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Objective: The aim of this study was to examine changes in passive length and stiffness of the gastrocnemius muscle-tendon unit in people after spinal cord injury., Design: In a prospective longitudinal study, eight wheelchair-dependent participants with severe paralysis were assessed 3 and 12 mos after spinal cord injury. Passive torque-angle data were obtained as the ankle was slowly rotated through range at six knee angles. Differences in passive ankle torque-angle data recorded at different knee angles were used to derive passive length-tension curves of the gastrocnemius muscle-tendon unit. Ultrasound imaging was used to determine fascicle and tendon contributions to the muscle-tendon unit length-tension curves., Results: The participants had ankle contractures (mean [SD] maximum passive ankle dorsiflexion angle, 88 [9] degrees) 3 mos after spinal cord injury. Ankle range did not worsen significantly during the subsequent 9 mos (mean change, -5 degrees; 95% confidence interval, -16 to 6 degrees). There were no changes in the mean slack length or the stiffness of the gastrocnemius muscle-tendon unit or in the slack lengths of the fascicles or the tendon between 3 and 12 mos after spinal cord injury. There were no consistent patterns of the change in slack length or stiffness with the changes in ankle range in the data from the individual participants., Conclusions: This study, the first longitudinal study of muscle length and stiffness after spinal cord injury, showed that the length and the stiffness of the gastrocnemius did not change substantially between 3 and 12 mos after injury.

Objective: To measure the effectiveness of hysterectomy in relieving adverse symptoms and to identify factors associated with lack of symptom relief., Methods: In a 2-year prospective study, data were collected before and at 3, 6, 12, 18, and 24 months after hysterectomy in 1,299 women who had hysterectomies for benign conditions at 28 hospitals across Maryland. Effectiveness was measured in terms of relief of symptoms such as problematic vaginal bleeding, pelvic pain, and urinary incontinence. Psychologic function and quality of life before and after surgery also were assessed., Results: Symptom severity, depression, and anxiety levels decreased significantly after hysterectomy and quality of life improved, particularly in the area of social function. However, 8% of women had at least as many symptoms at problematic-severe levels 1 and 2 years after hysterectomy as before. In multiple logistic regression, several presurgical patient characteristics predicted lack of symptom relief, including therapy for emotional or psychologic problems, depression, and household income of $35,000 or less. Bilateral oophorectomy predicted lack of symptom relief at 24 months but not at 12 months after hysterectomy., Conclusion: Significant improvements were seen after hysterectomy for all three aspects of health status (symptoms, psychologic function, and quality of life), which persisted or continued to improve throughout the 2 years of follow-up. However, hysterectomy did not relieve symptoms for some women, particularly those who had low incomes or were in therapy at the time of hysterectomy.

We have examined the effect of dose on contrast medium-induced reductions in glomerular filtration in anesthetized rabbits. The fraction of renal plasma flow that is filtered, the filtration fraction, was directly measured by the renal arteriovenous difference method using technetium-99m (99mTc) (Sn) DTPA as the tracer, arterial and renal venous extracorporeal shunts, a gamma camera and a computer. Filtration fraction (FF) was measured each 30 seconds before and after contrast medium (sodium/methylglucamine diatrizoate) was injected in 15 seconds at a dose of 0.5, 1.0 or 2.0 ml/kg, IV. In six animals that had a control FF of 0.19 +/- 0.01 there was a dose-related decrease in FF. The largest dose reduced FF by 53.3%. In three other animals that had a low control FF (0.07 +/- 0.01), the largest dose induced an even greater 71.0% decrease in FF. These data suggest that attempts at increasing contrast excretion by injecting larger doses will be offset, at least in part, by larger reductions in glomerular filtration, and that this effect may be greater when glomerular function is impaired.