Isokinetic measurement of foot invertor and evertor force in three positions of plantarflexion and dorsiflexion

The purpose of this study was to determine the ankle position at which the greatest peak torque occurs during isokinetic testing of inversion and eversion force. Testing of right foot invertors and evertors was performed at 10 degrees dorsiflexion, neutral dorsiflexion and plantarflexion, and 10 degrees plantarflexion on 25 untrained subjects with the MERAC isokinetic dynamometer. Subjects were retested to determine reliability. Results indicate that 10 degrees plantarflexion appears better than the other positions tested because reliability was highest and torque output was greatest at this position. Reliability was assessed with a Pearson product moment test and a paired comparisons test (p 相似文献   

Successful therapy of crystalcryoglobulinemia: a case report.

Successful therapy for a case of multiple myeloma with a spontaneously crystallizing cryoglobulin of the IgG2-kappa light chain variety was achieved, using both continuous-flow cell centrifugation plasmapheresis to rapidly lower the M component and combination chemotherapy with phenylalanine mustard, prednisone, procarbazine, and vincristine to control the myeloma process. This resulted in resolution of incapacitating large and small necrotic cutaneous ulcerations of the extremities. Physicochemical studies of the crystalcryoprotein demonstrated that cryoprecipitation was rapid and accompanied by the formation of needle-shaped crystals, yet was completely reversible at 37 degrees C. Cryocrit determinations varied depending upon relative centrifugal forces and temperature and did not always relate linearly to the amount of abnormal protein, thus making these alone unreliable in assessing response to therapy.     

Lymphatic mapping and intraoperative lymphoscintigraphy for identifying the sentinel node in penile tumors

Lymph node mapping has become an integral part of the management of melanoma and breast cancer with regard to both staging and treatment. We report our technique for lymphatic mapping and intraoperative lymphoscintigraphy applied to a patient with penile melanoma. This technique may improve the sensitivity of identifying the sentinel lymph node in patients with malignant penile lesions.     

Relationship of vaginal pH and Papanicolaou smear results to vaginal flora and pregnancy outcome

Prematurity is a major cause of perinatal morbidity. Studies have implicated components of the vaginal flora in the etiology of some cases of preterm birth. Current scoring systems do not include factors which directly reflect the vaginal flora. Since Papanicolaou smears and the vaginal pH may be affected by the vaginal flora and are easy tests to perform, we studied their relationship to vaginal flora and pregnancy outcome. Among 231 patients, those with a vaginal pH greater than or equal to 4.4 were significantly more likely to carry Trichomonas vaginalis (P less than 0.03); Bacteroides species (P less than 0.01), and Mycoplasma hominis (P less than 0.001), and to have premature rupture of the membranes (P less than 0.01), and preterm rupture of the membranes (P less than 0.05). Patients with atypia reported on Papanicolaou smear more frequently carried M. hominis (P less than 0.01), and had premature rupture of the membranes (P less than 0.01). Although the high sensitivity and negative predictive value of those tests may make them useful additions to current scoring systems, their low specificity prevents them from being independent predictors of risk.     

Public health reasoning: much more than deduction

The deductive paradigm has produced notable successes in epidemiology and public health. But while deductive logic has made a substantial contribution to the public health field, it must be recognized that there are also limits to that contribution. This report examines one such limit: the need for non-deductive models in public health reasoning. The findings of a study of public health reasoning in 879 members of the public are reported. Four non-deductive strategies were chosen for their capacity to bridge gaps in one’s knowledge. It emerged that subjects were adept at using these strategies in the absence of knowledge to arrive at judgements about public health problems. The implications of this finding for public health communication are discussed.     

Are patients with hip fractures more osteoporotic? Review of the evidence

This report critically reviews 15 case-control studies that disagree about whether patients who fracture their hip are significantly more osteoporotic than persons of similar age who do not. The most rigorously designed studies observed less bone mass in the hips of patients with fractures than in the hips of control subjects, but the differences were usually small and overlapping. Measurements at other sites in the skeleton did not consistently find differences. Those studies that protected against ascertainment bias generally found smaller differences than studies that did not. Patients with hip fractures do not appear to be distinctly more osteoporotic than persons of similar age. Therefore, factors besides bone mass, such as a tendency to fall, may be important determinants of which elderly persons will have fractures; thus, measurements of bone mass might not be a reliable way to identify those at greatest risk of hip fracture.