Biomedical subjects
Publications and source records attributed to E R Gardner.
Congenital funnel anus is a rare and poorly documented condition in which treatment strategies are still evolving. The authors present 2 cases and describe the findings after magnetic resonance imaging along with the treatment regime used successfully in these children.
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OBJECTIVE: To determine if a single-stage, submaximal fatigue test on a wheelchair ergometer would result in higher than expected energy expenditure. DESIGN: An experimental survey design contrasting physiologic responses during peak graded exercise tests and fatigue tests. SETTING: A rehabilitation science laboratory that included a prototypical wheelchair ergometer, open-circuit spirometry system, and heart rate monitor. PARTICIPANTS: Nine able-bodied non-wheelchair users (the NWC group: 6 men and 3 women, mean +/- SD age 30 +/- 7yrs) and 15 manual wheelchair users (the WC group: 12 men and 3 women, age 40 +/- 9yrs, time in wheelchair 16 +/- 9yrs). No subject had any disease, medication regimen, or upper body neurologic, orthopedic, or other condition that would limit wheelchair exercise. MAIN OUTCOME MEASURES: Peak oxygen uptake (VO2) for graded exercise testing and during fatigue testing, using a power output corresponding to 75% peak aerobic capacity on graded exercise test. RESULTS: In the WC group, VO2 at 6 minutes of fatigue testing was not significantly different from peak VO2. In the NWC group, VO2 was similar to the expected level throughout fatigue testing. CONCLUSION: Energy expenditure was higher than expected in the WC group but not in the NWC group. Fatigue testing may provide a useful evaluation of cardiorespiratory status in manual wheelchair users.
This paper summarizes the results of screening for participation in research programs involving functional neuromuscular stimulation (FNS). It examines the characteristics of a group of children and teenagers with spinal cord injuries (SCI) identified as potential candidates for FNS as defined by the rigorous inclusion criteria of the research studies. One hundred and thirteen children and teenagers under the age of 20 with cervical, thoracic or lumbar level spinal cord injuries were examined for inclusion in an experimental program of FNS to provide standing, walking, or prehension. Although biased towards adolescents with complete midthoracic and midcervical injuries, the age, sex, injury level, etiology, and neurological status of the sample coincided with previously published reports and consisted predominantly of teenage males injured in motor vehicle or sports related accidents. Approximately half of the individuals examined were physically appropriate for research participation without preparatory intervention. Treatment options to prepare individuals for FNS were identified in 25% of those considered inappropriate at the initial evaluation, indicating that the potential user population of clinical systems may be larger than estimates obtained from research applications. Peripheral denervation was the single most prevalent physical impediment to the application of FNS. Although the incidence of lower motor neuron (LMN) involvement was similar in subjects with tetraplegia and paraplegia, those with cervical lesions more frequently exhibited other medical complications that interfered with the application of FNS. Surgical procedures involving transfer of paralyzed but excitable muscles were identified in almost one third of the candidates with tetraplegia who were excluded due to denervation. Of those physically appropriate, psychological factors eliminated several candidates from consideration. Such concerns may also be addressed with suitable intervention in preparation for the clinical application of FNS. Almost 50% of those appropriate for FNS research elected to participate in the programs, with those declining citing the hospitalization, time and travel commitments as the primary factors influencing their decisions. Results suggest that FNS for standing, walking and hand grasp may be an option for a significant percentage of the pediatric SCI population.
We investigated the incidence of cephalosporin-resistant bacteria in infected hip arthroplasties. Of 740 patients having hip replacement or related procedures performed over three years, 30 had positive bacteriological cultures from tissue removed at the time of surgery. In 18 of the 30 cultures Staphylococcus epidermidis was grown and 12 of these were methicillin-resistant. A prospective study of skin swabs taken from 100 consecutive patients at the time of admission for THR showed methicillin-resistant Staphylococcus epidermidis in 25. This cephalosporin-resistant organism was shown to be the commonest proven cause of infection, and its presence as a skin commensal raises important questions about current antibiotic prophylaxis for joint replacement.
The effects of balance retraining on standing balance and locomotor performance were examined in postacute hemiparetic adults. Balance during habitual and instructed-even standing, as well as locomotor performance, were measured before and after a three- to four-week treatment period. Two groups of 21 matched subjects participated in physical therapy. One group received standing balance training with a specially designed feedback device that provided dynamic visual information about relative weight distribution over the paretic and nonparetic limb. Subjects trained with the feedback device showed significantly better static standing symmetry than did subjects who did not receive augmented feedback, p less than .05. Although both groups improved significantly in gait velocity, cadence, stride length, and cycle time, p less than .01, the initially identified asymmetrical locomotor pattern appeared to be only minimally affected by the standing balance training. Results indicated that although standing balance and locomotor control mechanisms may be highly interrelated, a reduction in standing balance asymmetry does not necessarily lead to a concomitant reduction in the asymmetrical limb movement patterns associated with hemiparetic locomotion.
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Longitudinal and cross-sectional data have demonstrated a high incidence of physical illness among psychiatric patient populations. Problems involved in the treatment of medically ill psychiatric patients include the nonspecificity of psychiatric symptoms, the inadequacy of previous examinations by a nonpsychiatric physician to rule out the possibility of physical disease causing psychiatric symptoms, and the patient's lack of awareness of current or pre-existing physical disease when consulting the psychiatrist. The following review examines nine categories of medical disorders that are known to produce psychiatric symptoms, with discussion of the psychiatric manifestations. Implications for current practice and training are briefly considered.
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The authors studied 100 state hospital psychiatric patients consecutively admitted to a research ward who were screened to eliminate physical illness before admission. They found an unusually high incidence of medical illness: 46% of these patients had an unrecognized medical illness that either caused or exacerbated their psychiatric illness, 80% had physical illnesses requiring treatment, and 4% had precancerous conditions or illnesses. A workup consisting of psychiatric and physical examination, SMA-34, urinalysis, ECG, and EEG after sleep deprivation identified over 90% of medical illnesses present in this population. The authors suggest that such a battery be part of the routine workup for all hospitalized psychiatric patients.
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