Isokinetic strength of knee extension and flexion was measured at two speeds of movement in 23 patients with Parkinson’s disease, to clarify whether muscle weakness is inherent to the disease. To counteract normal variation among subjects, we selected patients with symptoms completely or largely confined to one side and compared sides for each patient. The affected side was weaker than the other in both slow and fast movements early in the disease. In more advanced disease, the difference between sides diminished at the slow speed but remained significant at the faster speed. These observations suggest that weakness is inherent to Parkinson’s disease and influenced by movement speed.

This study suggests that individual preferences should be taken into consideration for video relaxation therapy.

We describe three cases of women with hot bath-related headache who reported that their severe paroxysmal headache could be provoked by pouring hot water over themselves or by soaking in a hot bath. In one patient, the headache was also brought on by exposure to cold wind. Another patient had headaches after she dived into a pool and started swimming. Neurological examination, routine laboratory tests, electroencephalography, and brain imaging showed no abnormality in any of the patients. Hot bath-related headache is a benign headache unassociated with a structural lesion.Key words: hot bath, headache, cold stimulus headache ( Headache 2000;40:173-175) We describe three cases of women with hot bathrelated headache who reported that their severe paroxysmal headaches were provoked by pouring hot water over themselves or by soaking in a hot bath. CASE HISTORIESPatient 1.-A 54-year-old woman developed a paroxysmal splitting headache with floating sensation in the bathroom for the first time on April 22, 1992. The headache lasted 5 to 10 minutes. She had suffered from tension-type headaches previously. The next day, she had the same severe headache with floating sensation when she undressed and poured hot water over herself just before soaking in a hot bath. The headache was not throbbing and lasted 10 minutes without photophobia, phonophobia, nausea, vomiting, and vertigo. Whenever she tried to take a hot bath daily for a week, this headache was brought on after pouring hot water over herself, but before soaking in the hot bath. She could not take a hot bath for 10 days because of this headache. On two occasions, she took a tablet containing ergotamine tartate, 1 mg, caffeine, 50 mg, and isopropylantipyrine, 300 mg, 30 minutes before she had a hot bath, however, she still had severe headaches. When she washed only her hair without undressing, she did not have a headache. The results of her neurological examination were normal. She was normotensive. The findings of a routine blood examination, a CT scan of the brain, MRI and angiography (MRA) of the brain, electroencephalography, and an HM-PAO SPECT scan of the brain were all negative. By avoiding taking a hot bath, she did not experience this severe headache at all. One month later, when she tried to pour hot water over herself in a hot bath, she did not develop a headache. Since that time, she has not experienced this severe headache.Patient 2.-A 49-year-old woman developed a severe bursting headache in the right occipital area for a few seconds when she went out of the house into the cold on the evening of January 22, 1991. The next day, she poured hot water over herself before taking a bath and developed a severe bursting headache in the right frontal to occipital area. She took an analgesic and diazepam, 5 mg. Her headache lasted 3 hours. Within a week, she had the headache whenever she poured hot water over herself before soaking in a hot bath. Twice she soaked in the hot bath despite the headache, but on other occasions she could not bathe and took an analg...

The clinical outcome after infrapopliteal bypass surgery was poorer in HD patients with CLI compared with non-HD patients. Malnutrition or chronic inflammation was associated with poor outcome in HD patients with CLI due to infrapopliteal occlusive disease.

We measured isokinetic muscle strength of knee extension and flexion in 18 patients with Parkinson's disease who showed marked laterality in symptom severity and compared strength between the sides in the same patient. In all patient groups, the maximum peak torque of the more affected side was significantly less than for the less affected side at 15 revolutions per minute (r.p.m.) and 30 r.p.m. with the difference between the sides being larger at 30 r.p.m. than at 15 r.p.m., while at 5 r.p.m. there were no significant differences between sides. In the Yahr stage I group, the maximum peak torque in both extension and flexion at each velocity showed no significant difference between the sides. In contrast, in the stage II and III groups the maximum peak torque at 5 r.p.m. showed no significant difference between the sides, while at 15 r.p.m. and 30 r.p.m. these values showed a tendency and a significant difference between the sides, respectively, with the more affected side being weaker. These results suggest that muscle weakness in patients with Parkinson's disease increases with performance velocity, especially as the disease progresses.