Perceptual Deprivation in the Acute Phase of Spinal Injury Rehabilitation

ABSTRACT

Patients in intensive care units are often reported to experience psychological disturbances which may be attributable to a number of well-researched causes. However, it is suggested that the total lack of proprioceptive and motor feedback after spinal trauma may be a significant factor in the genesis of these disturbances which are unique to this group of patients.

All cases admitted to the Regional Spinal Injuries Centre in Southport from January 1987 through December 1990 were assessed (n=187) and the conditions surrounding the occurrence of behavioural disturbances (n=23, 12.3%) established. The level of interaction with relatives and significant others was established for all acute admissions, and low frequency was found to correlate significantly with the development of perceptual deprivation experiences.

The effects of inadequate somatosensory input, lesion level, increasing age, and visitor variability for spinal patients is discussed and an algorithm presented to highlight the potential factors associated with aetiology and treatment of the problem.

The implications of these findings for the future management of acute spinal trauma are discussed.     

The Effects of Pre- and Post-Exercise Whey vs. Casein Protein Consumption on Body Composition and Performance Measures in Collegiate Female Athletes

Two of the most popular forms of protein on the market are whey and casein. Both proteins are derived from milk but each protein differs in absorption rate and bioavailability, thus it is possible that each type of protein may contribute differently to the adaptations elicited through resistance training. Therefore, the purpose of this study was to investigate the potential effects of ingestion of two types of protein in conjunction with a controlled resistance training program in collegiate female basketball players. Sixteen NCAA Division III female basketball players were matched according to body mass and randomly assigned in a double-blind manner to consume 24 g whey protein (WP) (N = 8, 20.0 ± 1.9 years, 1.58 ± 0.27 m, 66. 0 ± 4.9 kg, 27.0 ± 4.9 %BF) or 24 g casein protein (CP) (N = 8, 21.0 ± 2.8 years, 1.53 ± 0.29 m, 68.0 ± 2.9 kg, 25.0 ± 5.7 %BF) immediately pre- and post-exercise for eight weeks. Subjects participated in a supervised 4-day per week undulating periodized training program. At 0 and 8 weeks, subjects underwent DXA body composition analysis, and at 0 and 8 weeks underwent one repetition maximum (1RM) strength, muscle endurance, vertical jump, 5-10-5 agility run, and broad jump testing sessions. Data were analyzed using repeated measures ANOVA, and presented as mean ± SD changes from baseline after 60 days. No significant group x time interaction effects were observed among groups in changes in any variable (p > 0.05). A significant time effect was observed for body fat (WP: -2.0 ± 1.1 %BF; CP: -1.0 ± 1.6 %BF, p < 0.001), lean mass (WP: 1.5 ± 1.0 kg; CP: 1. 4 ± 1.0 kg, p < 0.001), fat mass (WP: -1.3 ± 1.2 kg; CP: -0.6 ± 1.4 kg, p < 0.001), leg press 1RM (WP: 88.7 ± 43.9 kg; CP: 90.0 ± 48.5 kg, p < 0.001), bench press 1RM (WP: 7.5 ± 4.6 kg; CP: 4.3 ± 4.5 kg, p = 0.01), vertical jump (WP: 4.1 ± 1.8 cm; CP: 3.5 ± 7.6 cm, p < 0.001), 5-10-5 (WP: -0.3 ± 0.2 sec; CP: -0.09 ± 0.42 sec, p < 0.001), and broad jump (WP: 10.4 ± 6.6 cm; CP: 12. 9 ± 7.1 cm, p < 0.001). The combination of a controlled undulating resistance training program with pre- and post-exercise protein supplementation is capable of inducing significant changes in performance and body composition. There does not appear to be a difference in the performance- enhancing effects between whey and casein proteins.

Key points

• Females can experience and increase in performance makers from consuming protein after resistance training.
• Females can have a decreased body fat composition when ingesting protein with daily resistance training and conditioning.
• There was no significant difference in performance markers between whey and casein.

