Transcranial Doppler ultrasonography in adults with sickle cell disease

BACKGROUND

Transcranial Doppler (TCD) is used to select children with sickle cell disease (SCD) for primary stroke prevention using regular blood transfusion. Whether it can also identify high stroke risk in adults with SCD is not known.

METHODS

The authors examined 112 adult patients from two convenience population samples with SCD and 53 healthy control subjects to compare velocities in adults to those reported in children with SCD and to evaluate the influence of age and hematocrit on TCD.

RESULTS

Adults with SCD had a higher mean time-averaged maximum mean velocity (110.9 +/- 25.7 cm/s) compared with healthy controls (71.1 +/- 12.0 cm/s), and the difference is approximately proportional to their anemia. No cases with velocities >/=200 cm/s (the threshold used in children for prophylactic treatment) were found in this sample.

CONCLUSIONS

Transcranial Doppler velocities in adults with sickle cell disease (SCD) are lower than those in children with SCD. Velocity criteria used in children cannot be used to stratify risk of stroke in adults.

A new ankle laxity tester and its use in the measurement of the effectiveness of taping

Damage to the lateral ligaments of the ankle, namely the anterior talofibular (ATFL) and the calcaneofibular (CFL) ligaments, is a frequently reported sports injury. The anterior drawer test is generally used to evaluate whether the ATFL has been torn, while the talar tilt test is used to determine if the CFL has been injured. Although these two manual tests are often utilized for quick diagnosis, they have been criticized because of their subjective nature and their inability to produce quantitative and reproducible results. A prototype ankle tester was manufactured that could measure the input force and torque, as well as the linear and angular deprivations for the anterior drawer test and the talar tilt test, respectively. This device was used to take readings on 10 human volunteers of a mean age of 21.6 years. This device was X-ray compatible, adjustable for varying patient sizes, relatively small, portable, and easy to operate. Testing was performed to determine how the stiffness of the ankle would respond to taping, and the effect of walking on the taped ankle. The overall mean anterior drawer was 5.93 mm and the mean talar tilt was 51.6 degrees for bare ankles using a force of 111 N (25 lbs) for the drawer and a torque of 16 N m for the tilt. Taping provided an average increase in stiffness of 11.3%, demonstrating that it did provide increased stability. However, statistically significant (P<0.05) decreases in the stiffness subsequent to taping were observed between the initially taped ankles and after 20 min of walking, when it was shown that talar tilt had increased. The prototype ankle tester produced repeatable measurements, and results show that the increase in stiffness due to taping did decrease after a short period of time.

Inconsistencies in the treatment of football neck injuries

There are clearly inconsistencies in treatment techniques offered by EMS providers to football athletes with potential severe neck injuries. It is unclear if current teaching methods or cirriculums play a role in these inconsistencies. Standardized cirriculum and practical skills would ensure consistent treatment of potential catastrophic neck injuries in football athletes. This study also suggest the need of formal protocols for treating these injuries. Many times there may be non-EMS providers involved in the care of the athletes. Communication of the protocols to all "team" members is vitally important. We ALL (EMS, athletic trainers, coaches, and physicians) need to be on the "same page" when treating such an injury. The result of a knowledgeable team may mean the difference between an athlete being a liability on society versus a productive member of society.

Diffuse well differentiated lymphocytic lymphoma: a clinical study of 22 patients

An analysis is presented of the clinical and prognostic features of 22 patients diagnosed with diffuse well differentiated lymphocytic lymphoma at Cleveland Metropolitan General Hospital between 1974 and 1987. At presentation, the disease was usually advanced with 86% of patients having stage IV disease and 73% of patients exhibiting bone marrow involvement. Ten second malignancies were documented in 7 (32%) of our patients. The goal of treatment in our patients was palliation except in the 2 stage 1 patients. The response rate to initial treatment was 55% (15% complete), although 75% of patients ultimately responded to some form of therapy; and the mean survival was 58 months, a figure not different from historical controls. There were no differences in survival between patients given simple versus complex therapy at diagnosis or at any time during the course of their disease; and no differences in survival between complete, partial and nonresponders.

Some properties of hemoglobin mobile (alpha 2 beta 2 73 Asp----Val)

A hemoglobin variant was identified as hemoglobin Mobile in which valine replaces the normal aspartic acid at beta 73. Studies of its oxygen equilibria and of its interactions in gelation when mixed with hemoglobin S were carried out. Hemoglobin Mobile had an oxygen affinity lower than that of hemoglobin A, as observed by others. However, in mixtures with hemoglobin S, hemoglobin Mobile appeared to impair gelation or increase solubility to a slightly greater extent than did hemoglobin A. Beta 73 is a known site of intermolecular interactions in polymers of hemoglobin S. Our studies suggest that the impairment of hemoglobin S polymer formation by altered intermolecular interactions is significantly less in Hb Mobile than in Hb Korle-Bu in which beta 73 is asparagine.

The hershey halo jig

The Hershey Halo Jig is a device for simplifying the application of the cranial halo ring. Secured by the patient's own body weight, the jig safely supports both the patient's head and the halo ring, leaving the surgeon's hands free for skull pin insertion. The head support is adjustable allowing cervical spine flexion or extension according to stability requirements. The halo jig significantly increases the speed, accuracy, and safety of halo application.

Platelet aggregation as a sign of septicemia in thermal injury. A prospective study

Serial measurements of coagulation activity, platelet counts, and platelet aggregation were done in patients with full-thickness burns involving 25% or more of body surface area to detect specific changes that might correlate with the onset of septicemia. Mean and maximal values for prothrombin time, partial thromboplastin time, thrombin time, activities of factor V and factor VIII, and concentrations of fibrinogen and fibrinogen-related antigens observed in the presence of bacterial septicemia did not differ significantly from those observed in the absence of septicemia. Mean platelet counts were significantly less with sepsis, but values in individual subjects were not indicative of the presence of septicemia. By contrast, platelet aggregation in response to adenosine diphosphate, epinephrine, and collagen always became severely abnormal with the onset of septicemia but not in the absence of sepsis.