The effect of treadmill training on the ambulation of stroke survivors in the early stages of rehabilitation: a randomized study.

The objective of this study was to compare the effects of conventional over-ground gait training with treadmill training on the restoration of gait in people with hemiparesis following a stroke. Twenty-five individuals in the early stages of rehabilitation were alternately assigned to one of two treatment groups. In addition to conventional physical therapy, the experimental group participated in 15 treadmill-training sessions in which a handrail was used for external support. The control group received the same number of equal length sessions of over-ground ambulation. Treatment effects were established by pre- and posttreatment assessment of: 1) functional walking ability, 2) walking speed, 3) stride length, 4) temporal characteristics of gait, and 5) electromyographic activity of calf muscles. Normal values were obtained from eight healthy individuals of approximately the same age as the stroke survivors. The study demonstrates that individuals following a stroke are well able to tolerate treadmill training in the early stage of their rehabilitation process without the use of a weight support apparatus. Furthermore, the findings suggest that treadmill training may be more effective than conventional gait training for improving some gait parameters such as functional ambulation, stride length, percentage of paretic single stance period, and gastrocnemius muscular activity.

Estrogen receptor protein and its correlation to recurrent breast cancer. A study of 213 patients at the Pennsylvania Hospital.

The value of having estrogen receptor protein analysis is more widely appreciated, and the estrogen receptor determination at the time of biopsy or mastectomy is rapidly becoming a standard procedure. The patients with positive estrogen receptors (and progesterone receptors) are now identified as those who will respond to hormone ablation or manipulation. Some authors have stated that a positive estrogen receptor has a "protective" value against regional metastasis and early recurrence. At the time of biopsy, a portion of the tumor is frozen in liquid nitrogen and sent for estrogen receptor (and progesterone receptor) analysis. The 200 breast cancer patients had estrogen receptors performed with 118 estrogen receptors positive and 82 estrogen receptors negative. The following is an analysis of the 130 mastectomy patients. Negative nodes: ER+, 50; ER-, 20. One to three positive nodes: ER+, 23; ER-, 12. Four and more positive nodes: ER+, 15; ER-, 10. At the present time, the data is being correlated to the patient's age, the time of recurrence, and its relationship to estrogen receptors and progesterone receptors.

Gastric cancer-survival at the Pennsylvania Hospital with and without adjuvant chemotherapy.

From 1964 to 1974, 122 patients were treated for gastric cancer; none of these patients received chemotherapy; 13 of this group were lost to follow-up. In 34 patients, the disease was too far advanced for surgical resection. Their survival ranged from 0.1 month to 7.5 months with a median survival of 1.1 months. Seventy-four patients were resected for cure; 60 patients underwent a subtotal gastrectomy. Survival ranged from 0 to 72 months with a median of eight months. Fourteen patients had total gastrectomies; survival ranged from 0.1 to 72 months with a median of 5.5 months. Only six of the resected patients had negative lymph nodes; their survival ranged from four to 36 months. In this series there were 11 operative deaths and only seven patients survived five years. Thirty-one patients who had resections were treated with adjuvant chemotherapy consisting of 0.5 g 5-fluorouracil (5-FU) IV on days 1, 8, 15, etc, and hydroxyurea (HU), 80 mg/kg per os (p.o.), on days 4, 11, 18, etc. This group has a range of survival from three to 164 months and a median survival of 25 months. Fifteen consecutive patients with nonresectable gastric cancer were treated with HU-FU with a survival of one to 30 months and a median survival of eight months. In patients with measurable disease, objective regression was clearly demonstrated.

Weight-bearing shifts of hemiparetic and healthy adults upon stepping on stairs of various heights.

OBJECTIVE: To examine and compare the effect of stepping on stairs of various heights on lower extremity weight bearing in hemiparetic patients. SETTING: Flieman Geriatric Rehabilitation Hospital, Haifa, Israel. SUBJECTS: Fifteen ambulatory hemiparetic patients following an acute cerebrovascular accident, and 16 age-matched healthy controls. INTERVENTIONS: Each subject was tested twice on two consecutive days in five weight-bearing positions which included level stance and stepping with either leg on 10-cm- and 17-cm-high steps. Data concerning weight distribution on the lower extremities were collected by two computerized forceplates. MAIN OUTCOME MEASURE: Weight borne by each foot expressed as percentage of overall body weight. RESULTS: In the attempted symmetrical level stance, the percentage of body weight borne by the paretic limb of the stroke patients was significantly lower than that of the nonparetic limb. Placing one foot on a step induced a weight shift to the foot placed on the floor regardless of step height. Weight shifting to the paretic limb was, however, significantly lower than to the nonparetic limb. Weight shifting to the nonparetic limb was significantly lower than to the corresponding limb of healthy individuals. Step height had no significant effect on weight distributions on the feet. CONCLUSIONS: Raising a foot on a step appears to be an appropriate strategy for weight shift training of stroke patients. Since weight shifting to both the paretic and nonparetic limb of stroke patients is impaired, treatment strategies should include training in weight shifting to both lower extremities.

Second malignancies diagnosed in patients receiving chemotherapy at the Pennsylvania Hospital.

During the past 15 years, the records of 2,020 patients who received chemotherapy on the surgical oncology, chemotherapy service at the Pennsylvania Hospital were reviewed. Thirty-five patients had pathologically confirmed second independent malignant tumors (not recurrences). The second cancers that developed were varied. The patients who developed these second malignancies ranged in age from 35 to 77 years (24 females, 11 males). The time interval involved was two to 102 months. Nine patients in this group of second malignancies received prior radiation therapy. The following is a list of the second cancers. There were 8 colons, 5 ovaries, 5 lungs, 6 acute myelogenous leukemias, 1 esophagus, 2 bladders, 2 epidermoid carcinomas of the skin, 2 melanomas, 1 chronic lymphatic leukemia, 1 breast cancer, 1 non-Hodgkin's malignant lymphoma, and 1 stomach cancer. The majority of second malignant tumors were amenable to some form of therapy, ie, surgery, radiation or chemotherapy. However, all of the acute myelogenous leukemias were totally refractory to any therapeutic modalities and rapidly expired. The majority of second cancers developed in patients receiving adjuvant chemotherapy. This is a patient population with a much longer expected survival time, particularly when compared to patients receiving chemotherapy for advanced disease. Twenty-five of the 34 second cancers developed in patients who received adjuvant chemotherapy for breast (14) or colorectal (11) cancers. The etiology of the second malignancies is very difficult to determine. However, alkylating agents appeared to be the possible etiologic agent involved in the development of acute myelogenous leukemia.