Multiple sclerosis. The value of clinical vestibular examination

A clinical vestibular examination was carried out on 82 patients with multiple sclerosis (MS) selected on McAlpine's criteria. Spontaneous nystagmus, positional nystagmus or pathological caloric test were found in 49 (60%) patients. Pathological horizontal optokinetic nystagmus occurred in 47 (57%) patients. In 36 cases horizontal optokinetic nystagmus was pathological to both sides, in 28 cases combined with a pathological vertical optokinetic nystagmus, indicative of diffuse intracerebral lesions. Lesions in the central vestibular system and in the optokinetic pathways were frequently discovered in early or atypical cases of MS.     

Reference values for pulsed Doppler signals from the blood flow on both sides of the aortic valve

Pulsed Doppler signals were recorded in 215 healthy subjects,120 males and 95 females, between 1 and 65 years of age. Themeasurements were performed in the left ventricular outflowtract (LVOT) and in the ascending aorta (AAO). Amplitude spectrafrom the Doppler signals were stored in digital form togetherwith adjustment data for the instrument, the simultaneouslyregistered ECG and respiration signal. The maximum velocity(V_max, the maximum acceleration (A_max) and the width of thevelocity distribution around V_max (width) were derived fromthese spectra and used for the characterization of the signals.These parameters were computed without observer interactionusing a computer program. Effects of age, sex, body surfacearea, heart rate and respiration were studied. Reference rangeswere calculated. The following conclusions can be drawn: V_maxand A_max in the AAO decrease clearly with increasing age fromapproximately 100 to 60 cm s^-1 and from 2000 to 1000 cm s^-2(medians), respectively. The variation of the width in the AAOis greater for people over 45 years. V_max, A_maxand width inthe LVOT increase slightly with advancing age from approximately60 to 80 cm s^-1, 800 to 1000 cm s^-2 and 12 to 15 cm s^-1 (medians),respectively. These parameters of flow were either unrelatedor only weakly related to other physiological variables in thisstudy group.     

Healthy research in cities: a case study on the translation of health research into action in The Netherlands

Health research plays a prominent role in Healthy City projectsin urban neighbourhoods. This article explores the problemsthat arise when research is used as a tool to promote healthaction. A special focus is on strategies to assess health needs.Additionally, a theoretical framework of ‘Cultures ofHealth’ is introduced. In a case study, a health promotionproject in an urban neighbourhood is examined in which researchplays a major role. The research, designed as action research,originates positive outcomes and demonstrates an adequate rolefor research on healthy cities.     

Reference values for pulsed Doppler signals from the blood flow velocity on both sides of the pulmonary valve

Pulsed Doppler signals were recorded from the pulmonary arteryand the right ventricular outflow tract in 215 healthy subjects(120 males, 95 females; 1–65 years). Amplitude spectrafrom these Doppler signals were stored in digital form togetherwith adjustment data for the instrument and the simultaneouslyrecorded ECG. From these Doppler spectra the median of the maximalvelocity ( V_max), the maximal acceleration (A_max) and the dispersionof the velocity distribution around V_max (width) were calculated.These three median values were used to characterize the Dopplerspectra and to define normal values for bloodflow velocities.Thus, calculations were made without observer interaction usinga well-defined computer program. The effect of age, gender,body surface area and heart rate were studied. Reference rangeswere calculated. There is a slight decrease of the median value of V_max and A_maxin the pulmonary artery during lifetime from 80 to 70 cm s^–1and from 1200 to 800 cms^–2, respectively. On the otherhand, there is no correlation between age and V_max and A_maxin the right ventricular outflow tract. The width of the spectraincreases with age at both sites. No significant changes withage were seen with the other variables.     

Normal diastolic filling patterns of the left ventricle

Pulsed Doppler measurements on both sides of the mitral valveand M-mode left ventricular echocardiograms were performed in215 healthy subjects, 120 males and 95 females, between oneand 65 years old, in order to evaluate normal diastolic fillingpatterns of the left ventricle. The relation between the maximumblood velocity during early passive filling (Ewave) and duringatrial contraction (A wave) was computed from the Doppler spectraobtained proximal and distal to the mitral valve, resultingin the EA ratio. The influence on the EA ratio of age, gender,body surface area, blood pressure, heart rate, PR interval,respiration, wall thickness and basal wall mass of the leftventricle was investigated. The study showed that the EA ratio measured proximal to themitral valve (in the left atrium) was significantly smallerthan the EA ratio measured distal (in the left ventricle) andthat the only prominent relations with the EA ratio were thosewith age and heart rate. The EA ratio declines with age: proximalto the mitral valve from approximately (medians) 2.5 to 1 anddistal to it from 3.5 to 1.5. All other physiological variablesare weakly related or unrelated to the EA ratio in this groupof healthy subjects.