Salivary and serum cortisol levels during recovery from intense exercise and prolonged, moderate exercise.

The aim of this study was to compare serum (SERc) and salivary cortisol (SALc) responses during recovery from two different exhaustive exercises to determine peak cortisol sampling time and the agreement between SERc and SALc levels. Twelve healthy men underwent a maximal treadmill graded exercise to exhaustion (MEx) and a prolonged, submaximal cycle exercise in the heat for 90 min (PEx) while SERc and SALc samples were taken in parallel at baseline, end of exercise, and 15 min intervals over one hour of recovery. MEx and PEx significantly increased SERc and SALc levels (p < 0.01) while absolute SERc levels were approximately 7-10 folds higher than SALc. SERc and SALc showed highly positive correlation (R = 0.667-0.910, p < 0.05) at most sampling times and only a few individual values were out of 95% limit of agreement when analyzed by Bland-Altman plots. However, peak SERc levels (MEx: 784.0±147, PEx: 705.5±212.0 nmol · L(-1)) occurred at 15 min of recovery, whereas peak SALc levels (MEx: 102.7±46.4, PEx: 95.7±40.9 nmol · L(-1)) were achieved at the end of exercise in MEx and PEx. The recovery trend of SERc and SALc also differed following MEx and PEx. Activity of 11ß-hydroxysteroid dehydrogenase type 2 enzymes may be suppressed following MEx compared to PEx. In conclusion, sampling for peak SERc and SALc levels should take into account their evolution and clearance characteristics as well as type of exercise performed, whereas SALc appeared to be a more sensitive marker than SERc for the measurement of cortisol responses during exercise recovery.

Measurement accuracy of heart rate and respiratory rate during graded exercise and sustained exercise in the heat using the Zephyr BioHarness.

The Zephyr BioHarness was tested to determine the accuracy of heart rate (HR) and respiratory rate (RR) measurements during 2 exercise protocols in conjunction with either a laboratory metabolic cart (Vmax) or a previously validated portable metabolic system (K4b2). In one protocol, HR and RR were measured using the BioHarness and Vmax during a graded exercise up to V˙O2max (n=12). In another protocol, HR and RR were measured using the BH and K4b2 during sustained exercise (30% and 50% V˙O2max for 20 min each) in a hot environment (30 °C, 50% relative humidity) (n=6). During the graded exercise, HR but not RR, obtained from the BioHarness was higher compared to the Vmax at baseline and 30% V˙O2max (p<0.05), but showed no significant difference at other stages with high correlation coefficients for both HR (r=0.87-0.96) and RR (r=0.90-0.99 above 30% V˙O2max). During the exercise in the heat, there were no significant differences between the BioHarness and K4b2 system. Correlation coefficients between the methods were low for HR but moderately to highly correlated (0.49-0.99) for RR. In conclusion, the BioHarness is comparable to Vmax and K4b2 over a wide range of V˙O2 during graded exercise and sustained exercise in the heat.

32 cases of sympathetic ophthalmia. A retrospective study at the National Eye Institute, Bethesda, Md., from 1982 to 1992.

OBJECTIVE: To examine the relationship between visual outcome and the clinical management of patients with sympathetic ophthalmia. METHODS: Thirty-two patients with sympathetic ophthalmia who were seen at the National Eye Institute, Bethesda, Md, between 1982 and 1992, were retrospectively reviewed. RESULTS: There were equal numbers of males and females. Sympathetic ophthalmia occurred after trauma in 23 patients and surgery in nine patients. Sixteen of the 32 patients had a final visual acuity of 20/40 or better; 10 patients had a visual acuity worse than 20/200. Good visual outcome was associated with early and aggressive treatment with corticosteroids, sometimes in combination with other immunosuppressive agents. Poor visual acuity was associated with glaucoma, chorioretinal scars in the macula, and persistent uncontrolled inflammation. CONCLUSION: Prompt and aggressive use of antiinflammatory therapy can improve the visual outcome of patients with sympathetic ophthalmia.

Cat-scratch disease.

Cat-scratch disease is a relatively common disorder that is the result of infection with a recently identified gram-negative bacillus. Although it is overwhelmingly a benign, self-limited illness requiring only supportive care, serious complications can occur and the disease may be life-threatening on occasion. Although randomized clinical trials of antibiotic therapy for CSD do not exist, CSD has demonstrated in vitro susceptibility to several antibiotics, and gentamicin has been reported beneficial in a few patients with systemic manifestations of the illness. Therefore, pending clinical trials, gentamicin may be worthy of consideration in CSD patients with serious manifestations of this illness. CSD is one of the most common causes of adenopathy and should be considered in all patients who present with unilateral or regional lymphadenopathy.

