Tennis elbow, natural course and relationship with physical activities: an inquiry among physicians

BACKGROUND: The main purposes of the study were to answer the following two questions: is a restrictive therapeutic management in case of tennis elbow (TE) better or worse than a regular therapeutic approach and do racket sports and other physical activities influence the risk to get TE and to what extent. METHODS: Design: Cross-sectional study by means of a postal questionnaire. The impression was verified that physicians are reserved about medical interventions when treating themselves for tennis elbow. The frequency of therapeutic measures and their results were compared with data reported in literature. Physical activities of physicians who had TE were compared with those of physicians who never had TE. Setting: Physicians who attended postgraduate courses on diagnosis and treatment in orthopedic medicine from 1984 to 1992. Participant: 72 physicians who had TE and 266 with no history of TE. Measure: The study is based on self-assessment of therapeutic approaches and their results, reported physical activities at the onset of TE and at the moment of the inquiry. By a team of experts the grade of grasping and/or dorsiflexion of the physical activities was classified. RESULTS: Compared with patients in general practice, physicians treating themselves for TE were more restrictive to use NSAID's, ointments or local steroid injections or to consult a specialist. No-one was treated with surgery and no-one interrupted her/his work because of TE. In all but two of the 72 cases the TE resolved within two years. The odds ratio for TE for playing racket sports versus not playing racket sports was 2.8 (95% confidence interval 1.64-4.82). The odds ratio for activities with low-grade grasping and/or dorsiflexion versus "no sports or hobbies" was 0.11 (0.02-0.50). CONCLUSIONS: Absence from work and therapeutic measures for TE are (in physicians) not necessary for a good result on the long term. Playing racket sports increases the risk to get TE by a factor of 2.8. Performing weekly activities with low grade grasping and/or dorsiflexion of the wrist may have a protective effect against developing tennis elbow.     

Evaluation of restoration of extensor pollicis function by transfer of the extensor indicis

The aim of this study was to assess long-term results of extensor indicis (EI) to extensor pollicis longus (EPL) transfers and to assess donor site morbidity. A specific EI-EPL evaluation method (SEEM) was used to measure EPL function after transfer. The outcomes in 17 patients are presented. Results were assessed by the Geldmacher score, the SEEM, mobility and strength of thumb and index finger, pinch and grip strength, and a questionnaire, comparing the operated and non-operated hands. Based on the SEEM, the results were excellent to good in 11 of 17 patients. There was no marked loss of independent extension of the index finger and only a 38% loss of extension strength.     

Formal retrospective case review and sudden infant death

A review of 24 consecutive sudden infant deaths was undertaken to evaluate the importance of the various stages in the postmortem assessment of such cases. Death in three cases was caused by obvious trauma. Of the remainder, 16 were attributed to sudden infant death syndrome (SIDS), 4 to accidental asphyxia (identified by death scene examination and/or formal case review) and 1 to a lingual thyroglossal duct cyst. Three (14%) of 21 deaths thought to be SIDS after postmortem examination were attributed to asphyxia following subsequent formal case review.     

Factors influencing the acceleration of human factor XIa inactivation by antithrombin III

Controversy exists in the literature concerning the potentiating effect of heparin on the inactivation rate of factor XIa by antithrombin III (AT III) in both purified systems and in plasma. We have analyzed the factors that could influence this reaction and found that ionic strength of the medium, as well as the type and concentration of the heparin preparations accounted for the major discrepancies in the literature. At I = 0.43 N, a preparation of bovine lung heparin at 1 U/mL did not augment the inactivation rate of factor XIa by inhibitors in plasma or by purified AT III. However, when ionic strength was decreased, a progressive increase in the potentiating effect was observed, reaching 6.5-fold at I = 0.15 N. At saturating concentrations of heparin, which results in the formation of 100% AT III-heparin complex, (greater than ten-fold molar excess over AT III) in purified systems, all heparin preparations (porcine, bovine, low molecular weight [LMW], and high affinity) yielded an approximately 30-fold augmentation of the factor XIa inactivation rate. However, when heparin was less than saturating, we observed that various heparin preparations affected the AT III-induced inactivation of factor XIa to different degrees even though they exhibited the same inhibitory activity (1 U/mL) against thrombin. This variation resulted from differences in the number of AT III binding sites in each heparin preparation, despite a similar Kd for each. Addition of high molecular weight kininogen (HK) to AT III-heparin complexes did not enhance their ability to inhibit factor XIa, and high concentrations of HK decreased the inactivation rate. A high therapeutic dose of heparin only permits the formation of 2.5% to 16.5% of the AT III-heparin complexes that can be achieved at saturation. We observed that 1 U/mL heparin (bovine lung heparin) (high therapeutic concentration) in virtually undiluted plasma only accelerated the inactivation rate of factor XIa (in the absence of other active enzymes) less than two-fold. These new observations further support our previous conclusion that therapeutic levels of heparin have little to no influence on the inactivation rate of factor XIa in plasma.     

