Influence of an irregular surface and low light on the step variability of patients with peripheral neuropathy during level gait

Patients with peripheral neuropathy (PN) report greater difficulty walking on irregular surfaces with low light (IL) than on flat surfaces with regular lighting (FR). We tested the primary hypothesis that older PN patients would demonstrate greater step width and step width variability under IL conditions than under FR conditions. Forty-two subjects (22 male, 20 female: mean +/- S.D.: 64.7 +/- 9.8 years) with PN underwent history, physical examination, and electrodiagnostic testing. Subjects were asked to walk 10 m at a comfortable speed while kinematic and force data were measured at 100 Hz using optoelectronic markers and foot switches. Ten trials were conducted under both IL and FR conditions. Step width, time, length, and speed were calculated with a MATLAB algorithm, with the standard deviation serving as the measure of variability. The results showed that under IL, as compared to FR, conditions subjects demonstrated greater step width (197.1 +/- 40.8 mm versus 180.5 +/- 32.4 mm; P < 0.001) and step width variability (40.4 +/- 9.0 mm versus 34.5 +/- 8.4 mm; P < 0.001), step time and its variability (P < 0.001 and P = 0.003, respectively), and step length variability (P < 0.001). Average step length and gait speed decreased under IL conditions (P < 0.001 for both). Step width variability and step time variability correlated best under IL conditions with a clinical measure of PN severity and fall history, respectively. We conclude that IL conditions cause PN patients to increase the variability of their step width and other gait parameters.     

A NEW Pk PHENOTYPE IN THE P BLOOD GROUP SYSTEM

A healthy 22-year-old woman was noted to have erythrocytes of the P^k phenotype: a strong P^k antigen, no detectable P antigen and anti-P antibody in her serum. Her erythrocytes contained four to six times as much P^k glycolipid (globotriaosylceramide or CTH) and approximately half as much P glycolipid (globotertraosylceramide or globoside) as normal red cells. The structures of CTH and globoside were characterized by analysis of permethylated sugars and complement fixation in addition to chromaographic mobility and sugar composition. Inasmuch as the erythrocytes of two P^k individuals that were analysed previously (Marcus et al., 1976) contained no detectable globoside, these abnormalities appear o represent a new phenotype in the P blood group system.     

An alternative use of the surgical mask for the protection of healthcare workers managing epistaxis

Epistaxis has a reported prevalence of 10-12 per cent in the general population and is thus one of the commonest emergencies in Otolaryngology. We suggest that the patient uses a surgical mask to prevent blood spray during epistaxis management. Utilizing the described technique we have found that protective clothing worn by the healthcare professional is consistently 'blood-free' at the end of the procedure. This is in contrast to findings when no facemask is applied.     

Influence of ethnicity and language concordance on physician-patient agreement about recommended changes in patient health behavior

The purpose of this study is to examine the association of ethnicity and language concordance with physician-patient agreement about physicians' recommendations for patient health behavior in the following areas: diet, exercise, medication, smoking, stress, and weight. Twenty-seven resident physicians at the University of New Mexico's internal medicine and family practice clinics and 427 of their patients participated. Random effects models were used to estimate the influence of ethnicity and language concordance on whether patients and physicians agreed about specific recommended changes in patient behavior. Ethnicity concordance was not significantly associated with physician-patient agreement. Language concordance positively influenced the likelihood of agreement about exercise but negatively influenced agreement about medications. The lowest percentage of agreement occurred in the area of medication regimens (60%). The results from this study indicate that language is an important barrier to physician-patient agreement, while ethnicity concordance has no effect. However, the influence of whether the physician and patient speak the same language on agreement is unclear and warrants further research.     

Functional outcomes after hemiglossectomy and reconstruction with a bilobed radial forearm free flap

OBJECTIVE: This study examines prospectively the functional outcomes of a cohort of patients who had undergone hemiglossectomy and reconstruction with a bilobed radial forearm free flap (RFFF) for oral tongue squamous cell carcinoma. METHODS: Speech and swallowing data were compiled for patients treated for oral tongue cancer with hemiglossectomy and and reconstruction with a bilobed RFFF. The three evaluation periods were preoperative, postoperatively, and postradiation therapy. RESULTS: Eleven patients were included in the study. A significant difference between preoperative and postoperative single-word intelligibility scores was observed. There was no significant difference across any of the evaluation times for sentence intelligibility. Swallowing analysis revealed fewer instances of laryngeal penetration with liquids postoperatively. No significant differences were found in laryngeal penetration with either the pudding or cookie consistencies across any of the evaluation times. There was no incidence of aspiration at any of the evaluation times. There were no significant differences in the number of problems with the oral or oral preparatory phases across any of the evaluation times. The neurotization status of the RFFF had no significant effect on any of the observed speech or swallowing parameters. CONCLUSIONS: The bilobed RFFF provides functional speech and excellent swallowing outcomes in the reconstruction of hemiglossectomy defects.