A comparison of the effects of electrode placement, muscle tension, and isometric torque of the knee extensors

Numerous electrical stimulation (ES) papers have been published using a variety of electrode placements and muscle tension criteria levels, making cross-comparisons difficult. The purpose of this study was to compare isometric knee extensor torques produced using three methods to induce muscle tension and three electrode placements. Twenty-three healthy, informed female volunteers (mean age = 24 yrs, SD = 3.2 yrs) participated in a practice session and three test sessions, each approximately 48 hrs apart. One of three electrode placements was randomly assigned during each test session. Maximal voluntary isometric contractions (MVIC) preceded the electrically induced isometric torque outputs. Comfortably tolerable and maximally tolerable ES intensities were combined with each of the following electrode placements: 1) lumbosacral plexus/femoral triangle (LS), 2) femoral triangle/transverse distal quadriceps (F), and 3) transverse proximal/distal quadriceps muscle (Q). A two-way ANOVA with repeated measures, Neuman-Keuls, and tests of simple main effects were used to analyze the data. Significantly greater torques were produced during the MVlCs than during either type of electrically induced isometric torque output (p < 0.05). During ES, the maximally tolerable intensity level produced significantly greater torques than the comfortably tolerable intensity level (p < 0.05). The F and Q electrode placements produced similar torques, both significantly greater than the torque produced with the LS electrode placement (p < 0.05). The method to induce muscle tension (voluntary or electrically induced), the criteria defining the level of muscle tension (MVIC, maximally or comfortably tolerable ES), and the electrode placement (LS, F, or Q) affect knee extensor torques and should be considered when using ES and when interpreting ES studies. Although the ideal rehabilitation program typically includes voluntary exercise to provide overload, certain pathologies may contradict this choice. In its place, ES has the potential to minimize strength losses or create gains while offering joint protection. J Orthop Sports Phys Ther 1992;15(4):168-174.     

Whole-abdomen radiation therapy in ovarian carcinoma: its role as a salvage therapeutic modality

A significant proportion of patients with epithelial ovarian carcinoma eventually fail after initial responses to chemotherapy. Further treatment with chemotherapy consisting of either the same combination or second-line regimens has been ineffective in producing durable responses. Thus, between June 1983 and June 1987, thirty patients with epithelial ovarian carcinoma who failed one or more chemotherapeutic regimens were treated with whole-abdominopelvic-cavity radiation therapy. Prior to the radiation the amount of residual disease after debulking was noted to be microscopic in 16 patients and macroscopic in 14 patients. Radiation was delivered with an open-field technique that extended from the domes of the diaphragm to the obturator foramina. Doses of 2500 cGy were planned to the whole abdomen, with a boost of another 2500 cGy to the pelvic and or paraaortic nodes when indicated. Higher doses were delivered to the areas of gross disease in the pelvis. Only 2 patients were unable to complete the planned therapy. Another 26% of the patients required interruption of the therapy secondary to hematologic toxicity but eventually completed the treatment. With an overall median follow-up of 14 months, 56% of the patients remain alive. Two-year actuarial survival and recurrence-free survival rates are 47 and 32%, respectively. The survival and recurrence-free survival rates for the group with microscopic residual disease--61 and 33%, respectively--are better than those for the patients with macroscopic residual disease--36 and 18%. The abdominopelvic cavity was the first site of failure in all but one of the 17 patients who have failed. In spite of the higher doses, pelvic failure alone or as a component occurred in 54% of the patients. Small bowel obstruction necessitating surgical intervention as a complication of therapy was seen in 13% of the patients.     

The efficacy of postoperative ondansetron (Zofran) orally disintegrating tablets for preventing nausea and vomiting after acoustic neuroma surgery

Postoperative nausea and vomiting is a frequent complication of craniotomy. We evaluated the ability of intraoperative IV ondansetron followed by postoperative ondansetron in an orally disintegrating tablet formulation to reduce the frequency and severity of postoperative nausea and vomiting in a prospective, randomized, placebo-controlled double-blind trial of 60 patients undergoing acoustic neuroma resection. Each patient received intraoperative ondansetron (4 mg IV) or placebo 30 min before case end. Postoperatively, patients received ondansetron in an orally disintegrating tablet formulation (8 mg BID) or placebo twice a day for up to 72 h. Metoclopramide was available as rescue therapy for both groups. Severity of nausea (as measured on a 10-cm visual scale), number of emetic episodes, and requirement for rescue therapy were recorded. In the immediate postoperative period, nausea severity was less in patients treated with ondansetron than placebo (3.3 +/- 4.1 versus 7.3 +/- 4.2; P < 0.001) and fewer patients experienced vomiting (3 of 28 versus 11 of 32; chi2 P < 0.01). More patients required some form of rescue treatment in the placebo group on the first postoperative day (26 of 32 versus 16 of 28; chi2 P < 0.01). We conclude that after acoustic neuroma surgery IV ondansetron treatment prevents immediate postoperative nausea and vomiting. Postoperative treatment with ondansetron in an orally disintegrating tablet formulation was associated with less frequent rescue therapy as compared with placebo on the first postoperative day.     

Is pelvic irradiation necessary in stage III1A Hodgkin's disease?

Eighteen patients with pathologic Stage (PS) III1A Hodgkin's disease were treated with mantle and para-aortic field radiation therapy alone between 1973 and 1988. The median follow-up time is 84 months (range 20-174 months). The 5-year survival and relapse-free survival rates are 76 and 82%. Six patients had extensive splenic involvement or bulky mediastinal adenopathy, and three have relapsed and are dead of disease. Of the other 12 patients, only one has had recurrence of disease and died. Patients with PS III1A Hodgkin's disease are good candidates for mantle and para-aortic radiation therapy only, provided that they do not have extensive splenic involvement or large mediastinal adenopathy.     

A review of hypofractionated palliative radiotherapy

Radiotherapy commonly is employed to address symptoms in patients with symptoms caused by cancer. For this article, the authors reviewed data supporting the use of hypofractionated palliative radiotherapy. In addition to single-fraction treatment for painful bony metastasis, the available literature suggested that courses of 2 to 14 external-beam fractions may provide equivalent relief to longer course treatment in patients with a poor prognosis who have primary cancers of the lung, rectum, bladder, prostate, head and neck, spleen, and gynecologic system. Hypofractionated treatment delivers palliation that is time efficient, cost effective, and minimally toxic. Evidence suggests that the reluctance of radiation oncologists to provide single-fraction treatment acts as a barrier to referrals from palliative care professionals. Collaboration in education, research, and patient advocacy will advance the common objectives of the 2 specialties and lead to an appropriate increase in the use of palliative hypofractionated radiotherapy.