Regular physical activity reduces the effects of Achilles tendon vibration on postural control for older women.

The aim was to determine in what extent physical activity influences postural control when visual, vestibular, and/or proprioceptive systems are disrupted. Two groups of healthy older women: an active group (74.0 ± 3.8 years) who practiced physical activities and a sedentary group (74.7 ± 6.3 years) who did not, underwent 12 postural conditions consisted in altering information emanating from sensory systems by means of sensory manipulations (i.e., eyes closed, cervical collar, tendon vibration, electromyostimulation, galvanic vestibular stimulation, foam surface). The center of foot pressure velocity was recorded on a force platform. Results indicate that the sensory manipulations altered postural control. The sedentary group was more disturbed than the active group by the use of tendon vibration. There was no clear difference between the two groups in the other conditions. This study suggests that the practice of physical activities is beneficial as a means of limiting the effects of tendon vibration on postural control through a better use of the not manipulated sensory systems and/or a more efficient reweighting to proprioceptive information from regions unaffected by the tendon vibration.

Impaired skeletal muscle endurance related to physical inactivity and altered lung function in COPD patients.

STUDY OBJECTIVE: The aims of this work were to determine (1) whether patients with COPD have impaired skeletal muscle performance (ie, maximal strength and endurance) compared with healthy subjects, and (2) whether the level of physical activity, body composition, and lung function are related to skeletal muscle performance in COPD patients. METHODS: Seventeen COPD patients and eight healthy age-matched control subjects performed maximum voluntary contraction (MVC) of the quadriceps and an endurance test consisting of dynamic contractions of the quadriceps against 20% of MVC at an imposed regular pace until exhaustion. The endurance test duration determined the muscle "limit time" (Tlim). A score of physical activity (PA score) was obtained using an adapted physical activity questionnaire for the elderly, and body composition was measured by the bioelectrical impedance method. Symptom-limited oxygen uptake (VO2 sl) was also assessed in COPD patients using a maximal incremental exercise test. RESULTS: The results showed that Tlim and PA score were significantly decreased in COPD patients (p<0.05). Significant positive correlations were found in the COPD group between Tlim and the PA score (r=0.60; p<0.05), FEV1 (r=0.52; p<0.05), and PaO2 (r=0.63; p<0.05). The same results were found between the PA score and VO2 sl (r=0.57; p<0.05) and FEV1 (r=0.63; p<0.05). CONCLUSION: These findings indicate impaired skeletal muscle endurance in COPD patients related to altered lung function and associated physical inactivity.

Skeletal muscle abnormalities in patients with COPD: contribution to exercise intolerance.

Exercise intolerance in COPD patients appears to be in part because of skeletal muscle dysfunction. Studies using biopsy techniques and magnetic resonance spectroscopy have demonstrated changes in enzyme activities and metabolism that indicate reduced oxidative capacity in the peripheral muscles of these patients. Regarding the respiratory muscles, the biochemical characteristics have been studied in only a few works and the results seem to depend on the specific muscle group studied. Several factors, such as hypoxemia, nutritional status, pharmacological treatment, and deconditioning, may be responsible for these skeletal muscle abnormalities. This brief review describes the changes in peripheral and respiratory muscles in COPD patients based on data from the literature. The causes of these muscle abnormalities, their contribution to exercise intolerance, and the effects of training are then discussed. We conclude with suggested directions for future investigation using contemporary noninvasive technologies.

[Four "alien" hands for two hands after a lesion in corpus callosum]. / Quatre mains "étranges" pour deux mains après une lésion calleuse.

Callosal lesions, associated or not to internal frontal lesions, may produce different types of complex gestural behaviors. Four signs can be identified, each of which has been generally reported separately: the "alien hand" sign, the "diagnostic apraxia", the "wayward hand" and the "callosal apraxia". Some authors justify considering these signs as different entities, while others propose regrouping them either in an unique syndrome--the "alien hand"--or as two syndromes--the "frontal alien hand" and the "callosal alien hand". We present the observation of a patient who presented with the four mentioned syndromes in association. In this context, we review the clinical features of each of the four signs and the arguments supporting their individualization.

[Group B Streptococcus late-onset disease presenting as cellulitis-adenitis syndrome]. / Síndrome de celulitis-adenitis por estreptococo del grupo B como presentación de sepsis neonatal tardía.

Cellulitis-adenitis syndrome is a rare clinical manifestation of group B Streptococcus (GBS) late-onset disease. Its significance lies in the fact that local infection may be the only initial sign of systemic infection that is often concurrent with meningitis. Soft tissue involvement (cellulitis-adenitis) can sometimes be the only initial manifestation of GBS infection. We report four cases of GBS cellulitis-adenitis syndrome from different hospitals in Barcelona and Tarragona. We emphasize that early diagnosis and treatment may improve the potentially poor prognosis of these patients, and stress the need to rule out central nervous system involvement by studying cerebrospinal fluid.

[Assessment of withholding life support and withdrawing life support in a vital emergency department]. / Évaluation des démarches de limitation et d'arrêt de traitement en salle d'accueil des urgences vitales.

