Usability of a visual feedback system to assess and improve movement disorders related to neck pain: Perceptions of physical therapists and patients.

A prototype visual feedback system has been developed to assess and improve movement disorders related to neck pain. The aim of this study was to assess the usability of the prototype in a rehabilitation setting. Twelve physical therapists integrated the device into their regular therapy programs for 24 neck pain patients with movement disorders. Each patient performed three individual therapy sessions with the device under physical therapist supervision. Usability was assessed by the physical therapists and patients using therapy diaries, the System Usability Scale, and focus group or personal interviews. Based on an overall usability rating of marginally acceptable, the visual feedback system was generally found to be a device with the potential to assess and train neck pain patients but needs improvement. To become a useful adjunct to regular physical therapy, improvements in the hardware and software, and further system developments are required.

Medical prescription of heroin to chronic heroin addicts in Switzerland - a review.

In 1994, a new project dealing with the treatment of heroin dependency was introduced in Switzerland. A group of heavy opiate addicts, who had failed in previous medical therapies, received heroin by prescription, supported by health and social services. The admission criteria to this treatment are summarized as the main results of this project: physical and mental health of the addicts improved on average during treatment, an improvement also took place in their social reintegration, a significant decrease in consumption of illegal drugs took place and illegal activities declined massively. The proportion of patients who continued the treatment in a time period of 12 months was held at 76%. Comparison of the treatment costs with the economic benefits shows that there is a total benefit per patient and per day of 26 US dollars. Further drug related political decisions in Switzerland as well as the assessments of the International Narcotics Control Board (INCB) of the United Nations to this project will be reported and discussed.

[Lead poisoning in calves due to old white lead paint]. / Vergiftung bei Mastkälbern mit Bleiweiss.

A case of poisoning by chronic ingestion of lead in calves with a peracute clinical course is described. The source of lead was a prime coat of white lead on old white painted doors. These doors originated from an institution for aged people and had been used as pen walls for fattening calves. About 12 weeks later five animals died within hours after onset of CNS-symptoms. The post mortem examination of three animals revealed one with multifocal laminar edema and mild vasculitis in the cerebrocortex, one with acid fast intranuclear inclusion bodies in the renal tubular epithelial cells and one without lesions. Liver, kidney and abomasal contents of two animals were analysed for lead content. The concentration was diagnostic for lead poisoning in one case only.

Beta-hydroxybutyric acid--an indicator for an alcoholic ketoacidosis as cause of death in deceased alcohol abusers.

We analyzed the postmortem blood of a total of 100 fatal cases for beta-hydroxybutyric acid (BHBA). In 25 cases of sudden and unexpected death of alcoholics we found pathologically increased levels of BHBA of 1260 to 47200 (median 8000) micromol/L. This led us to the diagnosis of an alcoholic ketoacidosis (AKA) as cause of death in these cases. The control group of 69 postmortem cases revealed that BHBA concentrations below 500 can be regarded as normal, and values up to 2500 micromol/L as elevated. Our study shows that BHBA values over 2500 micromol/L could lead to death, if no medical attention is sought. During storage we did not find any indication of postmortem formation or decomposition of BHBA in blood in vitro or in the corpses. In our opinion, BHBA should be considered the diagnostic marker of choice for the postmortem determination of alcoholic ketoacidosis (AKA) as the cause of death. The classical indications of such deaths are: unexpected death of a chronic alcoholic; none or only traces of ethanol in the blood; increased acetone blood concentration; and neither autopsy, histology, microbiology, nor toxicology reveal the cause of death. In six further cases a diabetic ketoacidosis (DKA) was diagnosed as the cause of death.

[A new drug reaches Switzerland: coma after intake of gamma-hydroxybutyrate (GHB)]. / Eine neue Droge erreicht die Schweiz: Koma nach Einnahme von Gamma-Hydroxybuttersäure (GHB).

The new recreational drug, gamma-hydroxybutyrate (GHB, "liquid ecstasy"), reached Switzerland in 1998. We describe two cases from the city of Zurich. In both of them the subjects were profoundly unconscious and needed hospitalization after intake of a colourless liquid. Both patients recovered after a few hours, rapidly and without after-effects. Gamma-hydoxybutyrate is abused mainly for its euphorigenic and sedative properties by young people in discos, at raves, or on the drug scene. It is also taken as an alleged anabolic agent among bodybuilders. Criminals use it to narcotise potential victims. We summarise its effects, adverse effects, diagnosis, treatment, toxicology, pharmacology, and medical applications.

Cladribine with cyclophosphamide and prednisone in the management of low-grade lymphoproliferative malignancies.

The feasibility of combining cladribine with cyclophosphamide and prednisone in the management of indolent lymphoid malignancies was determined. Nineteen patients [nine chronic lymphocytic leukaemia (CLL), seven non-Hodgkin's lymphoma (NHL) and three macroglobulinaemia (M))] received cladribine 0.1 mg kg(-1) per day as a subcutaneous bolus injection on days 1-3 (up to 5 injections) with intravenous cyclophosphamide 500 mg m(-2) on day 1 and oral prednisone 40 mg (m-2) on days 1-5 at 4-weekly intervals up to a maximum of six courses. A total of 80 courses were given. Overall response rate was 88%, with four patients achieving a complete clinical and haematological response and 12 achieving a partial response. Neutropenia WHO grade 4 in two patients and WHO grade 3 infection in one patient were the limiting toxicities on treatment. During the follow-up, WHO grade >3 haematological complications occurred in five patients and WHO grade >3 non-haematological complications in five patients. There were no treatment-related deaths. This study demonstrates the feasibility of the cladribine/cyclophosphamide/prednisone (CCP) combination that appears highly active and safe in the management of indolent lymphoid malignancies.

