Wheeling efficiency: the effects of varying tyre pressure with children and adolescents

PURPOSE: Clinicians often observe child wheelchair users wheeling on tyres that are not inflated to manufacturer's recommendations. The purpose of this study was to investigate changes in energy expenditure that are related to decreased tyre pressure. METHODS: A within subject repeated measures design was used to assess the energy requirements of wheeling with four randomized tire inflation levels (25, 50, 75 and 100% of recommended tire pressure, 100 psi). All 10 subjects (mean age 14.2 +/- 2.3 years completed four 5-minute trials (one for each tyre pressure), while wheeling at a constant, self-selected velocity. Heart rate and wheeling velocity were measured. RESULTS: There was no change in wheeling velocity with changes in tyre pressure; however, energy expenditure was found to increase by over 15% with decreasing tyre pressure (p < 0.05). CONCLUSIONS: In order for children to minimize their energy expenditure and, thus, improve their independence, clinicians and parents must be educated as to the importance of regular wheelchair tyre inflation regimes.     

Magnetic resonance imaging of acute orthopedic trauma to the lower extremity

This article reviews the role of magnetic resonance imaging in evaluating suspected or known lower limb fractures of the hip, knee, ankle, and forefoot.     

Effect of abdominal binders on breathing in tetraplegic patients.

We studied the effect on breathing of a conventional and a newly designed abdominal binder in seven patients with complete tetraplegia. The indices of respiratory ability used were the transdiaphragmatic pressure on maximal sniff (sniff Pdi), the maximum static inspiratory mouth pressure (PImax), and the vital capacity (VC). These were measured in patients with and without binders, in the supine position, raised up to 70 degrees on a tilt table, and seated upright. When patients were raised from the supine to the 70 degrees tilt and to the seated posture, sniff Pdi and VC decreased. Both binders improved VC in the seated position and at 70 degrees tilt, and sniff Pdi at 70 degrees tilt. The new binder was as effective as but no better than the conventional binder. PImax was too variable to be a valuable index of inspiratory power. These findings support the view that abdominal binders assist breathing in tetraplegic patients who are seated or raised to near vertical positions.     

Bacterial overgrowth after high-dose corticosteroid treatment

A 63-year-old man with systemic lupus erythematosus and selective IgA deficiency developed intractable diarrhoea the day after treatment with prednisone, 50 mg daily, was started. The diarrhoea was considered to be caused by bacterial overgrowth and was later successfully treated with doxycycline. Although IgA deficiency is a risk factor for bacterial overgrowth, a further predisposing condition is necessary for development of this disorder but was not present in this case. We therefore suppose that high-dose treatment with corticosteroids might be a hitherto undescribed risk factor for bacterial overgrowth in vulnerable patients.     

Stability of maxillary surgery in openbite versus nonopenbite malocclusions

Lateral cephalometric radiographs were evaluated to determine the posttreatment stability of 66 patients treated with LeFort I osteotomies to reposition their maxillae superiorly. The sample was divided into three groups based on the degree of pretreatment overbite: openbite subsample--no incisal overlap; overlap subsample--incisal overlap and no incisal contact; contact subsample--incisal overlap with incisal contact. The cephalograms were superimposed and linear measurements were made at each interval (pretreatment, posttreatment, and at least one year posttreatment). The results clearly show that the three subsamples reacted differently during the posttreatment interval. 42.9 percent of the subsample with pretreatment openbite showed a significant increase in facial height, significant eruption of maxillary molars, and a significant decrease in overbite. 28.6 percent of the openbite subsample and 16.7 percent of the overlap subsample showed a significant increase in facial height, significant eruption of maxillary incisors, and no change in overbite. The contact subsample had no significant posttreatment changes. Possible reasons for the posttreatment instability in the openbite subsample are proposed.     

Is CA-125 monitoring useful in patients with epithelial ovarian carcinoma and preoperative negative CA-125 serum levels?

Between December 1983 and December 1988 we examined the postoperative tumor marker development and correlated this to the clinical course of the disease in 56 patients suffering from primary epithelial ovarian carcinoma of International Federation of Gynecology and Obstetrics stages I-III and with a preoperative CA-125 serum level less than or equal to 65 U/ml. In 54% of all cases there was a reduction of more than 50% of the CA-125 serum level within the first 3 months after surgery. Nine out of thirteen patients with progressive disease (69%) showed an increasing CA-125 serum level with a median lead time of 6 months (0-11 months) prior to clinical diagnosis. These preliminary results indicate that the monitoring of cancer patients with CA-125 tumor marker seems to be a useful method of early diagnosis of progressive disease even in patients with preoperative serum levels lower than 65 U/ml.     

Barriers to sexually transmitted infection testing in New Zealand: a qualitative study

Objective: To investigate the barriers that prevent or delay people seeking a sexually transmitted infection (STI) test. Methods: Qualitative in‐depth interviews were conducted with 24 university students, who are a group prone to behaviours putting them at risk of STIs, to understand the factors that had prevented or delayed them from going for an STI test in the past. Resulting data were thematically analysed employing a qualitative content analysis method, and a final set of themes identified. Results: There were three main types of barrier to STI testing. These were: personal (underestimating risk, perceiving STIs as not serious, fear of invasive procedure, self‐consciousness in genital examination and being too busy); structural (financial cost of test and clinician attributes and attitude); and social (concern of being stigmatised). Conclusions and implications for public health: These data will help health providers and policy‐makers provide services that minimise barriers and develop effective strategies for improving STI testing rates. The results of this study suggest a holistic approach to encouraging testing is required, which includes addressing personal beliefs, working with healthcare providers to minimise structural barriers and developing initiatives to change social views about STIs.     

Australian Experience with the Freehand System®for Restoring Graspin Quadriplegia

Background : The purpose of the present study was to document the value of an implanted multichannel neuroprosthesis (Freehand System^ê) for restoring hand grasp in the first Australians to receive this device. Methods : Hand function in C5 quadriplegic patients was assessed via measurement of pinch forces, a grasp release test and tests of activities of daily living (ADL). Comparisons were made between presurgery scores and scores recorded after rehabilitation when the neuroprosthesis was and was not in use. Results : A significant difference for both lateral pinch (P = 0.003) and palmar grasp (P = 0.003) was found between forces recorded with and without the use of the neuroprosthesis after rehabilitation, but not between forces recorded presurgery and during rehabilitation without the neuroprosthesis. All subjects were able to grasp, move and release more objects within the 30‐s test period with the neuroprosthesis than without it. Collective results for the eight ADL tests for all six subjects show that, in 35 of the 48 (73%) occasions, less physical assistance and/or adaptive equipment was required when the Freehand system^ê was employed compared to when it was not used. In 41 of the 48 (85%) occasions, the six subjects expressed a preference for using the neuroprosthesis to perform these activities of daily living. Twelve months after rehabilitation, five of the six subjects still used the neuroprosthesis daily or every second day. Conclusion : The Freehand neuroprosthesis has provided useful hand function with few surgical and technical difficulties in these patients. Regular ongoing use of the device indicates user satisfaction.