Making good use of a sabbatical.
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Anecdotes as Topic↗
Biomedical subjects
J C Brand
Publications and source records attributed to J C Brand.
Radiographic analysis of femoral tunnel position in anterior cruciate ligament reconstruction.
Successful reconstruction of the anterior cruciate ligament (ACL) depends on anatomic placement of a graft ligament substitute. This study examined the accuracy of a plain radiograph in determining femoral tunnel position during ACL reconstruction. Nine cadaveric distal femurs had six separate tunnels made in each specimen: 12:00 (high position), 1:30 (anatomic position), and 3:00 (low position) in the left femora and 12:00 (high), 10:30 (anatomic), and 9:00 (low) in the right femora. At each position on the clock face, two 9-mm tunnels were drilled, leaving 2 mm (correct) and 12 mm (incorrect) of posterior wall intact. With a radiopaque tunnel dilator in each tunnel, a true lateral radiograph, a 10 degree externally rotated lateral radiograph, and a 10 degree internally rotated lateral radiograph were obtained. All radiographs were analyzed for femoral tunnel placement in the anteroposterior plane with the four-quadrant method described by Harner et al and the ratio method described by Aglietti et al. Statistically significant differences could only be distinguished between anatomic (10:30), anterior (12-mm rim), and posterior (2-mm rim) positions. There were no statistically significant differences for any of the other positions when comparing true laterals to true laterals, true laterals to internal or external oblique views, or when comparing internal and external oblique views. A malpositioned anterior tunnel (12-mm rim posterior), which was "low" at 9:00 or "high" at 12:00 in the notch (malplaced), could not be distinguished reliably from an anatomically correct placed tunnel with a single-plane lateral radiograph.
Analysis of Variance↗
Does pulsed low intensity ultrasound allow early return to normal activities when treating stress fractures? A review of one tarsal navicular and eight tibial stress fractures.
We sought to evaluate the efficacy of daily pulsed low intensity ultrasound (LIUS) with early return to activities for the treatment of lower extremity stress fractures. Eight patients (2 males, 6 females) with radiographic and bone scan confirmed tibial stress fractures participated in this study. Additionally, a case report of a tarsal navicular stress fracture is described. All patients except one were involved in athletics. Prior to the study, subjects completed a 5 question, 10 cm visual analog scale (VAS) regarding pain level (10 = extreme pain, 1 = no pain) and were assessed for functional performance. Subjects received 20-minute LIUS treatments 5 times a week for 4 weeks. Subjects maintained all functional activities during the treatment period. Seven patients with posterior-medial stress fractures participated without a brace. Subjects were re-tested after 4 weeks of treatment. Mann-Whitney U tests (VAS data) and paired t-tests (functional tests) assessed statistical significance (p<0.05). Although the intensity of practice was diminished in some instances, no time off from competitive sports was prescribed for the patients with the tibial stress fractures. The patient with the anterior tibial stress fracture underwent tibial intramedullary nailing at the conclusion of a season of play. In this uncontrolled experience, treatment of tibial stress fractures with daily pulsed LIUS was effective in pain relief and early return to vigorous activity without bracing for the patients with posterior-medial stress fractures.
Basketball↗
Carbohydrate feeding before exercise: effect of glycemic index.
Low glycemic index (GI) foods may confer an advantage when eaten before prolonged strenuous exercise by providing a slow-release source of glucose to the blood without an accompanying insulin surge. To test this hypothesis, eight trained cyclists pedalled to exhaustion one hour after ingestion of equal carbohydrate portions of four test meals: lentils, a low GI food (LGI); potato, a high GI food (HGI), and glucose and water. Plasma glucose and insulin levels were lower after LGI than after HGI from 30 to 60 min after ingestion (p less than 0.05). Plasma free fatty acid (FFA) levels were highest after water (p less than 0.05) followed by LGI and then glucose and HGI. From 45 to 60 min after ingestion, plasma lactate was higher in the HGI trial than in the LGI trial (p less than 0.05) and remained higher throughout the period of exercise. The rank order from lowest to highest for total carbohydrate oxidation during exercise was water, lentils, glucose and potato. Endurance time was 20 min longer after LGI than after HGI (p less than 0.05). These findings suggest that a low GI pre-game meal may prolong endurance during strenuous exercise by inducing less post-prandial hyperglycemia and hyperinsulinemia, lower levels of plasma lactate before and during exercise, and by maintaining plasma glucose and FFA at higher levels during critical periods of exercise.
