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Biomedical subjects

D D Cardenas

Publications and source records attributed to D D Cardenas.

At least 37 records · Page 2Linked to original sources
PubMed1996

Pregnancy in spinal cord injured women.

The management of pregnancy, labor, and delivery in women with spinal cord injury (SCI) has received increased attention by investigators and clinicians in recent years. Physicians who care for women with SCI need to become familiar with the general principles of care during pregnancy. This article presents a summary of publications identified by a MEDLINE search of the topics spinal cord injury, paraplegia, tetraplegia, and pregnancy, and by reviewing the reference lists of these articles. The current medical literature suggests excellent overall maternal and neonatal outcome. Certain medical complications such as urinary tract infections and autonomic hyperreflexia are predictable and can be managed successfully. Obstetrical management is changed little by SCI but needs to account for the risk of unattended delivery in the patient with a high level of lesion.

Animals↗
PubMed1996

Reflex sympathetic dystrophy of the lower extremity in tetraplegia: case report.

Reflex sympathetic dystrophy (RSD) of the upper extremities has been reported to occur following complete and incomplete injuries of the cervical cord. Such reports describe the value of the three-phase radionuclide bone scan (TPBS) in differentiating RSD from pain of other sources. To our knowledge, RSD of the lower extremities has not been reported in a patient with tetraplegia. We report a case of lower extremity RSD in a patient with complete traumatic injury of the cervical cord. The case illustrates the use of the TPBS to differentiate RSD from heterotopic ossification (HO) in the lower extremities. THe successful use of the alpha-adrenergic blocker, phenoxybenzamine, in the treatment of RSD is described. Follow-up to 30 months has shown no evidence of recurrence, and complete resolution of the scintigraphic findings.

Adrenergic alpha-Antagonists↗
PubMed1995

Urinary tract infection in persons with spinal cord injury.

Persons with spinal cord injury (SCI) have an increased risk of developing urinary tract infections. Certain structural and physiological factors, such as bladder over-distention, vesicoureteral reflux, high-pressure voiding, large post-void residuals, stones in the urinary tract, and outlet obstruction increase the risk of infection. The method of bladder drainage also influences the risk of urinary tract infection, and most persons with SCI on indwelling or intermittent catheterization develop urinary tract infection. The association of behavioral and demographic factors with the risk of urinary tract infection are less well understood. The method of specimen collection must be considered when determining the significance of bacteria. A national consensus conference sponsored by the National Institute on Disability and Rehabilitation Research defined significant bacteriuria as: > or = 10(2) colony forming units (cfu) of uropathogens per milliliter of urine in catheter specimens from persons on intermittent catheterization; > or = 10(4)cfu/mL in clean-voided specimens from catheter-free males using condom catheters; and any detectable concentration of uropathogens in indwelling catheter or suprapubic aspirate specimens. Symptomatic urinary tract infection warrants therapy, but the diagnosis is complicated by the poor sensitivity and specificity of symptoms and signs. Pyuria is generally present in persons with symptomatic urinary tract infection, although it is a nonspecific test, and its absence generally indicates the absence of symptomatic urinary tract infection. Treatment of asymptomatic bacteriuria has not been shown to be beneficial and increases the risk of development of antimicrobial-resistant uropathogens. Antibiotic prophylaxis is generally not recommended because of its unproven benefit in several studies and its association with emergence of antimicrobial resistance.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1995

Lower urinary changes over time in suprasacral spinal cord injury.

This paper reviews 179 patients (23 females and 156 males) with suprasacral spinal cord injury (SCI) who underwent videourodynamic evaluation to compare maximum detrusor pressure, compliance, and trabeculation with methods of bladder management, years post-injury, and age. The patients were divided into four groups based on mode of bladder management: clean intermittent catheterization (CIC), indwelling catheter (IND), external collector (EC), and voiding (V). Maximum pressure decreased significantly with increasing age for those using EC (P < 0.01) and CIC (P < 0.05). Maximum pressure also decreased significantly with years post-injury for patients on EC (P < 0.01) and was highest the first decade after injury and progressively decreased through the fifth decade. Post-hoc tests indicated more severe trabeculation in patients in the EC group than in either the CIC or IND groups. Age and trabeculation did not correlate in those on EC. We conclude that patients with long-standing suprasacral SCI using EC are more likely to have lower detrusor pressures than are those with less chronic SCI. This finding may reflect the effects of age as well as reduced survival in those using EC with chronically elevated detrusor pressure.

