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Objective: To present an unusual case of delayed presentation of pericardial rupture with luxation of the heart 6 months after the initial injury., Design: Diagnosis, outcome, associated injuries, and treatment are discussed., Methods: A high index of suspicion is required to make the diagnosis; no single diagnostic test can be used as a screening tool., Conclusion: Once recognized, treatment of pericardial rupture is relatively simple.

Objective: Our purpose was to compare the effect of arginine vasopressin stimulation on platelet free intracellular calcium levels in normal pregnancy, incipient preeclampsia, and established preeclampsia., Study Design: Cross-sectional and prospective observational study designs were used. Platelet free intracellular calcium was measured by flow cytometry in 10 nonpregnant female volunteers, 10 women with established preeclampsia and their normal pregnant matched controls, and 64 normal pregnant women at 28 weeks' gestation. All pregnant women were nulliparous., Results: Increased response to arginine vasopressin stimulation was observed in nonpregnant compared with pregnant women (p < 0.001). No differences were observed between women with normal pregnancy, incipient preeclampsia, or established preeclampsia., Conclusion: The platelet intracellular free calcium response to arginine vasopressin is not a feature of incipient or established preeclampsia. Therefore, in contrast to a previous report, it does not appear to have value as a predictive test for preeclampsia.

Muscular activity is a fundamental determinant of muscle mass. Transcutaneous muscle stimulation (TMS) may reverse muscle atrophy and lean mass loss in immobile patients by "artificial exercise." Four paraplegic patients with upper motor neuron lesions entered The Ohio State University Clinical Research Center for a 21-day metabolic balance study. After 6 days of baseline monitoring, each underwent isometric tetanic contractions (15 sec on; 45 sec off) of all major lower extremity muscle groups with TMS for 10 hr daily. Cross-sectional areas of muscle plus bone were calculated with CAT scan planimetry at 7 levels in both lower extremities before and after the TMS period. Three patients completed the metabolic balance study. TMS produced significant growth of innervated thigh and calf muscles in all paraplegic patients. Little growth occurred where bone and tendon predominate. No significant changes in nitrogen balance (urine and stool excretion), potassium balance (urine excretion only), or phosphate balance (urine excretion only) could be demonstrated. Two possible explanations are (1) that the patients may have been underfed and (2) that perhaps due to an increase in metabolic rate owing to the stimulation, lean tissue in other locations may have been mobilized to meet leg muscle demands. Future studies will incorporate metabolic monitoring of oxygen consumption and CO2 production during the experiment.

Midline pancreatic injury from blunt trauma can be very subtle. Although nonoperative management usually results in early complications, chronic symptoms may develop 2 months to 2 years after injury. Four patients with pancreatic sequestrum demonstrated the need for ERCP in patients with epigastric pain developing late after injury, emphasizing the importance of early operation and complete exploration of pancreatic injuries.

The loss of lean muscle mass is one of the hallmarks of protein-calorie malnutrition. Anthropometry is a standardized technique used to assess the response of muscle mass to nutrition therapy by quantifying the muscle and fat compartments. That technique does not accurately reflect actual limb composition, whereas computerized tomography does. Twenty lower extremities on randomly chosen men and women patients were evaluated by anthropometry and computerized tomography. Total area, muscle plus bone area, total volume, and muscle plus bone volume were correlated, using Heymsfield's equation and computerized tomography-generated areas. Anthropometrics overestimated total and muscle plus bone cross-sectional areas at almost every level. Anthropometry overestimated total area and total volume by 5% to 10% but overestimated muscle plus bone area and muscle plus bone volume by as much as 40%. Anthropometry, while easily performed and useful in large population groups for epidemiological studies, offers a poor assessment of lower extremity composition. On the other hand, computerized tomography is also easily performed and, while impractical for large population groups, does offer an accurate assessment of the lower extremity tissue compartments and is an instrument that might be used in research on lean muscle mass.