Physicians who keep lax records put careers in danger, college course warns.

During a recent workshop sponsored by the College of Physicians and Surgeons of Ontario, Dr. Paul Caulford identified the most common problems with medical records: they are much too brief, don't tell the patient's story and are missing important details. He warned that physicians must pay more attention to their records because "the way things are moving, the scrutiny of records in the past in nothing in comparison to what it will be like in the future."     

306. Martin Kirschner zum 100. Geburtstag

Zusammenfassung Kirschner wurde 1879 in Breslau geboren. 1916 erhielt er den Ruf auf den Lehrstuhl in Königsberg, 1927 nach TÜbingen und 1934 nach Heidelberg. An diesen Stätten erbaute er neue Kliniken. Erfolgreich arbeitete er auf allen chirurgischen Teilgebieten. Besonders erwähnenswert seien die erste erfolgreiche pulmonale Embolektomie, die einzeitige Lungenlappenresektion, ein neues Verfahren in der Oesophaguschirurgie, die EinfÜhrung des halbstarren Kirschner-Drahtes, in der Schmerzbekämpfung die Avertinnarkose, die Spinalanaesthesie und die Elektrocoagulation des Ganglion Gasseri. 1932 begrÜndete er die heute von Zenker fortgefÜhrte Operationslehre.     

A comparison of the effects of electrode placement, muscle tension, and isometric torque of the knee extensors

Numerous electrical stimulation (ES) papers have been published using a variety of electrode placements and muscle tension criteria levels, making cross-comparisons difficult. The purpose of this study was to compare isometric knee extensor torques produced using three methods to induce muscle tension and three electrode placements. Twenty-three healthy, informed female volunteers (mean age = 24 yrs, SD = 3.2 yrs) participated in a practice session and three test sessions, each approximately 48 hrs apart. One of three electrode placements was randomly assigned during each test session. Maximal voluntary isometric contractions (MVIC) preceded the electrically induced isometric torque outputs. Comfortably tolerable and maximally tolerable ES intensities were combined with each of the following electrode placements: 1) lumbosacral plexus/femoral triangle (LS), 2) femoral triangle/transverse distal quadriceps (F), and 3) transverse proximal/distal quadriceps muscle (Q). A two-way ANOVA with repeated measures, Neuman-Keuls, and tests of simple main effects were used to analyze the data. Significantly greater torques were produced during the MVlCs than during either type of electrically induced isometric torque output (p < 0.05). During ES, the maximally tolerable intensity level produced significantly greater torques than the comfortably tolerable intensity level (p < 0.05). The F and Q electrode placements produced similar torques, both significantly greater than the torque produced with the LS electrode placement (p < 0.05). The method to induce muscle tension (voluntary or electrically induced), the criteria defining the level of muscle tension (MVIC, maximally or comfortably tolerable ES), and the electrode placement (LS, F, or Q) affect knee extensor torques and should be considered when using ES and when interpreting ES studies. Although the ideal rehabilitation program typically includes voluntary exercise to provide overload, certain pathologies may contradict this choice. In its place, ES has the potential to minimize strength losses or create gains while offering joint protection. J Orthop Sports Phys Ther 1992;15(4):168-174.     

Marked increase of plasma hyaluronan after major thermal injury and infusion therapy

Hyaluronan (HYA) is an important structural element in skin and is presumably participating in regulation of the interstitial fluid volume. HYA is transported via the lymphatics from the tissues to the blood, where its concentration is normally very low. Fluid flux through the interstitium is markedly increased after thermal injury. The present study was performed to determine whether major thermal injury would affect plasma levels of HYA. In halothane-anesthetized sheep subjected to 40% BSA full-thickness scald burns, plasma HYA concentration increased from 116 +/- 19 (mean +/- SEM) to 172 +/- 18 ng/ml within 1 hr after injury (P less than 0.05). After 3 hr of fluid therapy plasma HYA concentration was further elevated to 10 times baseline (1417 +/- 322 ng/ml) (P less than 0.01). To clarify whether this rise represented an increased "washout" of interstitial HYA, attributable either to the burn injury or the subsequent fluid therapy, awake sheep were subjected to overhydration. Following a 3-hr infusion of lactated Ringer's 2.5 liter/hr, plasma HYA concentration increased to 2-3 times baseline. Lung lymph flow and its concentration of HYA increased, leading to an increase in the lymphatic flux of HYA to 10-20 times baseline. In peripheral lymph HYA flux increased 2-3 times baseline. Infusion of lactated Ringer's markedly increased lymphatic removal of HYA. However, plasma concentrations of HYA were 3 times higher after thermal injury than following fluid challenge alone, suggesting that thermal injury per se may also increase input of HYA into the systemic circulation.     