Adolescent↗
PubMed1994

Oral physostigmine and impaired memory in adults with brain injury.

The purpose of this study was to examine the effects of physostigmine, a cholinergic agonist, on memory loss after traumatic brain injury (TBI), as compared to placebo or scopolamine, a cholinergic antagonist, using a double-blind, placebo-controlled design. Each subject received each active drug and placebo. Neuropsychological measures (Wechsler Memory Scale I and II, Selective Reminding Test, Trail-Making Test, Parts A and B, Digit Symbol, and Memory Questionnaire) and measures of clinical balance were completed at baseline, after each drug phase, and at 1 month follow-up. Thirty-six subjects completed the study with results showing an improvement in memory scores in 44% of subjects (responders) while taking oral physostigmine. The most sensitive measure was the Selective Reminding Test, specifically Long-term Storage. The impact of drugs on standing balance as compared to placebo was improved standing time in the responders: (1) with physostigmine when standing tandem with eyes closed (p < 0.05), and (2) with scopolamine when standing on one foot with eyes closed (p < 0.05). Results support the potential benefit of cholinergic agonists on memory after TBI and the need for further research of possible clinical markers for the drug.

Administration, Cutaneous↗
PubMed1992

Rehabilitation, aging and chronic renal disease.

Restorative management of the disabled elderly requires knowledge about realistic functional expectations, in addition to knowledge about a patient's particular disease. Health outlook, especially sense of control, should also be assessed because rehabilitation depends on the patient's active participation. A comparison of 349 older end-stage renal disease (ESRD) patients on chronic dialysis and 354 similar-age persons selected as a control group showed that significantly compromised physical function and health outlook were reported by the dialysis patients compared with the control group. Increasing exercise capacity and participation in dialysis self-care activity are recommended ways to improve physical functioning and health outlook among ESRD patients. Individuals who cannot perform strenuous activity can improve in level of fitness; improvements in anemia and muscle strength are key variables. Clinical application of therapeutic and rehabilitative strategies to improve physical function and health outlook in the geriatric renal patient is greatly needed.

Activities of Daily Living↗
PubMed1992

Risks associated with pregnancy in spinal cord-injured women.

We reviewed the experience with pregnancy in spinal cord-injured women at the University of Washington over the past 10 years. During that time, 11 women with spinal cord injury had 13 pregnancies. Infant outcome was uniformly good. No major obstetric complication occurred. The mothers experienced medical problems including urinary tract infection in ten and pyelonephritis in three. Autonomic hyperreflexia occurred in three of five subjects with lesions at or above the sixth thoracic vertebra. Pregnancy in the spinal cord-injured patient involves medical risk for the mother, but with careful management, an excellent outcome for both mother and infant may be anticipated.

Adult↗
PubMed1991

Dorsal nerve of the penis nerve conduction velocity: a new technique.

In the evaluation of a possible peripheral neuropathic process as the etiology of erectile dysfunction, studies of the dorsal nerve of the penis may be unique in that they allow examination of the most distal segment of pudendal nerve in isolation. This study describes a new technique using a simple traction device for elongation of the penis to determine the orthodromic nerve conduction of the dorsal nerve of the penis. With stimulation at the glans, and recording at the base of the penis, the value obtained in 20 normal subjects was 36.2 +/- 3.2 m/s with an amplitude of 2.29 +/- 1.08 mV.

Adult↗
PubMed1991

Diagnostic imaging of heterotopic ossification with coexistent deep-venous thrombosis in flaccid paraplegia.