OBJECTIVES: To evaluate the practices of withholding and withdrawing of life sustaining therapies in a vital emergencies department and to confront them with Leonetti law procedures. STUDY DESIGN: Prospective, observational study. PATIENT AND METHODS: Collection of data performed by a physician (senior or junior) for all patients for whom a decision of withholding or withdrawing life sustaining treatments was taken. RESULTS: Fifty-two patients were included. A withholding life sustaining treatments as non aggressive resuscitation procedures were instituted for 65% of the patients, of whom 85% were "waiting resuscitation". In 50% of the cases, the decision was taken by a single physician. The approval of the nursing staff was researched in 65% of the cases. The decision was written in the medical file in 94% of the cases. The patient's will was researched in 15% of the cases. The family was consulted about patient's will in 10% of the cases. The family was informed of the decision in 90% of the cases. CONCLUSION: The application of Leonetti law in vital emergencies department is flawed. It appears to be necessary to realize new studies and to release official guidelines or recommendations specifically made for emergencies department to improve the practices of withholding or withdrawing life sustaining treatments.

Improved skeletal muscle performance after individualized exercise training in patients with chronic obstructive pulmonary disease.

BACKGROUND: In addition to the respiratory limitation in patients with chronic obstructive pulmonary disease (COPD), skeletal muscle abnormalities may occur and contribute to the exercise intolerance. This study assessed the ability of the skeletal muscle of patients with COPD to adapt to individualized exercise training at the gas exchange threshold (GET) METHODS: Fourteen patients (8 in a training group and 6 controls) performed the following exercise tests before and after a 3-week training period: an incremental exercise test, maximal voluntary contraction of the quadriceps, and three endurance tests consisting of dynamic contractions of the quadriceps until exhaustion. These endurance tests, characterized by three different power outputs, were used to determine muscle limit times and critical power. RESULTS: The results showed that training increased exercise tolerance (+11% for symptom limited peak oxygen consumption (VO2 sl], P < 0.05), maximum voluntary contraction (+8%, P < 0.05), limit times (from +45% to +161%, P < 0.05) and critical power (+39%, P < 0.05). CONCLUSIONS: These findings indicate greater muscle strength and endurance after training in COPD patients and suggest better muscular recruitment and improved oxidative capacity in the exercising muscles. The sharp differences in the magnitude of VO2 sl and limit times suggest that the kinetics of peripheral and central changes in response to training are different. In conclusion, peripheral muscle performance can be increased rapidly in response to an individualized training program at the GET in COPD patients.

Comparison of two training programmes in chronic airway limitation patients: standardized versus individualized protocols.

This study tested the effect of two methods of training, one individualized at the heart rate corresponding to the gas exchange threshold (GET) and the other at the heart rate corresponding to 50% of maximal heart rate reserve, on maximal and submaximal cardiorespiratory response in 24 patients with chronic airway limitation (CAL). The patients were randomly assigned to either the individualized training group (IT; n = 12) or the standardized training group (ST; n = 12). The training programme consisted of 4 weeks of stationary bicycle exercise, 5 days.week-1. Before reconditioning began, the target level based on heart rate was not significantly different between groups (109 +/- 4 versus 110 +/- 3 beats.min-1, in IT and ST, respectively). Post-training, a significant increase in symptom-limited oxygen uptake (V'O2.sl) and maximal O2 pulse was found in IT, whereas ST exhibited no significant change. In each group, GET was statistically increased in much the same way as V'O2,sl, with a higher increase in IT (p < 0.01) than ST (p < 0.05). Nevertheless, IT exhibited a concomitant and gradual decrease in minute ventilation (V'E), carbon dioxide production (V'CO2), and venous lactate concentration ([La]), whereas ST presented no significant change in these parameters (intergroup p < 0.01). Breathing pattern was also altered after IT, at the same metabolic level and at the same ventilation level (intergroup p < 0.05). Cardiac responses were modified in the two groups. At the same metabolic level, a significantly lower cardiac frequency was found both for IT and ST (intragroup p < 0.05 after training). In contrast, the increase in O2 pulse was only significantly higher in It after training. These data show the greater efficiency of an individualized training protocol based on determination of gas exchange threshold as compared to a standardized protocol, in improving exercise performance, when applied to a patient group. Despite an apparently similar target training level, the individualized method clearly optimized the physiological training effects in patients with chronic airway limitation and, more particularly, decreased their ventilatory requirement.

Síndrome de celulitis-adenitis por estreptococo del grupo B como presentación de sepsis neonatal tardía / Group B Streptococcus late-onset disease presenting as cellulitis-adenitis syndrome

El síndrome de celulitis-adenitis es una forma de presentación clínica poco frecuente de la sepsis neonatal tardía por estreptococo del grupo B. La principal importancia de esta entidad radica en el hecho que se trata de una manifestación local de un proceso infeccioso sistémico que con frecuencia afecta al sistema nervioso central (SNC). En ocasiones, la afectación de tejidos blandos (adenitis-celulitis) puede ser la única manifestación inicial de la dicha infección. Se presentan 4 casos de esta entidad en diferentes centros hospitalarios de Barcelona y Tarragona, con la intención de remarcar que el diagnóstico y el tratamiento precoces pueden mejorar el pronóstico potencialmente grave de estos pacientes, y se insiste en la necesidad de descartar una posible afectación del SNC mediante estudio del líquido cefalorraquídeo (AU)