Segmental response of the lower esophageal sphincter to increased intragastric pressure

An important controversy exists concerning the adaptive capacity of the lower esophageal sphincter (LES) in response to increases in intragastric pressure. This capacity would characterize the LES as a dynamic element in preventing gastroesophageal reflux (GER). This physiological property was studied in 15 male cats using an experimental model in which the gastroesophageal antireflux barrier was generated eyclusively by the intrinsic tone of the LES. Under these conditions, the intragastric pressure (GP) and sphincter pressure (LESP) were measured by electromanometric procedures. When the gastric lumen was perfused with known volumes (25, 50, 75, 100, 125, 150 ml) of saline solution, increases in GP and LESP were observed. Both pressures increased slowly as the gastric volume rose, and when both values were equal, GER appeared. Studying the physiological properties of the LES by direct methods in this model, we conclude that (a) there is segmental pressure response of the LES when faced with direct opening stimulation such as an increase in GP; and (b) the increase in LES resting tone has a linear relation with the increase in GP.     

Indices of social risk among first attenders of an emergency mental health service in post-conflict East Timor: an exploratory investigation

OBJECTIVE: Little is known about the profile of patients treated in mental health services in low-income, post-conflict countries, especially in the post-emergency phase. We postulated that patients attending the first community mental health service in East Timor would be characterized not only by mental disturbance but by high levels of social vulnerability. METHOD: Drawing on existing methods and on consultations with East Timorese mental health staff, five social indicators were identified: dangerousness; inability to undertake life-sustaining self-care; bizarre behaviour; incapacitating distress; and social unmanageability. Adequate levels of interrater reliability (65-91%) were achieved in identifying these indicators from case notes. Forty-eight randomly selected case notes were analyzed to ascertain the prevalence of social risk factors as well as the referral source and broad diagnostic groupings. RESULTS: Major referral sources were the family, humanitarian agencies and the police. Twenty-nine percent met criteria for dangerousness; 42% for inability to undertake self-care; 58% for bizarre behaviour; 75% for distress; and 19% for unmanageability. Ninety-eight percent fulfilled at least one social indicator, with the modal score being 2. CONCLUSIONS: Although the approach to documentation and analysis was preliminary, the data suggest that a focus on social risk indicators may assist in determining those mentally disturbed persons in need of priority care in resource-poor post-conflict countries.     

Corneal graft after drug-induced toxic epidermal necrolysis (Lyell's disease)

Toxic epidermal necrolysis (TEN) is a clinical syndrome characterizedby extensive epidermal loss similar to that found in scalding. Drugsensitization is generally considered to be the mechanism leading tothis condition. Severe ocular manifestations are present in nearlyall patients.We report a case of TEN with severe ocular involvement, on whom twopenetrating keratoplasties were performed in the same eye.Although the prognosis of keratoplasty is reported to be poor whencicatricial changes are present, after the second graft, our patient'ssymptoms of pain decreased and her visual acuity from lightperception improved to 20/40. The graft remains transparant underimmunosuppressive therapy twenty-three months after surgery.     

New hypothesis for the origin of cranio-sacral motion

A new hypothesis for the origin of Cranio-Sacral Motion (CSM), has been formulated. Presently accepted concepts are called in to question based on biomechanical studies of cerebro-spinal fluid pulsation waves, neural envelopes and studies of those physiologic factors which influence vessel wall tonus. The difference between the rhythm of venomotion and the Cerebro-Spinal Fluid (CSF) is explained and a new hypothesis is put forwards. It is suggested that CSM is probably the expression of Local Venomotion (LVM) and not of CSF pulsations or the consequences of it. The function of ‘rigidity’ of the skull sutures is discussed, and finally, a suggestion is made for osteopathic normalization of skull bone restrictions, using the patient's respiration as a powerfull and well controlled means of treatment.     

AAOMPT clinical guidelines: A model for standardizing manipulation terminology in physical therapy practice

We propose describing a manipulative technique using 6 characteristics: Rate of force application: Describe the rate at which the force was applied. Location in range of available movement: Describe whether motion was intended to occur only at the beginning of the available range of movement, towards the middle of the available range of movement, or at the end point of the available range of movement. Direction of force: Describe the direction in which the therapist imparts the force. Target of force: Describe the location to which the therapist intended to apply the force. Relative structural movement: Describe which structure or region was intended to remain stable and which structure or region was intended to move, with the moving structure or region being named first and the stable segment named second, separated by the word "on." Patient position: Describe the position of the patient, for example, supine, prone, recumbent. This would include any premanipulative positioning of a region of the body, such as being positioned in rotation or side bending.