摘要:

The goal of this study was to evaluate the differences in angle reproduction capability after nonconstrained posterior cruciate ligament retaining total knee arthroplasty after a follow-up time of 63.9 months compared with the healthy contralateral leg and a control group. In 28 total knee arthroplasty patients (mean age, 65.7 yr) and 25 control subjects (mean age, 55.7 yr), 16 measurements were made between 0° and 90° in 30° steps. The leg was positioned by the examiner and then relaxed; afterward, the subject was asked to reproduce the original position. Each measurement was made with the patient or control being blindfolded and not blindfolded to assess the influence of visual control. We found significant differences in total knee arthroplasty patients in contrast to healthy subjects. Without visual control, the mean deviation of the total knee arthroplasty group starting with a 0° angle was 7.7 ± 5.9° and 4.6 ± 4.7° for the healthy subjects. With visual control, the mean deviation in the patient group was 11 ± 7.5°, and in the control group, it was 7.2 ± 5.0°. Total knee arthroplasty patients did not show significant differences between the operated on and the contralateral knee. Also, in the total knee arthroplasty group, significant differences could not be found comparing reproduction with and without visual control and comparing both starting positions. In the control group, significant differences could be found comparing visual and nonvisual control in the 60° angle. The comparison between the 30 and 60° repositioning from both 0 and 90° starting positions showed a significant difference in the 60° angle. In summary, reduced proprioceptive capabilities are present after knee arthroplasty in both the operated on and the contralateral leg in our study group. Postoperative complaints can perhaps be explained by a loss of proprioceptive capabilities, especially at the 60° angle. The operative technique should involve special care of ligaments and muscles to preserve stability and receptors as well. Rehabilitation should pay more attention to the remaining receptors.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Reduced fertility in men with spinal cord injury results from the inability to ejaculate and poor semen quality. Vibratory penile stimulation can induce ejaculation in many men with spinal cord injuries, but few studies have reported the effects of repeated vibratory stimulation on quantitative semen analysis tests. Fourteen spinal cord-injured males were enrolled in a prospective study to develop a quantitative profile of antegrade and retrograde ejaculate specimens collected during repeated vibratory stimulation. Antegrade specimens were obtained in 51 (84%) and retrograde specimens were obtained in all of the 61 trials (100%). Sperm were present in 70% and 64% of the antegrade and retrograde samples, respectively. Of the patients who underwent repeated vibratory stimulation attempts, three showed marked improvement in sperm counts and characteristics with repeated vibration and five showed normal fluctuation or no change in semen quality. Overall, there was a trend toward higher sperm counts in the antegrade samples (mean, 74.1 million) than in the retrograde samples (mean, 40 million), but no statistical significance was found. Mean sperm motility, sperm progressive motility, and percent normal sperm morphology were not significantly different between antegrade and retrograde specimens. Fructose and zinc, semen markers that reflect the presence of a true ejaculate, were present in all antegrade and retrograde specimens. In conclusion, (1) both antegrade and retrograde ejaculation occur with vibratory penile stimulation, with antegrade samples containing greater numbers of sperm but retrograde samples also having significant sperm counts, (2) repeated vibration may increase sperm concentration or may result in only minimal changes reflective of normal fluctuations, and (3) vibratory stimulation results in true ejaculation, as evidenced by semen markers.

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:

Thromboembolic obstruction of the brachiocephalic artery can have significant functional consequences because it threatens arterial circulation to the right upper limb and right cerebrum. A case is presented of a young man who sustained right basal ganglia infarct 2 mo after suffering multiple gunshot wounds to his chest. The severity of his hemiplegia rendered his left arm nonfunctional. Later, he developed progressive symptoms of right upper limb claudication, making it impossible to perform activities of daily living independently with the hemiplegic technique. Arteriography revealed a pseudoaneurysm near the bifurcation of the brachiocephalic artery; the likely source was thromboembolism to the right common carotid and right subclavian artery. Surgical ligation of the subclavian artery and vascular bypass from the common carotid to the brachial artery restored blood flow to his right upper limb. The arm claudication was relieved, and he was again able to perform activities of daily living independently. This case represents an unusual cause of dual disability with bilateral upper limb dysfunction from a single thromboembolic source. Accurate diagnosis and treatment prevented this patient from developing permanent impairment and restored him to functional independence.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Morbid obesity is a common chronic condition that predisposes affected individuals to a decrease in functional status. The purpose of this case series is to highlight the benefit of institutional rehabilitation for this subgroup of patients. A 6-mo retrospective review of 117 consecutive admissions to the rehabilitation unit of a municipal hospital center was conducted. A total of four patients (3.4%) met the criteria for morbid obesity. We present the brief case histories of these four subjects. All showed significant functional improvement and were able to return home after a mean length of stay of 61 days. They each required specialized rehabilitation intervention and specialized equipment such as extra large beds and oversize walkers. All four subjects had obstructive pulmonary disease, accounting for their initial hospital admission. This study demonstrates that inpatient rehabilitation improves functional status in morbidly obese patients. Further research regarding physiatric intervention in the morbidly obese patient is needed.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We present a patient with a lesion of the mesial frontal cortex, including the supplementary motor areas bilaterally, who on clinical examination revealed no spontaneous movements, although neurophysiological examination indicated integrity of the corticospinal tract to thenar and tibialis anterior muscles bilaterally. The patient was alert, speech was hesitant, and he was able to move his hands only on command. The role of the supplementary motor areas in planning, setting, and execution of skillful voluntary movements has been previously established by direct cortical electrical stimulation and studies of regional cerebral blood flow. The findings in our patient support the role of the supplementary motor areas in initiating movements. The presence of motor evoked potentials after acute insults to the brain is considered to be associated with a good functional outcome. This is in contrast to our patient who did not show improvement in motor performance, despite preserved motor evoked potentials. Hence, in the case of bilateral lesions to the supplementary motor areas sparing the corticospinal tract, the presence of motor evoked potentials may not predict functional recovery.

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