POSTTHROMBOPHLEBITIC SYNDROME—Rehabilitation of Patients

A common cause of disability in industrial workers is the postthrombophlebitic syndrome. Swelling of one or both lower extremities may require frequent rest periods during the day for relief. The disabling symptoms are aching, burning, heaviness, and bursting or throbbing pains in the legs. The nights are often disturbed by restlessness of the legs in which it is difficult to find a comfortable position to sleep. It follows from a few days to even years an inflammation of the veins of the legs.Treatment is directed at reducing the swelling of the legs. This often necessitates a change in the patient''s routine of daily living. Frequent rest periods are often required with the legs in the horizontal position. Elastic bandages or stockings must be worn, and drugs must be taken to improve blood flow. The adjustment is necessary not only at work, but also at home.If the patient cannot continue at his previous job, efforts should be made to place him in a new job where the necessary adjustments can be made. This is possible primarily in industries manufacturing small items such as instruments, toys and appliances.     

Medication and skilled work

There is increasing interest in the way in which drugs impair performance. This has arisen because some may impair day-to-day skills of those whose occupations demand vigilance and motor skill, and of those who are involved in decision making or where interpersonal relations are crucial. For many years the position was adopted, at least in certain occupations where impaired performance could be a danger to others, that the use of any drug should preclude employment. However, recent advances in therapeutics and a greater understanding of drug action in man has made this rather uncomplicated view of life less tenable, and there is now an increasing desire that advances in therapy should, if at all possible, be available to occupational groups, such as airline pilots. In this way the adverse effect which a drug may have on performance has become an important aspect of its clinical profile. Hypnotics appropriate for transient insomnia, which may arise from the irregularity of rest inherent in many occupations, need to be free of residual effects, antihistamines that are sedative must be avoided, and drugs used in the management of mild hypertension, often during the important years of middle life, must be as free as possible from central effects. And it must be emphasized that these drugs are often used by active, healthy or near healthy individuals. The issues involved in the safe use of a particular drug by a particular individual are complex, and as with all aspects of therapeutics it is sometimes necessary to balance efficacy and adverse effects.     

The contralateral coordination of walking legs in the crayfish Astacus leptodactylus

The coupling mechanisms which coordinate the movement of ipsilateral walking legs in the crayfish have been described in earlier investigations. Concerning the coupling between contralateral legs it was only known that these influences are weaker than those acting between ipsilateral legs. The nature of these coupling mechanisms between contralateral legs of the crayfish are investigated here by running left and right legs on separate walking belts at different speeds. The results show that coordination is performed by a phase-dependent shift of the anterior extreme position of the influenced leg. This backward shift leads to a shortening of both the return stroke and the following power stroke. As the coupling influence is only weak, several steps might be necessary to retain normal coordination after a disturbance. This corresponds to v. Holst's relative coordination. The influences act in both directions, from left to right and vice versa. However, one side may be more or less dominant. A gradient was found in the way that anterior leg pairs show less strong coordination than posterior legs. In some cases the coupling between diagonally neighbouring legs was found to be stronger than between contralateral legs of the same segment. The interpretation of this result is still open.     

MANAGEMENT OF VARICOSE VEINS DURING PREGNANCY

The incidence of recurrences after radical venous operations done during pregnancy or where pregnancy has occurred subsequently is much higher than it is in cases in which pregnancy is not a factor. These discouraging results are due to increased venous pressure, obstruction to the venous drainage of the lower extremities and hormonal factors. The management of varicose veins during pregnancy should be by conservative means consisting of proper elastic support, elevation of the extremities at night and during rest periods in the day, avoiding static dependency of the legs, and control of body weight. In event of venous stasis and severe symptoms of varicosis that cannot be controlled by conservative measures, limited surgical intervention is indicated. This should consist of high ligation and division of the involved venous trunk and the immediate tributaries. Radical extirpation of varicose veins should be reserved until further pregnancy is not contemplated.     

Does the activity of ankle plantar flexors differ between limbs while healthy,young subjects stand at ease?

Inferences on the active contribution of plantar flexors to the stabilisation of human standing posture have been drawn from surface electromyograms (EMGs). Surface EMGs were however often detected unilaterally, presuming the myoelectric activity from muscles in a single leg reflects the pattern of muscle activation in both legs. In this study we question whether surface EMGs detected from plantar flexor muscles in both legs provide equal estimates of the duration of activity. Arrays of surface electrodes were used to collect EMGs from gastrocnemius and soleus muscles while twelve, young male participants stood at ease for 60 s. Muscles in each leg were deemed active whenever the Root Mean Square amplitude of EMGs (40 ms epochs) detected by any channel in the arrays exceeded the noise level, defined from EMGs detected during rest. The Chi-Square statistics revealed significant differences in the relative number of active periods for both muscles in 10 out of 12 participants tested, ranging from 2% to 65% (χ² > 17.90; P < 0.01). Pearson correlation analysis indicated side differences in the duration of gastrocnemius though not soleus activity were associated with the centre of pressure mean, lateral position (R = 0.60; P = 0.035). These results suggest therefore that surface EMGs may provide different estimates of the timing of plantar flexors’ activity if collected unilaterally during standing and that asymmetric activation may be not necessarily associated with weight distribution between limbs. Depending on the body side from which EMGs are collected, the active contribution of plantar flexors to standing stabilization may be either under- or over-valued.     

SEED DORMANCY IN ISANTHUS BRACHIATUS (LABIATAE)

Seed dormancy and its ecological aspects were investigated in Isanthus brachiatus, a summer annual plant of limestone outcrops in southeastern United States. Freshly matured seeds are dormant and exhibit physiological polymorphism with respect to the conditions necessary to overcome dormancy. Fifteen to thirty-five percent of the seeds in a seed crop require only one stratification treatment and germinate the first spring following their dispersal in autumn. The remainder of the seeds require two, three, or more stratification treatments and thus do not germinate until after two, three, or more overwintering periods in the field. In those seeds that require more than one stratification treatment to overcome dormancy, the stratification periods must be separated by a “rest” period, which in nature corresponds to summer. The ecological significance of this type of seed dormancy mechanism in I. brachiatus is discussed in relation to adaptation to its habitat.     

Anatomy and histochemistry of hindlimb flight posture in birds. I. The extended hindlimb posture of shorebirds

Birds utilize one of two hindlimb postures during flight: an extended posture (with the hip and knee joints flexed, while the ankle joint is extended caudally) or a flexed posture (with the hip, knee, and ankle joints flexed beneath the body). American Avocets (Recurvirostra americana) and Black‐necked Stilts (Himantopus mexicanus) extend their legs caudally during flight and support them for extended periods. Slow tonic and slow twitch muscle fibers are typically found in muscles functioning in postural support due to the fatigue resistance of these fibers. We hypothesized that a set of small muscles composed of high percentages of slow fibers and thus dedicated to postural support would function in securing the legs in the extended posture during flight. This study examined the anatomy and histochemical profile of eleven hindlimb muscles to gain insight into their functional roles during flight. Contrary to our hypothesis, all muscles possessed both fast twitch and slow twitch or slow tonic fibers. We believe this finding is due to the versatility of dynamic and postural functions the leg muscles must facilitate, including standing, walking, running, swimming, and hindlimb support during flight. Whether birds use an extended or flexed hindlimb flight posture may be related to the aerodynamic effect of leg position or may reflect evolutionary history. J. Morphol., 2008. © 2008 Wiley‐Liss, Inc.     

Tight turns in stick insects

We investigated insects Carausius morosus walking whilst hanging upside down along a narrow 3 mm horizontal beam. At the end of the beam, the animal takes a 180° turn. This is a difficult situation because substrate area is small and moves relative to the body during the turn. We investigated how leg movements are organised during this turn. A non-contact of either front leg appears to indicate the end of the beam. However, a turn can only begin if the hind legs stand in an appropriate position relative to each other; the outer hind leg must not be placed posterior to the inner hind leg. When starting the turn, both front legs are lifted and usually held in a relatively stable position and then the inner middle leg performs a swing-and-search movement: The leg begins a swing, which is continued by a searching movement to the side and to the rear, and eventually grasps the beam. At the same time the body is turned usually being supported by the outer middle leg and both hind legs. Then front legs followed by the outer middle leg reach the beam. A scheme describing the turns based on a few simple behavioural elements is proposed.     

