A novel cytogenetic abnormality in Burkitt lymphoma associated with treatment resistant disease.

We present a patient with deletion of IgH associated with the reciprocal translocation (8;14) in Burkitt lymphoma. The patient had treatment resistant disease and died 10 weeks after diagnosis. The deletion was detected by fluorescence in situ hybridization at diagnosis and again after failure of chemotherapy. To our knowledge this is the first report of such a deletion.

Prevalence of malnutrition on admission to four hospitals in England. The Malnutrition Prevalence Group.

AIMS: The primary objective was to estimate prevalence of malnutrition on admission to four hospitals. Secondary objectives included assessing the relationship between nutritional status and length of hospital stay, numbers of new prescriptions, new infections and disease severity. METHODS: We entered eligible patients according to predefined quotas for elective and emergency admissions to 23 specialties. We measured height, weight, Body Mass Index and anthropometrics, and recorded history of unintentional weight loss. Patients who had lost > or = 10% of their body weight, had a Body Mass Index <20, or had a Body Mass Index <20 with one anthropometric measurement <15th centile were considered malnourished. RESULTS: Of 1611 eligible patients, 761 did not participate; 269 were too ill; 256 could not be weighed; and 236 refused consent. Eight hundred and fifty were subsequently evaluated. Prevalence of malnutrition on admission was 20%. Length of stay, new prescriptions and infections and disease severity were significantly higher in the malnourished. CONCLUSIONS: One patient in every five admitted to hospital is malnourished. Although this figure is unacceptably high, it may underestimate true prevalence. Malnutrition was associated with increased length of stay, new prescriptions and infections. Malnutrition may also have contributed to disease severity.

Hot-Pack and 1-MHz Ultrasound Treatments Have an Additive Effect on Muscle Temperature Increase.

OBJECTIVE: Therapeutic ultrasound is an effective deep heating modality commonly applied alone or after cooling or heating of the treatment area. The purpose of this study was to examine the tissue temperature rise in the human triceps surae muscle group after ultrasound with prior heating via a silicate gel hot pack. DESIGN AND SETTING: This study was designed as a 2 x 2 x 3 factorial with repeated measures on two factors (depth and time). Independent variables were temperature of pack (hot and room temperature), depth of measurement (1 cm and 3 cm), and time (beginning, after pack application, and after ultrasound). The dependent variable was tissue temperature. Subjects were assigned to one of two treatment groups: ultrasound preceded by a 15-minute hot pack treatment or ultrasound preceded by a 15-minute application with a silicate gel pack at room temperature. Measurements were taken while subjects were treated in a university training room. SUBJECTS: Twenty-one uninjured male and female college student volunteers were randomly assigned to one of the two pack groups. MEASUREMENTS: The hot packs were stored in 75 degrees C water. A 1-MHz ultrasound treatment was administered for 10 minutes at an intensity of 1.5 W/cm(2). Tissue temperature was measured every 30 seconds using 23-gauge hypodermic microprobes interfaced with a telethermometer and inserted 1 and 3 cm below the surface of anesthetized triceps surae muscle. RESULTS: At both tissue depths, there was a 0.8 degrees C greater increase in tissue temperature with hot packs and ultrasound. At 1 cm, ultrasound increased temperature 3.5 degrees C after a 0.5 degrees C rise during the room temperature-pack application, but only 0.6 degrees C after a 3.8 degrees C increase during hot-pack application. At 3 cm, ultrasound increased temperature 3.85 degrees C following a slight (-0.26 degrees C) decrease during the room temperature-pack application and 3.68 degrees C after a 0.74 degrees C increase during hot-pack application. CONCLUSIONS: Vigorous increases in deep muscle temperature (>/=4 degrees C) can be reached with 2 to 3 minutes less total sonation time when preheated with a hot pack. Thus, ultrasound and hot packs have an additive effect on intramuscular temperature, but the characteristics of the additive effect are different, primarily because there appears to be a tissue temperature plateau.

Pulsed ultrasound fails to diminish delayed-onset muscle soreness symptoms.

