Skin vasodilator response to local heating in human chronic spinal cord injury

Local heating evokes an increase in skin blood flow (SkBF), which consists of an initial peak (axon-reflex mediated) followed by a brief nadir and a secondary rise to a plateau. The aim of this study was to investigate whether heat provoked vasodilatation detects sympathetic vasomotor dysfunction and completeness of injury in patients with spinal cord injury (SCI). Twelve (seven complete, and five incomplete; level C4-L4) SCI patients, and nine healthy subjects as controls were studied. Thermostatic laser Doppler probes, which heat the skin locally, were placed on the dorsum of the hand and foot. SkBF was measured by laser Doppler flowmetry at baseline and at the first peak of vasodilatation (SkBF(max)). On the hand, SkBF at baseline and SkBF(max) were similar between the three groups. On the foot, SkBF at baseline was similar between the three groups but SkBF(max) was significantly diminished in complete SCI patients compared with controls (P < 0.01). In conclusion, heat provoked axon-reflex vasodilatation was diminished in the foot, below the level of lesion, in complete SCI. This test, that evaluates localized sympathetic vasomotor dysfunction, may be a useful non-invasive technique to detect completeness of autonomic disruption after SCI.     

A randomized controlled trial of integrated versus parallel housing services for homeless adults with severe mental illness

This study compared two contemporary approaches to linking housing and mental health services. In the integrated housing program, case management and housing services were provided by teams within a single agency and were closely coordinated. In the parallel housing condition, case management services were provided by mobile assertive community treatment teams and housing by routine community-based landlords. Adults with severe mental illness who were at high risk for homelessness (n = 121; 72.7% schizophrenia spectrum) were assigned randomly to integrated or parallel housing services and followed for 18 months. Integrated housing services led to more days of stable housing and greater life satisfaction than parallel housing services, especially for male participants. Integrated housing services were also associated with greater reductions in psychiatric symptoms. Closer integration between clinical and housing services, and greater use of supervised living settings, led to more time in stable housing for participants in the integrated housing services condition and was associated with greater gains in several outcome domains.     

The case of a 86-years old woman first diagnosed with Huntington's disease

This is the rare case of a woman first diagnosed with Huntington's disease at the age of 86. She was first seen at our hospital in 1999 for evaluation of dementia. Prior to her hospitalization, she had been treated with Melperone for restlessness. There was no essential psychopathology other than mild dementia (MMSE 21). A neurological work-up identified generalized involuntary movements and genetic testing revealed 40 CAG repeats. Over the course of the next several years, the patient began to exhibit the full range of symptoms associated with Huntington's disease, such as severe involuntary movements and progressive dementia. In the end, she was bed-ridden and only able to utter a few unintelligible words and she succumbed to an infection in 2003 at the age of 89, almost 4 years after her initial diagnosis of Huntington's disease. This case points to the need to consider Huntington's disease as a differential diagnosis even when evaluating the geropsychiatric population. It is particularly important to isolate involuntary movements which cannot be attributed to tardive dyskinesia in those who have been treated with neuroleptics in the past.     

Subakutes proximales Engpasssyndrom des N. radialis im Hiatus radialis

Endogenous lesions of the radial nerve at the upper arm level and in the canalis spiralis are exceptional. Entrapment of the radial nerve in the hiatus radialis following forced arm movements, stretching, or as a consequence of pathologies of the surrounding tissue is known. We observed two patients suffering from a painful subacute middle radial nerve palsy with complete axonal degeneration caused by a lesion at the hiatus radialis, demonstrated by EMG, sonography, MRI, and surgical exploration. Successful nerve repair, in one case with a nerve graft, was performed. In both cases the most appropriate explanation was a focal neuritis with swelling of the nerve followed by strangulation at the hiatus radialis. In one case acute neuroborreliosis was the reason for the neuritis.     