Facilitating cervical spine radiography in blunt trauma.

The interpretation of cervical spine radiographs is an important facet of the evaluation of blunt trauma victims. The diagnostic accuracy of cervical spine films is dependent upon the technical adequacy of the radiographs and the clinician's diagnostic and interpretive skills. The anxiety inherent in cervical radiographic interpretation by the nonradiologist can be minimized by coupling the use of several simple techniques aimed at enhancing visualization of all cervical spine elements and optimizing bony definitions with an unhurried, methodical radiographic evaluation utilizing a number of radiologic "pearls" in those instances in which injury is less than readily apparent but still suspect.

Evaluation of neck discomfort, neck tenderness, and neurologic deficits as indicators for radiography in blunt trauma victims.

Seventeen of 480 adult blunt trauma victims who sustained cervical spine injuries (CSI) were studied prospectively. In reliable patients, complaints of neck discomfort and tenderness demonstrated sensitivities of 86% and 79%, respectively, for CSI. A positive physical examination, defined as neurologic deficits, or cervical region discomfort or tenderness was noted in 13 of 14 reliable individuals sustaining CSI (sensitivity 93%, specificity 16%, positive predictive value 3.3%, negative predictive value 98.7%). Lack of absolute sensitivity of these studied clinical parameters, either singly or in concert, for CSI suggests that eliminating cervical spine radiography on the basis of the absence of neck discomfort, tenderness, or neurological deficits in reliable blunt trauma victims could result in missed CSI. An enormous prospective data base will be required to definitively address the sensitivity of all clinical parameters currently employed to determine the need for cervical spine radiography in reliable blunt trauma victims.

Compartment syndrome after simple venipuncture in an anticoagulated patient.

An excessively anticoagulated 52-year-old man on chronic warfarin therapy developed a forearm compartment syndrome after venipuncture in an antecubital vein. At fasciotomy, active venous bleeding into the forearm from the venipuncture site was noted, and a large forearm hematoma was evacuated. Anticoagulated patients or those with coagulopathies are at risk for compartment syndrome after percutaneous needle punctures and should be warned of this possibility. Such individuals should be instructed to seek immediate medical attention if any signs or symptoms of this complication occur.

Corneal bee sting with retained stinger.

Bee stings of the cornea are rarely reported, but have the potential for causing serious ophthalmologic injuries. We present a case of corneal bee sting with retained stinger apparatus and associated iritis and discuss the pathologic mechanisms of injury, evaluation, and treatment of these uncommon presentations.

Vaginal pessary-induced mechanical bowel obstruction.

We present a case of a mechanical bowel obstruction secondary to an impacted vaginal pessary. As the elderly segment of the population continues to grow, pessary use is increasing in absolute numbers, and clinicians must consider these medical devices when evaluating abdominal, gynecological, and urological complaints in elderly women.

Transdermal drug delivery system exposure outcomes.

Transdermal drug delivery systems are increasingly popular, yet few data exist regarding medical outcomes after exposures. Using data collected through a Regional Poison Information System, this retrospective study identified 61 cases of transdermal drug delivery system exposures reported over a recent 5-year period. Exposure routes included dermal (48 patients), oral (10 patients), combined oral and dermal (one patient), parenteral use of gel residue (one patient), and combined oral and parenteral (one patient). Forty-four exposures (72%) were managed by home telephone consultation only. Eleven of 17 patients (18%) evaluated in health care facilities were admitted, including eight (13%) to intensive care units. Hospital admission correlated statistically with clonidine and fentanyl exposures, oral exposures, and drug abuse. Clonidine exposure also correlated statistically with intensive care admission. One fatality was recorded, and all other patients recovered uneventfully. Transdermal drug delivery system exposures are infrequently reported to our regional poison information center but are associated with a significant hospital use and admission rate.

Flumazenil reversal of carisoprodol (Soma) intoxication.

A 52-year-old woman presented with central nervous system depression and a Glasgow Coma Score of 9 secondary to ingestion of carisoprodol, a centrally acting muscle relaxant analgesic. After administration of i.v. flumazenil, the patient's neurologic status normalized and she required no further therapy. Carisoprodol and its active sedative-hypnotic metabolite, meprobamate, are gamma aminobutyric acid receptor indirect agonists with central nervous system chloride ion channel conduction effects similar to the benzodiazepines, thus making flumazenil a potentially useful antidote in toxic presentations.