OBJECTIVE: We investigated the effects of pulsed ultrasound on swelling, muscle soreness perception, relaxed-elbow extension angle, and muscular strength. DESIGN AND SETTING: Eight sets of concentric and eccentric actions induced delayed-onset muscle soreness of the elbow flexors. Group 1 received 20% pulsed ultrasound treatments (1-MHz, 7 minutes, 1.5 W/ cm(2) temporal peak intensity) twice a day immediately after postexercise assessments and at 3, 24, 27, 48, 51, 72, and 75 hours postexercise. Group 2 received sham treatments immediately after postexercise assessments and at 3,27, 51, and 75 hours postexercise and true treatments of pulsed ultrasound at 24, 48, and 72 hours postexercise. Group 3 received sham treatments of no ultrasonic output immediately after postexercise assessments and at 3, 24, 27, 48, 51, 72, and 75 hours postexercise. SUBJECTS: Thirty-six college-age females. MEASUREMENTS: We recorded upper-arm circumference, perceived soreness, relaxed-elbow extension angle, and elbow-flexion strength before (pretest), immediately postexercise, and at 24, 48, 72, and 96 hours postexercise. RESULTS: We noted differences over time but no treatment effect between groups or interactions between time and group for upper-arm circumference, perceived soreness, relaxed-elbow extension angle, or elbow-flexion strength. CONCLUSIONS: Pulsed ultrasound as used in this study did not significantly diminish the effects of delayed-onset muscle soreness on soreness perception, swelling, relaxed-elbow extension angle, and strength.

Cold- and hot-pack contrast therapy: subcutaneous and intramuscular temperature change.

OBJECTIVE: To investigate the temperature changes in subcutaneous and intramuscular tissue during a 20-minute cold- and hot-pack contrast therapy treatment. DESIGN AND SETTING: Subjects were randomly exposed to 20 minutes of contrast therapy (5 minutes of heat with a hydrocollator pack followed by 5 minutes of cold with an ice pack, repeated twice) and 20 minutes of cold therapy (ice pack only) in a university laboratory. SUBJECTS: Nine men and seven women with no history of peripheral vascular disease and no allergy to cephalexin hydrochloride volunteered for the study. MEASUREMENTS: Subcutaneous and intramuscular tissue temperatures were measured by 26-gauge hypodermic needle microprobes inserted into the left calf just below the skin or 1 cm below the skin and subcutaneous fat, respectively. RESULTS: With contrast therapy, muscular temperature did not fluctuate significantly over the 20-minute period compared with the subcutaneous temperature, which fluctuated from 8 degrees C to 14 degrees C each 5-minute interval. When subjects were treated with ice alone, muscle temperature decreased 7 degrees C and subcutaneous temperature decreased 17 degrees C over the 20-minute treatment. CONCLUSIONS: Our results show that contrast therapy has little effect on deep muscle temperature. Therefore, if most of the physiologic effects attributed to cold and hot contrast therapy depend on substantial fluctuations in tissue temperature, contrast therapy needs to be reconsidered as a viable therapeutic modality.

The effects of high-volt pulsed current electrical stimulation on delayed-onset muscle soreness.

OBJECTIVE: We investigated three 30-minute high-volt pulsed current electrical stimulation (HVPC) treatments of 125 pps to reduce pain, restore range of motion (ROM), and recover strength loss associated with delayed-onset muscle soreness (DOMS). DESIGN AND SETTING: Randomized, masked comparison of three 30-minute treatment and sham HVPC regimens over a 48-hour period. SUBJECTS: Twenty-eight college students. MEASUREMENTS: Subjects performed concentric and eccentric knee extensions with the right leg to induce muscle soreness. Assessments were made before and after the exercise bout and each treatment at 24, 48, and 72 hours postexercise. RESULTS: Three separate 2 x 3 x 2 ANOVAs were used to determine significant differences (p < .05) between days, treatments, and pre-post treatment effects and significant interaction among these variables. Scheffe post hoc tests showed no significant reduction in pain perception or improvement in loss of function at 24, 48, and 72 hours postexercise. Mean pain perception assessments (0 = no pain, 10 = severe pain) for the HVPC group were 2.9, 4.5, and 3.5 and for the sham group 3.8, 4.8, and 3.5). Mean ROM losses for the HVPC group were 9.0 degrees , 22.3 degrees , and 26.2 degrees , and for the sham group were 9.5 degrees , 23.1 degrees , and 23.0 degrees . Mean strength losses (1RM) for the HVPC group were 25.9, 25.7, and 20.8 lbs and for the sham group were 22.3, 22.3, and 13.8 lbs. CONCLUSIONS: HVPC as we studied it was ineffective in providing lasting pain reduction and at reducing ROM and strength losses associated with DOMS.

The Stretching Window Part Two: Rate of Thermal Decay in Deep Muscle Following 1-MHz Ultrasound.

