The maximal double step length test can evaluate more adequately the decrease of physical function with age, than the maximal single step length test

The maximal double step length (MDSL) test is a modified version of the maximal step length (MSL) test used to evaluate the dynamic balance related to falls in the elderly. Although this test can evaluate their physical function using movements similar to daily activities as compared to MSL, it has not been clarified whether it can adequately evaluate the activities of daily living (ADL) abilities of the elderly, as they decrease with age. This study aimed to examine the relationship between both MSL and MDSL on age and ADL in elderly subjects. Fifty-seven elderly females who live independently (age 74.8 ± 5.6 years) were recruited. MSL and MDSL were conducted twice after completing an ADL questionnaire. Intra-class correlation coefficients (ICCs) of both tests were high (for MSL: ICC = 0.95, for MDSL: ICC = 0.81-0.82). Age and ADL significantly correlated to MDSL (age: r = −0.32-0.41, ADL: r = 0.28-0.48), but not to MSL (age: r = −0.19, ADL: r = 0.15). MDSL has high reliability as it relates to age and ADL. It may be more useful to evaluate ADL required for independent living and prevent falls in the elderly better than MSL.     

A clinical evaluation of the maximal histalog test

Summary and conclusions A maximal dose of Histalog (2.0 mg./kg.) was evaluated as a stimulant for clinical testing of gastric secretion in 131 patients. The tube must be positioned fluoroscopically in the gastric antrum prior to testing—failure to do so results in a significantly reduced recovery of secretion. It is also recommended that continued antral position of the tube be checked fluoroscopicaly toward the end of the test.The highest hourly output of gastric secretion was found to occur between 30 and 90 min. after Histalog administration in patients with duodenal ulcer and between 60 and 120 min. in control subjects. However, the highest discriminating difference in secretion between ulcer and nonulcer subjects occurs within the first hour (p=<1%), whereas the difference between 60 and 120 min. is negligible. In the detection and secretory evaluation of duodenal ulcer patients, therefore, it would seem most practical and sufficient to run the test for 90 min. after Histalog administration.Serious side reactions to these large doses of Histalog may occur. Severe vasomotor collapse was observed in 3 patients (2%) and occurred despite the prior administration of Benadryl in 2. Significant bleeding from the stomach was noted in 14 patients (10%). These reactions limit the usefulness of the procedure and underscore the necessity for caution in its application as a routine diagnostic aid.     

A comparison of sudden near maximal exercise test (dash method) and Bruce protocol for pediatric patients

We examined 24 pediatric patients to evaluate the usefulness of sudden near maximal exercise test (dash method), where the subjects began to run at Bruce protocol of the last stage. 1) No considerable differences between two protocols were found in maximal oxygen consumption (V O2max), maximal heart rate (HRmax), maximal systolic blood pressure, and findings of electrocardiography. 2) The sudden maximal exercise test could be completed during a shorter period compared to Bruce protocol. 3) The sudden maximal exercise protocol reached 84% of HRmax and 47% of V O2max at one minute after the onset of the protocol, and produced 96% of HRmax and 89% of V O2max at two minutes after the onset. We considered that sudden maximal exercise protocol was useful to obtain a response similar to Bruce protocol at maximal exercise within a short period. We have to pay attention to the safety of the patients because their cardiopulmonary response to sudden maximal exercise protocol is dramatic.     

Exercise test variables of a population with maximal bicycle exercise test

The aim of the study was to establish reference values for appraising the circulatory response of men and women to age-predicted maximal heart rate (220-age) exercise testing. The data of exercise testing have been analysed in 942 subjects (608 men and 334 women). Under exercise testing the mean maximal heart rate was 177/min in both sexes. Increase in heart rate per minute of exercise was 5.59 +/- 1.93 in men, 9.00 +/- 4.94 in women. At the peak of exercise test, systolic blood pressure was considerably higher in men than in women (188.96 +/- 27.98 vs. 171.66 +/- 28.46 mmHg; p much less than 0.0001). The average working capacity was 1.7 W/kg among men and 1.31 W/kg among women. The duration of exercise testing time was significantly longer in men than in women (918.6 + 269.4 vs. 578.4 +/- 193.2 s; p less than 0.0001). Reference values for testing time are given according to sex and age with due consideration of body weight and height.     

Five year follow-up of double Master's test, maximal treadmill stress test, and resting and postexercise apexcardiogram in asymptomatic persons.

