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A double-blind, placebo-controlled, parallel-group, multicentre study was conducted to evaluate the efficacy of pentoxifylline (Trental) in patients with multi-infarct dementia (MID) according to DSM-III-R criteria. Men and women aged 45 years or older, with a Hachinski Ischemia Scale scoreor = 7 and a Mini Mental State Examination (MMSE) score of 10-25 at entry, and computed tomographic evidence of vascular disease were enrolled. A total of 289 patients were randomised to receive either oral pentoxifylline 400 mg t.i.d. or placebo for 9 months, and efficacy was assessed every 3 months. The primary outcome variable was the difference in scores between the two treatment groups, as measured on the Gottfries, Bråne, Steen (GBS) scale. Secondary outcome variables included the scores achieved on the Sandoz Clinical Assessment Geriatric (SCAG) scale and MMSE, and a battery of psychological and other tests. The intention-to-treat analysis for patients completing the study (n = 239) showed a statistically significant difference in the total GBS score in favour of pentoxifylline (improvement of 3.5 points, p = 0.028). A significant difference in the total GBS score in favour of pentoxifylline was even almost achieved in the intention-to-treat analysis for all evaluable patients (n = 269, improvement of 2.1 points, p = 0.065). It is concluded that treatment with pentoxifylline is beneficial for patients with MID, the global results of the GBS and SCAG scales being reinforced by significant improvements in those subscales specific for intellectual and cognitive function.

Background and Aims:Ruptures of the distal part of the biceps brachii tendon are rare. The diagnosis is often delayed and only late repair can be considered. In this study, the recovery of muscle strength after late repair of the distal biceps brachii tendon was evaluated.Materials and Methods:Sixteen patients with a ruptured distal biceps brachii tendon were analysed. The mean delay from the primary trauma to the operation was 35 weeks. The tendon was anatomically re-attached with bone anchors. In three cases a tendon graft was needed. The operated arms were immobilised postoperatively for four weeks, after which mobilisation was allowed. Maximal static flexion and supination strength was measured after an average follow-up time of 124 weeks by using a computer-based isokinetic dynamometer.Results:Patient satisfaction and overall muscle strength recovery were very good. Compared to the non-operated side, average flexion strength recovery was 90% and corresponding recovery of supination strength 78%. Weakness on supination remained in the cases where a tendon graft was used. One patient needed a re-operation for a re-rupture. There were three cases of transient paresthesia of the cutaneous nerve. All patients resumed their previous work.Conclusion:Late anatomical repair of the biceps brachii tendon restores very good flexion and moderate supination strength. This operation should always be considered when the primary diagnosis is delayed.

In order to quantify muscle strength in recessive myotonia congenita (MC) the peak and average peak torques (PT and APT, respectively) of knee flexion and extension of 19 MC patients were measured at speeds of 60 degrees/s and 200 degrees/s. Muscle endurance was measured at a speed of 200 degrees/s. No differences were found between the patient and control groups for PT and APT values for flexion at the high speed, nor were there any differences between the patients and the controls for PT and APT measured at the low speed for knee flexion and extension or muscle endurance at the high speed. However, PT and APT values of the patients for extension at the high speed, 100 +/- 41 Nm (mean +/- SD) and 95 +/- 39, were significantly lower than those of the controls, 129 +/- 43 and 124 +/- 42, respectively. There was no correlation between muscle strength or endurance and disease severity. The muscle strength of the patient group was diminished (p0.0001) during the beginning of the measurement at the high speed. The results suggest that after myotonic inhibition subsides the muscle strength of MC patients ranges within normal limits except in rapid and powerful motor activities.

The purposes of this study was 1) to assess the plantar flexion and dorsiflexion peak torques (PT) of the ankles at 30, 90 and 240.. s-1 in 101 patients (86 men, 15 women) who had been operated on for unilateral, complete closed Achilles tendon (AT) rupture at Oulu University Hospital, Oulu, Finland, in the period 1987-1992, 2) to determine whether comparison between the legs shows any impairment, 3) to study whether the weakness is speed-dependent, 4) to determine at what angular displacement of the ankle the weakness is manifested, 5) to study how the results correlate with age, type of operation and follow-up time. The Lido Multi-joint II dynamometer was used for the measurements. There was no significant dorsiflexion weakness detectable upon comparison between the legs, but the mean relative peak torque deficits in the injured limb were 8.4, 9.0 and 3.0% at 30, 90 and 240.. s-1 respectively for the men and 15.0, 16.6 and 6.4% for the women. The mean percentage torque differences were significantly greater in the women at all the test speeds (p < 0.05). The difference in PT was significantly greater at the two low test speeds (30 and 90.. s-1) than at the high speed (240.. s-1, p < 0.001). The weakness was manifested at an angular displacement of 80-120 degrees, where the average peak work (PW) difference between the two legs was significant in both sexes (p < 0.05). The patient's age (21-63), the type of operation (Lindholm or Silfverskiold technique) and the follow-up time (0.7-6.7 years) did not significantly affect the results. In conclusion, and AT rupture implied an average 3.0 to 16.6% impairment in isokinetic plantar flexion muscle strength. The impairment was greater in the women, was manifested at an angular displacement of 80-120 degrees, and was greater at low test speeds. Age, type of operation and follow-up time did not account for the PT differences between the patients.