Thermal ultrasound can be effective in increasing extensibility of collagen, thus aiding joint mobilization and stretching. In 1995, we reported on the rate of temperature decay following 3-MHz ultrasound in subcutaneous tissues. We repeated that study at 1-MHz frequency to see if the stretching window is different for deep muscle. Twenty subjects had two 23-gauge thermistors inserted 2.5 cm and 5 cm deep into their triceps surae muscle. We administered 1-MHz continuous ultrasound at 1.5 W/cm(2) until the tissue temperature increased 4 degrees C (vigorous heating). Immediately following the treatment, we recorded the rate at which the temperature dropped at 30second intervals. We ran a stepwise nonlinear regression analysis to predict temperature decay as a function of time following ultrasound treatment. There was a significant nonlinear relationship between time and temperature decay. At 2.5 cm, the average time for the temperature to drop each degree was: 1 degrees C = 2:34; 2 degrees C = 6:35; 3 degrees C = 12:10: and 4 degrees C = 21:14. At 5 cm, the average time for the temperature to drop each degree was: 1 degrees C = 2:31, 2 degrees C = 6:50: 3 degrees C = 14:32; and 4 degrees C = 27:49. Based upon prior research, thermal decay of 1-MHz ultrasound was slower than 3 MHz, and the deeper tissue cooled at a slower rate than superficial tissue following 1-MHz ultrasound. The data illustrated that the stretching window was open longer for deep-seated structures than for superficial ones.

A comparison of anterior knee laxity in female intercollegiate gymnasts to a normal population.

Increased joint laxity may predispose an individual to ligamentous injury. Female gymnasts have a high incidence of ligamentous injury, including the anterior cruciate ligament (ACL). Previous authors have found a relationship between ACL disruption and preexisting ligament laxity. The purpose of this study was to compare anterior knee laxity in the knees of female intercollegiate gymnasts with those of a normal female population. A secondary purpose was to measure genu recurvatum and assess the relationship between it and anterior laxity in the knee. We tested 30 gymnasts and 30 control subjects having no history of ACL injury with the KT-1000 knee arthrometer. The quadriceps active, 133 N (30 lb) anterior drawer, and manual maximum tests were performed on the subjects' right knees along with goniometer measurements. Using a two-way analysis of variance (ANOVA) with repeating measures, we detected a significant increase in anterior laxity when comparing the 133 N to the manual maximum test, but no significant difference between gymnasts and nongymnasts. We concluded that gymnasts, as a group, are not abnormally lax when compared to an active population of similar age. Future comparison of the longitudinal data of those who incur ACL injury during their gymnastics careers may show whether individuals with increased laxity have increased risk of ligamentous injury.

Metal ion binding to apo, holo, and reconstituted horse spleen ferritin.

The binding of Cd2+, Zn2+, Cu2+, Ni2+, Co2+, Mn2+, and Mg2+ to apo, holo, reconstituted horse spleen ferritin (HoSF), and native holo HoSF with phosphate removed was measured by gel-exclusion chromatography. Three classes of strong binding interactions (Kd < 10(-7) M) with apo HoSF at pH 7.5 were found for the various M2+ studied: high stoichiometric binding (30-54 M2+/HoSF) for Cd2+, Zn2+, Cu2+, with two protons released per metal bound; intermediate binding (16 M2+/HoSF) for Ni2+ and Co2+, with one proton released per metal bound; and low levels of binding (2-12 M2+/HoSF) for Mn2+, Mg2+, and Fe2+, with < 0.5 protons released per metal bound. M2+ binding to apo HoSF was nearly abolished at pH 5.5, except for Fe2+ and Cu2+, which remained unaffected by pH alteration. Holo HoSF bound much higher levels of M2+, a result directly attributable to the presence of phosphate binding sites. This conclusion was confirmed by decreased binding of M2+ to HoSF reconstituted in the absence of phosphate and by native holo HoSF with phosphate chemically removed. The binding of Cd2+ to apo HoSF was 54 per HoSF, but in the presence of developing core, the amount bound decreased to about 30 Cd2+/HoSF. This result indicated that Cd2+ and developing core were competing for the same sites on the HoSF interior, suggesting that 24 of the Cd2+ were bound to the inside surface. No other M2+ studied bound to the interior of HoSF by this criterion. Several of the M2+ appeared to bind strongly to the phosphate-free mineral core surface in reconstituted HoSF.

Contrast therapy and intramuscular temperature in the human leg.

