ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Skin flora from the perineum, penis and urethra of 15 adult male outpatients with spinal cord injury (SCI) and neurogenic bladder dysfunction were compared with that of 10 neurologically normal controls. Gram-positive cocci and diphtheroids were the predominant isolates from controls with no enteric organisms recovered except Escherichia coli in four instances. Among SCI patients, in addition to normal Gram-positive flora, one species of Gram-negative rod was isolated from three patients, two species from five patients, three species from three patients, four species from three patients and five species from one individual. Skin isolates included various members of Enterobacteriaceae, Pseudomonas, Acinetobacter and Enterococcus. Average bacterial counts in perineal, penile and urethral cultures from SCI patients were each 1 log greater than in controls. Bacteria were isolated from 12 of 14 urine cultures obtained from SCI patients immediately after collection of skin cultures. Organisms isolated from urine were present in one or more skin sites in every instance. Differences in skin flora between SCI patients and neurologically normal persons may be the result of variables such as antibiotic usage, presence of a condom catheter, skin moisture, urine leakage, pH, skin temperature, personal hygiene and/or neurogenic bowel management.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Urinary tract infections (UTIs) are a frequent and potentially disabling problem for children with neurogenic bladders. Frequent monitoring for UTIs using bacterial culture is expensive and troublesome; thus an inexpensive, dependable screening method is desirable. Three hundred and twenty-nine urine specimens were obtained from 141 children with neurogenic bladders, 86% of whom had meningomyelocele. During the 11-month study period, 43% of the children had at least one positive culture (100,000 CFU/ml). The results of bacterial culture were compared with the occurrence of signs and symptoms, the presence of reflux and the results of a dipstick test for nitrite and leukocyte esterase. Analysis of the data revealed that (1) UTIs were significantly more common in children with reflux; (2) the presence of signs and symptoms was neither sensitive nor specific (positive predictive value (PPV)=0.44, negative predictive value (NPV)=0.84); (3) urinalysis was an unreliable screening tool (PPV=0.63, NPV=0.73); and (4) the combination of nitrite and leukocyte esterase was more sensitive and specific than either by itself (combined PPV=0.69, NPV=0.88). Children with neurogenic bladders who have reflux or have signs and symptoms should continue regular bacterial cultures, whereas others can be screened dependably using the combined leukocyte esterase and nitrite test.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Brachial plexus injury and proximal mononeuropathy have been reported as a potential complications in the hemiplegic shoulder after a stroke. The diagnosis of brachial plexus injury and proximal mononeuropathy in the hemiplegic extremity is complicated by the upper motor neuron findings on physical examination and by the diffusely abnormal electrodiagnostic test results frequently seen in hemiplegic limbs. This study investigated the incidence of brachial plexus injury and proximal mononeuropathy after a thromboembolic stroke. Hemiplegic patients (n=50) underwent physical examination, needle electromyography of the hemiplegic extremities and nerve conduction studies across the brachial plexus within 4 months after a stroke. Combining the physical examination and electromyographic findings we were unable to make a diagnosis of brachial plexus injury or proximal mononeuropathy in any hemiplegic patient. Spontaneous electromyographic activity was observed in 68% of the arms and 70% of the legs examined on the hemiplegic side. The severity and incidence of spontaneous activity was evenly distributed in upper and lower trunk muscles. Mean central latencies across the lower brachial plexus were slightly delayed (12.5 ± 2v11.6 ± 2.2 ms, P<0.01) compared with the contralateral normal limb, but in no case was the F wave unilaterally unelicitable. The mean hypothenar compound muscle action potential amplitude was diminished (7 ± 2.7 v 9.2 ± 4.1 mV, P<0.01) in the hemiplegic hand compared with the normal side and the degree of amplitude loss inversely corresponded (r=-0.6, P<0.01) to the amount of spontaneous electromyographic activity observed in the first dorsal interosseus muscle. There was no correlation between compound muscle action potential amplitude and muscle strength, and no individual patient had an absent or severely reduced compound muscle action potential amplitude, even when there was no volitional movement in the corresponding muscle (n=16). There was a negative correlation (r=-0.8, P<0.001) between spontaneous activity and muscle strength in the hemiplegic arm. A positive correlation (r=0.5, P<0.01) was observed between the number of days following stroke that needle examination was performed and the degree of spontaneous electromyographic activity observed. In the context of the literature we concluded that these findings probably reflect minimal motor axon degeneration secondary to the cortical lesion rather than any brachial plexus injury or proximal mononeuropathy with severe axonal loss or complete conduction block.