Effect of 4-aminopyridine on gait in ambulatory spinal cord injuries: a double-blind, placebo-controlled, crossover trial.

UNLABELLED: Animal and human research have shown that the drug 4-aminopyridine (4-AP) may improve gait in spinal cord lesions by enhancing nerve transmission to affected muscles. STUDY DESIGN: Prospective, randomized, double-blind, placebo-controlled, crossover trial. OBJECTIVES: To determine the efficacy of 4-AP in improving lower limb muscle strength and biomechanical gait patterns of chronic spinal cord injuries (SCI). SETTING: The Rehabilitation Centre (Ottawa, Canada). METHODS: In all, 15 chronic, ambulatory SCI persons were randomized to an initial 2 weeks of 40 mg/day, oral medication of either placebo or immediate-release, 4-AP and subsequently crossed over to the alternate medication for the following 2 weeks. Evaluations were conducted at baseline (before starting 4-AP or placebo medication), 2 weeks, and 4 weeks. Measures included dynamometer lower limb isometric muscle force and biomechanical gait measures including temporal-spatial parameters, electromyographic activation patterns, joint kinematics and kinetics. Subjective impressions of the drug by the participants were obtained from an exit survey. RESULTS: Despite some positive comments from subjects, statistical and clinical analyses showed no within-subject differences between placebo and 4-AP measures of lower limb muscle force and objective gait analyses (ANOVA statistic P>0.05). CONCLUSION: Results demonstrated the importance of placebo-controlled trials and quantitative outcome measures for the evaluation of 4-AP aimed to enhance gait for chronic, ambulatory SCI persons. Energy expenditure measures and mood may relate more to subjective comments and is suggested for future investigations.

Electromyographic versus rhythmic positional biofeedback in computerized gait retraining with stroke patients.

This research provides a preliminary investigation of the relative efficacy of electromyographic (EMG) versus a novel biofeedback (BFB) approach to improve ankle control and functional gait in stroke patients. A computerized system was designed to provide audiovisual feedback of either muscle activity or ankle position during dorsiflexion and plantar flexion. The novel approach also included rhythmic pacing to emphasize the rapid timing of ankle motion necessary to switch from stance to swing during walking. Thirty-seven subjects were randomly assigned to one of the following groups: (1) no-treatment control, (2) EMG BFB, and (3) rhythmic positional BFB. Blind evaluations of ankle performance, gait, and perceived exertion were performed at regular intervals. Analyses of covariance revealed that subjects receiving rhythmic positional BFB significantly increased their walking speeds relative to other groups at posttest (p = .02) and at three-month follow-up (p = .035), without any increase in subjectively reported energy cost. The ability of positional BFB to emphasize the timing events during walking provided optimistic results for carry-over into gait functioning. The degree of sensorimotor recovery and time since onset of stroke were considered important factors in determining outcomes.

Transversalis fascia-Cooper ligament vs. ileopubic tract repair for medial inguinal hernia.

In a prospective randomized study of 171 patients, transversalis fascia-Cooper ligament (McVay) repair of medial inguinal hernia was compared with transversalis fascia-ileopubic tract (Ottsen) repair. After median follow-up of 5 years, the total recurrence rate was 9% (95% confidence interval 4-17) following McVay repair and 15% (9-25) following the Ottsen operation. The difference was not statistically significant, but the analysis showed that, whereas the recurrence rate associated with McVay herniorrhaphy was almost constant after 2 years, recurrences continued to appear after Ottsen repair.

Fracture of the penis with urethral rupture.

We report a case of fracture of the penis. Emergency operation revealed total rupture of the urethra. The ruptures of the tunica albuginea as well as the urethra were sutured, and convalescence was uneventful. A slight urethral stricture without practical significance was demonstrated during followup. In cases of fracture of the penis with suspected urethral damage we advise urethrography followed by emergency operation.