Acute myocardial infarction and renal failure following naphtha ingestion.

We present a case of a non-Q wave myocardial infarction and acute renal failure following an ingestion of naphtha, a petroleum distillate composed primarily of hydrocarbons. The patient's renal, metabolic, and cardiac status improved over several days with aggressive volume replacement and bicarbonate therapy. Acute cardiotoxic effects of hydrocarbon exposure generally manifest as dysrhythmias, secondary to myocardial sensitization to circulating catecholamines, or, possibly, coronary vasospasm. Ischemia from associated hypotension or direct myocardial toxicity are other potential causes of naphtha-related cardiac injury.

Clonidine and sleep apnea syndrome interaction: antagonism with yohimbine.

A patient with sleep apnea syndrome, concurrently taking clonidine as an antihypertensive, presented with severe respiratory acidosis, hypotension, and associated central nervous system depression. Acidosis was improved by mechanical ventilation, and central nervous system (CNS) depression and hypotension were reversed with yohimbine. Clonidine may have an additive CNS depressive effect in sleep apnea syndrome and should be used with caution in such patients. Yohimbine's sympathetic-enhancing effects may be useful in clonidine toxic states.

Dextromethorphan- and pseudoephedrine-induced agitated psychosis and ataxia: case report.

Pseudoephedrine and dextromethorphan are therapeutic constituents of numerous commonly used, over-the-counter cough and cold preparations. Although this drug combination is generally considered quite safe if utilized in recommended doses, overmedication or overdose can result in serious neurologic and cardiovascular abnormalities that occasionally can be life-threatening. We present a case of a 2-year-old child who developed hyperirritability, psychosis, and ataxia after being overmedicated with a pseudoephedrine/dextromethorphan combination cough preparation, and discuss probable mechanisms of toxicity and risk factors for adverse events.

Cervical spine radiography after blunt trauma. Is it always needed?

In trauma cases, the mere presence of a cervical immobilization device is not an indication for radiography of the cervical spine. High-yield radiographic criteria have been prospectively determined for cases of blunt trauma, and these identify individuals at low risk for cervical spine injuries. Cervical spine radiography is not required for patients who are alert, cooperative, and nonintoxicated and do not have neurologic deficits, cervical signs or symptoms, antecedent spinal mobility disorders, or distracting injuries. Cervical spine radiography alone does not ensure detection of all injuries. Adequate history taking and careful examination are always essential and may dictate additional studies.

Ergonomic comparison of a chem/bio prototype firefighter ensemble and a standard ensemble.

Firefighter turnout gear and equipment protect the wearer against external hazards but, unfortunately, restrict mobility. The aim of this study was to determine the ease of mobility and comfort while wearing a new prototype firefighter ensemble (PE) with additional chemical/biological hazard protection compared to a standard ensemble (SE) by measuring static and dynamic range of motion (ROM), job-related tasks, and comfort. Eight healthy adults (five males, three females), aged 20-40 years, participated in this study. The study consisted of two repeated phases, separated by five uses of the ensembles. Subjects randomly donned either the SE or PE in either dry or wet conditions on separate days. In each phase, five tests were carried out as follows: baseline (non-ensemble), SE-dry, SE-wet, PE-dry, and PE-wet. There was a significant reduction (P < 0.05) of wrist flexion for PE-dry condition compared to the same SE-dry condition. Donning the PE took 80 s longer than the SE in phase 1, this difference disappeared in phase 2. There was a significant decrease (P < 0.05) in post-test comfort wearing the PE compared to the SE. The data collected in this study suggest that, in spite of design features to enhance chemical/biological hazard protection, the PE design does not decrease the wearer's overall functional mobility compared to the SE. However, subjects seem to be more comfortable wearing the SE compared to the PE. These overall findings support the need for a comprehensive ergonomic evaluation of protective clothing systems to ascertain human factors issues.

[Not Available]. / Un secret pour vieillir en santé: l'exercice.

The elderly face a decrease in physical capacity and an increase in chronic health problems. Exercise increases cardiovascular fitness, muscle strength and bone mass. Training programs are feasible and beneficial for the elderly. Regular exercice can lead to longer and healthier life.