Survey of blindness and visual impairment in Bioko, Equatorial Guinea.

AIMS: This study was designed to estimate the prevalence of blindness and its main aetiologies in Bioko, an onchocerciasis endemic zone of Equatorial Guinea. METHODS: Random sampling was applied, proportionally to population distribution into urban or rural areas. All the subjects underwent a basic eye examination by trained nurses. In the presence of any ocular affection or a visual acuity of less than 0.3, the subject was visited by the ophthalmologist. This visit included direct and indirect ophthalmoscopy, anterior segment examination with a slit lamp, and intraocular pressure recording. Blindness and visual impairment were defined by using the WHO criteria. RESULTS: 3218 subjects were screened, with a mean age of 34.1 (SD 21.6) years, ranging from 1 month to 102 years (median 34 years). The overall prevalence of blindness was 3.2% (95% CI: 2.6% to 3.9%). Unilateral blindness was present in 4.2%. Visual impairment was diagnosed in 200 patients (6.8%). More than 20% of the acuities inferior to 0.7 improved when explored with a pinhole. The main causes of blindness were cataracts (61.3%); macular affection (25.3%), optic atrophy (16%), and glaucoma (13.3%). Ocular onchocerciasis was detected in 12 cases (0.4%). CONCLUSION: Ocular onchocerciasis was very uncommon in an area of high endemicity. Results also pointed at the lack of basic ophthalmologist eye care and optician resources in the island.

Intraoperative long-latency reflex activity in idiopathic scoliosis demonstrates abnormal central processing. A possible cause of idiopathic scoliosis.

Segmental reflex regulation in 37 patients with idiopathic scoliosis and 8 patients with nonidiopathic scoliosis was studied by recording evoked reflex muscle potentials from four muscle groups in each lower extremity during partial neuromuscular blockade. Effects on reflex activity mediated through descending systems arising in the brain stem were investigated by recording from proximal-distal and flexor-extensor muscles. Ipsilateral and contralateral long-latency complex polysynaptic activity was present in all 37 patients with idiopathic scoliosis. This reflex activity was absent in eight nonidiopathic scoliosis patients. Long-latency reflex activity may represent segmental disinhibition. The presence of long-latency reflex activity in patients with idiopathic scoliosis and the absence of this activity in nonidiopathic scoliosis patients with curves of equal magnitude demonstrates that the curve per se is not responsible for the activity. This would imply that abnormal reflex processing may play a role in the development of the spinal deformity in patients with idiopathic scoliosis.

Evaluation of intrapedicular screw position using intraoperative evoked electromyography.

STUDY DESIGN: This study analyzed the parameters needed for electrical stimulation of vertebral pedicle drill bits and screws. OBJECTIVES: The feasibility of using electrically evoked electromyography was studied. SUMMARY OF BACKGROUND DATA: Considerable potential for damage of adjacent nerve roots with incorrectly placed bits and screws exists with pedicular fixation of the lumbar spine. METHODS: Ninety-five drill bits, one hundred forty-four screws, and thirty-four exposed nerve roots were electrically stimulated in thirty-six patients. Simultaneous evoked electromyographic activity was recorded from four muscle groups in each lower extremity during partial neuromuscular blockade. RESULTS: A constant current threshold of 6 mA or less correlated with misplaced drill bits and screws that broached the cortex. Evoked electromyography was 93% sensitive whereas radiography was only 63% sensitive to detecting bits and screws that had broached the cortex. CONCLUSIONS: Evoked electromyography is a valuable sensitive adjunct to radiographic examination of pedicle drill bit and screw placement.

Intraoperative lower extremity reflex muscle activity as an adjunct to conventional somatosensory-evoked potentials and descending neurogenic monitoring in idiopathic scoliosis.

STUDY DESIGN: Lower extremity polysynaptic reflexes and descending neurogenic motor and ascending somatosensory activity were recorded. OBJECTIVE: Two cases are presented to illustrate the intraoperative use of lower extremity reflex recordings for detecting compromise of spinal cord function. SUMMARY OF BACKGROUND DATA: Lower extremity reflex processing can be used to measure integrated spinal cord activity, whereas descending neurogenic and ascending somatosensory potentials measure only long tract function. METHODS: Eight channels of lower extremity polysynaptic reflex activity were recorded simultaneously after unilateral lower extremity mixed nerve stimulation. Sequential descending neurogenic and ascending somatosensory activity was recorded simultaneously with reflex recordings. RESULTS: In these two patients with idiopathic scoliosis, intraoperative reflexes changed before descending neurogenic and before ascending somatosensory activity changed. High-amplitude synchronous persistent reflex activity correlated with a postoperative neurologic deficit. Low-amplitude asynchronous transient reflex activity was not associated with a postoperative neurologic deficit. CONCLUSION: Intraoperative lower extremity reflex changes are more sensitive to spinal cord compromise than are changes in long tract function. Lower extremity polysynaptic reflexes monitor the integrated activity of the spinal cord that is responsible for the control of complex motor behavior.

Electromyographic biofeedback and recovery of quadriceps femoris muscle function following anterior cruciate ligament reconstruction.

