Functional outcome,rehabilitation use and length of hospital stay for stroke patients in south Madrid

BACKGROUND: Health status and use of resources by stroke patients in Spain are unknown. METHODS: A total of 103 acute stroke patients resident in south Madrid, population 665,168, were seen in 1996 at a general hospital and three primary care centres and evaluated at 5-10 days, 3 and 6 months after stroke. Health outcomes and patterns of rehabilitation and hospital use by patient groups were studied using multivariate logistic regression. RESULTS: The group receiving rehabilitation exhibited higher levels of impairment, disability and handicap at each time point, these differences decreasing with time, except in the distribution of walking ability which was unimodal in that group. Younger age, poor walking ability and motor capacity, pain on the paretic side and living with a spouse predicted use of rehabilitation; low level of education predicted a long hospital stay. CONCLUSION: Rehabilitation for stroke in south Madrid was sparse and used mainly by young, severely affected patients.     

Acoustic quality of cry in very-low-birth-weight infants at the age of 1 1/2 years

BACKGROUND: Infant cry characteristics reflect the integrity of the central nervous system. Previous studies have shown that preterm infants and infants with neurological conditions have different cry characteristics such as fundamental frequency compared to healthy full-term infants. Cry characteristics of preterm infants after the first year of life have not been studied. AIMS: The aim of this study was to assess the quality of cry in 1 1/2-year-old very-low-birth-weight infants (VLBWI, < or =1500 g at birth). STUDY SUBJECTS AND DESIGN: Study groups included 21 VLBWI and 25 healthy full-term controls. Thirty seconds of pain cry after vaccination was recorded at well-baby clinics. The first cry utterance was acoustically analyzed using Praat software. The quality of cry was compared between the groups. In addition, the association of cry quality to patient characteristics, to developmental outcome, and to findings in brain imaging studies of the VLBWI was studied. RESULTS: The cry response was elicited in 20 of the 21 VLBWI and in 20 out of 25 full-term infants. VLBWI had higher minimum fundamental frequency and fourth formant values. Patient characteristics that were associated with cry quality were 5-min Apgar scores, the occurrence of bronchopulmonary dysplasia, Bayley Psychomotor Index scores at 12 months, and current weight and head circumference. CONCLUSIONS: Differences found between the study groups were not explained primarily by brain pathology or by patient characteristics, so it seems that prematurity has an impact on cry quality still at the age of 1 1/2 years.     

Idiotype vaccination in multiple myeloma induced a reduction of circulating clonal tumor B cells

Myeloma cells express the idiotype (Id)-specific antigen that may be targeted by Id vaccination. Six patients with stage I IgG myeloma were immunized with the autologous purified M component together with the adjuvant cytokines interleukin 12 (IL-12) alone or in combination with granulocyte-macrophage colony-stimulating factor (GM-CSF). The effect of Id vaccination on circulating clonal tumor B cells was monitored by a real-time allele-specific oligonucleotide polymerase chain reaction method. No other treatment was given. Reduction of blood tumor mass was observed in 4 of 6 patients, with one patient achieving a complete molecular remission in blood. In 3 of these 4 patients an Id-specific T-cell response was induced. In the remaining 2 patients with an unchanged level of blood tumor cells, one patient mounted a T-cell response, whereas the other did not. No significant change in the serum M protein level was noted. Id vaccination may target clonal B cells, suggesting that this strategy might be conducive to achieving tumor control. The clinical significance of these findings remains to be established.     