Heterotopic ossification and deep-venous thrombosis can coexist. This raises potential problems because diagnosis depends heavily on imaging studies, and an ideal imaging study which will cost-effectively and noninvasively diagnose both conditions simultaneously is not readily available. A case of coexistent heterotopic ossification and deep-venous thrombosis in flaccid paraplegia is presented. In this case, deep-venous thrombosis and pulmonary embolus were diagnosed and treatment was begun without knowledge of the coexistent heterotopic ossification. Alternative imaging and laboratory diagnostic strategies are discussed. It was concluded that, at this time, clinical acumen and judicious use of traditional diagnostic alternatives is the best means of selecting appropriate treatment. Awareness of the coexistence of the two conditions are careful attention to the patient's clinical course can minimize treatment delays and resultant morbidity.

Diagnostic Imaging↗
PubMed1991

Fatigue and depression in brain-injured patients correlated with quadriceps strength and endurance.

Many brain-injured (BI) patients complain of persistent fatigue that may alter their lifestyles. In order to assess muscular strength and endurance after brain injury, 22 BI men, greater than 9 months postinjury and aged 20 to 51 years, were separated into two groups based on a complaint of fatigue (fatigue n = 13, nonfatigue n = 9); each performed one maximal isometric knee extension at 60 degrees and 20 maximal isokinetic contractions at 20 rpm using a Cybex II dynamometer. A third group of age-matched, able-bodied men (n = 10) were used as controls. A battery of tests assessing the presence of fatigue (using a symptom checklist and two rating scales), depression, anxiety, and health status were given at the time of isokinetic/isometric testing. The mean fatigue rating, a subjective score, for the fatigue group of BI subjects was significantly worse than the other groups (p less than .01). There was a positive correlation between clinically significant Zung depression scores and fatigue rating (r = .46) and between Zung anxiety scores and fatigue rating. The depression scores for those who complained of fatigue were significantly higher than the other groups (p less than .005). Maximal isometric contractions were no different among the three groups. The mean maximal isokinetic torque during the 20 repetitions was greater in controls than in the BI groups, but did not reach statistical significance (p less than .25). There were no significant declines in isokinetic torque in the 20 repetitions for any of the groups, and the fatigue index was nearly equal for all three groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Bladder volume determination using a dedicated, portable ultrasound scanner.

Urethral catheterization, the standard method for measurement of bladder volume, is associated with patient discomfort plus the risks of urethral trauma and urinary tract infection. A portable ultrasound instrument that automatically determines bladder volume was used for 164 determinations and the digital readout correlated with the catheterized volume (r2 equals 0.79). This instrument is a noninvasive alternative to urethral catheterization for the determination of bladder volume in most patients.

Evaluation Studies as Topic↗
PubMed1990

Effectiveness of behavioral therapy for chronic low back pain: a component analysis.

The effects of outpatient group behavioral therapy including aerobic exercise (BE), behavioral therapy only (B), and aerobic exercise only (E) on pain and physical and psychosocial disability were evaluated and compared in a group of mildly disabled chronic low-back-pain patients. Ninety-six Ss were randomly assigned to the 3 treatments and a waiting-list control (WL) condition and assessed on a variety of patient self-report, spouse-rated, and direct observational measures at pretreatment, posttreatment, and 6- and 12-month follow-ups. Patients in the BE condition, but not the B or E conditions, improved significantly more pretreatment to posttreatment than did WL patients on the patient self-report and observer-rated measures. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no significant differences among treatments.

Adult↗
PubMed1990

Ultrasound measurement of urine volume of children with neurogenic bladder.

This study assessed the accuracy and precision of a portable ultrasound unit which computes bladder volume after scans are made in the sagittal and transverse planes. 39 ultrasound measures were made on 20 children between the ages of one month and 16 years, and these measures were then compared with catheterized volumes. The mean difference of ultrasound minus true volume was 6.9 ml (SD 32ml). The ultrasound scanner was found to be accurate, inexpensive and easy to use for measuring post-voiding residual urine volumes in children with neurogenic bladder.