Electrical stimulation as a strength improvement technique: a review

The dominant philosophy within rehabilitation has been that electrical stimulation is a valuable kinesthetic muscle reeducation technique, but voluntary exercise is of greater benefit in restoring voluntary muscular control and improving the strength of injured muscle. Much publicized Soviet research has suggested that this preference for voluntary exercise may be inappropriate and that electrical stimulation is the technique of choice for strengthening normally innervated muscle. This position has not been supported by the limited non-Soviet research. Whether this lack of support is attributable to an inability to duplicate the Soviet current format and/or application technique, or simply that electrical stimulation programs are not more effective than voluntary exercise programs, is presently unknown. To date, neither the voluntary exercise philosophy nor the nonvoluntary exercise (electrical stimulation) philosophy has overwhelming scientific support. Electrical stimulation programs must be compared with traditional voluntary exercise programs before practitioners are in a position to confidently accept or to refute either method. Until an adequate number of research studies have been conducted, practitioners cannot meet their obligation to know what the most effective strength improvement techniques are and to make such treatment available.J Orthop Sports Phys Ther 1982;4(2):91-98.     

Thermographically visualized cutaneous reactions after irradiation with fast electrons (author's transl)]

A comparison was made between thermographically visualized cutaneous reactions of two groups of patients after a therapy with fast electrons. One group underwent one-series irradiation, the other group received two series with an interval of 21 days. The cutaneous reaction after the interval only appeared following considerably higher doses than with one-series therapy. This difference indicates the recuperative capability of normal tissue after the exposition to subtolerance effects. The data were evaluated using a function derived from the Ellis-formula. A "biological dosimeter" can be developed based on thermic reactions of subcutaneous connective tissue.     

It works better when problems are shared. Interview by Mark Perlberg.

In an exclusive interview, Jeannette R. Kramer, a specialist in the provision of long-term care, discusses the concept of the therapeutic community that she and her husband have instituted in the skilled nursing care facility that they own and operate. By providing an environment in which patients, their families, and the staff can communicate easily, the nursing facility can pinpoint problems and solve them early.     

Effect of basal ganglia injury on central dopamine activity in Gulf War syndrome: correlation of proton magnetic resonance spectroscopy and plasma homovanillic acid levels

BACKGROUND: Many complaints of Gulf War veterans are compatible with a neurologic illness involving the basal ganglia. METHODS: In 12 veterans with Haley Gulf War syndrome 2 and in 15 healthy control veterans of similar age, sex, and educational level, we assessed functioning neuronal mass in both basal ganglia by measuring the ratio of N-acetyl-aspartate to creatine with proton magnetic resonance spectroscopy. Central dopamine activity was assessed by measuring the ratio of plasma homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenlyglycol (MHPG). RESULTS: The logarithm of the age-standardized HVA/MHPG ratio was inversely associated with functioning neuronal mass in the left basal ganglia (R(2) = 0.56; F(1,27) = 33.82; P<.001) but not with that in the right (R(2) = 0. 04; F(1,26) = 1.09; P =.30). Controlling for age, renal clearances of creatinine and weak organic anions, handedness, and smoking did not substantially alter the associations. CONCLUSIONS: The reduction in functioning neuronal mass in the left basal ganglia of these veterans with Gulf War syndrome seems to have altered central dopamine production in a lateralized pattern. This finding supports the theory that Gulf War syndrome is a neurologic illness, in part related to injury to dopaminergic neurons in the basal ganglia.     

Temporäre Instrumentation bei Luxationen, Subluxationen und Frakturen der unteren HWS

The anterior interbody fusion with instrumentation seems to be the standard procedure in unstable traumatic lesions of the lower cervical spine. The goal of this study was to objective the outcome of patients, treated by only temporary stabilisation of the injured motion segment (without bone-graft fusion). Between 1990 and 1998 155 patients with traumatic lesions of the cervical spine were treated operatively, in 22 cases transfixation of the injured level without bone-graft application was performed, an implant-removal was carried out in 12 patients so long. Only patients were included into the study, who were less then 45 years old at trauma and who had no trauma related osseous or disc encrouchment of the spinal canal. Not included were patients with degenerative formations of the cervical spine at time of trauma. Until follow up all patients with implantat removal returned back to work in their former profession, 11 of 12 patients classified their result as excellent or good. No secondary instabilities or postraumatic disc prolapse were observed. Restmobility in flexion/extension of the injured level was demonstrated in 8 patients. The preservation of traumatized motion segments may reduce the incidence of degenerative alterations and hypermobilities in adjacent levels. The transfixation technique in anterior procedures leads to a reduced time of spinal exposure, complications as a result of spinal graft manipulation, pseudarthrosis or donor graft site problems are no more relevant.