Force, pressure, and motion measurements in the foot: current concepts

Modern foot-pressure measurement studies have successfully debunked the tripod theory; on the contrary, the highest peak loads under the forefoot occur as often as not under the third metatarsal head and not the first and fifth. This does not necessarily mean that the first metatarsophalangeal joint does not sustain the highest pressures; calculations based on the measured pressures under the metatarsals and digits show that it does. One must bear in mind that the hallux consistently bears significantly more pressure than any of the other toes. It is likely that the pressure borne by the first metatarsal head and hallux combined consistently exceed that for the other four metatarsal heads and their respective digits. In other words, the first ray probably has the consistently highest load in normal feet, even when the second or third metatarsal head achieves a greater peak pressure than the first metatarsal head. Three lines of evidence suggest the role that pressure plays in forefoot pathology. First, metatarsalgia is commonly associated with hallux valgus. It often arises following or is exacerbated by hallux valgus surgery (especially arthroplastic procedures). Patients with hallux valgus demonstrate increased peak pressure under the lateral metatarsal heads that actually increases following the Keller procedure. Second, the peak pressure under callosities are, on the average, higher than normal. Third, diabetic plantar ulcers occur at sites of high pressure. The correlations between peak loads on the lateral column and both age and weight merit some attention, since it is common experience that the prevalence of symptomatic foot lesions is higher in older populations. The correlation with body weight may be unexpected. One would expect that, on the average, body weight would correlate with the weight-bearing surface area of the foot and, therefore, the pressure would be relatively constant. The increased pressure under the medial column suggests a relative instability of the medial column with advancing age and weight. Pressure should not be construed as the only factor. The large overlap in peak pressures found under diabetic ulcers and intact skin in both normal and diabetic feet makes this apparent. However, while peak pressures have been extensively studied, there has been no attempt to measure the duration or frequency of loading on a day-to-day basis. According to Brand, it is not the absolute loads applied to a part but repetitive pressure that is responsible for tissue breakdown, especially when such repetitive loads are applied without any interim period for the tissues to recover.(ABSTRACT TRUNCATED AT 400 WORDS)     

Depressed pathological gamblers

Depressed gamblers (n = 14) were compared with normal controls (n = 41) for antecedent life events. The depressed gamblers had experienced significantly more life events, and undesirable or exit life events, during the 6 months before the onset of depression.     

Anesthesia and/or Sedation for Pulsed Dye Laser Therapy

One of the most exciting developments in pediatric dermatology has been the use of the flashlamp-pumped, 585-nm, pulsed dye laser for treatment of vascular birthmarks. In many cases the results are miraculous. The increase in self-esteem and happiness of many children and adolescents has been overwhelming; for some, depression has been lifted, stuttering has ceased, social involvement has increased, and antidepressants have been discontinued. There are many success stories to tell.
Despite the remarkable effects of the pulsed dye laser and the medical and psychosocial indications for its use, the issue of pain control remains significant. We have no perfect outpatient pediatric anesthetic. Most methods carry either some risk or, if not hazardous, often are not very effective for controlling pain. Needless to say, a diversity of opinions exist on how to manage discomfort from this treatment modality. Therefore, we thought it would be useful to share the experiences and opinions of several dermatologists who have extensive experience with the pulsed dye laser.     

Digoxin cannot account for the reported association of EKG abnormalities and rhegmatogenous retinal detachment

The prevalence of cardiovascular disease (by EKG criteria) in patients with rhegmatogenous retinal detachments has been reported to be more than four times that found in age-matched controls. Adhesion between the retinal pigment epithelium (RPE) and the photoreceptors is facilitated by RPE transport. Because RPE transport is driven by a Na-K ATPase, it has been suggested that the correlation of EKG abnormalities and retinal detachment may be due to clinical use of digoxin, a Na-K ATPase inhibitor frequently given to patients with cardiovascular disease. The prevalence of EKG abnormalities in 299 consecutive patients with primary retinal detachment is about the same as that reported previously. However, 92% of these patients with EKG abnormalities did not take digoxin. Therefore, clinical use of digoxin cannot account for the reported association of EKG abnormalities and rhegmatogenous retinal detachment.     

Ultrastructural study of micro-blood vessels in human brain tumors and peritumoral tissue

Summary Ultrastructural and tracer studies have demonstrated that vasogenic edema, a serious complication of brain tumor is the result of increased permeability of tumor vessels. However, not much information is available on the alterations in the vessels in the peritumoral areas. Therefore, we studied the ultrastructural changes in the tumor micro-blood vessels (MBVs) in 20 cases of glioma and compared these with the changes in the peritumoral MBVs in 10 of these cases.The tumor MBVs showed remarkable structural changes, viz, increase in pinocytotic vesicles, large vacuoles and microvilli in the endothelial cells, varying degrees of endothelial attenuation and fenestration, an occasional partially or completely opened-up junction and some pale and edematous endothelial cells, which can adequately explain their increased permeability.The peritumoral MBVs also showed evidence of increased permeability in the form of increased pinocytotic vesicles, large vacuoles and microvilli associated with pale and edematous cytoplasm of some endothelial cells. Thickened multilayered basement membrane, absence of ensheathment of capillary basement membrane by astrocytic cell processes and widened perivascular space were observed in both tumoral and peritumoral MBVs.An interesting observation was that in the peritumoral MBVs, the pinocytotic vesicles were most conspicuously seen on the abluminal side of the endothelial cells often fused with the abluminal plasma membrane. Although a static study like this cannot indicate any definite direction of movement of fluid, we feel that the occurrence of reverse pinocytosis is a distinct possibility in the peritumoral MBVs and that it may be an important means of resorption of edema fluid.     

