Does supervised exercise offer adjuvant benefit over exercise advice alone for the treatment of intermittent claudication? A randomised trial.

OBJECTIVE: Exercise advice is the main treatment for symptom relief in the UK for patients with mild to moderate Intermittent Claudication (IC). Would a weekly exercise and motivation class for 6 months offer adjuvant benefit over written and verbal exercise advice alone? PATIENTS AND METHODS: Fifty-nine patients attending a regional vascular centre for whom IC was the main factor affecting mobility were randomised to either exercise advice alone (n=30) or exercise advice with a once a week 45 min supervised exercise/motivation class (n=29). The mean age was 68 years. Baseline and 6-month assessment included a Quality of Life Questionnaire--the Short-Form-36, the Charing Cross Symptom Specific Claudication Questionnaire (CCCQ) and treadmill walking distance (3.5 km/h 12%). RESULTS: At 6-month follow-up the supervised exercise group had improved their treadmill walking by 129% compared to 69% in the advice alone group (p=0.001). This significant improvement was maintained at the subsequent 9 and 12-month follow-up assessments. By the 9-month stage the advice only group CCCQ score had improved 16% from baseline, while the supervised exercise group had a significantly better 43% improvement in base line score (p<0.05). Self reported frequency of walks was higher in the exercise class group being significant for improvement in CCCQ score. CONCLUSION: A weekly, supervised exercise and motivation class for a 6-month period provides a significant improvement in patients' symptoms, quality of life, and distance walked compared with advice alone and this improvement continues after attendance at class has ceased.     

Localized pulmonary disease due to Trichosporon beigelii.

A case of pulmonary infection caused by Trichosporon beigelii is reported. The infection occurred in a neutropenic patient with acute lymphoblastic leukemia. His chest radiograph showed a 6-cm pulmonary infiltrate in the right midzone and an apical infiltrate on the left. Repeated cultures of bronchoalveolar lavage grew budding yeast that was identified as T beigelii on the basis of morphological, cultural, and biochemical characteristics. He responded to amphotericin-B therapy. Systemic infections caused by this yeast are rare and its causal relationship in localized lung disease has been reported only seven times previously.     

The synchronization of respiration and swallow sounds with videofluoroscopy during swallowing

Simultaneous recording of adult subjects sipping small amounts of fluid from a cup have been obtained by videofluoroscopy together with feeding respiratory patterns and swallow sounds from the Exeter Dysphagia Assessment Technique (EDAT). These allowed visual representations of respiration and swallow sounds to be superimposed on a videofluoroscopy recording using a split-screen technique. Sequentially numbered, 1/50 sec, half-frame photographic prints were examined and schematic drawings of the relevant radiographs were made. These were superimposed on to the actual EDAT printed chart of the same swallow event, theri exact time relationship with respiration and cervical swallow sounds being preserved. The results allow events in the barium videofluoroscopy to be related to events in the feeding respiratory pattern and swallow sounds recorded by EDAT.     

Accuracy of face-bow transfer: effect on surgical prediction and postsurgical result.

One of the most common errors in model surgery for orthognathic surgery is in the mounting of the models on the articulator. This study assessed the ability of one type of face-bow to transfer the maxillary model to the articulator. Twenty-five consecutive mountings were evaluated by calculating the angle made between the maxillary occlusal plane on the cephalogram and comparing it with the maxillary occlusal plane angle on the articulator. An accurate face-bow transfer should transfer this angle, making the two similar. It was found that a significant difference between the maxillary occlusal plane angle on the cephalogram and the articulator was found in the average case. The implications of such errors and a technique to avoid them are presented.     

Paranoid and nonparanoid schizophrenic processing of facially displayed affect.

It was proposed that differences between paranoid and nonparanoid schizophrenics in the processing of affective information may reflect underlying differences in their schema for emotion-laden information. Performances of 14 paranoid schizophrenics, 13 nonparanoid schizophrenics, and 15 matched controls were compared on a facial affect judgment task, and a matched control task comprising geometric figures largely devoid of emotional information. Subjects were required to rate friendliness, select an emotion label, and subsequently to remember the stimuli. Nonparanoids were deficient in overall labeling of facial affect, suggesting a weak cognitive schema for emotional information. The paranoids were particularly more accurate than the nonparanoids at labeling the negative facial affects, suggesting well-developed negative emotional aspects in their cognitive schema. Unexpectedly, nonparanoids relative to paranoids displayed a greater memory deficit in the recognition of geometric figures than in the recognition of faces. The nonparanoid deficit suggests these subjects may have poorly organized schema for remembering less structured nonverbal information. The findings support the idea of fundamental cognitive processing differences between paranoid and nonparanoid schizophrenia.     

Necrotizing staphylococcal pneumonia in a neonate.

Hospitalized neonates are commonly colonized soon after birth with Staphylococcus aureus. The majority of neonates do not develop infectious sequelae; however, premature neonates appear to be more susceptible to serious infections, such as pneumonia. We report a case of an extremely low birth weight infant who developed necrotizing pneumonia due to methicillin-resistant Staphylococcal aureus (MRSA). The MRSA isolate from this neonate is identical to the strains that have been causing primarily community-associated skin and soft tissue infections. The severe course of this patient may be attributed to the presence of the Panton-Valentine leukocidin gene, a well-known virulence factor leading to soft tissue and pulmonary infections.