Hypnotizability and the Treatment of Chronic Facial Pain

The Carleton University Responsiveness to Suggestion Scale (CURSS) of Spanos, Radtke, Hodgins, Bertrand ³ and Stam and Spanos, Radtke, Hodgins, Stam, and Bertrand (1983) was individually administered to a sample of 61 facial pain patients. The mean scores on the 3 CURSS suggestibility dimensions were higher than those of the college student norms. As in previous studies using the CURSS, however, objective scores were smaller when experienced involuntariness was taken into account. Observer scores of overt responses were highly related to self-scores of overt responses. The CURSS also proved a good predictor of reductions in clinical pain following a psychologically based treatment program.     

Minactivin expression in human monocyte and macrophage populations

Adherent monolayer cultures of human blood monocytes, peritoneal macrophages, bone marrow macrophages, and colonic mucosa macrophages were examined for their ability to produce and secrete minactivin, a specific inactivator of urokinase-type plasminogen activator. All except colonic mucosa macrophages produced and secreted appreciable amounts of minactivin, but only blood monocytes were stimulated by muramyl dipeptide (adjuvant peptide) to increase production. The minactivin from each of these populations could be shown to preferentially inhibit urokinase-type plasminogen activator and not trypsin, plasmin, or "tissue"-type plasminogen activator (HPA66). A plasminogen-activating enzyme present in monocyte cultures appeared unaffected by the presence of minactivin and could be shown to be regulated independently by dexamethasone.     

Impaired renal function is associated with markers of endothelial dysfunction and increased inflammatory activity.

BACKGROUND: Patients with end-stage renal disease (ESRD) as well as those with mild renal insufficiency are at increased risk for the development of cardiovascular disease, which cannot be attributed entirely to traditional risk factors. Endothelial dysfunction and chronic inflammatory activity, two important phenomena in atherogenesis, can be found in ESRD. At present, it is unclear whether endothelial dysfunction and chronic inflammatory activity are related to renal function in the pre-dialysis stage. METHODS: In a cross-sectional, single-centre study, four groups of 20 subjects with renal function ranging from a normal, calculated creatinine clearance (>90 ml/min) to a pre-dialysis situation (<31 ml/min) were investigated. We measured markers of endothelial function [von Willebrand factor (vWf), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), tissue-type plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1) and E-selectin (ES)], and markers of inflammatory activity [secretory phospholipase A(2) (sPLA(2)) and C-reactive protein (CRP)]. Using these markers, composite endothelial function and inflammatory activity scores were constructed. RESULTS: Creatinine clearance correlated with the endothelial function score (r=-0.43, P<0.001), the inflammatory activity score (r=-0.53, P<0.05), vWf (r=-0.54, P<0.001), sVCAM-1 (r=-0.50, P<0.001), sPLA(2) (r=-0.28, P<0.05), homocysteine (r=-0.61, P<0.001), age (r=-0.54, P<0.001) and blood pressure (r=-0.44, P<0.001). In multivariate analyses, creatinine clearance was an independent determinant of the endothelial function score (beta=-0.34, P=0.006), plasma vWf (beta=-0.37, P=0.022) and sICAM-1 (beta=-0.33, P=0.012). The relationship of creatinine clearance with sVCAM-1 and endothelial function score was not significant when plasma homocysteine was added to the model. Creatinine clearance was also a determinant of the inflammatory activity score (beta=-0.31, P=0.025) and sPLA(2) (beta=-0.32, P=0.024), although this was no longer significant after correction for systolic blood pressure. CONCLUSIONS: Renal dysfunction is associated with markers of endothelial dysfunction and inflammatory activity. Plasma homocysteine may be an intermediate factor in the relationship between endothelial dysfunction and renal function, while blood pressure may modulate the association between inflammatory activity and renal function.     

Repeatability and variation of quantitative gait data in subgroups of patients with stroke

We aimed to determine the repeatability and variation of quantitative gait data in patients with stroke and to compare the subgroups in terms of gait variability. Time-distance and kinematic characteristics of gait were evaluated in 90 inpatients (30 women) with hemiparesis (mean+/-S.D. age 57.7+/-12.5 years and time since stroke 5.99+/-6.46 months). Subgroups were based on "gender", "side of paresis", "lesion type", "motor recovery level", "sensory status", "time since stroke" and "walking velocity". Repeatability was adequate to excellent in all stroke subgroups (ICC range 0.48-0.98). Walking velocity was the most repeatable gait parameter after stroke. Variation in step length was significantly higher in women than in men (CV 16% versus 9%, p<0.05). Slow walkers (walking velocity <0.34 m/s) had a higher variation than fast walkers in step length (CV 12.5% versus 7.5%, p<0.01), single support time (CV 11.9% versus 6.3%, p<0.05), peak hip extensions in stance (CV 11.5% versus 3.7%, p<0.01) and knee flexion in swing (CV 11.8% versus 6.5%, p<0.05). In our stroke patients, their age, time since injury, lesion characteristics, impaired proprioception or level of motor recovery had no effect on gait variability. For better interpretation of quantitative gait data, clinicians should consider that variation in step length, single support time, peak hip extension in stance and knee flexion in swing differs according to walking velocity after stroke.