A sports medicine clinic in the community.

We report the attempt to set up a mini sports medicine clinic in a health centre resourced by a Department of Community Medicine. The type of problems seen are similar to those reported by other clinics. On the results of this pilot project, we believe it would be possible to establish similar clinics in health centres elsewhere in the United Kingdom. The National Health Service resources required are minimal, but the benefits to local communities are considerable.     

Hemangioma of the adrenal gland. Apropos of a case

A case of adrenal hemangioma is reported, displayed by computed tomography and confirmed by pathologic investigation. This rare tumor poses a difficult diagnostic challenge and rejoins the problem of incidentally discovered adrenal masses.     

High tech home care: a look at a success story.

The expansion of technology has allowed patients to receive intravenous therapy at home. This case study discusses the problems of a patient with diabetes mellitus and malignant otitis externa. This patient received intravenous therapy for the last 3 years of his life. In spite of several hospitalizations, he was able to return and remain home until his death. Management of the patient's discharge and home care seemed to be a major factor in his ability to remain in the community.     

Factor VIII assays. Assessment of variables

Factor VIII assays are the most common specific coagulation factor assay performed in the United States. Interlaboratory proficiency studies have documented persistent problems with variation in results between laboratories. The Coagulation Resource Committee of the College of American Pathologists conducted a workshop to analyze variables that may affect performance of the one-stage factor assay. The results indicate that accuracy of the assay can be improved by uniform standardization of reference plasma samples and that reproducibility can be enhanced through appropriate choice of reagents and instruments. Optimizing performance of this assay should lead to more reproducible interlaboratory results.     

Altered patterns of reflex excitability subsequent to contusion injury of the rat spinal cord.

1. The present study investigated regulation of reflex excitability after experimental contusion injury of the spinal cord. 2. Four measures of H-reflex excitability were evaluated in normal rats and at 6, 28, and 60 days after contusion injury at the T8 level: 1) reflex thresholds, 2) slope of the reflex recruitment curves, 3) maximal plantar H-reflex/maximal plantar M-response (Hmax/Mmax) ratios, and 4) rate-sensitive depression (i.e., the decrease in reflex magnitude relative to repetition rate). 3. Tested as a function of the afferent volley magnitude, the thresholds for reflex initiation fell progressively subsequent to contusion injury. No change was observed at 6 days postinjury, and the decrease at 28 days was not significant. However, by 60 days postinjury, the threshold had decreased by 23% of the maximal afferent volley, and this decrease was significant, [analysis of variance (ANOVA, P < or = 0.01)]. 4. Hmax/Mmax ratios elicited in postcontusion animals at 0.3 Hz were not significantly different from those recorded in normal animals. 5. The slopes of the recruitment curves were markedly reduced subsequent to contusion injury. The decrease was greatest at 6 days postinjury. Although some recovery toward normal occurred at 28 and 60 days postinjury, the slopes of recruitment curves in postcontusion animals remained significantly decreased. 6. H-reflexes elicited at 1-5 Hz were less sensitive to rate depression in postcontusion animals than in normal animals at the same respective frequencies. The decrease was progressive in onset, becoming significant by 28 days postinjury, and of an enduring nature, i.e., still significantly different from normal in the reflexes tested 60 days postinjury. 7. Rate sensitivity of the tibial nerve monosynaptic reflex (MSR) was also compared in normal and postcontusion animals. Rate sensitivity of the tibial MSRs was significantly reduced at 28 and 60 days post-contusion, compared with normal animals. 8. These data indicate that significant changes in lumbar reflex excitability result from midthoracic contusion injury of the spinal cord. These changes include reflex threshold, slope of recruitment, and rate-sensitive depression. Although recruitment slope was most altered in the shortest postinjury interval tested, followed by some recovery, the other changes were progressive in onset and enduring in duration.     

Call patterns and basilar papilla tuning in cricket frogs. I. Differences among populations and between sexes.

Male cricket frogs (Acris crepitans) produce a broad-band, high frequency advertisement call with a single spectral peak (the dominant frequency). We measured the dominant frequencies of male calls from six populations in central Texas and one from Indiana and compared them to the tuning of basilar papilla afferents in males and females. Averaging over all populations, mean call dominant frequency was 3.69 kHz, mean male basilar papilla tuning was 3.63 kHz, and mean female basilar papilla tuning was 3.17 kHz. Among populations, mean dominant frequency varied from 3.56 kHz to 3.82 kHz. Dominant frequencies were slightly higher in the more eastern Texas populations occupying pine forest habitats than in the more western populations occupying open grassland habitats. Changes in dominant frequency in a population coincided with changes in tuning of both male and female basilar papillae. Furthermore, within populations females were tuned on average lower than males and lower than the mean dominant frequency of calls in their own population. We suggest that the coincident changes in calls and basilar papilla tuning plus the sexual difference in tuning indicate that female mate choice would be directed toward males from her home population with low frequency calls or toward males from foreign populations with average calls lower in frequency than those in her home population. This in turn suggests that any gene flow between populations would be biased from east to west and from forest to open habitats.     

CROHN'S DISEASE: A COLON AND RECTAL DEPARTMENT EXPERIENCE

This study reviewed a series of patients with Crohn's disease managed by surgeons of the Department of Colon and Rectal Surgery, St Vincent's Hospital, Melbourne, since 1978. There were 306 patients: 171 males and 135 females. The mean age at diagnosis was 33.4 years (range 11–93). The distribution of the disease was small bowel 32.3%, small bowel and colon 26.5%, colon 39.9%, and anal disease alone 1.6%. A total of 416 abdominal operations were performed on 204 patients. The commonest indications for surgery were failed medical therapy (21.9%), small bowel obstruction (15.9%), enteric tistula (10.1%), and intra-abdominal abscess (10.1%). The most frequently performed procedures were ileocolic resection with anastomosis (28.8%), small bowel resection (9.4%), and total colectomy and ileostomy (7.0%). Postoperative complications included anastomotic leaks in 4.0%. intra-abdominal abscess formation in 3.6%, and enterocutaneous fistulae developed in 6%. Three patients died during the review period. During follow up (mean 84.4). 30% of patients developed recurrence requiring further surgery at a mean of 72.7 months postoperatively. The most frequent site for a recurrence was the pre-anastomotic terminal ileum (61.7%). In conclusion. the majority of patients with Crohn's disease will require resectional surgery at some stage. This can be performed with a low mortality and morbidity, and a recurrence rate of around 5% per year.