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Objective: To compare the pattern of pelvic girdle muscle activation in normal subjects and hemiparetic patients while stepping and maintaining standing balance.Design: Group comparison.Method: Seventeen patients who had regained the ability to walk after a single hemiparetic stroke were studied together with 16 normal controls. Median interval between stroke and testing was 17 months. Amplitude and onset latency of surface EMG activity in hip abductors and adductors were recorded in response to sideways pushes in either direction while standing. Similar recordings were made in the same subjects during gait initiation and a single stride.Results: In the standing balance task, normal subjects resisted a sideways push to the left with the left gluteus medius (74 ms) and with the right adductor (111 ms), and vice versa. In hemiparetic patients, the amplitude of activity was reduced in the hemiparetic muscles, the onset latencies of which were delayed (gluteus medius 96 ms, adductor 144 ms). Contralateral, non-paretic, adductor activity was increased after a push towards the hemiparetic side of patients with stroke and the latency was normal (110 ms). During self initiated sideways weight shifts at gait initiation, hemiplegic muscle activation was impaired. By contrast, the pattern and peak amplitude of hip muscle activation in stepping was normal in both hemiparetic and non-hemiparetic muscles of the subjects with stroke.Conclusions: In ambulant patients with stroke, a normal pattern of activation of hemiparetic muscles is seen in stepping whereas the response of these muscles to a perturbation while standing remains grossly impaired and is compensated by increased activity of the contralateral muscles. This suggests that hemiparetic patients should be able to step before regaining standing balance. [ABSTRACT FROM AUTHOR]

Intracompartmental pressure monitoring remains the primary method of diagnosing chronic compartment syndrome. MIBI perfusion imaging is widely available and offers a radionuclear imaging technique for diagnosing this condition. Although the results are not identical with those from pressure monitoring, MIBI may offer a useful screening test for this condition. [ABSTRACT FROM AUTHOR]

Elbow movement during voluntary positioning of the hand (with the arm supported against gravity) is described in a longitudinal study of five patients recovering from hemiplegia due to stroke. Over a twelve month period, four of the patients improved their speed of movement, three exhibiting slightly better recovery of elbow extension, one of flexion. In some instances co-contraction of the elbow agonist and antagonist (measured just before the onset of movement) decreased with time after stroke. The effects of contrasting movements at the shoulder on elbow movement were also studied. Estimates of recovery were generally similar whether patients kept the shoulder still or made movements that were synergic or counter-synergic to those of the elbow. [ABSTRACT FROM AUTHOR]

Epidermal growth factor (EGF), present in saliva and gastric juice, is a potent mitogen and an important element of mucosal defence. Changes in salivary and gastric juice epidermal growth factor in response to non-steroidal anti-inflammatory drug (NSAIDs) ingestion were measured to assess the role of EGF in gastric mucosal adaptation to NSAIDs. Patients with arthritis underwent endoscopy with collection of saliva and gastric juice for EGF measurement, before and two weeks after continuous NSAID ingestion. During this period patients also received either the prostaglandin analogue misoprostol or placebo in addition to their NSAID. In the misoprostol group (n = 5) there was no observed mucosal damage and no change in either salivary or gastric juice EGF. In the placebo group (n = 10) three patients developed erosions. Salivary EGF did not change (mean (SEM) 3.02 (0.54) ng/ml v 2.80 (0.41) ng/ml) but gastric juice EGF increased from 0.42 (0.12) ng/ml to 0.69 (0.14) ng/ml (p < 0.05). This increased EGF could contribute to the increased cellular proliferation observed during NSAID ingestion and may represent an important mechanism underlying gastric mucosal adaptation. [ABSTRACT FROM PUBLISHER]

Seventeen patients with intractable sciatica due to prolapse of a lumbar disc, treated by intradiscal injection of chymopapain (chemonucleolysis) were studied. Analysis of serial 24 hour urine collections showed a significant increase in urinary glycosaminoglycan after chemonucleolysis. This was not detected in four patients undergoing routine discography. Enzymic analysis of urinary glycosaminoglycan after chemonucleolysis suggested that the increase in levels was largely due to an increase in the amounts of chondroitin sulphate present, probably resulting from proteoglycan breakdown in the intervertebral disc. Eight of the patients treated by chemonucleolysis underwent serial computed tomography (CT). One month after the injection the only change seen was a loss of definition of the disc prolapse, which could be interpreted as a loss of turgidity in the disc as a result of proteoglycan breakdown by chymopapain. By six months the CT of those patients whose symptoms had improved showed that the degree of disc prolapse was usually less marked and the disc margin more clearly defined, suggesting that by this stage anatomical remodelling had occurred. [ABSTRACT FROM PUBLISHER]