Key words: whey, casein, protein, females, body composition, performance     

Epicardial Colour-Doppler Scanning of Coronary Artery Stenoses and Graft Anastomoses

Objective : Epicardial ultrasound scanning was applied during coronary surgery to assess coronary artery stenoses and quality of distal graft anastomoses, with special emphasis to the left anterior descending artery (LAD). Design : Twenty-three patients with coronary artery disease (M:F 19:4, mean age 65.0 &#45 9.5 years) had coronary artery bypass grafting (CABG) on cardiopulmonary bypass. Intraoperative scanning of coronary artery stenoses and graft anastomoses was performed with a new 10 MHz linear array Vingmed transducer connected to a GE Vingmed System FiVe echocardiography unit. Coronary stenoses detected by ultrasound were compared with preoperative angiograms. Intraoperatively, coronary graft flow was assessed with a Medi-Stim transit-time flowmeter. Results : Twenty LADs were investigated. In 17 LADs (85%) stenoses were clearly identified. In three LADs (15%) stenoses were not identified because LADs were deeply intramyocardial or the stenosis was very proximal. There was a significant correlation between LAD stenoses detected by ultrasound and angiogram ( R = 0.7; p < 0.01). Mean number of grafts was 3.8 &#45 0.9. Of 26 LAD anastomoses assessed, good images were obtained in 22 cases (84.4%); the mean LAD diameter measured 1 cm below the anastomosis was 1.6 &#45 0.2 mm. In two LADs images were rated fair and in two LADs images were poor because of intramyocardial LAD. No technical error of the anastomoses was detected. All grafts had good flows as ascertained by flow measurements. Conclusion : Epicardial ultrasound scanning with the new 10 MHz transducer allowed satisfactory imaging of coronary stenoses and graft anastomoses. Factors limiting the quality of imaging are proximal lesions, intramyocardial vessel, vessel tortuosity, and extensive calcifications. Epicardial ultrasound scanning with updated technology should become a further advancement to graft assessment during off-pump coronary surgery.     

Cochlear implantation in the elderly: surgical and hearing outcomes

Background

At the present time, 50 to 60% of the population above 70 years of age suffers from a hearing impairment and from 0.6 to 1.1% has a severe to profound loss, which cannot benefit from an hearing aid. Moreover, it is expected that this prevalence will grow by more than two-fold in the next 40 years. There is strong evidence that hearing loss in older adults is associated with both cognitive load and social isolation, which in turn, are associated with cognitive and physical functioning. Cochlear implant (CI) dramatically improves sound audibility and speech understanding. The aim of this paper was to analyze outcome and complications of CI treatment in elderly patients.

Methods

A retrospective study on 17 patients, aged at implantation between 65 and 79 years (mean = 70.47 ± 3.94), unilaterally implanted for severe to profound bilateral hearing loss. The following data were statistically evaluated: pre-implant pure-tone threshold and tests of speech recognition, both with hearing aid that without; post-implant threshold and speech perception with CI off and on. Moreover, statistical correlations of PTA improvement between two age groups (65 to 70 and over 70 years) were carried out.

Results

Mean PTA improved from 111.25 (± 17.51) (pre-implant) to 43.81 (± 9.27) (post-implant); and the mean SRT improved from 90 dB to 65 dB. Moreover there was no statistical difference in PTA improvement between the two age groups (65 to 70 and over 70 years). No severe per- or post-operative surgical complications were noted.

Discussion

In the elderly, CI is a safe procedure that significantly improves hearing threshold (p < 0.00001) and speech perception (p < 0.01). Support of family and professionals, as well as duration of deafness and pre-implant scores greatly influence the results of rehabilitation and its perceived benefit. CI should not be denied in older individuals who are otherwise in good health.

     

Correspondence: Cox inhibitors and bone healing

No Abstract available     

Incorporation of vancomycin-supplemented bone allograftsRadiographical,histopathological and immunohistochemical study in pigs

We compared the incorporation of bone allografts with or without vancomycin in tibial defects of 18 pigs. High-quality radiographs, histological examination, immunological expression of metalloproteinase-13 (MMP-13) and transforming growth factor-beta 2 (TGFß2) indicated that there was no significant difference in bone allograft incorporation between up to 220 times the MIC (minimum inhibitory concentration) in bone allografts with 1 g of vancomycin in each 300 g of allograft or without this supplement.     

