Effects of spinal manipulative therapy on autonomic activity and the cardiovascular system: a case study using the electrocardiogram and arterial tonometry.

OBJECTIVE: To determine if there is alteration in the autonomic nervous and cardiovascular systems after chiropractic manipulative therapy (CMT). A novel approach was used to quantitatively probe for changes in the activity of the autonomic nervous system, in blood pressure, and in pressure pulse transmission time. This approach uses the electrocardiogram and arterial tonometry equipment. DESIGN: This case study involves 1 subject treated over a 6-week period (2 visits/week). Respiration, electrocardiogram, and left and right radial artery blood pressures were measured during the baseline (2 visits) and treatment (10 visits) phases. Measurements were obtained before (n = 3) and after (n = 3) a break period (baseline) or before and after CMT. High-velocity, low-amplitude CMT that produced joint cavitation was used. SETTING: The study was performed at the Parker College Research Institute in a temperature-controlled laboratory. MAIN OUTCOME MEASURES: Fourier analysis was performed on the electrocardiogram-determined rest-redistribution intervals. The low frequency power between 0.04 to 0.15 Hz and the high frequency power between 0.15 to 0.40 Hz represent the activity of the sympathetic and parasympathetic nervous systems, respectively. The main outcome measure was the sympathovagal index, which is determined from the ratio of low frequency to high frequency. The arterial pressure and the time for pressure pulses to travel from the heart to the radial artery recording sites (pressure pulse transmission time) were studied. Differences (average of 3 measurements after treatment minus measurements before treatment) for each variable were calculated. RESULTS: After the 1st CMT treatment, the difference between treatment and baseline decreased for both the low frequency/high frequency (-2.804 +/- 1.273) and low frequency power (-0.135 +/- 0.056). These findings indicated that the parasympathetic nervous system predominated the sympathetic nervous system. After the 3rd, 4th, 6th, and 9th treatment, the difference between treatment and baseline increased for low frequency/high frequency (0.908 +/- 0.338, 2.313 +/- 0.300, 2.776 +/- 1.102, and 0. 988 +/- 0.269, respectively) and indicated that the sympathetic nervous system predominated the parasympathetic nervous system. In addition, the difference between treatment and baseline for the pressure pulse transmission time decreased bilaterally after the 4th treatment (left, -13.52 +/- 3.70 ms; right, -9.75 +/- 3.76 ms) and 6th treatment (left, -9.53 +/- 3.60 ms; right, -9.24 +/- 3.50 ms), which indicated that arterial compliance had decreased. Furthermore, after the 6th treatment, the difference between treatment and baseline for the rest-redistribution interval time decreased (-0.084 +/- 0.014 s). The difference between treatment and baseline for the systolic, diastolic, and mean arterial pressure for the above-mentioned treatments was not considered significant. CONCLUSION: This case study is the first to attempt to use electrocardiogram and arterial tonometry data to study the effects of CMT on the autonomic nervous and cardiovascular systems over an extended period of time. These devices allowed a more in-depth study of the cardiovascular and autonomic changes associated with CMT. Although changes in the autonomic nervous and cardiovascular systems can be detected, further development of a reliable and reproducible experimental protocol is required before validating the effects of CMT on these systems.

Medicinal maggots: an ancient remedy for some contemporary afflictions.

Certain fly larvae can infest corpses or the wounds of live hosts. Those which are least invasive on live hosts have been used therapeutically, to remove dead tissue from wounds, and promote healing. This medicinal use of maggots is increasing around the world, due to its efficacy, safety and simplicity. Given our low cultural esteem for maggots, the increasing use and popularity of maggot therapy is evidence of its utility. Maggot therapy has successfully treated many types of chronic wounds, but much clinical and basic research is needed still. In this review, the biology of myiasis and the history of maggot therapy are presented, the current status of our understanding and clinical use of medicinal maggots is discussed, and opportunities for future research and applications are proposed.

Clinical study of yoga techniques in university students with asthma: a controlled study.

Adult asthmatics, ranging from 19 to 52 years from an asthma and allergy clinic in a university setting volunteered to participate in the study. The 17 students were randomly divided into yoga (9 subjects) and nonyoga control (8 subjects) groups. The yoga group was taught a set of breathing and relaxation techniques including breath slowing exercises (pranayama), physical postures (yogasanas), and meditation. Yoga techniques were taught at the university health center, three times a week for 16 weeks. All the subjects in both groups maintained daily symptom and medication diaries, collected A.M. and P.M. peak flow readings, and completed weekly questionnaires. Spirometry was performed on each subject every week. Analysis of the data showed that the subjects in the yoga group reported a significant degree of relaxation, positive attitude, and better yoga exercise tolerance. There was also a tendency toward lesser usage of beta adrenergic inhalers. The pulmonary functions did not vary significantly between yoga and control groups. Yoga techniques seem beneficial as an adjunct to the medical management of asthma.