Urinary excretion of total cystine and the dibasic amino acids arginine,lysine and ornithine in relation to genetic findings in patients with cystinuria treated with sulfhydryl compounds

Advances in molecular genetics have brought a deeper understanding of cystinuria. This autosomal recessive disease, which is caused by a defective tubular reabsorption of cystine and the three dibasic amino acids arginine, lysine and ornithine, results in a lifelong risk of renal stone formation because of the low solubility of cystine in urine. Mutations detected within the two genes known to be associated with cystinuria, SLC3A1 (related to type I) and SLC7A9 (related to non-type I), cannot, however, in all cases explain the disease. Inasmuch as a high urinary concentration of cystine is the basis of stone formation in these patients, our aim was to measure urinary total cystine, arginine, lysine and ornithine, in patients currently lacking a full genetic explanation for their disease. Thirty-three patients with cystinuria who were on long-term treatment with tiopronin or D-penicillamine were divided into two groups. Group 1 comprised eight patients who carried mutation in one of the SLC3A1 alleles and two patients who completely lacked mutations both in the SLC3A1 and the SLC7A9 genes, that is genetic findings discordant with the increased urinary excretion of cystine and the dibasic amino acids in these patients. Group 2 comprised 23 patients homozygous for mutations within SLC3A1, that is genetic findings in accordance with the excretion pattern of classic type I cystinuria. When the two groups were compared, Group 1 had a significantly higher total urinary excretion of cystine (p<0.01) as well as of arginine, lysine and ornithine (p<0.05) than Group 2. Also, when the two patients without mutations were excluded from the calculations, there still was a significant difference in the urinary excretion of total cystine (p<0.05). This suggests that the two patients without any detected mutations in the two known cystine transport genes also contributed to the difference. These unexpected findings indicate that an additional gene or genes participate in the urinary cystine reabsorption in the cystinuric patients who currently are without a full genetic explanation for their disease.     

Skeletal muscle changes following myelotomy in paraplegic patients

Pourpre's dorsal T-shaped myelotomy was performed on three paraplegic patients in which medical and electro-physiological procedures proved to be ineffective concerning muscle spasms. The myelotomy led to the elimination of spasms and of muscle hypertonicity in the lower limbs. Biopsies of the rectus femoris muscles were performed bilaterally one year before and two months following myelotomy. The first biopsy revealed fascicular atrophy, with type I fibre preferential atrophy, which is usually found in paraplegic patients. After myelotomy some histological differences were seen: reduction of type II fibre diameter and the presence of target-targetoid fibres and of atrophic dark fibres. There was a difference of fibre pattern type in hypertonic spastic muscles compared to that seen in spasm relieved by myelotomy. The morphological changes seen after myelotomy are interpreted as denervation changes because of the surgical lesion by the myelotomy on the anterior horn cells.     

Sclerosing injections to treat midportion Achilles tendinosis: a randomised controlled study evaluating two different concentrations of Polidocanol

Two to three ultrasound (US) and colour Doppler (CD)-guided injections of the sclerosing substance Polidocanol (5 mg/ml) have been demonstrated to give good clinical results in patients with chronic midportion Achilles tendinopathy. This study aimed to investigate if a higher concentration of Polidocanol (10 mg/ml) would lead to a less number of treatments, and lower volumes, needed for good clinical results. Fifty-two consecutive Achilles tendons (48 patients, mean age 49.6 years) with chronic painful midportion Achilles tendinopathy, were randomised to treatment with Polidocanol 5 mg/ml (group A) or 10 mg/ml (group B). The patients and treating physician were blinded to the concentration of Polidocanol injected. All patients had structural tendon changes and neovascularisation in the Achilles midportion. Treatment was US + CD-guided injections targeting the region with neovascularisation (outside ventral tendon). A maximum of three treatments (6-8 weeks in between) were given before evaluation. Patients not satisfied after three treatments were given additional treatment with Polidocanol 10 mg/ml, up to five treatments. For evaluation, the patients recorded the severity of Achilles tendon pain during activity on a visual analogue scale (VAS), before and after treatment. Patient satisfaction with treatment was also assessed. At follow-up (mean 14 months) after three treatments, 18/26 patients in group A and 19/26 patients in group B were satisfied with the treatment and had a significantly reduced level of tendon pain (P < 0.05). After completion of the study, additional treatments with Polidocanol 10 mg/ml in the not satisfied patients resulted in 26/26 satisfied patients in both groups A and B. In summary, we found no significant differences in the number of satisfied patients, number of injections or volumes given, between patients treated with 5 or 10 mg/ml Polidocanol.