摘要:

The hypothesis for this study was that catecholamine levels increase during urinary catheterization in human patients with spinal cord injury. Catecholamine levels, blood pressure, and pulse were measured prospectively in 40 subjects at baseline and during urinary catheterization. Results showed a significant increase in norepinephrine levels from baseline 245 ± 240 pg (standard deviation (SD)) to 314 ± 311 pg (SD) during catheterization (P= 0.018, Wilcoxon's). Results also showed a nonsignificant increase in epinephrine levels from baseline (56 ± 70 pg, SD) to catheterization (84 ± 125 pg, SD;P= 0.35, Wilcoxon's). Systolic blood pressure increased from 114 to 124 mm Hg (P= 0.004, pairedttest). Diastolic blood pressure increased from 75 to 78 mm Hg (P= 0.11, pairedttest). There was no significant change in diastolic blood pressure or pulse (P= 0.11 andP= 0.29, respectively, pairedttest). In conclusion, norepinephrine levels increased during catheterization in patients with spinal cord injury. Knowledge of catecholamine levels in this process may assist in determining both pathophysiology and potential pharmacologic treatment options in future studies.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A concern for individuals with hemiparesis affecting their gait, which heretofore has never been studied, is the possibility that various compensations occurring in the unaffected limb may strain or fatigue the muscles or ligaments and/or predispose to joint injury in that limb. We studied the biomechanics of the unaffected limb during walking in 20 subjects with hemiparesis who had stiff-legged gait as a result of stroke. An optoelectronic motion analysis and force platform system was used to estimate torques in all three planes about the hip, knee, and ankle. Sagittal plane joint motion and power about the unaffected hip, knee, and ankle were also studied. Data were compared with control walking data collected from 20 able-bodied controls. On average, peak torques and powers were all either reduced or the same compared with controls, even though in some instances values were >2 standard deviations (SD) above the control means. Our findings suggest that on average the probability of excessive muscular-tendon effort and the risk for biomechanical injury in the unaffected limb are minimal compared with able-bodied, walking controls. However, given individual variability, we recommend routine clinical gait analysis for all people with stiff-legged gait to eliminate excessive values in certain biomechanical parameters, which could, if not addressed, predispose to muscle-tendon strain or joint or ligamentous injury.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Current evidence indicates that the neuroendocrine system is the highest regulator of immune/inflammatory reactions. We hypothesized that immune alterations, which were related to the level of injury, found in a cohort of spinal cord-injured subjects may be influenced by altered hormonal patterns postinjury. Therefore, we investigated aspects of both pituitary and adrenal function in the same cohort of spinal cord-injured subjects. We found significant elevations in both cortisol and dehydroepiandrosterone sulfate in chronic spinal cord-injured survivors compared with their able-bodied age- and gender-matched controls. Levels of dehydroepiandrosterone, adrenocorticotropin, and prolactin were not different in spinal cord-injured subjects overall compared with their controls. Both dehydroepiandrosterone sulfate and dehydroepiandrosterone were higher in tetraplegics compared with their controls, but we found no such differences in paraplegics compared with their controls. When the two groups of spinal cord-injured subjects were compared with each other, we also found differences between these two subject groups in dehydroepiandrosterone sulfate and dehydroepiandrosterone (higher in the tetraplegics compared with paraplegics). We found no differences between either group of spinal cord-injured subjects and their controls for adrenocorticotropin, prolactin, or cortisol. These data suggest that some hormonal differences between subjects and their controls may be further related to the level of injury (specifically dehydroepiandrosterone and dehydroepiandrosterone). Finally, we investigated correlations within subjects for the above hormones. Dehydroepiandrosterone sulfate and prolactin were highly correlated (the higher the dehydroepiandrosterone sulfate, the higher the prolactin) but only in the tetraplegic subjects.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The P300 response is a cognitive event-related potential recorded over the scalp. The tone-evoked P300 response has been used to predict outcomes of patients with brain injury. However, it may lead to false predictions because some normal people have a very small tone-evoked P300 response. It is hypothesized that speech may generate a more robust P300 response than tones. A voice-generator prototype was designed for this study. The rare speech signal was the word "mommy" in a female voice. The common signal was a 1000-Hz tone. Twenty-two normal adults (11 males, 11 females; age range, 18-60 yr) were tested for both speech-evoked and tone-evoked P300 responses. Speech-evoked P300 responses had significantly larger amplitudes (mean, 12.1 μV) than the tone-evoked responses (mean, 5.9 μV;P< 0.0001). Six subjects with brain injury were also tested using the same protocol: two subjects with severe brain injury showed no response to either stimulus. Both died within 1 wk after the testing. Although two subjects with moderate brain injury could not complete the testing because of agitated behavior, two other subjects with mild traumatic brain injury showed a larger speech-evoked than tone-evoked P300 response. The speech-evoked P300 response may be promising in predicting outcomes of patients with brain injury.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The uncommon causes of anterior knee pain should always be considered in the differential diagnosis of a painful knee when treatment of common origins become ineffective. A case is presented in which the revised diagnosis of infrapatellar contracture syndrome was made after noting delayed progress in the rehabilitation of an active female patient with a presumed anterior horn medial meniscus tear and a contracted patellar tendon. The patient improved after the treatment program was augmented with closed manipulation under arthroscopy and infrapatellar injection of both corticosteroids and a local anesthetic. Infrapatellar contraction syndrome and other uncommon sources of anterior knee pain, including arthrofibrosis, Hoffa's syndrome, tibial collateral ligament bursitis, saphenous nerve palsy, isolated ganglions of the anterior cruciate ligament, slipped capital femoral epiphysis, and knee tumors, are subsequently discussed. Delayed functional advancement in a rehabilitation program requires full reassessment of the patient's diagnosis and treatment plan. Alternative diagnoses of knee pain are not always of common origins. Ample knowledge of uncommon causes of anterior knee pain is necessary to form a full differential diagnosis in patients with challenging presentations.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Cervical radiculopathy can be diagnosed on physical examination with the Spurling test, which narrows neural foramina via neck extension along with coupled rotation and side-bending. In the presence of cervical radiculopathy, this test can reproduce radicular symptoms by transmitting compressive forces to affected nerve roots as they traverse the neural foramina. Treatment of cervical radiculopathy includes patient education to avoid obvious postures that exacerbate radicular symptoms and to assume positions that centralize discomfort. A potentially harmful position to which many patients are unwittingly subjected at least several times per year occurs when their hair is being shampooed in a salon sink before a haircut. This posture causes neck extension and is combined with rotation and side-bending as the patient's head is being manipulated during the shampooing. When the stylist then also applies a mild compressive force while shampooing the patient's hair, hyperextension of the neck is produced. We present two patients with cervical radiculopathy that was significantly exacerbated after the patient's hair had been shampooed in a salon sink; subsequently, these patients required oral administration of steroids. These cases illustrate that patients with suspected or known cervical radiculopathy should be forewarned to avoid this otherwise seemingly innocuous activity.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID