, rate of force development and power output appear to be beneficial for generating superior club head speed. A stiffer system may reduce the time needed to remove the "slack" from the series elastic component therefore, reducing electromechanical delay and enhancing rate of force development. The large positive association with rate of force development suggests that increasing this component, along with power production may be superior focal components for training in golfers due to the short duration of the downswing.

Carbon monoxide poisoning: Novel magnetic resonance imaging pattern in the acute setting.

The presentation of carbon monoxide (CO) poisoning is non-specific and highly variable. The diagnosis is made when a compatible history and examination occur in a patient with elevated carboxyhaemoglobin levels. The severity of intoxication is difficult to assess accurately based on laboratory markers alone. Magnetic resonance imaging (MRI) has been shown to have superior sensitivity to computed tomography for the detection of abnormalities post CO poisoning. We report a novel imaging pattern on MRI undertaken in the acute setting in a patient with CO intoxication. We also discuss the management and follow up of patients with CO poisoning.

Prophylactic treatment for cytosine arabinoside-induced keratoconjunctivitis.

High-dose cytosine arabinoside (Ara-C) is known to cause keratoconjunctivitis in a large proportion of patients. Topical steroids are a popular choice of prophylactic treatment. The objective of this survey was to evaluate the type, dose, frequency and duration of drops used in all centres (n = 117) participating in the acute myeloid leukaemia trial 15 (AML 15), and to assess adherence to the trial protocol prescribed guidelines. All centres used prophylactic treatment; however, the dose of Ara-C at which it was initiated varied from 100 to 6000 mg/m(2)/day. All centres used some form of steroid prophylaxis with prednisolone 0.5% being the most commonly used (98/117), but only 6 of the 117 centres initiated treatment at doses recommended in the trial protocol. Ten centres used lubricants in addition to steroids. No centre reported the use of non-steroidal anti-inflammatory drops. The duration of treatment ranged from 2 days prior to commencing Ara-C to 28 days post-treatment. Twenty-two centres reported complications of which preservative allergy was the commonest. There is a large variation in prophylactic treatment practice in the UK. Clear guidance on the use of prophylaxis and further studies are required to ascertain the most effective prophylactic treatment and regimen.

Psychosis or temporal lobotomy: SPECT findings in a paraplegic patient with chronic mental illness.

OBJECTIVE: To ascertain if single proton emission computerized tomography (SPECT) imaging involving a patient with a history of head trauma, paraplegia, and chronic mental illness, would provide useful information regarding diagnosis and treatment. METHOD: A case report. RESULTS: SPECT data indicated a convexity of the temporal lobe; it was significantly crumpled inward in the location of the traumatic blow suffered 18 years earlier. The center of hypoperfusion suggested a complete disruption of connections between the temporal lobe and Broca's area, and a practically ablated left temporal area. CONCLUSION: The patient was reclassified with an organic psychosis and as an individual who might benefit more from medications to treat temporal lobe irritability rather than antipsychotic medications. Despite these findings and recommendations, psychiatric personnel discharged the patient without implementation. He is currently in critical condition following a suicide attempt.

Establishing guidelines for pharmacotherapy trials in bulimia nervosa and anorexia nervosa.

OBJECTIVE: This paper addresses the lack of a standard protocol for pharmacotherapy trials for patients with bulimia nervosa (BN) and anorexia nervosa (AN). METHOD: Twenty-two surveys were sent to established researchers in the field of eating disorders to elicit their opinions regarding medication trials, including baseline laboratory tests, the optimal length/frequency of medication management sessions, and the information that should or should not be included in these sessions. RESULTS: Sixteen of 22 researchers completed and returned the survey. Their answers are the basis of the data presented. DISCUSSION: We propose a battery of screening laboratory tests for both conditions. We suggest 30-45-min initial medication management sessions in both AN and BN trials with 15-min follow-ups to be held weekly for AN subjects, and weekly for 2 weeks, then biweekly for 2 weeks, then monthly, for BN subjects. We also recommend that published trials should include explicit details of medication management.

MR arthrographic depiction of tears of the rotator cuff: benefit of abduction and external rotation of the arm.

PURPOSE: To show the effectiveness of positioning the arm in abduction and external rotation (ABER) during magnetic resonance (MR) arthrography for depiction of tears of the rotator cuff. MATERIALS AND METHODS: Five throwing athletes with shoulder pain were prospectively imaged with standard MR imaging, MR arthrography, and ABER MR arthrography. The status of the rotator cuff was recorded; arthroscopic correlation was obtained. RESULTS: One partial tear of the distal infraspinatus tendon was detected with ABER MR arthrography only. One full-thickness tear was detected with both MR arthrography and ABER MR arthrography, but the component of the tear that extended into the infraspinatus tendon was depicted with ABER MR arthrography only. One partial tear was detected with both MR arthrography and ABER MR arthrography; no additional information was provided by either technique alone. CONCLUSION: The ABER position may be useful in detection and characterization of tears of the rotator cuff, especially partial tears of the undersurface. This information would be useful in selection of patients for conservative therapy, arthroscopy, or arthrotomy.

Psychiatric patients' belief in general health factors and sin as causes of illness.

Of 52 psychiatric inpatients, 81% believed that factors such as proper diet, sleep, and exercise affect the development of illnesses, and 23% believed that sin-related factors, such as sinful thoughts or acts, have such an effect.

Bone abnormalities of the knee: prevalence and significance at MR imaging.