Contrast therapy, although having a long history of use in sports medicine and physical therapy, remains insufficiently researched. We investigated the thermal effects of contrast therapy on intramuscular temperature. We randomly assigned 28 college students to either a control or a contrast group, eight women and six men per group. We shaved and cleansed a 4- x 4-cm area of skin over the right medial calf and inserted a microprobe to a depth of 1 cm below the skin and subcutaneous fat in the center of the gastrocnemius. Each control subject immersed the treatment leg in a hot whirlpool (40.6 degrees C) for 20 minutes. Each contrast subject first immersed the treatment leg in a hot whirlpool (40.6 degrees C) for 4 minutes then into a cold whirlpool (15.6 degrees C) for 1 minute. Contrast subjects repeated this sequence three additional times. We recorded intramuscular temperatures every 30 seconds over the entire treatment time for both groups. The control group had a temperature increase of 2.83 +/- 1.14 degrees C over the 20-minute treatment. The contrast group temperature increased 0.39 +/- 0.46 degrees C from baseline to the end of the treatment. The largest temperature change from the end of one contrast immersion to the end of the next was only 0.15 +/- 0.10 degrees C. None of the differences between the end of one immersion to the end of the next were significant. Conversely, all differences between the same time periods in the control group had significant temperature increases. Apparently contrast therapy, as studied, is incapable of producing any significant physiological effect on the intramuscular tissue temperature 1 cm below the skin and subcutaneous tissue. We recommend that further research be done to examine the effects of longer periods in both the hot and cold environments on the intramuscular temperature of the human leg. Further investigation of intra-articular or peri-articular temperature change produced by contrast therapy should also be undertaken.

Temperature changes during therapeutic ultrasound in the precooled human gastrocnemius muscle.

Therapeutic ultrasound is frequently employed as a deep heating rehabilitation modality. It is administered in one of three ways: a) ultrasound with no preceding treatment, b) ultrasound on preheated tissues, or c) ultrasound on precooled tissues. The purpose of this study was to investigate the effect of ultrasound treatments on the tissue temperature rise of precooled human gastrocnemius muscle. Sixteen male subjects had a 23-gauge hypodermic needle microprobe inserted 3 cm deep into the medial aspect of their anesthetized gastrocnemius muscles. Data were gathered on each subject for one of two randomly assigned treatments: a) ultrasound treatment on precooled tissue, or b) ultrasound with no preceding treatment. Each treatment consisted of ultrasound delivered topically at 1.5 watts/cm(2) in a continuous mode for 10 minutes. Ultrasound was applied in an overlapping longitudinal motion at 4 cm/s, with temperature readings recorded at 30-second intervals. We discovered a difference between the two treatment methods [t(14) = 16.26, p < .0001]. Ultrasound alone increased tissue temperature an average of 2 degrees C, whereas ultrasound preceded by 15 minutes of ice did not increase tissue temperature even to the original baseline level. We concluded that, at a depth of 3 cm, ultrasound alone provided a greater heating effect than ultrasound preceded by an ice treatment.

Cryotherapy and sequential exercise bouts following cryotherapy on concentric and eccentric strength in the quadriceps.

We investigated the effects of cryotherapy followed by sequential exercise bouts on concentric and eccentric strength of the quadriceps. Nineteen males (18-27 years) participated in a two-stage design involving four sequences: ice and exercise, ice and rest, no ice and exercise, and no ice and rest. We gathered concentric and eccentric strength measures (torque) using a kinetic communicator (KIN-COM) prior to exercise, immediately following treatment, and 20- and 40-minutes post-treatment. There were significant decreases in concentric and eccentric strength immediately following the 25-minute cryotherapy treatment. This suggests that applying ice immediately prior to participation or returning an athlete to competition immediately following cryotherapy treatment may adversely affect his/her ability to perform. It appears that the reduction in strength following cryotherapy is of short duration (less than 20 minutes). The delayed effect of the ice treatment and sequential exercise appears to affect concentric and eccentric strength differently. Ice did not have a delayed effect on concentric strength, but there was a significant difference in eccentric values. This difference was a failure to improve during post-tests at the rate of those not treated with ice. Exercise did not have a significant effect on eccentric strength recovery, but there was a significant difference in concentric values. Moderate exercise following cryotherapy appears to help the recovery of concentric strength.

The effects of ice massage, ice massage with exercise, and exercise on the prevention and treatment of delayed onset muscle soreness.

We investigated the effects of ice massage, ice massage with exercise, and exercise on the prevention and treatment of delayed onset muscle soreness (DOMS). Twenty-two subjects were randomly assigned to one of four groups. Preexercise measures were recorded for range of motion (ROM), strength, perceived soreness, and serum creatine kinase (CK) levels. Subjects performed up to 300 concentric/eccentric contractions of the elbow flexors with 90% of their 10 repetition maximum to induce muscle soreness. Dependent variables were assessed at 2, 4, 6, 24, 48, 72, 96, and 120 hours postexercise. Significant differences occurred in all variables with respect to time (ANOVA(p<.05)). However, no significant mode of treatment, or mode of treatment/assessment time interaction was present. Decreases in range of motion and flexion strength correspond with increases in perceived soreness. The nonsignificant mode of treatment/assessment time interaction suggests that the use of ice massage, ice massage with exercise, or exercise alone is not effective in significantly reducing the symptoms of delayed onset muscle soreness. In fact, though not statistically significant, the pattern of the data suggested the use of ice in the treatment of DOMS may be contraindicated. Further investigation is recommended.