Ophthalmomyiasis in Kuwait: first report of infections due to the larvae of Oestrus ovis before and after the Gulf conflict.

We report for the first time four cases of ophthalmomyiasis due to the larvae of Oestrus ovis in Kuwait, before and after Operations Desert Shield and Desert Storm. The larvae were easily removed under local anaesthetic. The symptom complex of acute foreign body sensation, irritation, redness, lacrimation and photophobia resolved rapidly. Ophthalmic antibiotic and corticosteroid drops were also instilled and recovery was uneventful. The ophthalmomyiasis may not always be associated with contact with sheep-rearing per se. Medical personnel should therefore be aware that in cases of what might appear initially as acute, non-specific catarrhal conjunctivitis, patients with the persistent symptom complex should be re-examined to exclude ophthalmomyiasis due to the larvae of O. ovis in endemic areas.

Barium enemas are a headache.

The frequency of headache after Picolax (sodium picosulphate, Nordic Ltd) preparation for barium enema was investigated and its association with dehydration, as assessed by haemoconcentration, was determined. Eleven out of 41 patients (26.8%) complained specifically of headaches. Although patients with and without headaches developed significant increases in haemoglobin concentration after Picolax preparation, the rise in haemoglobin in those with headaches was significantly greater than in those without (P less than 0.05). In both groups the haemoglobin concentration returned to normal after a bowel washout. These results suggest an association between dehydration and headache developing after a Picolax regimen. It may be possible to prevent this symptom by advising on the intake of specific volumes of fluid during preparation for barium enema.

Anti-herpes virus combinations in relation to drug resistance.

Two broad categories of combinations have been subject to experimental investigation against HSV-1 and HSV-2; those consisting of an active antiviral drug and an inhibitor of its catabolism and those which contain two active antiviral agents. The latter seek to exploit biochemical mechanisms likely to lead to a synergistic or complementary interaction. Examples of both types of combination for the suppression of resistance development and for the treatment of infection caused by resistant strains are discussed. Their possible relevance to the latent state is considered.

Clinical experience of zinc supplementation during intravenous nutrition in Crohn's disease: value of serum and urine zinc measurements.

Serum zinc concentrations and urine zinc excretion have been studied in 10 patients with severe Crohn's disease before and during 59 patient-weeks of intravenous nutrition. Before serum zinc concentrations (9.9 +/- 1.0 mumol/l: mean +/- SEM) and urine zinc excretion (3-3 +/- 0.6 mumol/24h) were less than controls (p less than 0.01). No patients had clinical signs of zinc deficiency before intravenous nutrition and none developed signs during it. There was no overall change in serum zinc concentrations, despite improvements in body weight, skinfold thickness, and mid-arm circumference in all patients, and increased serum albumin and serum transferrin concentrations during all but two periods of intravenous nutrition. Nor was there any relationship between serum zinc concentrations and zinc uptake (up to 220 mumol/day), serum zinc concentrations remaining significantly lower than control levels. Urine zinc excretion during the first week of intravenous nutrition showed a 1.2 to 53-fold increase (mean 11-fold) over pre-intravenous nutrition levels, and a positive relationship was demonstrated between zinc intake and urine zinc excretion. It is suggested that zinc supplied by the intravenous route is inefficiently transported to the tissues, and that some is excreted in the form of small molecular weight chelates into urine. Recommendations are made for the supply of intravenous zinc, based on monitoring urine zinc excretion in individual patients.

Mg deficiency in chronic inflammatory bowel disease and requirements during intravenous nutrition.

Assessment of magnesium (Mg) status by serum and 24-hr urine estimations has been used to study a group of 17 patients with severe Crohn's disease, 10 of whom have required intravenous (IV) nutrition. Mg depletion was present in 15 (88%) and severe enough to cause symptoms in two. Urine levels were low in most patients and would appear to be a more sensitive indication of Mg depletion than serum levels alone. Serum Mg levels were significantly lower in the Crohn's group than in a group of hospital controls; 5-10 mmol of IV Mg were required daily to prevent Mg depletion during IV nutrition and some patients required higher intakes. Three patients with particularly severe malabsorption required oral Mg supplements in the long-term. The rationale for using our method of assessing Mg status, and the importance of recognizing and treating chronic Mg deficiency are presented.