Focal abnormal signal intensity within the distal femoral condyles or proximal tibial plateaus is frequently seen on T1- or intermediate-weighted magnetic resonance (MR) images of the knee. To characterize the prevalence and significance of these findings better, a retrospective study of MR imaging of the knee, performed on the first 434 consecutive patients at a primarily outpatient community MR imaging center, was undertaken. A signal intensity loss demonstrated on images with a short echo time (20 or 25 msec) was divided into three types based on morphologic criteria. A type 1 finding was a diffuse, often reticulated signal intensity loss in the metaphyseal and epiphyseal regions of bone. A type 2 loss was associated with an interruption in the smooth, black cortical line. A type 3 finding was a profound signal intensity loss primarily restricted to the immediate subcortical region. Seventeen percent of all cases revealed a type 1 or 2 loss that may have been compatible with acute bone injuries. These bone lesions were frequently associated with tears of the anterior cruciate ligament and contralateral collateral ligament, but infrequently these lesions were detected with plain radiography and arthroscopy. When associated with a weight-bearing cortex, bone injuries detected with MR imaging may explain clinical symptoms of pain on weight bearing, and type 1 injuries may represent regions of bone at increased risk for the subsequent development of insufficiency fractures if the bone is not adequately protected during trabecular healing.

Religious beliefs and practices among 52 psychiatric inpatients in Minnesota.

The authors studied the religious beliefs, practices, and experiences of 52 psychiatric inpatients. The rate of belief in the major tenets of faith (God, the Devil, and an afterlife) was uniformly high and in accord with national and local public poll results. Patients with depressive and anxiety disorders tended to score lower than those with other diagnoses on a wide variety of indexes of religion. The authors conclude that religion is an important factor in most patients' lives and that individual inquiry and systematic research into this neglected area are both feasible and important.

Lymphomas of the mucosa-associated lymphoid tissue. Signet ring cell lymphomas presenting in mucosal lymphoid organs.

Four cases of lymphoma are reported which were postulate to have developed from neoplastic transformation of the lymphoid cells of the mucosa-associated lymphoid tissue (MALT). This contention is primarily based on two observations: the peculiar "homing" tendency of these lymphomas and the immunoglobulin isotype. Both properties are characteristic of the lymphoid cells of the MALT. These lymphomas can also be identified by their histologic structure (signet ring cell lymphomas) and their presentation in an MALT organ. These lymphomas are probably separable from other lymphomas proposed to arise from lymphocytes of the gut-associated lymphoid system (GALT).

Randomized study for the treatment of adult advanced Hodgkin's disease: mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) versus lomustine, vinblastine, and prednisone.

Forty-seven patients with advanced Hodgkin's disease were entered in a prospective, randomized trial comparing MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) with a regimen containing lomustine (CCNU), vinblastine, and prednisone (CCNU-VP). Both groups were comparable for the variables of age, stage, substage (symptoms), histology, prior radiation, and sites of involvement. Seventy-two percent of CCNU-VP-treated patients achieved a pathologically documented complete remission (CR) compared to 41% of the MOPP-treated group. Two additional patients treated with MOPP had remission documented only clinically but have been long-term, disease-free survivors. There was a greater frequency of CR in the patients who had received previous irradiation when compared to patients with no prior irradiation. After a median follow-up of greater than 89 months, there is no statistical difference between the two treatment groups in survival (45% for MOPP and 60% for CCNU-VP). Further, no statistical difference in survival for the two treatment groups was noted when compared by histology, stage, or symptoms. The CCNU-VP combination was better tolerated with significantly less nausea and emesis. The alternative drug regimen of CCNU-VP appears to be as effective as MOPP in producing CR and long-term survival in patients with advanced Hodgkin's disease.

The clinical significance of the morphological subdivision of diffuse "histiocytic" lymphoma: a study of 162 patients treated by the Southwest Oncology Group.

We grouped 162 patients wtih advanced, diffuse histiocytic lymphoma (DHL) into various morphological subtypes to ascertain whether there were any significant differences in survival among them. These patients were staged and treated from 1972 to 1977 according to the protocols of the Southwest Oncology Group. Of the 159 patients on whom a consensus on the diagnosis was reached, 115 were classified morphologically as having large non-cleaved, 26 as B-immunoblastic, 9 as large cleaved, and 6 as T-immunoblastic. The 3 remaining patients did not fit any of these subtypes, but each had a single prominent nucleolus in most tumor cells ("prominent nucleolus" type). Morphological subdivision of DHL did not identify any subgroup of patients with a significantly longer survival, but clinical parameters such as stage, symptoms, and type of treatment significantly influenced survival times.

Intergroup Hodgkin's disease in children study of stages I and II: a preliminary report.

The intergroup study of involved-field (IF) radiotherapy, IF radiotherapy plus MOPP chemotherapy, and extended-field (EF) radiotherapy for treatment of Hodgkin's disease in children has assessed 305 patients. Of these, 279 were "not ineligible" (no mediate cause for disqualification). Among 223 randomized patients, 144 were evaluable, 131 had documentation of complete or partial remission, 20 of the remitters relapsed, and two died. Among 62 nonrandomized patients with favorable presentations (unilateral upper neck, unilateral inguinal, or massive mediastinal disease), 29 had documented remission, two relapsed, and none died. Length of initial disease control (LIDC) was used to measure duration of response. LIDC was best in patients given IF plus MOPP, and 95% are disease free. EF was better than IF radiotherapy (P = 0.004). Of the disease characteristics prognostic for response (stage, histologic subtype, and presence of symptoms), only the last factor had a statistically significant effect on LIDC (P = 0.004). Ninety-six percent of the patients survive. Using criteria developed by the committee, 23% of the staging procedures reviewed were nonevaluable and 28% of the radiotherapy treatments were nonevaluable. The necessity for criteria for evaluation of staging and treatment is certain. Length of followup is too short for correlations of treatment with significant late effects and for relevant therapeutic recommendations.