The purpose of this study was to compare the effects of biofeedback-facilitated exercise with exercise alone on the recovery rate of quadriceps femoris muscle function following anterior cruciate ligament (ACL) reconstruction. Functional measures included 1) a dynamometric test of quadriceps femoris muscle isometric peak torque during the 12th postoperative week and 2) the number of days post-operatively that a patient achieved full active extension of the knee. Twenty-two patients with acute ACL injury were randomly assigned to a Treatment (biofeedback) Group (n = 11) or a Control (nonfeedback) Group (n = 11) during the first therapy session one week after reconstructive surgery. After the patients had completed the 12-week exercise program, the quadriceps femoris muscle isometric peak torque in the operative limb was compared with that in the nonoperative limb at three angles (90 degrees, 60 degrees, and 45 degrees) of extension. An analysis of variance revealed significant differences between the Treatment and Control Groups at all three angles. Mean recovery time was calculated for each group, and a t test for independent samples indicated a significant difference between the groups. These results demonstrate that the addition of biofeedback to muscle strengthening exercises facilitates the rate of recovery of quadriceps femoris muscle function following ACL reconstruction.

Electrical stimulation versus electromyographic biofeedback in the recovery of quadriceps femoris muscle function following anterior cruciate ligament surgery.

Both electrical stimulation and electromyographic biofeedback have been shown to be more effective than voluntary isometric exercise alone in the recovery of quadriceps femoris muscle force following anterior cruciate ligament (ACL) reconstruction. In a comparison of these two modalities, 30 patients with ACL reconstruction were randomly assigned to either a group receiving electrical stimulation in conjunction with voluntary isometric exercise or a group receiving biofeedback in conjunction with voluntary isometric exercise. Following 6 weeks of a rehabilitative exercise protocol, the quadriceps femoris muscle isometric peak torque in the operative limb was compared with that in the nonoperative limb. A t test of independent samples indicated that the biofeedback group recovered a significantly greater percentage of their nonoperative limb's peak torque than did the electrical stimulation group. Measurements of active knee extension were taken at weeks 1, 2, 4, and 6 of the exercise program. A two-way analysis of variance (groups x weeks) indicated no significant difference between the rate at which each group recovered full active extension. The authors concluded that biofeedback is more effective than electrical stimulation in facilitating the recovery of peak torque and that biofeedback is comparable to electrical stimulation in the recovery of active knee extension.

Subjective evaluation of function following moderately accelerated rehabilitation of anterior cruciate ligament reconstructed knees.

Rehabilitation protocols following anterior cruciate ligament reconstructions have become increasingly aggressive in the past several years, preparing the patient to return to sport activities within 4 to 6 months. In 1989, we initiated a moderately accelerated protocol and were interested in the long-term effects of early weight bearing, immediate full motion, early incorporation of closed chain activities, and early return to sport. We received responses from 58 of 180 patients surveyed. All had undergone a bone-patellar tendon-bone autograft reconstruction procedure 12 to 21 months prior and had followed the rehabilitation protocol described. Results of the Lysholm Knee Scoring Scale and a questionnaire regarding preinjury and postinjury activity levels, pain and stability ratings, and current activity indicated that the majority of these patients had returned to sport and recreation and were participating at levels of moderate to high intensity with little or no difficulty.

TCI left ventricular assist device: nursing implications.

The use of left ventricular devices as a bridge to transplantation has gained considerable acceptance in transplant centers nationwide. A new, innovative assist device that allows for greater patient mobility with a decreased incidence of patient complications is now being used at St. Luke's Episcopal Hospital to support the potential transplant recipient while waiting for a donor heart. The authors discuss the pathophysiology related to this type of assist device, along with two case studies and the nursing diagnoses indicated for patients using this unique device as a bridge to transplant.

Activity-based costing management in a private practice setting.

Activity-based costing is a method of calculating cost of a service, focusing on operations. It gives quick and tangible cost information to operations and financial managers. While this method has be used more in the manufacturing area, it is gaining acceptance in the medical practice. This article describes activity-based costing and illustrates how to start utilizing it in a practice.

Clonal analysis of murine graft-vs-host disease. II. Leukokines that stimulate fibroblast proliferation and collagen synthesis in graft-vs. host disease.

T lymphocyte clones were established from mice with acute and chronic graft-vs-host disease (GVHD) [C57B6/6 (B6) mice transplanted i.v. with LP/J spleen cells] and immune mice (LP/J mice immunized intraperitoneally with B6 spleen cells). To determine the role of leukokines in the increased collagen production that characterizes chronic GVHD, the supernatants of in vitro stimulated clones were assayed for their effect on 1) B6 embryonic fibroblast proliferation, 2) total fibroblast collagen secretion, and 3) collagen secretion per fibroblast. Four of nine chronic GVHD (CG) clones stimulated both total collagen secretion and collagen secretion per fibroblast, but none stimulated fibroblast proliferation. Six of 10 immune (I) clones stimulated fibroblast proliferation, and none stimulated collagen secretion per fibroblast. Acute GVHD (G) clones were heterogeneous; 2/10 G clones stimulated fibroblast proliferation, 5/10 stimulated total collagen secretion, and 4/10 stimulated collagen secretion per fibroblast. I and CG clones may act synergistically in vivo. The presence of CG-like clones in mice with acute GVHD suggest that the immunologic events that culminate in chronic GVHD are initiated early after transplantation.

The implications of domestic violence for home care providers.

The effects of domestic violence are revealed in shelters for battered women, but with more emphasis on prevention, cues to violence may first be detected in home settings. The most common injury sites involve the upper body. Based on a 2-year record (N = 153) review at a shelter for battered women, prevalence of injuries, health conditions and substance use were examined. Most women (82%) reported injuries, and most had past injuries severe enough to require surgery or hospitalization. This article educates home care providers about the types of abuse they are likely to find in women from violent homes and their health implications.