SIGNIFICANCE AND TECHNIQUE OF SHORT-TERM EXPERIMENTS ON SOLUTE ABSORPTION BY PLANT TISSUE

The significance of short-term absorption periods in experimentson solute absorption by plant tissues is discussed. A techniqueis described for such short-term experiments. As applied inexperiments on ion absorption by barley roots, the techniquepermits accurate absorption rate determinations to be made inabsorption periods of ten minutes or even less. The heterogeneityof cation uptake by this tissue is demonstrated. A readily exchangeablefraction is often present which must be accounted for if ratesof metabolically active transport are to be determined. ¹ Present address: Department of Botany, Southern Illinois University,Carbondale, Illinois. (Received December 4, 1962; )     

Experimental Studies and Dynamics Modeling Analysis of the Swimming and Diving of Whirligig Beetles (Coleoptera: Gyrinidae)

Whirligig beetles (Coleoptera, Gyrinidae) can fly through the air, swiftly swim on the surface of water, and quickly dive across the air-water interface. The propulsive efficiency of the species is believed to be one of the highest measured for a thrust generating apparatus within the animal kingdom. The goals of this research were to understand the distinctive biological mechanisms that allow the beetles to swim and dive, while searching for potential bio-inspired robotics applications. Through static and dynamic measurements obtained using a combination of microscopy and high-speed imaging, parameters associated with the morphology and beating kinematics of the whirligig beetle''s legs in swimming and diving were obtained. Using data obtained from these experiments, dynamics models of both swimming and diving were developed. Through analysis of simulations conducted using these models it was possible to determine several key principles associated with the swimming and diving processes. First, we determined that curved swimming trajectories were more energy efficient than linear trajectories, which explains why they are more often observed in nature. Second, we concluded that the hind legs were able to propel the beetle farther than the middle legs, and also that the hind legs were able to generate a larger angular velocity than the middle legs. However, analysis of circular swimming trajectories showed that the middle legs were important in maintaining stable trajectories, and thus were necessary for steering. Finally, we discovered that in order for the beetle to transition from swimming to diving, the legs must change the plane in which they beat, which provides the force required to alter the tilt angle of the body necessary to break the surface tension of water. We have further examined how the principles learned from this study may be applied to the design of bio-inspired swimming/diving robots.     

A model of leg coordination in the stick insect,Carausius morosus

A model of interleg coordination presented in a separate report is evaluated here by perturbing the step pattern in three ways. First, when the initial leg configuration is varied, the simulated leg movements assume a stable coordination from natural starting configurations in a natural way (Fig. 1a). They also rapidly re-establish the normal coordination when started from unnatural configurations (Fig. 1b-d). An explicit hierarchy of natural frequencies for the legs of the three thoracic segments is not required. Second, when the coordination is perturbed by assigning one or more legs a retraction velocity different from the rest, gliding coordination or various integer step ratios can be produced (Figs. 2–4). Third, when the swing of one leg is obstructed, characteristic changes in the stepping of other legs occur (Fig. 5). Overall differences between the step patterns of the model and those of the stick insect are related to the form of the coordinating mechanisms. Errors made by the model, such as overlapping swings by adjacent legs or discrepancies in step timing and step end-points, point out the limitations of a model restricted to kinematic parameters.     

Navajo Categories of Objects at Rest

Navajo culture partitions the domain of objects at rest into fifteen general categories based on the variables of size, shape, firmness, density, position, cohesiveness, animate or inanimate, and contained or non-contained. Each of the fifteen general categories are partitioned into fifteen additional categories based on the variables of plurality, grouping, and patterning, making a total of 225 basic categories in the cultural domain of objects at rest. Of these 225 cultural categories, 102 are a sub-set which have distinct mono-lexical markers and the remainder are unmarked. This analysis deals with the problem of the relationship between language and culture, and it concludes that sets of mono-lexical markers and cultural categories are often not congruent, and that componential analyses of sets of lexical items often fail to uncover the total set of cultural categories in a given domain.     

RESULTS OF LONG-CONTINUED CORTISONE ADMINISTRATION IN RHEUMATOID ARTHRITIS

The administration of cortisone acetate to patients with rheumatoid arthritis usually produces prompt and often dramatic suppression of the disease manifestations. The effects of the hormone are not lasting, however, and after withdrawal relapse ensues. For sustained improvement in a chronic disease such as rheumatoid arthritis, it appears that cortisone must be given more or less continuously. This raises the question whether administration may be continued effectively and safely for long periods.Seventy-six patients with rheumatoid arthritis were given cortisone in the hope that treatment could be continued uninterruptedly for extended periods. For various clinical reasons it was necessary to discontinue treatment in 16 of these before six months, but the remaining 60 patients received the hormone uninterruptedly for six to 15 months. By using initial large suppressive amounts, then gradually reducing the dosage, and finally employing smaller maintenance doses, adequate degrees of rheumatic control were maintained in approximately two-thirds of the original 76 patients. The ability to sustain satisfactory improvement varied indirectly, in general, with the severity of the rheumatoid arthritis. The chief detriment to better results in the more severe cases was the intervention of adverse hormonal side effects which developed frequently when large or relatively large maintenance doses were required to support satisfactory improvement.Unwanted signs of hormonal excess developed in 40 per cent of cases at some time during the course of treatment. Most of them were mild or transient and disappeared or lessened when the dose of cortisone was reduced, but when the dose was reduced the degree of improvement often declined also.During prolonged cortisone therapy evidence of functional suppression of the adrenal cortices, as indicated by a decreased response of circulating eosinophils to exogenous ACTH, was present. The depression of cortical function was temporary, however. Whether irreversible damage may result when the drug is employed for longer periods cannot yet be answered.     