Feasibility, toxicity, and activity of LNH84-derived chemotherapy in the management of aggressive lymphomas.

The results of chemotherapy remain unsatisfactory for many patients with advanced lymphomas. Both standard and more aggressive chemotherapy regimens might have their respective role in the management of theses diseases. We have tested the feasibility and assessed the toxicity and activity of a LNH84-derived chemotherapy for aggressive non-Hodgkin's lymphoma in two general hospitals. Thirty-three untreated patients were included over a period of 4 years. Median age was 39 years, 21 were male. International Working Formulation was F for 2 patients, G for 17, H for 8, I for 1, J for 4, one unclassified. Seventeen patients had B symptoms, 15 stage IV, 8 bulky disease, 21 abnormal LDH, 5 performance status > or =2. The overall response rate was 93%. The single treatment related death resulted from bleomycin acute pneumonitis. Neutropenia WHO grade 4 occurred in all patients, resulting in infections grade 3 in 12 and thrombocytopenia grade 4 in 3. In the induction phase, courses could never be repeated day 14. The dose intensity of the four drugs contained in this phase is thus calculated between 64.5 and 81.5%. At 3 years, overall survival is 80% and event-free survival is 62%. This LNH84-derived regimen is effective. However, the induction phase is toxic and a 3-weekly interval appears more appropriate. Such intensive treatment might benefit patients with very aggressive lymphomas and this should be studied in randomized comparison against standard CHOP.

[Alcoholic ketoacidosis]. / Alkoholische Ketoazidose.

Alcoholic ketoacidosis (AKA) is an important and probably underdiagnosed differential diagnosis for metabolic acidosis with an increased anion gap. It occurs in patients with prolonged ethanol intake. After a brief period of starvation induced by alcoholic gastritis patients typically present with vomiting, abdominal pain and Kussmaul breathing. Routine testing for urine or serum ketones with ketostix may be negative, since they do not detect beta-hydroxybutyrate and this is characteristically elevated in AKA. We present three cases of AKA and discuss diagnosis, pathophysiology and management of this disorder.

Abuse of germanium associated with fatal lactic acidosis.

Germanium compounds are marketed as nonprescription drugs in Europe and are recommended by the suppliers for AIDS and metastatic cancer disease. We observed a patient with nonmetastatic breast cancer who died because of severe lactic acidosis (plasma lactate concentration = 27 mmol/l) after ingestion of 25 g of elemental germanium over a 2-months period. Renal failure and hepatotoxicity had newly developed during germanium intake. Postmortem examination revealed severe hydropic vacuolation of tubule cells and the presence of inclusion bodies predominantly in straight proximal tubule cells with normal appearance of renal interstitium and glomeruli. The liver showed panlobular steatosis. Urine, blood and tissue (kidney, liver, muscle, pancreas) levels of germanium were high. Lactic acidosis may have been caused by the combined, germanium-induced renal and hepatic failure (underutilization), but it remains to be seen whether germanium can affect lactate production and/or metabolism directly.

[Suicide by severing blood vessels using local anesthesia: reduced risk in extraction of HIV infected tissue using a stomacher]. / Suicid durch Eröffnen von Gefässen unter Lokalanästhesie: risikoarme Extraktion von HIV-infiziertem Gewebe mittels Stomacher.

Authors report an unusual suicide undertaken by a medical person who after applying the local anesthetic lidocaine, opened a leg vein with a scalpel. The cause of the suicide was presumed advanced AIDS symptoms with a progressive Kaposi sarcoma and Non-Hodgkin lymphoma. For the toxicological investigation of the tissue we used the stomacher extraction system, a method not widely known in Forensic science, however, recommended for the extraction of all infectious tissues.

Identification of skulls by video superimposition.

A method of matching skulls with photographic portraits or impressions of the face in clay by video superimposition is described. Two different practical cases are presented. The first one deals with the identification of a skull of a six-year-old girl, the second with the identification of the skull of the famous Swiss Pedagogue Johann Heinrich Pestalozzi, who died about 160 years ago. The advantages and versatility of this method are shown; also the setup of the equipment and the working technique.

The role of surgery in stage IIC and III nonseminomatous testicular cancer.

30 Patients with stage IIC and III nonseminomatous testicular cancer underwent surgery for residual tumor after induction chemotherapy (postinductive surgery). There were no operative deaths and surgical morbidity was not influenced by preoperative chemotherapy. A complete surgical remission was achieved in 9 of 15 patients with mediastinal or pulmonary deposits and in 6 of 12 patients with retroperitoneal metastases. Alphafetoprotein (AFP) levels over 10(4)ng/ml at diagnosis and persistently elevated AFP values preoperatively were associated with failure of surgery to achieve complete remission (p less than .05) and to achieve long-term survival even after surgical complete remission. Fifteen of 17 patients with radical surgery remained disease-free after a median follow-up of 33 months. Six of the 13 relapsing patients had elevated AFP levels prior to definitive surgery. In one patient a contralateral testicular cancer was diagnosed 60 months after postinductive surgery. Of the 17 disease-free survivors, 12 had no tumor, 4 had mature teratoma and only one patient had mature teratoma with malignant foci in the resected surgical specimen. We conclude that AFP levels at diagnosis, elevated AFP prior to definitive surgery, achievement of complete surgical remission and histology of residual tumor are important prognostic factors determining long-term survival in residual stage IIC and III nonseminomatous testicular cancer.

Direction sensitive laser Doppler velocimeter with polarized beams.

The described system measures the flow velocity without directional ambiguity. It does not need an optical frequency offset. Polarized illumination beams and two optical detection channels with appropriate polarizing elements are used to determine the flow direction. The Doppler signals from the two channels are identical but have a phase offset that changes sign if the flow direction is reversed. The method has been verified experimentally for low and high concentrations of scattering particles.