CROHN'S DISEASE: A COLON AND RECTAL DEPARTMENT EXPERIENCE

This study reviewed a series of patients with Crohn's disease managed by surgeons of the Department of Colon and Rectal Surgery, St Vincent's Hospital, Melbourne, since 1978. There were 306 patients: 171 males and 135 females. The mean age at diagnosis was 33.4 years (range 11–93). The distribution of the disease was small bowel 32.3%, small bowel and colon 26.5%, colon 39.9%, and anal disease alone 1.6%. A total of 416 abdominal operations were performed on 204 patients. The commonest indications for surgery were failed medical therapy (21.9%), small bowel obstruction (15.9%), enteric tistula (10.1%), and intra-abdominal abscess (10.1%). The most frequently performed procedures were ileocolic resection with anastomosis (28.8%), small bowel resection (9.4%), and total colectomy and ileostomy (7.0%). Postoperative complications included anastomotic leaks in 4.0%. intra-abdominal abscess formation in 3.6%, and enterocutaneous fistulae developed in 6%. Three patients died during the review period. During follow up (mean 84.4). 30% of patients developed recurrence requiring further surgery at a mean of 72.7 months postoperatively. The most frequent site for a recurrence was the pre-anastomotic terminal ileum (61.7%). In conclusion. the majority of patients with Crohn's disease will require resectional surgery at some stage. This can be performed with a low mortality and morbidity, and a recurrence rate of around 5% per year.     

Design, spectrum measurements and simulations for a 238Pu alpha-particle irradiator for bystander effect and genomic instability experiments.

Design, spectrum measurements and simulations for an alpha-particle irradiator for bystander effect and genomic instability experiments are presented. Measured alpha-particle energy spectra were used to confirm the characteristics of the source of the irradiator specified by the manufacturer of the source. The spectra were measured in vacuum with a high-resolution spectrometer and simulated with an AASI Monte Carlo code. As a next step, we simulated alpha-particle energy spectra at the target plane of the irradiator for three different source-to-target distances. In these simulations, helium was used as the medium between the source and the exit window of the irradiator; its pressure and temperature corresponded to those of the ambient air. Mean energies and full-widths at half-maximum (FWHM) were calculated for the three different helium gas tracks.     

Spatio-temporal expression of estrogen sulfotransferase within the hepatic lobule of male rats: implication of in situ estrogen inactivation in androgen action.

Estrogen sulfotransferase (EST) catalyzes transfer of the sulfate group from phosphoadenosine phosphosulfate to estrogenic steroids. Since estrogen sulfates do not bind to the estrogen receptor with high affinity, EST can control the intracellular level of the receptor-active estrogens. Androgen action in the rat liver, as indicated by the androgenic induction of alpha 2u-globulin, is inhibited by low levels of estrogens. Thus, in situ estrogen inactivation by EST is expected to increase hepatic androgen sensitivity. During the lifespan of the animal, rat liver undergoes three distinct phases of androgen sensitivity, i.e. prepubertal androgen insensitivity, androgen sensitivity after approximately 40 days of age, and androgen insensitivity during senescence (greater than 750 days). EST in the liver is expressed only after puberty, when the liver becomes androgen sensitive. Furthermore, localization of EST and its corresponding mRNA within the lobular unit of the liver demonstrates that only androgen-responsive hepatocytes located around the central vein contain immunoreactive EST and its corresponding mRNA. These temporal and spatial correlations of EST expression and hepatic androgen sensitivity support the concept that steroid-inactivating enzymes play important roles in sex hormone action.     

Analysis of cocaine, benzoylecgonine, ecgonine methyl ester, ethylcocaine and norcocaine in human urine using HPLC with post-column ion-pair extraction and fluorescence detection.

The measurement of cocaine and its major metabolites has been achieved by an HPLC method that compensates for their different solubilities and detection properties. Although ecgonine methyl ester is a major metabolite it is generally not measured by HPLC because it is poorly detectable by UV, and its water solubility makes recovery from urine difficult. Using modified solid-phase extraction procedures recoveries of 85% for ecgonine methyl ester, 97% for cocaine, 106% for benzoylecgonine and 80% for ethylcocaine have been obtained from urine. Increased chromatographic retention and detection sensitivity has been obtained by formation of the t-butyldimethylsilyl derivative of ecgonine methyl ester which was found to be stable in the HPLC mobile phase for at least 1 week. Alkylation of norcocaine and benzoylecgonine has improved their detection sensitivity and also chromatographic resolution. All calibrations were linear over the range 200-1000 ng ml-1 in urine with correlation coefficients > 0.99.