To investigate whether the noninvasive determination of transcutaneous oxygen tension (TcO2) can be used to evaluate the degree of hemiplegia, we measured TcO2 before and after a 2-mo rehabilitation course in 12 patients with hemiplegia caused by cerebrovascular diseases. All patients with no evidence of heart failure (ejection fraction evaluated by echocardiogram: 68.7 +/- 6.4%) began to receive conventional physical therapy a few days after the onset of stroke. The measurement of TcO2 was performed at 9:00 a.m. with an electrode placed on the skin surface of the flexion side of the forearm 5 cm distal to the elbow. Before rehabilitation, the difference in TcO2 between the paralyzed and healthy upper limbs ((delta)TcO2) in patients at Brunnstrom's stage V was significantly lower than that in patients at stages II, III, and IV (P < 0.05, P <0.01, and P < 0.01, respectively). After rehabilitation, (delta)TcO2 in patients at Brunnstrom's stage V was significantly lower than that in patients at stage III(P < 0.05). The (delta)TcO2 in the patients with severe hemiplegia was larger than that in patients with slight hemiplegia. In addition, TcO2 at the paralyzed upper limb increased significantly after rehabilitation (before 62.7 +/- 10.5 mm Hg; after 71.9 +/- 9.0 mm Hg; P < 0.05), although arterial blood oxygen tension (PaO2) did not. Therefore, the TcO2 determination may be useful in assessing the degree of hemiplegia in upper limbs.

Aged↗

PubMedDate not supplied

Effective physical therapy for chronic obstructive pulmonary disease. Pilot study of exercise in hot spring water.

Respiratory function and arterial blood gas were examined before and after a two-month exercise program performed in a pool filled with hot spring water in 22 patients (70.9 +/- 9.1 years of age) with stable chronic obstructive pulmonary disease (12 cases of bronchial asthma and 10 cases of pulmonary emphysema) treated at our hospital between 1991 and 1994. The ratio of forced expired volume in one second to forced vital capacity (FEV1%) was significantly increased after the exercise program (P < 0.05), whereas the ratio of forced vital capacity to predicted normal value (%FVC) did not change. In addition, a tendency toward an increase in peak flow without an increase in maximum expiratory flow at 25 and 50% (V25 and V50) was observed. Although PaO2 was not increased, PaCO2 was selectively decreased by the exercise program (P < 0.05). The changes in respiratory function and arterial blood gas were considered attributable to respiratory muscle training and small airway clearance. Exercise in a pool filled with hot spring water may be useful in treating chronic obstructive pulmonary disease.

Aged↗

PubMedDate not supplied

Motor aphasia due to prolonged hypoglycaemic coma in a patient with insulin-dependent diabetes mellitus.

A 45-year-old insulin-dependent diabetic man was in a hypoglycaemic coma for one month but recovered after continuous infusion of glucose and insulin. An isolated neurological deficit, motor aphasia, persisted after recovery from the coma. Repeated computerized tomography did not demonstrate any abnormal findings attributable to coma or aphasia. Precise follow-up examinations of aphasia showed improvement of Broca type motor aphasia to transcortical motor aphasia. Hypoglycaemic aphasia in a patient after recovery from prolonged coma is rare and its clinical course and pathogenesis are discussed with reference to the available literature.

Aphasia, Broca↗

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Cerebral haemorrhage complicating adult-onset Still's disease: a case report.

The case of a 75-year-old Japanese woman with adult-onset Still's disease who presented with cerebral haemorrhage is described. She had been in clinical remission for 2 years, after induction therapy including non-steroidal anti-inflammatory drugs, prednisolone, cyclophosphamide and mizoribine followed by auranofin, until her cerebral haemorrhage occurred, although her serum level of ferritin had gradually increased. After the onset of cerebral haemorrhage, the patient's serum level of thrombomodulin was elevated although c-reactive protein and lactate dehydrogenase were not increased. Anti-cardiolipin antibody and lupus anti-coagulant were not detected. Patients with adult-onset Still's disease are rarely reported to develop cerebral vascular disease, possibly because the disease is most frequent in young adults. The cerebral haemorrhage may have been caused by the vasculitis due to Still's disease.

Adult↗

PubMedDate not supplied

Correlation between the depth of inverted T waves and the serum level of ferritin in a deferoxamine-treated patient with primary hemochromatosis and hyperthyroidism.

A 74-year-old female having primary hemochromatosis and hyperthyroidism is described. The initial ECG showed sinus rhythm, and depression of ST segment and inversion of T waves in I, II, III, aVF, and V4-6. By deferoxamine and propylthiouracil, the serum level of ferritin was decreased from 4,500 ng/ml to 440 ng/ml in a period of 6 months. The thyroid function was also returned to normal. After cessation of both drugs, the serum ferritin level increased gradually reaching a level of 3,100 ng/ml in the next 15 months but the thyroid function remained normal. During and after the deferoxamine administration, the depth of inverted T waves became more shallow and gradually deeper again, respectively. There seemed to be a correlation between the depth of inverted T waves and the serum level of ferritin. It was, however, unlikely that toxic iron may have induced the hyperfunction of the thyroid gland.

Aged↗

PubMedDate not supplied

Electron microscopic analysis of myeloma cells in relation to drug response and prognosis.

Myeloma cells obtained from 33 patients were analyzed by electron microscopy to determine whether there is any correlation among ultrastructural characteristics of myeloma cells, drug response, and prognosis. The median survival time after diagnosis of responders (18 cases) and nonresponders (15 cases) was more than 423 days and 139 days, respectively. Nuclear immaturity and three cytoplasmic abnormalities--scattered pattern of mitochondria, single-sac looplike structures, and numerous intramitochondrial granules--were found to be associated with poor outcome. Although the cytoplasm of almost all the myeloma cells examined was judged to be mature or intermediate, the degree of nuclear immaturity was considered to correspond closely to the grade of nuclear-cytoplasmic asynchrony. Thus the electron microscopic examination of myeloma cells is of use to assess accurately their immaturity and abnormality and might provide clues for the prediction of drug response and prognosis of individual patients.

Female↗

PubMedDate not supplied

Effects of hyperthermal stress on the fibrinolytic system.

The effects of hyperthermal stress on the coagulation and fibrinolytic systems were examined in five healthy subjects who took a 3-min 47 degrees C hot-spring bath. After a 3-min 47 degrees C bath, the sublingual temperature was transiently increased about 1.8 degrees C, returning to the baseline level within 60 min. The plasma level of plasminogen activator inhibitor-1 antigen (PAI-1) was transiently increased 15 min after the start of bathing and returned to the pre-bathing level 360 min later. The plasma levels of tissue plasminogen activator antigen, alpha 2 plasmin inhibitor activity, plasmin-antiplasmin complex, thrombin-antithrombin III complex, and thrombomodulin antigen were not influenced by the bath. The in vivo result correlated well with the in vitro result that PAI-1 was released from cultured endothelial cells by heating. These findings suggest that the increase in plasma PAI-1 level may be due to the direct hyperthermal action of the very hot hot-spring bath on the endothelial cells and that acute hyperthermal stress may decrease the fibrinolytic capacity, leading to the occurrence of thrombotic events.

Adult↗

PubMedDate not supplied

Is the circadian change in hematocrit and blood viscosity a factor triggering cerebral and myocardial infarction?

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Adult↗