Identifying structural barriers to an effective HIV response: using the National Composite Policy Index data to evaluate the human rights,legal and policy environment

Introduction

Attention to the negative effects of structural barriers on HIV efforts is increasing. Reviewing national legal and policy environments with attention to the international human rights commitments of states is a means of assessing and providing focus for addressing these barriers to effective HIV responses.

Methods

Law and policy data from the 171 countries reporting under the Declaration of Commitment from the 2001 United Nations General Assembly Special Session on HIV/AIDS were analyzed to assess attention to human rights in national legal and policy environments as relevant to the health and rights of key populations such as people who inject drugs, men who have sex with men and sex workers.

Results

Seventy-eight governments and civil society in 106 countries report the existence of laws and policies which present obstacles to accessing HIV services for key populations. Laws and policies which positively affect access to HIV-related services, in and of themselves constituting structural interventions, were also reported. The dissonance between laws and how this impacts the availability and use of HIV-related services deserve greater attention.

Conclusions

Recognition of the harms inherent in laws that constitute structural barriers to effective HIV responses and the potential positive role that a supportive legal environment can play suggests the need for legal reform to ensure an enabling regulatory framework within which HIV services can be effectively delivered and used by the populations who need them. Moving beyond laws and policies, further efforts are required to determine how to capture information on the range of structural barriers. Teasing apart the impact of different barriers, as well as the structural interventions put in place to address them, remains complicated. Capturing the impact of policy and legal interventions can ultimately support governments and civil society to ensure the human rights of key populations are protected in national HIV responses.     

Three Cases of Scalp Melanomas Discovered by Hairdressers

Studies have demonstrated that patients are able to identify melanoma in many cases. A limitation to using self-examination as a means of melanoma detection is the fact that in certain areas of the body, such as the scalp, self-examination is difficult to adequately perform. This may be one of the reasons why scalp melanomas carry a worse prognosis than melanomas detected in other areas of the body. The authors present three cases of scalp melanomas that were detected by the patient’s hairdressers and suggest that with minimal training, hairdressers could become a valuable resource in assisting dermatologists in the early diagnosis of scalp melanoma.Melanoma has high cure rates when diagnosed early, but poor survival when found at an advanced stage. Most melanomas are visible on the skin, which allows for self-detection. In fact, in one report based on a population-based survey, 53 percent of melanomas were detected by patients, 26 percent by physicians, 17 percent by family, and three percent by others.1 Further, self-examination leads to decreased melanoma thickness in comparison to patients who do not perform self-examinations, with variable sensitivity data ranging from 25 to 93 percent, but high specificity of 83 to 97 percent.2 Despite the benefits of self-examination in early melanoma detection, this is often very difficult on the scalp. Most patients visit a hairdresser more frequently than they see a dermatologist, so there may be a role for training hairdressers in melanoma detection as they are likely to see the entire scalp in the course of their work. The authors present three cases of scalp melanomas in which the patients presented to outpatient clinics at the University of Pittsburgh Department of Dermatology after their hairdressers initally detected the melanomas.1-4     

Surgical treatment of obstruction of the nasolacrimal ducts in patients with anatomical endonasal variants

The presence of anatomical endonasal variants (concha bullosa, nasal septal deviation, or hypertrophic turbinates) may cause more complications in patients with epiphora who have external dacryocystorhinostomy (DCR). The purpose of this study was to assess the results of surgical placement of a stent in 28 patients. They were randomised into two groups and had either DCR or placement of a Song's polyurethane stent. They were followed up for 18 months. Twenty-six patients had a good result. The success rate was 13/14 for those who had DCR and 13/14 for those who had a stent. Operating time was significantly less for placing a stent (mean (SD) 15 (2) minutes) compared with 40 (3) minutes for DCR (p<0.01). Placement of a polyurethane stent is an effective and short procedure for nasolacrimal obstruction, which is suitable for patients with unusual intranasal conditions.