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Biomedical subjects

M B Smith

Publications and source records attributed to M B Smith.

At least 145 records · Page 8Linked to original sources

Interrater reliability of a modified Ashworth scale of muscle spasticity.

We undertook this investigation to determine the interrater reliability of manual tests of elbow flexor muscle spasticity graded on a modified Ashworth scale. We each independently graded the elbow flexor muscle spasticity of 30 patients with intracranial lesions. We agreed on 86.7% of our ratings. The Kendall's tau correlation between our grades was .847 (p less than .001). Thus, the relationship between the raters' judgments was significant and the reliability was good. Although the results were limited to the elbow flexor muscle group, we believe them to be positive enough to encourage further trials of the modified Ashworth scale for grading spasticity.

Elbow Joint↗

Assessment of strength deficits in eight paretic upper extremity muscle groups of stroke patients with hemiplegia.

This retrospective investigation was undertaken to describe and compare the initial and discharge strength deficits of eight upper extremity muscle groups of 42 patients who were hemiparetic secondary to cerebrovascular accidents (CVAs). Static strengths of the eight muscle groups were measured using a hand-held dynamometer, and strength deficits were calculated against the side ipsilateral to the side affected by the CVA. A two-way analysis of variance for repeated measures revealed significant differences (p less than .001) in the strength deficits of the eight muscle groups and between initial and discharge strength deficits. The strength deficits of the shoulder medial rotator and abductor muscle groups were significantly less than those of any other muscle group. No difference was found in the proportion of muscle groups improving in strength in patients tested within six weeks after the onset of hemiplegia versus patients tested six weeks later. Our results do not confirm the common expectation of relatively lesser involvement of the elbow flexor muscles after a CVA. The results do suggest that patients improve in muscle strength concurrent with a rehabilitation program.

Adult↗

Relationship between static muscle strength deficits and spasticity in stroke patients with hemiparesis.

The purpose of this retrospective investigation was to determine whether a relationship exists between static strength deficits in the shoulder medial (internal) rotator and elbow flexor muscles and spasticity in these muscles or their antagonists. We reviewed the records of the first 50 stroke patients with hemiparesis who met the entry criteria for the study and who were admitted over a four-month period of time. Static muscle strength was measured by hand-held dynamometry. Spasticity was graded on the Ashworth scale. Kendall's tau correlations were calculated between static muscle strength deficits and spasticity. Static strength deficits of the shoulder medial rotator and elbow flexor muscles were correlated (p less than .01) with the agonist muscles' spasticity, but not with the antagonist muscles' spasticity. Muscle group spasticity and strength deficits, therefore, appear to be covarying manifestations of cerebrovascular accidents. Clinicians, thus, may interpret an agonist muscle's capacity for force production in light of its own tone rather than that of its antagonist.

Adult↗

Upper extremity strength deficits in hemiplegic stroke patients: relationship between admission and discharge assessment and time since onset.

This study describes objective upper extremity strength deficits in hemiplegic stroke patients on initial and discharge assessment, and the relationship between these deficits and the time since onset. The static strength of ten different muscle groups had been measured bilaterally in patients (n = 24 to 58, depending on the muscle group), using a hand-held dynamometer. Strength deficits were calculated in relation to the nonparetic side of the body. Zero order correlations were calculated for strength deficit and time variables. Only the relationships between the strength deficits of the initial and discharge assessments were significant (p less than 0.01). These results suggest that the strength deficits of an initial assessment are the best predictors of strength deficits at discharge. This finding has implications for clinicians in clinical decision-making and in addressing patient expectations.

Aged↗

Urinary and serum silicon in normal and uraemic individuals.

The urinary excretion of silicon (Si) in humans was studied in normal subjects on a low Si diet, a normal diet, and after ingestion of silicate antacid. Measurements of 24-hour urinary excretion of Si showed that urinary Si was derived mainly from dietary intake. The serum concentration of Si was determined in normal individuals and in patients with chronic renal failure. In health, serum Si is maintained within a narrow range, but a significant hypersilicaemia occurs in uraemia. The concentration of Si was measured in the water supply, dialysate and pre-dialysis and post-dialysis serum in patients on regular haemo-dialysis in three areas with low, intermediate and high concentrations of Si in the water supply. Si was removed during dialysis in the region where it was naturally low in the water or where reverse osmosis was used, but it was dialysed into patients in regions with intermediate and high concentrations in the water. Serum Si levels returned to normal after renal transplantation. Preliminary analysis of the geographical variation in the Si content of tap water suggests that uraemic hypersilicaemia may protect haemodialysed patients from the development of aluminium dementia. The kidney would appear from these studies to be the major organ for elimination of absorbed Si.

Adult↗

Influence of propranolol on acidosis and high energy phosphates in ischaemic myocardium of the rabbit.

Catecholamines stimulate adenosine triphosphate consumption and glycogenolysis in isolated hearts. In ischaemic myocardium a protective effect of beta adrenergic blockade may therefore arise from reduced adenosine triphosphate consumption or attenuation of acidosis. To characterise the biochemical mechanism of this protective effect phosphorus metabolite concentrations and intracellular pH were measured in an ischaemic region of the rabbit heart in vivo using 31P-nuclear magnetic resonance spectroscopy. After occlusion of the left anterior descending coronary artery there was a rapid decrease in intracellular phosphocreatine concentrations, and intracellular adenosine triphosphate concentrations decreased at a rate of approximately 0.5 mumol X g-1 dry weight X min-1. Intracellular pH decreased approximately linearly to a final pH of about 5.8. In the ischaemic myocardium of the animals treated with propranolol the intracellular concentrations of adenosine triphosphate were higher and those of phosphocreatine lower and the pH was the same compared with control after 30 minutes of ischaemia. Thus any protective effect of propranolol in vivo is not associated with attenuation of intracellular acidosis in this preparation.

Adenosine Triphosphate↗

Relationship between independent sitting balance and side of hemiparesis.

We conducted a retrospective chart audit of initial physical therapy evaluations to determine the incidence of sitting imbalance and its relationship to the side of weakness in hemiparetic patients. A review of the records of 105 patients revealed that the left side was predominantly affected in 52 patients and the right side in 53 patients. Age, time since onset, and proportion of men and women did not differ between the left and right hemiparetic patients. Most patients (81.0%) could sit independently, but 32.7% of those with left-sided weakness and 5.7% of those with right-sided weakness could not. A chi-square analysis revealed a significant relationship between the side of weakness and independent sitting balance (p less than .001). The phi-square test revealed the strength of this relationship to be .12. Patients with left hemiparesis are more likely to have difficulty with independent sitting than patients with right hemiparesis, which may affect their progress in rehabilitation.

Activities of Daily Living↗

Effect of pretreatment with propranolol on intra-ocular pressure changes during induction of anaesthesia.

It is well documented that intra-ocular pressure (IOP) increases following the administration of suxamethonium and also after laryngoscopy and intubation. It is possible that there may be a final common pathway mediated by beta adrenergic transmission which leads to this pressure rise. If so, this mechanism should be inhibited by beta adrenoceptor blockade. Pretreatment with propranolol prevented a significant rise in IOP during a thiopentone, suxamethonium, intubation induction sequence. The change in IOP was even more pronounced during a thiopentone, alcuronium, intubation induction sequence as the base-line IOP was not regained, but there was significant cardiovascular depression. In both these methods the IOP did not remain stable; there was an initial reduction followed by a rise in pressure. Whether these changes in IOP are clinically important remains an open question.

Adult↗

Shoulder pain in hemiplegia: statistical relationship with five variables.