The double Master's test, the maximal treadmill stress test, the resting apexcardiogram, and the postexercise apexcardiogram significantly correlated with the development of subsequent coronary heart disease within five years in 100 asymptomatic persons. The maximal treadmill stress test correlated better than the double Master's test in predicting subsequent coronary heart disease. The presence of both an abnormal maximal treadmill stress and an abnormal a-wave ratio in the postexercise apexcardiogram had the best value in predicting subsequent coronary heart disease.     

Reproducibility of mean transit time for maximal myocardial flow assessment by videodensitometry

In the assessment of myocardial perfusion by ECG-triggered digital radiography, time parameters are calculated from the time density curve (TDC) and related to blood flow. Recently we developed a method which uses mean transit time (T _mn ) as time parameter, and which is in accordance with the original principles of indicator dilution theory. In this approach, variability in vascular volume is excluded and T _mn ⁻¹, determined at maximal hyperemia, showed an excellent correlation with maximal flow in animal validation studies. For calculation of T _mn , however, a large part of the descending limb of the TDC has to be known for reliable extrapolation, and especially this part of the curve is subject to variability in image quality in man. Therefore we tested reproducibility of T _mn in 30 arteries in 20 patients. T _mn was derived from the TDCs, obtained from paired studies under identical circumstances with an interval of 10 minutes. Satisfactory images could be obtained in all but one patient. Image processing was performed in an identical way in the paired studies. Reproducibility proved to be excellent for all three coronary arteries. The absolute value of the relative differences between the first and second determination was 7±7% for the LAD, 6±3% for LCx and 4±2% for the RCA (mean ± SD). Correlation coefficients between both measurements were 0.97, 0.95 and 0.95 for the respective arteries. Therefore, it is concluded that, using this approach, T _mn at maximal hyperemia can be determined reproducibly in man and used for maximal myocardial flow assessment.     

The unidirectional valve is the best method to determine maximal inspiratory pressure during weaning

OBJECTIVES: Although maximal inspiratory pressure (MIP) is used as an index of inspiratory muscular strength, there is no consensus on how to measure it. We compared, during weaning from mechanical ventilation, two methods of measurement to determine which shows the greater values (MIPbest) and is more reproducible. One method measured MIP when negative pressure was maintained for at least 1 s after a forceful expiration, and the other method measured MIP with a unidirectional expiratory valve (MIPuni). DESIGN: The study had a crossover design, and patients randomly performed three measurements of each method (t1). The procedure was repeated by the same observer after 20 min (t2). The maximal value in each method was considered. SETTING: ICU, Hospital A.C. Camargo, S?o Paulo, Brazil. PATIENTS: Fifty-four consecutive patients undergoing short-term mechanical ventilation who became eligible for the study when their physicians decided to restore spontaneous breathing. RESULTS: MIPbest values were arrived at using MIPuni 75% of the time either in tl or t2. MIPuni yielded a higher average of MIPbest values in t1 and t2 (p < 0.0001). The effort-to-effort coefficient of variation of one method compared with the other during t1 and t2 was similar (p > 0.2 for t1; p > 0.8 for t2). Also, when comparing tl and t2, the coefficients of variation were similar for each method (p > 0.62). CONCLUSIONS: Because MIPuni displayed the maximal values, it is the best method for estimating MIP in patients undergoing short-term mechanical ventilation. The reproducibility of consecutive measurements was similar between the methods, even after a short period of time.     

Peak or plateau maximal inspiratory mouth pressure: which is best?

There is no clear evidence as to how maximal inspiratory mouth pressure (PI,max) should be measured, although plateau pressures sustained for 1 s and measured at residual volume (RV) are usually recommended. Peak and plateau PI,max were measured at RV and at functional residual capacity (FRC) in 533 healthy subjects (aged 10-90 yrs) in order to comparably test all PI,max measurements for their predictors, reproducibility and normal values. Plateau pressures accounted for 82.0-86.3%, of peak pressures. Peak and plateau pressures measured at FRC accounted for 84.3-90.5% of pressures at RV, and were highly correlated. Age was negatively predictive and weight and body mass index positively predictive of PI,max, but regression parameters were low. All PI,max measurements were comparable when calculating regression parameters, between-subject variability and reproducibility. In conclusion, peak and plateau maximal inspiratory mouth pressure are comparably useful for the assessment of inspiratory muscle strength and can be reliably measured at functional residual capacity and at residual volume. Regression equations are of low impact in predicting normal values due to the weak influence of demographic and anthropometric factors and to the high unexplained between-subject-variability. Age-related 5th percentiles can indicate the lower limit of the normal range.