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This study was designed to establish the intra-rater and inter-rater reliability of measurements of trigger point sensitivity using a commercially available pressure threshold meter. Fifty healthy adult volunteers (25 men and 25 women, aged 20 to 51 years) underwent repeated pressure threshold readings from two separate trigger point locations in the trapezius muscle, TP2 (left) and TP3 (right) by two independent examiners. Pressure threshold readings, using a 1.0 kg/s application, were done alternately by each experimenter. Measurements from each trigger point were completed 5 minutes apart. Intraclass correlation coefficients (ICC) revealed the inter-rater reliability to be high for both the first (ICC=0.82) and second trial (ICC=0.90) of TP2 and for the first (ICC=0.86) and second trial (ICC=0.92) of TP3. Intrarater reliabilities for TP3 (ICC=0.91) were higher than for TP2 (ICC,=0.80; ICC2=0.83). These results show that the pressure threshold meter is highly reliable in measuring trigger point sensitivity, between and within experimenters, and may be useful in the diagnosis and monitoring of treatment of myofascial pain syndrome.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Activity progression of persons with physical disabilities and accompanying cardiovascular disease in medical rehabilitation centers is traditionally based on cardiac precautions derived from acute care settings. Concern that these guidelines were too conservative and restrictive led to exercise testing and evaluation of 64 physically disabled male patients with a history of coronary artery disease. The sample had a mean age of 62.4 years. The exercise test was an adaptation of the Schwade Arm Ergometer Protocol with blood pressure measured at baseline, immediately after each 2 minutes of exercise, peak exercise and each minute for 6 minutes after peak exercise. Heart rate was monitored continuously. Patients achieved a mean peak heart rate of 115 beats per minute, mean peak systolic pressure of 169 mm Hg and mean peak diastolic pressure of 89 mm Hg. Ischemic electrocardiographic changes occurred in four of the 64 patients. Based on the achieved ranges of values of heart rate, systolic and diastolic pressures and comparison of these results with baseline (pre-exercise) values, more liberal guidelines for prescribing activity in the non-acute inpatient setting are provided.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Presently, there are few electrodiagnostic medicine techniques to evaluate lesions affecting the thoracic nerve roots or spinal cord. A new electrophysiologic technique to assess these structures, intercostal somatosensory-evoked potentials (SEPs), is described. Thirty neurologically normal subjects were used in this investigation to generate intercostal SEPs. Bilateral intercostal SEPs were easily elicited after stimulation of the third intercostal nerves just lateral to the sternum anteriorly. Intercostal SEPs were also easily elicited from the fifth, seventh and ninth intercostal nerves along the anterior axillary line bilaterally. Intercostal SEPs are not only easily and painlessly obtained, but are specific for individual spinal levels. This SEP method will provide the clinician with another neural stimulation procedure to assist in the diagnosis of both central and peripheral thoracic neural compromise.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The catastrophic reaction is a rare affective disorder following left hemispheric strokes. It is characterized by a disruptive emotional outburst involving anxiety, agitation and aggressive behavior. A case is presented that appears to underscore the intense frustration that these individuals experience when they cannot adequately express themselves through language. The catastrophic reaction behavior proved to be unremitting and failed to respond to withdrawal of the patient from threatening or difficult therapies, use of medications or attempts at behavioral modification. The catastrophic reaction appears to be a specific consequence of the intense frustration and perceived loss associated with an expressive aphasia. This may help explain the reportedly higher incidence of depression in left frontal strokes.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Clonidine, a centrally acting a2 receptor adrenergic agonist, has been successfully used as adjunctive therapy in patients with spinal cord injury with problematic spasticity not adequately controlled by recognized spasmolytic agents. A transdermal system providing approximately constant and continuous systemic delivery of clonidine has been recently introduced to enhance patient compliance. However, experience with transdermal clonidine in the management of spasticity is limited. Three cases are presented of patients with spasticity as the result of cervical spinal cord injury, inadequately managed by oral baclofen, in whom transdermal clonidine was administered. Significant improvement in spastic hypertonia was observed in all three cases. Transdermally delivered clonidine was well tolerated, with reported side effects limited to dryness of the mouth.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Transverse myelitis has been cited as a rare and unusual complication of systemic lupus erythematosus (SLE). A review of the literature reveals only 10 cases of transverse myelitis as the initial presentation of SLE, and only one with reported benefits from antimalarial therapy. The case of a 30-year-old woman is reviewed. She presented to the emergency room with complaints of hypogastric and low back pain. The ensuing course was one of frank urinary retention and rapidly progressing quadriparesis. Magnetic resonance imaging of the spine revealed marked edema of the cervical and thoracic spine. A diagnosis of SLE was based on positive antinuclear antibodies and leukopenia. The patient was treated with high dose methylprednisolone, plasmapheresis and pulse cyclophosphamide for 3 months. Subsequently, treatment was begun with hydroxychloroquine, and significant improvement in her neurologic and functional status was achieved after 1 month of therapy. Ten months after her onset of symptoms, the patient suffered an acute exacerbation of paraparesis and urinary retention. Again, she improved clinically after high dose methylprednisolone and pulse cyclophosphamide for 1 month. Hydroxychloroquine was continued throughout the duration of therapy.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID