Urinary free deoxypyridinoline excretion in lactating and non-lactating Arabic women of the United Arab Emirates.

BACKGROUND: This study aimed to measure urinary free deoxypyridinoline (Dpd) excretion in non-lactating and lactating Arabic women of the United Arab Emirates. METHODS: Morning urine specimens were obtained from 679 non-pregnant, non-lactating women and 268 lactating women. Commercial enzyme-linked immunoassay kits were used for urinary free Dpd determinations. RESULTS: For the non-lactating women, the mean urinary free Dpd excretion was 9.20 nmol/mmol creatinine (95% confidence interval: 8.82-9.59). This result was significantly higher than those reported elsewhere. There was a trend towards lower Dpd excretion with increasing age (ANOVA test of linearity P<0.05). Urinary free Dpd in lactating women was 9.92 (9.33-10.5); this was not significantly different from that of non-lactating women (P=0.052). Dpd excretion was higher in the first month post-partum, with a significant trend towards diminishing levels thereafter, returning to non-lactating levels by 9 months post-partum (ANOVA test for linearity P<0.005). CONCLUSION: Dpd excretion in UAE Arabic women aged 20-44 years was higher than in other groups. This could be due to ethnicity or vitamin D status.

Use of a tourniquet in patients with sickle-cell disease.

Fifteen patients, 13 male and two female, known to be carrying the sickle-cell gene (12 HbSS and 3 HbAS), who were undergoing operations requiring a bloodless field, were included in the study. Of the 12 with HbSS, seven had haemoglobin A1 component of between 11 and 27%, three had fetal haemoglobin ranging from 5.7 to 29% and the remaining two had increased haemoglobin A2 concentrations suggesting a beta non-thalassaemia combination. All had a tourniquet applied to the appropriate limb and were given general anaesthesia with moderate hyperventilation throughout the procedure. The tourniquet inflation time was 61.7 +/- 27.5 min. The mean PaO2 remained above 200 mmHg, mean PaCO2 was less than 37 mmHg, and pH ranged between 7.40 and 7.45. There were no clinically important changes in BP or ECG. All patients made uneventful recoveries and none developed sickle-cell crises. It is suggested that it is safe to use tourniquet in patients with sickle-cell disease provided optimum acid-base status and oxygenation are maintained throughout the procedure.

Congenital brachial palsy in the eastern province of Saudi Arabia.

The clinical features of 57 patients (31 males, 26 females) with congenital brachial palsy seen at the King Fahd Hospital of the University over a 5-year period are described. Delivery was difficult in 32 (56%), 20 (35%) were large babies (birth weight greater than 3,600 g), and 20 deliveries required either forceps or vacuum extraction. The presentation at delivery was vertex in 45, breech in five, and shoulder in four. Associated injuries or features, encountered in 14 cases, were fractures of the clavicle and humerus (six cases each), and skull fracture and Horner's syndrome in one patient each. The right and left sides were involved in 31 and 24 cases, respectively, and both sides in only two cases. All the muscle groups of the affected limb were most commonly involved (40%), and hand muscles alone were affected in only one patient. Although 60% of the cases presented late to the hospital, functional recovery was observed in 63%. The major predisposing factors identified in this study were technically difficult deliveries, large infants, and breech or shoulder presentation with assisted delivery. It is suggested that early identification of these factors and improvement in obstetric care of both the mothers and babies during delivery would reduce the incidence and severity of this disability.

A clinical review of the orthotic treatment of myelomeningocele patients.

High myelomeningocele lesions do not preclude an acceptable level of functional walking provided that an integrated programme of surgical treatment and bracing is adopted. Clinical analysis of 100 patients with myelomeningocele shows that the development of the "swivel walker" and "hip guidance orthosis" has been associated with an improved level of function. Over 30 per cent of patients with thoracic lesions and 68 per cent of those with lumbar lesions achieved independent walking. For this reason the criteria used at present by paediatricians to govern the selection of infants for non-active treatment may require reconsideration.

Bone marrow pressure changes under an inflatable tourniquet.

Theoretical calculations suggest that under a limb tourniquet, the pressure at the bone/tissue interface is greater than it is more peripherally. The central bony core must be incompressible for this hypothesis to be correct. Experiments designed to measure the intramedullary pressure confirm that this pressure does not rise at tourniquet pressures above the systolic blood pressure. It has also been suggested that shear stresses are the most likely cause of nerve damage under a tourniquet but this depends on the conversion of the tissue under compression into a fibro-elastic solid. This is likely to occur when all fluid has been driven out. From the experiments such a fluid shift does not seen to occur via the intramedullary cavity but it must nevertheless occur at an early stage of rising tourniquet pressure, probably by fluid shift through the veins proximal and distal to the tourniquet.

Chronic arthropathy in von Willebrand's disease.

In von Willebrand's disease, chronic arthropathy is thought to be rare. We present four young patients, three girls and a boy, with severe von Willebrand's disease, who developed chronic progressive arthropathy due to joint haemorrhage, similar to that seen in haemophilia. Chronic joint disease is not as uncommon as is generally assumed.

Pseudomembranous colitis following cephradine prophylaxis.

Two patients on antibiotic prophylaxis with cephradine after orthopaedic implant surgery developed pseudomembranous colitis. Routine administration of antibiotics after such surgery is the policy at many centres. Development of diarrhoea in these patients should be viewed seriously lest this condition is overlooked. Despite recent advances, pseudomembranous colitis can still have a fatal outcome.

Clinical evaluation of spina bifida patients using hip guidance orthosis.

A hip guidance orthosis has been designed to provide the highest potential level of ambulation for the child with myelomeningocele. It permits low energy-cost ambulation at a reasonable speed, and independent transfer from chair to walking and vice versa. It also enables some patients to ascend or descend steps of up to 150mm, as well as gradients of up to one in 10. A review of 27 patients who had used the orthosis for periods of between six and 45 months was undertaken in order to establish the degree of benefit. 17 patients had no power in hips or below, the rest having some power in one or both hips. 17 patients had dorsal lesions and the remainder had lumbar lesions. Using Hoffer's (1973) classification, 13 patients had improved ambulation when using the hip guidance orthosis, and most of the remainder showed some measurable improvement in ambulation. 14 patients were tested for speed of ambulation and heart rate before and after use of the orthosis, and the mean increase in speed was 87.3 per cent, with a mean decrease in heart rate of 10bpm--a clear improvement in efficiency. The results indicate that the hip guidance orthosis can provide low-energy ambulation for spina bifida patients with dorsal and high lumbar lesions in a form acceptable both to patients and parents.

A comparison of axillary, elbow and Canadian crutches.

Crutches can be used by patients with injuries to the lower extremities in order to perform 'swing-through' gait. Because axillary crutches have been associated with axillary artery thrombosis and crutch palsy, they have to a large extent been superseded by elbow crutches. Canadian crutches combine many of the features of axillary and elbow crutches, and a study of the three types suggests that they have advantages in terms of energy cost.

Fractures of the clavicle.

Three hundred and forty-two patients with fractures of the clavicle attended the Fractrure Clinic at Bridgend General Hospital between 1957 and 1972. The history of injury was recorded in the notes at the first visit but in only 215 cases was the exact mechanism of the injury clearly stated. Of these, 91 per cent were caused by a fall or a blow on the point of the shoulder. All patients were treated symptomatically. A triangular sling was applied to support the weight of the arm and early use of the limb was encouraged. One hundred unselected patients were followed up, the longest period being 15 years and the shortest, 1 year. None had any loss of function of muscle power at the shoulder. Only 15 per cent were left with any noteworthy deformity at the site of fracture.