Use of a new cross-linked collagen membrane for the treatment of dehiscence-type defects at titanium implants: a prospective, randomized-controlled double-blinded clinical multicenter study

Objectives: The aim of the present randomized-controlled double-blinded clinical multicenter study was to assess the use of either a new cross-linked (VN) or a native collagen membrane (BG) for the treatment of dehiscence-type defects at titanium implants.
Material and methods: A total of n =54 patients were recruited in four German university clinics. According to a parallel-groups design, dehiscence-type defects at titanium implants were filled with a natural bone mineral and randomly assigned to either VN or BG. Submerged sites were allowed to heal for 4 months. Primary (e.g., changes in defect length –ΔDL, quality of newly formed tissue [0–4] – TQ) and secondary parameters (e.g., membrane exposure, tissue conditions at dehisced sites) were consecutively recorded.
Results: Four patients were excluded due to an early wound infection (VN:3; BG:1), and one patient was lost during follow-up (VN). The mean ΔDL was 3.0 ± 2.5 mm in the VN, and 1.94 ± 2.13 mm in the BG group. The assessment of TQ revealed comparable mean values in both groups (VN: 3.05 ± 1.66, BG: 3.46 ± 1.48). A significant correlation between membrane exposure and inflammation of the adjacent soft tissue was observed in the VN group. In both groups, the mean DL and TQ values were not significantly different at either non-exposed or exposed implant sites.
Conclusion: The results of the present study have indicated that VN supported bone regeneration on a level non-inferior to BG. However, in case of a premature membrane exposure, cross-linking might impair soft-tissue healing or may even cause wound infections.     

Video as an Effective Method to Deliver Pretest Information for Rapid Human Immunodeficiency Testing

Objectives: Video‐based delivery of human immunodeficiency virus (HIV) pretest information might assist in streamlining HIV screening and testing efforts in the emergency department (ED). The objectives of this study were to determine if the video “Do you know about rapid HIV testing?” is an acceptable alternative to an in‐person information session on rapid HIV pretest information, in regard to comprehension of rapid HIV pretest fundamentals, and to identify patients who might have difficulties in comprehending pretest information. Methods: This was a noninferiority trial of 574 participants in an ED opt‐in rapid HIV screening program who were randomly assigned to receive identical pretest information from either an animated and live‐action 9.5‐minute video or an in‐person information session. Pretest information comprehension was assessed using a questionnaire. The video would be accepted as not inferior to the in‐person information session if the 95% confidence interval (CI) of the difference (Δ) in mean scores on the questionnaire between the two information groups was less than a 10% decrease in the in‐person information session arm’s mean score. Linear regression models were constructed to identify patients with lower mean scores based upon study arm assignment, demographic characteristics, and history of prior HIV testing. Results: The questionnaire mean scores were 20.1 (95% CI = 19.7 to 20.5) for the video arm and 20.8 (95% CI = 20.4 to 21.2) for the in‐person information session arm. The difference in mean scores compared to the mean score for the in‐person information session met the noninferiority criterion for this investigation (Δ = 0.68; 95% CI = 0.18 to 1.26). In a multivariable linear regression model, Blacks/African Americans, Hispanics, and those with Medicare and Medicaid insurance exhibited slightly lower mean scores, regardless of the pretest information delivery format. There was a strong relationship between fewer years of formal education and lower mean scores on the questionnaire. Age, gender, type of insurance, partner/marital status, and history of prior HIV testing were not predictive of scores on the questionnaire. Conclusions: In terms of patient comprehension of rapid HIV pretest information fundamentals, the video was an acceptable substitute to pretest information delivered by an HIV test counselor. Both the video and the in‐person information session were less effective in providing pretest information for patients with fewer years of formal education.     

International Emergency Medicine: A Review of the Literature From 2008

As the specialty of emergency medicine (EM) continues to evolve in countries around the world, and as interest in international emergency medicine (IEM) continues to grow within the United States, the IEM Literature Review Group recognizes a need for a high‐quality, consolidated, and easily accessible evidence base of literature. In response to that need, the group created an annual publication that strives to provide readers with access to the highest quality and most relevant IEM research. This publication represents our fourth annual review, covering the top 26 IEM research articles published in 2008. Articles were selected for the review according to explicit, predetermined criteria that include both methodologic quality and perceived impact of the research. It is our hope that this annual review will act as a forum for disseminating best practices while also stimulating further research in the field of IEM.