ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Nonparalytic polio (NPP) is commonly thought to be synonymous with "abortive polio," in which the poliovirus neither entered the central nervous system nor damaged neurons. Described are two epidemic illness-"The Summer Grippe" and Iceland disease-apparently caused by a low virulence but neuropathic type 2 poliovirus. Studies show that neuronal lesions in the brain and spinal cord and muscle weakness were common in NPP, and epidemiologic studies document late-onset weakness and fatigue in 14% to 42% of NPP survivors. These findings indicate that clinicians should not require a history of paralytic polio, electromyographic evidence of denervation, and new muscle weakness for the diagnosis of "Postpolio Syndrome" but should be aware that NPP, and possibly even poliovirus-induced "minor illnesses," can be associated with acute central nervous system damage and late-onset muscle weakness and fatigue.

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

We describe four cases of postpolio syndrome with typical histories, physical examination results, and electrodiagnostic evidence of extensive anterior horn cell disease, as well as the putative pathophysiology of postpolio syndrome in persons with histories of nonparalytic polio and the diagnostic implications for individuals older than 40 yr of age who are experiencing unexplained new weakness, fatigue, and muscle or joint pain. Although the diagnosis of postpolio syndrome traditionally has required a remote history of paralytic polio, many persons such as the ones described here with typical symptoms of postpolio syndrome have no clear history of paralytic disease and are being misdiagnosed. With this in mind, we believe that the diagnostic criteria for postpolio syndrome should be modified to include the following: a history of remote paralytic polioorfindings on history, physical examination results, and laboratory studies compatible with poliovirus damage of the central nervous system earlier in life.

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:To determine the effects on symptoms, pulmonary function, sleep, and other clinical variables of treating kyphoscoliosis-associated chronic alveolar hypoventilation with nocturnal nasal ventilation.Design:Sixteen patients with kyphoscoliosis were treated with nocturnal nasal ventilation delivered by volume-cycled (seven patients) and pressure-cycled (nine patients) ventilators. Dyspnea, morning headaches, fatigue, hypersomnolence, and perceived sleep quality were assessed.Results:All pretreatment symptoms improved significantly with nasal ventilation. Likewise, PaO2(mm Hg), PaO2/FIO2, PaCO2(mm Hg), pH, and forced vital capacity (in milliliters and as a percentage of predicted normal) significantly improved with treatment. Maximum inspiratory pressures and maximum expiratory pressures also significantly increased. Tidal volumes increased significantly and breathing frequency decreased (not significant). Although perceived sleep quality improved, as well as sleep oxyhemoglobin saturation, there was no significant change in sleep architecture. Hospitalization days for respiratory difficulties also decreased from 10.9 ± 13.3 days in the 6 mo before intermittent positive-pressure ventilation to 0 days during the first 6 mo of treatment.Conclusions:Although not apparently affecting sleep architecture, nocturnal nasal ventilation can significantly improve nocturnal and daytime blood gases, pulmonary function, and symptoms of hypoventilation for patients with severe kyphoscoliosis.

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:To compare balance, mobility, recent falls, and injuries among elderly African American and white women.Design:This was a nonexperimental study. Participants, who were older than 65 yr of age, able to walk at least 30 ft, not residing in a nursing home, and with no acute medical problems, were recruited from 17 senior citizens' community centers.Results:Compared with white women (n=180), African American women (n=118) took fewer medications, had greater body mass indexes, had less muscle strength, and had more medical conditions and neurologic abnormalities. Additionally, these women were less active and had poorer performances on an obstacle course. The two groups had a similar histories of falls and injuries. For both groups, activity level and neurologic findings were predictors of obstacle course performance. For white women, muscle strength was an additional predictor of obstacle course performance. An additional predictor for African American women was range of motion.Conclusion:The poorer balance and mobility of African American women compared with white women may have consequences such as their functional dependence, resulting in their greater use of hospitals and formal and informal health services.

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:To investigate the effect of isometric biceps brachii contraction and neck flexion on the time course of threshold sural amplitude.Design:Twelve healthy subjects, who were asked to lie supine on an examination bench, performed 1 min of muscle contraction. The sural sensory nerve action potential was recorded before, immediately after, and at 2-min intervals after muscle contraction. The preexercise level of stimulus intensity remained unchanged for sural readings throughout the entire course of the experiment.Results:The temporal changes in sensory nerve action potential amplitudes for both maneuvers were similar (P= 0.9734, two-way interaction). The mean sural amplitude after neck flexion increased from 6.0 ± 2.9 μV (SD) to 10.6 ± 6.6 μV (SD) 10 min after contraction. Similarly, mean sural amplitude increased from 6.5 ± 1.8 μV (SD) to 14.5 ± 9.7 μV (SD) 8 min after biceps brachii contraction. Statistical analysis performed using repeated measures with post hoc least significant difference showed a significant temporal effect in the two groups (P= 0.04).Conclusion:The temporal responses of threshold sural amplitudes after isometric biceps brachii contraction and central reinforcement neck flexion maneuvers are nearly identical with regard to increase in the amplitude.

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:To assess the outcomes of botulinum toxin injection of spastic finger flexors followed by intensive training of finger extensors.Design:Fourteen subjects with chronic hemiplegia spasticity of the upper limb had electromyographic-guided botulinum toxin injection into the long finger flexors. All patients presented with minimal active finger extension with the wrist flexed, sustained clonus of the finger flexors, functional proximal arm function, and absence of fixed contracture. Cadaver dissections directed selection of two injection sites: the flexor digitorum sublimis and the flexor digitorum profundus. Fifty mouse units of botulinum toxin were injected into each muscle. After injection, the subjects were instructed in a home program of stretching the long finger flexors, upper limb weight bearing with a weight-bearing splint, and exercise to improve finger extension control.Results:Compared with preinjection measures, assessment the first week after the initial injection showed significantly reduced tone, reduced clonus, and greater active finger extension with the wrist in the neutral position. Four months later, the Ashworth scale increased to preinjection levels in the six subjects with repeated injections but was again decreased postinjection. Active finger extension with the wrist in the neutral position and clonus showed a statistically nonsignificant trend toward cumulative improvement after the second injection.Conclusion:The greatest change in finger extension and spasticity reduction occurred after the first injection. Continued significant improvement in finger extension was not observed.

ISSN:0894-9115    

出版商:OVID    

年代:2000

数据来源: OVID