The locomotion of the camel (Camelus dromedarius)

The feet and gaits of many camels Camelus dromedarius were studied and filmed in Mauritania, Africa. The camel has a digitigrade stance, large feet to support the animal in soft sand, and soles of flexible pads that step readily onto small stones where necessary. The walking stride is long and slow, with the body supported for much of each stride on the two right or two left legs. The pattern of supporting legs was significantly different in slow compared to fast walking camels, and in young compared to adult camels and compared to adults pulling water at the wells. There was no difference in pattern in one individual's walk, when it was either loaded or unloaded. The angles that the leg bones made with each other and with the horizon are depicted for the walk and the pace. The camel is the only animal which paces often and never trots. The pace is an unstable gait only suitable for flat terrain such as that in deserts. It may have evolved from the pace-like walk which is by far the dominant gait in this animal, which spends most of each day walking from plant to plant browsing or grazing. The pace is not used by all camelids, as one author has claimed. The pace and the gallop were only used by the camels at wells, when the animals were chased from the water by men.     

Free physical movements during waiting while standing and sitting.

Man's habitual physical movements in a daily life situation while waiting for someone in front of a railway station in either a standing or sitting posture were studied. The free movements of 113 male and 171 female standing subjects and 236 male and 67 female sitting subjects were recorded for a period of three minutes by commentary using a tape recorder. The mean frequency of spontaneous movements was 13.8/min during standing and 14.3/min during sitting, the neck and lower limb movements being frequent in the former and the neck and upper limb movements in the latter. Males smoked, yawned, and crossed their legs more often than females. Any physical movement was most frequently followed by cessation of movements. Kinds of movements following a preceding motion proved almost independent from the type of the preceding one. Most of such movements ended within 2.5 sec, scarcely lasting for longer than 30 sec, while about 90% of the periods of being still were shorter than 15 sec. It is suggested that most of spontaneous physical movements in waiting occurred independently and were intercalated between short pure rest periods.     

The problem of the number of tarsomeres in the regenerated cockroach leg.

There are 5 tarsomeres in the normal cockroach leg, but this number is often reduced in regenerated legs. In order to examine this complicated situation, fore-, mid-, and hindlegs of German cockroaches were amputated at 11 different tarsal levels and at 18 different times during the last instar. When tarsi were amputated at or proximal to the 3rd tarsomere, 4-segmented tarsi regenerated. When legs were amputated distal to the 3rd tarsomere, the regenerated tarsi had 5 segments. Three-segmented tarsi rarely regenerated when legs were amputated proximal to 3rd tarsomere and in the latter half of the instar period. The lengths of all tarsomeres of regenerated tarsi were measured together with those of unoperated contralateral tarsomeres, and the ratios of the former to the latter were calculated. The ratios ranged from 28 to 138% for the various tarsomeres and levels of amputation. From a comparison of the ratios and morphological observations, it was suggested that the 3rd tarsomere of the normal 5-segmented tarsus has disappeared in the regenerated 4-segmented tarsus. Pads and disto-lateral spines of tarsomeres were observed on unoperated and regenerated tarsi. It was of interest that double spines were often found on the 4-segmented tarsi, mostly on the 2nd tarsomere, just proximal to the position of the missing 3rd tarsomere. This observation supported the idea that the 3rd tarsomere has not simply disappeared, but has probably fused with the 2nd tarsomere.     