Analysis of Variance↗
Relative effectiveness of milks with reduced amounts of lactose in alleviating milk intolerance.
The relative effectiveness of five milk products with various levels of lactose reduction [0%, 50%, 80% (#1), 80% (#2), and 95%] was evaluated in six subjects with lactose malabsorption. Breath hydrogen was measured for 4 h after consumption of 300 mL of each product in a single-blind, randomized design. The mean +/- SEM maximum breath-hydrogen rise (ppm) after the 0%, 50%, 80% (#1), 80% (#2), and 95% lactose-reduced (LR) milks was 31 +/- 6, 7 +/- 3, 5 +/- 3, 5 +/- 2, and 8 +/- 3, respectively. The difference between whole milk and the LR milks was statistically significant (P less than 0.05) but there was no difference between any of the LR milks. Whole milk provoked symptoms in most subjects whereas 95% LR milk produced none. Only one of six subjects reacted to the 50% and 80% LR milks. The results suggest that a 50% level of lactose reduction in milk may be adequate to relieve the signs and symptoms of milk intolerance in the majority of healthy adults with lactose malabsorption.
Adult↗
Rupture of the flexor hallucis longus after hallux valgus surgery: case report and comments on technique for adductor release.
A case of flexor hallucis longus (FHL) rupture following hallux valgus surgery is reported here. The authors conjecture that the FHL rupture was caused by a partial laceration of the FHL at the time of the surgical hallux valgus correction. The authors treated the painful problem by surgically debriding the distal stump of the FHL from under the first metatarsophalangeal joint (MP) and tenodesing that the proximal stump to the flexor digitorum longus (FDL). The authors describe a technique that minimizes the complications of an adductor tenotomy associated with a distal chevron type of hallux valgus correction.
Adult↗
Low-glycemic index foods improve long-term glycemic control in NIDDM.
OBJECTIVE: To compare high- and low-glycemic index (GI) diets in the treatment of non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS: Sixteen subjects with well-controlled NIDDM and normal lipid profile, 10 of whom continued oral hypoglycemic medication, participated in the study. A diet that emphasized low-GI foods (e.g., porridge, pasta) was compared with a high-GI diet (e.g., processed cereals, potatoes). The GI of the low-GI diet was 15% lower than the high-GI diet (77 +/- 3 vs. 91 +/- 1) but otherwise similar in macronutrient composition and fiber, as determined by a 4-day weighed record. The diets were instituted under instruction from a dietitian who visited subjects at home on a weekly basis. Body weight was maintained within 1-2 kg. RESULTS: Glycemic control was improved on the low-GI diet compared with the high-GI diet (statistically significant findings, P less than 0.05). Mean glycosylated hemoglobin at the end of the low-GI diet was 11% lower (7.0 +/- 0.3%) than at the end of the high-GI diet (7.9 +/- 0.5%), and the 8-h plasma glucose profile was lower (area under the curve above fasting 128 +/- 23 vs. 148 +/- 22 mmol.h-1.L-1, respectively). Mean fasting plasma glucose, total cholesterol triglycerides, and lipoproteins did not show important differences. CONCLUSIONS: A low-GI diet gives a modest improvement in long-term glycemic control but not plasma lipids in normolipidemic well-controlled subjects with NIDDM.
Blood Glucose↗
Composition of the subsistence foods of the Wopkaimin people of Papua New Guinea.
