Comparison of physiological responses to maximal arm exercise among able-bodied, paraplegics and quadriplegics

A comparison of pulmonary, cardiovascular and metabolic responses was made in 32 subjects consisting of 11 able-bodied, 8 paraplegics (T4-L3 lesions) and 13 quadriplegics (C5-C8 lesions) during maximal arm cranking exercise. A progressive continuous arm cranking test, modified for each group, was employed to elicit maximal responses with pulmonary and metabolic determinations made with open circuit spirometry and selected cardiovascular measurements made by impedance cardiography. Additionally, non-exercise static and dynamic lung function assessments were made. Quadriplegics had significantly lower (p less than 0.05) tidal volumes, vital capacities, forced expiratory volumes at 1 seconds, and maximal breathing capacities than the other two groups. The mean peak VO2 during maximal arm cranking was 28.2, 25.3 and 12.0 ml/kg.min for the able-bodied (AB), paraplegics (PP) and quadriplegics (QP), respectively. Furthermore, reduced cardiovascular function was observed in the QP as evident in the low peak HR (109 b/min), peak SV (52 ml/b) and peak Q (5.7 l/min). Values for the QP were 64% and 64% peak HR, 89% and 50% peak SV and 54% and 33% peak Q of values observed for the PP and AB groups, respectively. The peak SV and Q values were significantly lower (P less than 0.05) for the PP group when compared with the AB group. Although not statistically significant the estimated a-v O2 difference was higher for both spinal cord injured groups (14.0 and 14.6 ml O2/100 ml, PP and QP respectively). The impaired work capacity and reduced oxygen transport and utilisation of the QP group can be attributed to impaired sympathetic cardiac stimulation and a smaller available active muscle mass.     

More than 10 years registration of continuing medical education as part of quality control by The Netherlands Society for Oto‐Rhino‐Laryngology and Cervico‐Facial Surgery

More than 10 years registration of continuing medical education as part of quality control by The Netherlands Society for Oto‐Rhino‐Laryngology and Cervico‐Facial Surgery After more than 10 years registration, 93% of ENT specialists in The Netherlands fulfil the requirements for continuing medical education in spite of the fact that sanctions (no re‐registration) have not been implemented to date. Improvements have been made over the years. Information about how to set up a comparable system was supplied to 10 other scientific societies. A recurrent point for discussion is whether or not to award points for presentations, papers and (co)publications. On the one hand, it seems reasonable to reward the effort but, on the other hand, it creates practical problems. As a matter of fact, all members who give papers and write articles appear to attend more than enough postgraduate education. The process of accurate registration of continuing medical education, including accreditation and certification, is time‐consuming. Moreover, it requires intensive and essential supervision by an experienced colleague who has a thorough knowledge of the specialist field.     

Familial amyloidotic polyneuropathy: long-term follow-up of abdominal fat tissue aspirate in patients with and without liver transplantation.

To estimate the evolution of amyloid in tissue, we studied abdominal fat aspirates of cases with familial amyloidotic polyneuropathy (FAP) longitudinally at regular intervals between 1994 and 2006. In 22 cases (13 carriers and nine patients) not yet transplanted median follow-up was 3.3 years (range 0.4-11.3). We found a significant increase in the amyloid grade of fat tissue from 2+ to 4+ and from 0 to 4+ in two of three subjects with follow-ups of >7 years, after 7 and 11 years, respectively. All other subjects remained negative or did not show a significant change. In 11 liver transplant patients, follow-up with fat aspirate was available with a median duration of 3.1 years (range 1.0-10.1). A comparison was made with cardiac amyloid as judged by the cardiac septum diameter and the serum NT-ProBNP (N-terminal pro-B-type natriuretic peptide) level. No stable increase of amyloid in fat was seen in any patient. A stable decrease of amyloid grade was seen in one patient 5 years after transplantation. In contrast, the cardiac septum diameter increased >or=4 mm in six of the 11 transplant patients. Our study shows the diagnostic utility of a regularly repeated fat aspirate in carriers at risk for the development of ATTR amyloidosis. Evolution of amyloid deposition in fat tissue is very gradual. After liver transplantation, amyloid deposition in fat tissue seems to stabilize and may even decrease in the long term, whereas amyloid deposition in cardiac tissue appears to be progressive.     

The Manner Born: Birth Rites in Cross‐Cultural Perspective

Edited by Lauren Dundes. Walnut Creek (CA): Altamira Press, 2003. 239 pages. $27.95, paperback, $75.00, hardback.     

Sequential 99mTc-hydrazinonicotinamide-annexin V imaging for predicting response to chemotherapy.

This study was undertaken to evaluate changes in relative (99m)Tc-hydrazinonicotinamide (HYNIC)-annexin V tumor uptake over time in patients undergoing chemotherapeutic treatment at baseline and at 5-7 h and 40-44 h after treatment initiation. Imaging results are related to clinical outcomes, as assessed with response evaluation criteria in solid tumors (RECIST). METHODS: We prospectively included 20 patients (11 men and 9 women; mean age, 59.8 y; range, 22-75 y) scheduled for chemotherapy (n = 19) or bisphosphonate treatment (n = 1). Curable disease was present in 5 patients. The other patients had metastatic disease and were treated in a palliative setting. Three of the 20 enrolled patients were excluded from analysis: 1 patient ultimately refused the proposed chemotherapy treatment; because of difficulties with the labeling procedure, 1 patient did not receive a pretreatment scan; and 1 patient presented with an allergic reaction (rash and nausea) to the (99m)Tc-HYNIC-annexin V formulation. The remaining 17 patients underwent 3 scintigraphic scans with (99m)Tc-HYNIC-annexin V: before treatment and 5-7 h and 40-44 h after treatment initiation. The tumor response was evaluated with RECIST and related to observed changes in the ratios of tumor activity to background activity for the largest known lesion; values exceeding 25% the baseline value on either the 5- to 7-h scan or the 40- to 44-h scan were considered significant. RESULTS: With the proposed sequential imaging protocol and a 25% change threshold, responders to treatment could be separated from nonresponders with a 94% accuracy (16/17 patients). CONCLUSION: Sequential (99m)Tc-HYNIC-annexin V imaging may allow for assessment of the response to chemotherapy within 3 d after treatment initiation.     

Pharmacy Fill Patterns in Young Urban Children with Persistent Asthma

Background. Medication adherence impacts healthcare utilization. Pharmacy records are useful to establish fill patterns. Objective. Use pharmacy records to establish medication patterns fill patterns for comparison to healthcare utilization. Methods. Pharmacy records of 175 children with persistent asthma were collected and compared to healthcare utilization. Results. Majority of subjects had significant healthcare utilization, low numbers of rescue medications, and poor controller medication fill rates. Those with more rescue medications had more healthcare utilization and more controller medications. Conclusions. Pharmacy fill patterns demonstrate few rescue and/or controller medication fills. Those with more rescue medications reported increased healthcare utilization despite controller medications.