A series of 40 patients accepted for prosthetic rehabilitation after lower limb amputations for peripheral vascular disease were reviewed nine to 27 months later. Two have since died, one has not been traced, and 37 have been assessed. Fourteen were successful full-time limb users ('walkers'), 10 were partial users ('partial walkers') and 13 were wheelchair-dependent ('none walkers' or 'wheelchair users'). Of the walkers, 85% completed a 10-metre walk in under 30 seconds (mean 20s), whereas 90% of the partial walkers took over 30 seconds (mean 79s). The Barthel Activities of Daily Living (ADL) Index, a measure of independence in self-care, correlated closely with outcome status and walking speed. Other items that correlated well with outcome included grip strength, assessed using a simple hand-held dynanometer, and cardiovascular fitness, the measure being time taken for the pulse to return to resting baselme after exercise. This was less than two minutes in 85% of the walkers (mean 94s) and two minutes or more in 100% of the partial walkers (mean 240s). Age did not indicate whether prosthetic training would be successful, but in those who were walking it correlated closely with speed. The partial walkers had lower kitchen and domestic activity scores, which were due to lack of environmental modification for wheelchair use, it being assessed that their walking status conferred ability to do tasks whilst standing. These patients can easily be identified by measuring their walking speed and Barthel ADL Index.
SUMMARY1. Five subjects were given 373 test meals of 750 ml. water containing a range of concentrations of glucose or potassium chloride.2. The greater the concentration of solute in the meals, the greater was the volume of the test meal recovered from the stomach after a fixed time.3. When the concentrations of the solutes were expressed as m-osmole/l. corrected by osmotic coefficients based on vapour pressures at 370 C, glucose and potassium chloride were indistinguishable in slowing gastric emptying.4. These results are consistent with the regulation of gastric emptying by a duodenal receptor responding to osmotic pressure.5. Potassium chloride was more nauseating than glucose on an osmolar basis.
SUMMARY1. Five subjects took 210 test meals of 750 ml. water containing 30-300 m-molal glucose or glycine, or 15-150 m-molal diglycine, or plain water.2. The greater the concentration of solute, the greater was the volume of original meal recovered from the stomach after a fixed time.3. On a molal basis glucose was half as effective as diglycine in slowing gastric emptying. This was consistent with the osmoreceptor being exposed to the diglycine after it had been split by the hydrolase of the cytosol of enterocytes (the absorbing cells of the small intestine).4. The slowing of gastric emptying (ml./mole.l.) was about 10% greater for glycine than it was for glucose. There was apparently a threshold concentration below which glycine did not slow gastric emptying.5. It was proposed that the response of the duodenal osmoreceptor might depend upon shrinking and swelling of the lateral intercellular space around the enterocytes.
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