Distributing coordinated motor outputs to several body segments: escape movements in the cockroach

In the escape behavior of the cockroach, all six legs begin to make directed movements nearly simultaneously. The sensory stimulus that evokes these leg movements is a wind puff. Posterior wind receptors excite giant interneurons that carry a multi-cellular code for stimulus direction — and thus for turn direction-to the three thoracic ganglia, which innervate the three pairs of legs. We have attemptd to discriminate among various possible ways that the directional information in the giant interneurons could be distributed to each leg's motor circuit. Do the giant interneurons, for instance, inform separately each thoracic ganglion of wind direction? Or is there one readout system that conveys this information to all three ganglia, and if so, might the identified thoracic interneurons, which are postsynaptic to the giant interneurons, subserve this function? We made mid-sagittal lesions in one or two thoracic ganglia, thus severing the initial segments of all the known thoracic interneurons in these ganglia, and thus causing their projection axons to the other thoracic ganglia to degenerate. This lesion did not sever the giant interneurons, however (Fig. 5). Following such lesions, the legs innervated by the intact thoracic ganglia made normally directed leg movements (Figs. 4, 6, 7). Thus, the projection axons of the thoracic interneurons are not necessary for normal leg movements. Rather, the giant interneurons appear to specify to each thoracic ganglion in which direction to move the pair of legs it innervates.     

ROENTGEN DIAGNOSIS OF INTRA-ABDOMINAL HERNIA

The primary radiologic evidence of intra-abdominal hernia is disturbance of normal small intestine arrangement. Loops of intestine are crowded together as if in a bag, giving the appearance of clumping or sacculation. Dilatation and loss of mobility may occur with varying degrees of stasis. Displacement of viscera or pressure deformity may be observed.Studies of the small bowel are necessary to demonstrate these conditions and must be made with the patient in the erect as well as the horizontal position. Repeated studies may be required, and the best time to make them is during an acute attack, as the hernia may be temporarily reduced during a remission.The clinical symptoms are sufficiently characteristic to suggest the diagnosis in most cases. The usual history is of repeated attacks of abdominal pain or discomfort, usually accompanied by distention, varying in periodicity and intensity, with or without nausea or vomiting, and not accompanied by laboratory data or clinical signs indicative of inflammatory disease.Similar or identical clinical and roentgenologic evidence may be produced by torsion of the small bowel or by peritoneal adhesions.The hernia or torsion may reduce spontaneously before or at the time of operation. Therefore, a careful search for abnormal fossae, mesenteric defects or adhesive bands is necessary if herniation or torsion is not found.     

Elder abuse--an ethical dilemma for caregivers

The mistreatment of elders by their adult children, spouses, or other caregivers is a problem of increasing magnitude. We have few laws and even fewer policies to help caregivers identify and prevent abuse, partly because it has no common pattern, and partly because it so often goes unreported. Abuse can be intentional or unintentional, and as often results from failing to act, as from acts of anger or cruelty. Therefore, we must do a better job of enforcing mandatory reporting and educating and supporting our caregivers to prevent stress and burnout. Above all, we must seek an ethical course of action, knowing that there are legal, personal, and professional ethical ideals and standards that can guide us, whether the elderly are being cared for in their own home or in nursing homes.     

Less is more: restricted application of insecticide to cattle to improve the cost and efficacy of tsetse control

Studies were carried out in Zimbabwe of the responses of tsetse to cattle treated with deltamethrin applied to the parts of the body where most tsetse were shown to land. Large proportions of Glossina pallidipes Austen (Diptera: Glossinidae) landed on the belly ( approximately 25%) and legs ( approximately 70%), particularly the front legs ( approximately 50%). Substantial proportions of Glossina morsitans morsitans Westwood landed on the legs ( approximately 50%) and belly (25%), with the remainder landing on the torso, particularly the flanks ( approximately 15%). Studies were made of the knockdown rate of wild, female G. pallidipes exposed to cattle treated with a 1% pour-on or 0.005% suspension concentrate of deltamethrin applied to the (a) whole body, (b) belly and legs, (c) legs, (d) front legs, (e) middle and lower front legs, or (f) lower front legs. The restricted treatments used 20%, 10%, 5%, 2% or 1% of the active ingredient applied in the whole-body treatments. There was a marked seasonal effect on the performance of all treatments. With the whole-body treatment, the persistence period (knockdown > 50%) ranged from approximately 10 days during the hot, wet season (mean daily temperature > 30 degrees C) to approximately 20 days during the cool, dry season (< 22 degrees C). Restricting the application of insecticide reduced the seasonal persistence periods to approximately 10-15 days if only the legs and belly were treated, approximately 5-15 days if only the legs were treated and < 5 days for the more restricted treatments. The restricted application did not affect the landing distribution of tsetse or the duration of landing bouts (mean = 30 s). The results suggest that more cost-effective control of tsetse could be achieved by applying insecticide to the belly and legs of cattle at 2-week intervals, rather than using the current practice of treating the whole body of each animal at monthly intervals. This would cut the cost of insecticide by 40%, improve efficacy by 27% and reduce the threats to non-target organisms and the enzootic stability of tick-borne diseases.