Forty-four samples of food, representing 35 species of animals and plants consumed by the Wopkaimin people of highland Papua New Guinea, were analyzed for their nutrient composition, many for the first time. Moisture, protein, fat and minerals (Na, K, Mg, Ca, Fe, Zn, Cu) were assayed directly. Energy and total carbohydrate content were calculated. The animal foods were high in protein, Fe and Zn. Ca was very high (greater than 1000mg/100g) in birds, frogs and fish containing soft edible bones. Leafy vegetables were relatively high in protein, iron and calcium. The five samples of taro (Colocasia esculenta) showed wide variation in composition. The results provide further information on the nutritional value of Papua New Guinean foods.
Food Analysis↗
Bilateral unicameral bone cysts in the hamate bones.
This is a case report of bilateral unicameral bone cysts located in the hamate bones of a 22-year-old man. Unicameral bone cysts are rarely seen in the bones of the hand or bilaterally. In this case the diagnosis was made clinically using both radiographic and magnetic resonance imaging studies, and verified by microscopy of the biopsied specimen. Treatment consisted of curettage, autogenous bone grafting, and immobilization. To our knowledge there has not been any record in the literature of symmetrical unicameral bone cysts in the carpal bones.
Adult↗
Effect of yeast lactase enzyme on "colic" in infants fed human milk.
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Breast Feeding↗
Plasma glucose and insulin responses to traditional Pima Indian meals.
The in vivo glycemic and insulin responses and in vitro starch digestibility were determined for six staple foods (corn, lima beans, white and yellow teparies, mesquite, and acorns) traditionally consumed by Pima Indians. Equivalent carbohydrate portions (25 g) of the foods were fed to eight healthy Caucasian volunteers. The calculated glycemic indices (GIs) (mean +/- SEM with glucose as the standard) were all low, ranging from 16 +/- 2 for acorns to 40 +/- 5 for corn. Insulin responses and in vitro starch digestibilities correlated with the GI. These results provide further support for the hypothesis that the slow digestion and absorption of starch in traditional foods was a factor that helped protect susceptible populations from developing diabetes.
Arizona↗
Breath hydrogen excretion in infants with colic.
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Breath Tests↗
Breath hydrogen excretion in infants with colic.
Breath hydrogen excretion as an index of incomplete lactose absorption was measured in 118 healthy infants who were either breast fed or given a formula feed containing lactose, some of whom had colic. Infants with colic (n = 65) were selected on the basis of the mother's report of a history of inconsolable crying lasting several hours each day. Infants in the control group (n = 53) were not reported to cry excessively by their mothers. Breath samples were collected using a face mask sampling device preprandially, and 90 and 150 minutes after the start of a feed. Normalised breath hydrogen concentrations were higher in the group with colic than in the control group at each time point. The median maximum breath hydrogen concentration in the colic group was 29 ppm, and in the control group 11 ppm. The percentage of infants with incomplete lactose absorption (breath hydrogen concentration more than 20 ppm) in the colic group was 62% compared with 32% in the control group. The clinical importance of the observed association between increased breath hydrogen excretion and infantile colic remains to be determined. Increased breath hydrogen excretion indicative of incomplete lactose absorption may be either a cause or an effect of colic in infants.
Breast Feeding↗
Application of glycemic index to mixed meals.
Plasma glucose and insulin responses to six different meals were determined and compared with values predicted by published glycemic indices of the component foods. The test meals were of different ethnic origins: Indian (lentil curry with rice), Italian (spaghetti bolognaise), Chinese (stir-fried vegetables and chicken with rice), Greek (lentil stew), Western (sirloin chop and vegetables); and Lebanese (sandwich with unleavened bread and hummos). Eight healthy volunteers were given 50 g carbohydrate portions of the above meals after an overnight fast. The glycemic and insulin indices were highest for the Lebanese meal and lowest for the Greek with significant differences among the meals (ANOVA, p less than 0.05). The observed glycemic indices correlated well with the predicted glycemic indices (r = 0.88, p less than 0.01) and insulin responses parallelled the glycemic responses (r = 0.83, p less than 0.05). These results suggest that the glycemic index approach will be useful in planning diets for diabetic people.