Adolescent↗
PubMed1989

Experience with portable ultrasound equipment and measurement of urine volumes: inter-user reliability and factors of patient position.

A portable ultrasound unit has been developed that provides a noninvasive technique to measure urine volume. We assessed the effect of patient position on the accuracy of measurements as well as inter-user reliability and user training. There were 63 ultrasound measurements of urine volume made by a trained and an inexperienced examiner, and the values were compared to true volumes obtained by catheterization in 16 adults with a neurogenic bladder. Subjects were tested in the seated and supine positions. Correlation for ultrasound volumes between the trained and inexperienced examiners was highly significant. Accuracy and precision of the ultrasound measurements were not affected by patient position. Thus, little training is necessary to use this instrument, inter-user reliability is good, and accuracy and precision are clinically acceptable whether patients are in the seated or supine positions.

Adult↗
PubMed1988

Carbon dioxide cystometry and postural changes in patients with multiple sclerosis.

Ninety-one subjects with multiple sclerosis were evaluated by carbon dioxide cystometry in the supine, sitting, and standing positions, and by water cystometry in the supine position. Detrusor responses in supine studies were characterized as normal, hyperreflexic, or areflexic. Carbon dioxide and water cystometry were without difference in determining types of detrusor responses. Positional changes (particularly standing) resulted in reassessing of normal supine bladder responses as hyperreflexic. Hyperreflexia was aggravated with sitting and standing. Positional changes did not demonstrate conversion of areflexia to hyperreflexia. The relatively small proportion of dyssynergic sphincter responses probably represents a population of patients with early stage multiple sclerosis. Carbon dioxide cystometry, with positional changes, is relatively safe, easily performed, and an accurate method of evaluating detrusor response in patients with multiple sclerosis who have a changing clinical course or unresponsiveness to treatment.

Adult↗
PubMed1988

Residual urine volumes in patients with spinal cord injury: measurement with a portable ultrasound instrument.

Spinal cord injured (SCI) patients are often placed on an intermittent catheterization (IC) program during their initial rehabilitation in an effort to establish a catheter-free state. A noninvasive method to quantitatively determine residual urine volumes would decrease unnecessary catheterizations and be useful in the management of an IC program. This study was undertaken to determine if bladder volumes could be accurately determined in a group of SCI patients using a portable ultrasound scanner. Fifteen SCI patients underwent a total of 224 ultrasonic bladder volume determinations and 57 urethral catheterizations. Immediately prior to catheterization, two investigators alternately performed a total of four ultrasound readings on each patient using a hand-held portable instrument, the BVI 2000. The first ultrasound volume determination was comparable to the average ultrasound volume (r2 = 0.956). For catheterized volumes versus the initial ultrasound volume determination, r2 = 0.80. The average error was 18% for catheterized volumes within the range 50-700ml. Our results compare favorably with both real-time scanning using standard equipment and other portable instruments. The noninvasive nature, negligible risks, and reasonable estimates of volume warrant consideration of portable ultrasound scanning for the determination of bladder volumes in SCI patients.

Evaluation Studies as Topic↗
PubMed1987

Bacteriuria with fever after spinal cord injury.

Urinary tract infection continues to be a common problem among spinal cord injured (SCI) individuals despite the strides that have been made during the last decade in the care of the neurogenic bladder. A critical analysis of the system of drainage compared with the occurrence of bacteriuria with fever (BWF) is reported in a group of 705 SCI patients. At the first year (year 1) follow-up, patients being catheterized by someone else (ICO) were much more likely to have experienced at least one episode of BWF than those on self-intermittent catheterization (SIC) (p less than 0.025) or those using an indwelling catheter (IND) (p less than 0.005). In patients who underwent external sphincterotomy, the incidence of BWF was significantly decreased in year 1 (p less than 0.025) compared to those on ICO.

Bacteriuria↗