The incidence of shoulder pain and the statistical relationship between it and five other variables (patient age, time since onset of hemiplegia, range of hemiplegic shoulder external rotation, spasticity and weakness) were investigated retrospectively. Of 50 consecutive hemiplegic patients whose records were reviewed, 36 had shoulder pain. The variables significantly (p less than 0.01) correlated with shoulder pain were: time since onset of hemiplegia (r = 0.45) and ROSER (r = -0.61). The relationship between shoulder pain and range of shoulder motion remained significant when other factors were partialled out. The relationship between shoulder pain and time since onset was not significant when the affect of range of shoulder motion was partialled out. Therefore, range of shoulder external rotation was considered the factor related most significantly to shoulder pain. This finding suggests that shoulder pain demonstrated by hemiplegia patients may be, in part, a manifestation of adhesive capsulitis.

Adult↗

A comparison of in vivo catalysis by creatine kinase in avian skeletal muscles with different fibre composition.

The maximum activity of creatine kinase in vitro is similar in the pectoralis major muscle of the chicken and the duck. However, the flux (phosphocreatine to ATP) as measured by 31P saturation transfer NMR in vivo is almost 2-fold higher in the duck. This apparent discrepancy can be accounted for by the differences in the cytosolic free ADP concentrations in resting muscle.

Adenosine Diphosphate↗

A 31P NMR study of the epididymis and epididymal sperm of the bull and hamster.

31P NMR signals assigned to intracellular adenine nucleotides and to inorganic phosphate were detected in dense suspensions of epididymal sperm obtained from bulls or hamsters. Similar adenine nucleotide signals and an additional large resonance peak, attributable to extracellular glycerylphosphorylcholine, were observed with whole bovine cauda epididymides. Provision of the glycolytic substrate fructose to such sperm suspensions promoted apparent conversion of intracellular ADP to ATP with a concomitant decrease in cellular inorganic phosphate (Pi) content. Subsequent treatment with the methylxanthine caffeine resulted in diminution of the intracellular gamma-P-ATP signal that was consistent with the decreased ATP and ADP contents previously demonstrated by chemical analyses of cellular extracts. Alternatively, treatment with fructose followed by the membrane-selective detergent digitonin produced loss of the nucleotide NMR signals, indicating release of ATP and Pi from the sperm cytosol with subsequent hydrolysis in the extracellular medium. Comparison of intracellular Pi and ATP resonance signals with those of ATP and Pi in vitro, in media of varied pH and cation composition, allowed calculation of a cytosolic pH of 6.5-6.6 and a cytosolic Mg2+ concentration of 0.5 mM for fresh suspensions of bovine cauda epididymal sperm. Intracellular Pi of hamster epididymal sperm reported a similar cytosolic pH. Other, more acidic compartments were not detected in these experiments. However, during prolonged incubation, the pH of the bovine sperm interior slowly decreased as the extracellular medium was acidified by extensive production of lactate. Intracellular ATP was detectable until cytosolic pH declined to approximately 5.5. Rapid intracellular acidification, resulting from exchange of internal K+ for H+, was observed after treatment with carboxylic acid ionophore nigericin. This lowering of internal pH was followed by a slower return toward initial internal pH values, probably as a consequence of secondary exchange of internal protons for other external monovalent cations, rather than as a result of the operation of a cellular homeostatic mechanism. Together, these studies utilizing noninvasive NMR techniques provide evidence that within the bovine epididymis sperm utilize an unknown energy source to phosphorylate adenine nucleotides and maintain a slightly acidic cytosolic pH.

Animals↗

The role of fetal adrenal hormones in the switch from fetal to adult globin synthesis in the sheep.