Adult↗
Food service departments in New South Wales--a survey.
A survey of all food service departments in NSW hospitals was carried out using a mailed questionnaire. The response rate was 74%. The result reveal that in almost half of the hospitals the head of department had no formal qualifications. Few hospitals used cook-chill or cook-freeze catering systems; the great majority used conventional food production and plated patients meals in a central kitchen location. A significant proportion of hospitals dis not satisfy the Australian Council on Hospital Standards recommendations regarding meal times. In general private hospitals had fewer special diet patients and did not provide food for Meals-on-Wheels. Recommendations are made for the improvement of hospital food service operations.
Food Handling↗
Slowly digested and absorbed carbohydrate in traditional bushfoods: a protective factor against diabetes?
The aim of this study was to compare the digestibility and metabolic responses of western foods with traditional staples of two populations that show a susceptibility to diabetes, namely Australian Aborigines and Pacific islanders. Rate of starch digestion was studied in vitro in 37 foods (20 Australian Aboriginal bushfoods, 10 Pacific island foods, and 7 western foods), and rate of absorption of 9 foods (8 bushfoods and 1 western food) was studied in human volunteers. In vitro studies showed that 23 of 30 traditional foods were digested more slowly than 7 western foods. Six of 8 bushfoods produced significantly smaller areas under 3-h postprandial plasma glucose curves than potatoes in seven healthy Caucasian volunteers. There was a good correlation between starch digestibility and plasma glucose response. Our findings are consistent with the hypothesis that carbohydrate in traditional diets is slowly digested and absorbed and may once have been protective against diabetes.
Australia↗
Plasma glucose and insulin responses to starchy foods in Australian aborigines: a population now at high risk of diabetes.
We compared plasma glucose and insulin responses to an Aboriginal bushfood and its western equivalent in healthy Aborigines and Caucasians. Bush potato (Ipomoea costata), an Aboriginal bushfood which is slowly digested in vitro, and potato (Solanum tuberosum), which has a high glycemic index, were studied. The areas under the glucose and insulin curves for Aborigines were 34% and 42% smaller, respectively, after bush potato than after potato (p less than 0.05). In Caucasians only the insulin response to bush potato was lower (by 19%) than that to potato (p less than 0.05). Compared with Caucasians, Aborigines produced 2.5 times greater glucose and insulin responses to potato (p less than 0.025). Their insulin responses to bush potato were also twice as large (p less than 0.05) although glucose responses were not significantly different. These findings add weight to the hypothesis that rapidly digested carbohydrate in western diets may be one of the factors in the lifestyle change which precipitates diabetes in indigenous populations.
Adult↗
Glycemic index of processed wheat products.
Our aim was to determine the in vivo glycemic and insulin responses and in vitro starch digestibility of seven processed wheat products (shortbread biscuits, custard, quick-cooking wheat, wholemeal bread, water biscuits, puffed wheat, and puffed crispbread). The degree of starch gelatinization in the foods was measured. Fifty-gram carbohydrate portions of the foods were fed to eight volunteers after an overnight fast. The calculated glycemic indices (GI) (mean +/- SEM) ranged from 43 +/- 10 for custard to 81 +/- 9 for puffed crispbread. Insulin responses paralleled the glycemic responses. The GI correlated positively with the percentage of starch digested in vitro (p less than 0.05). The degree of starch gelatinization ranged from 0.4 to 60% and correlated positively with the percentage starch digested in vitro (p less than 0.05). Differences in the glycemic and insulin responses to wheat products may be explained in part by the extent of processing and the degree of gelatinization achieved.
Blood Glucose↗