The switch from gamma (fetal) to beta (adult) globin production was studied by the analysis of globin synthesis in chronically cannulated ovine fetuses and newborn lambs. The gamma/alpha globin synthesis ratio decreased from 0.98 +/- 0.11 (S.D.) (n = 4 samples) at 100-120 days of gestation to 0.15 +/- 0.07 (n = 4) in lambs of 150-156 days post-conception, and the beta/alpha synthesis ratio increased from 0.04 +/- 0.06 (n = 4) to 1.13 +/- 0.21 (n = 4) over the same period. In bilaterally adrenalectomized fetuses, which survived in utero until 151-156 days, the gamma/alpha and beta/alpha synthesis ratios were 0.64 +/- 0.14 (n = 3) and 0.25 +/- 0.07 (n = 3) respectively in the 150- to 156-day period. Bilateral adrenalectomy did not affect the time of onset of beta globin synthesis, but significantly decreased the rate. In one bilaterally adrenalectomized fetus the infusion of increasing concentrations of cortisol restored the rate of beta globin synthesis to normal. Treatment of three intact fetuses with 100 micrograms cortisol/h for 3 weeks, from 100 to 121 days, did not affect the timing or rate of switch from gamma to beta globin synthesis. Thus fetal adrenal secretions, probably cortisol, affected the rate of change of gamma to beta globin synthesis but other factors must have been involved in the initiation of the switch.

Adrenal Cortex Hormones↗

In vivo phosphorus-31 nuclear magnetic resonance study of the regional metabolic response to cardiac ischemia.

We applied 31P nuclear magnetic resonance to the study of acute ischemia in vivo. In open-chest rabbits, the left anterior descending coronary artery was occluded after control spectra were obtained. Phosphocreatine concentration decreased in the first minute and ATP concentration declined subsequently, and pH decreased to 5.8 within 20 min. Intracellular acidosis was greater than that previously reported for the isolated perfused rabbit heart.

Acid-Base Equilibrium↗

Consequences of removal of a "normal" appendix.

Five hundred consecutive cases of appendicectomy were reviewed. The incidence of non-inflamed appendices removed at operation was 29.6% and was nearly twice as high in females than in males (P less than 0.001). The incidence of perforated appendices in patients with acute appendicitis was low (6.5%), and there were no deaths. Postoperative complications, mostly infections occurred in 6.7% of patients with a non-inflamed appendix and in 19.3% of patients with appendicitis (P less than 0.001). No features of the history or examination were sufficiently discriminatory to enable a definite diagnosis to be reliably established before operation. Appendicectomy remains the safest management option in patients with suspected appendicitis in whom diagnostic doubt remains after thorough clinical evaluation and observation.

Adolescent↗

Hope and despair: keys to the socio-psychodynamics of youth.

A psychology of hope and despair is offered, integrating findings from recent psychological research in application to the interpretation of unrest among youth in the 1960s, of present socially problematic behavior, and of response to life under threat of nuclear holocaust. Survey data suggest a complex pattern: the majority of youth are hopeful about their own immediate future, but far fewer are optimistic about their nation and the world. Implications for individual action and social policy are offered.

Adolescent↗

Analysis of rates of globin synthesis in normal human fetuses and neonates and in twins.

The factors responsible for the switch from gamma- to beta-globin synthesis, which occurs in man in the perinatal period, are still unknown. In this study the relationship of fetal maturity (as measured by gestation age and fetal weight) to changing rates of globin synthesis was analyzed. The relationship of rates of erythropoiesis to the switch was also analyzed. Rates of globin chain synthesis were studied in blood from fetuses from 10-41 wk gestation, in neonates up to 6 mo of age, and in a series of twins from 29-40 wk gestation. The beta/gamma-globin synthesis ratio in fetal blood remained relatively constant until 30-34 wk gestation when an increase in beta-globin production was observed. Adult levels of globin synthesis were present in neonates at 6-9 wk after birth. The gamma/alpha-globin synthesis ratio showed a reciprocal change, falling after 30 wk gestation. Globin synthesis ratios in fetuses and neonates from 32-41 wk post-conception showed a significant correlation with age (beta/gamma: p less than 0.001; beta/alpha:p less than 0.001; gamma/alpha: p less than 0.05), and there were significant correlations between the beta/alpha and beta/gamma synthesis ratios and weight (p less than 0.05 for both ratios). Globin synthesis ratios in 12 sets of twins from 29-40 wk gestation were generally within the normal range for gestational age. However, the switch to beta-globin production was more advanced than expected from weight for some of these babies.

Birth Weight↗