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Biomedical subjects

G Davidoff

Publications and source records attributed to G Davidoff.

At least 19 recordsLinked to original sources
PubMed1992

An open trial of vacuum penile tumescence: constriction therapy for neurological impotence.

Sexual dysfunction is a frequent result of traumatic and non traumatic neurological disorders, including spinal cord injury, stroke, traumatic brain injury and autonomic neuropathy (for example, as may be seen in patients with diabetes mellitus). Although many methods have been suggested for the treatment of some of these problems in male patients, most are invasive and have a substantial morbidity. This is the report of a pilot trial of vacuum tumescence constriction therapy for 30 patients with chronic neurological impotence. Seventeen of these patients, following sexual counselling and training, decided to purchase such a device. At follow up, a mean of 21 months, over 50% of those who had purchased the device were still actively using it. The frequency of coitus increased from 0.3/wk to 1.5/wk (t = -5.7; p less than 0.0001). No significant morbidity was reported by patients. Vacuum tumescence constriction therapy shows promise as a noninvasive method for the treatment of neurological impotence.

Adult↗
PubMed1992

Noninvasive treatment for erectile dysfunction in the neurogenically disabled population.

Erectile dysfunction is the most prevalent sexual dysfunction in neurogenically disabled men. Studies of rehabilitation patients indicate that the restoration of sexual functioning is considered an important priority. This article reports on a pilot study of vacuum tumescence constriction therapy as a noninvasive method for use by a population with traumatic or nontraumatic neurologic disorders such as spinal cord injury, stroke, multiple sclerosis, and diabetes mellitus. Of the 30 patients who participated in the study, 17 purchased the device and over 50% of them reported using the device on a long-term basis. Frequency of coitus increased from 0.3/wk to 1.5/wk. Included in the study are methods used by patients to integrate the device into their sex life, the role of the patient's partner in the decision to purchase the device, and the rate of partner satisfaction. There were no reports of substantial morbidity. Thus, this method shows promise as a noninvasive treatment for men who are moderately to severely neurogenically disabled.

Equipment and Supplies↗
PubMed1992

Risk factors for heterotopic ossification in children and adolescents with severe traumatic brain injury.

Previous reports on the incidence of heterotopic ossification (HO) in children and adolescents with traumatic brain injury (TBI) have ranged from 3% to 20%. These studies mention HO briefly or address patient cohorts with coma more than three months. We reviewed the medical records of 90 children younger than 19 years old, who were comatose more than 24 hours after TBI. Mean followup was 33.1 months (range = 2 to 128 months). Incidence of HO was 14.4% (n = 13). One to five sites were involved, with hip and knee most frequent, followed by shoulder, elbow, and nonjoint sites. Children with HO were older than 11 years (relative risk [RR] = 18.85, confidence interval [CI] = 3.7, 95.7), had a greater length of coma (RR = 7.22, CI = 1.4, 37.1), and had a greater associated risk for poor functional outcome (RR = 2.89, CI = 1.02, 7.9) compared to those without RO. Multiple limb fractures showed a trend toward association with increased incidence of HO. Other factors, including gender, history of skull fracture, brain CAT scan findings, and presence of spasticity, were not predictive of HO. Eleven children were treated with etidronate, four with nonsteroidal antiinflammatory drugs, and one with surgery. Only three children had residual functional impairments attributed to the presence of HO.

Adolescent↗
PubMed1991

Compressive mononeuropathies of the upper extremity in chronic paraplegia.

Controversy exists with regard to the actual prevalence of compressive mononeuropathies at the wrist which may occur following chronic paraplegia. Thirty one chronic paraplegics, with a mean age of 37.9 years (range 20-68 years), and mean time since injury of 9.7 years (range 1-28 years), were studied with a comprehensive neurologic and electrodiagnostic (EDX) assessment. No patient had any clinical or EDX evidence of a peripheral polyneuropathy. The diagnosis of a median mononeuropathy at the wrist was determined by the following criteria: (a) prolonged median sensory distal latency greater than ipsilateral ulnar sensory distal latency greater than or equal to 0.5 msec; (b) a median mid-palmar sensory latency greater than ipsilateral ulnar mid-palmar sensory latency of greater than or equal to 0.3 msec; or (c) a median motor distal latency greater than or equal to 1.7 milliseconds as compared to the ipsilateral ulnar motor distal latency. Ulnar mononeuropathy at the wrist or across the elbow was also characterised. The EDX criteria for a median mononeuropathy at the wrist was met in 55% of subjects (24% of these with bilateral presentations). The location of ulnar mononeuropathies included: two at the superficial sensory branch at the wrist, one at the deep motor branch at the wrist, and three patients with a conduction block across the elbow. Overall, 67% of all patients tested had evidence of at least one mononeuropathy of the upper extremity. There was no association between prevalence of compressive mononeuropathies and age of the patient or time since onset of injury.

Adult↗
PubMed1991

Exercise testing and training in patients with peripheral vascular disease and lower extremity amputation.

Patients with peripheral vascular disease have a high risk of coronary artery disease. The risk is even greater when the peripheral vascular disease leads to lower extremity amputation. Exercise testing using lower extremity exercise has been the "gold standard" for screening for coronary artery disease, but many patients with peripheral vascular disease and those with amputations have difficulty doing this type of exercise. Arm exercise ergometry has been shown to be a safe and effective alternative for the detection of coronary artery disease in patients who cannot do leg exercise. This test has also been used to determine safe exercise levels and may be able to predict the ultimate level of prosthetic use in amputees. Exercise training with arm ergometry also improves cardiovascular efficiency and upper body strength in poorly conditioned patients. Studies are needed to appreciate fully the role of exercise testing and training in the recovery of these patients after amputation.

Amputation, Surgical↗
PubMed1990

Transverse myelitis associated with mycoplasma pneumoniae: case report.

Acute transverse myelitis (ATM) is a disorder of the spinal region of the central nervous system. In the present case, the clinical course showed ATM associated with mycoplasma pneumoniae (MP) and little recovery; the girl was left with a flaccid paraplegia, and thus differed from other cases in the literature which all reported complete or near-complete recovery.

Adolescent↗
PubMed1990

Rehospitalization after initial rehabilitation for acute spinal cord injury: incidence and risk factors.

Many acute spinal cord injury (SCI) patients require rehospitalization after discharge from initial rehabilitation. Previous studies of rehospitalization for these patients have been cross-sectional with respect to time since injury (in years), and have not allowed for comparison of patients with equal exposure to the risk of medical complications once they have reentered the community. To examine the incidence, cause, and monetary cost of rehospitalizations during the first year after discharge from initial rehabilitative care (day 365), the medical records of 88 consecutive, acute SCI patients who completed initial rehabilitation at a regional model SCI care system were reviewed. Cases were excluded from the study if the patient was lost to follow-up before day 365. All readmissions to the regional SCI care system during the follow-up period were reviewed for primary diagnosis, length of stay (LOS), and hospital charges incurred. Thirty-four patients (39%) were readmitted at least once by day 365. There was a total of 47 readmissions; mean LOS was 11.9 +/- 2.1 days per admission (+/- 1SE), and mean hospital charge per admission was $9,683. Univariate comparisons between the characteristics of patients who were readmitted vs those who were not indicated that the readmitted group was less educated (11.8 +/- 2.1 years vs 12.9 +/- 0.3 years, p less than 0.05) and had a substantially longer initial rehabilitation LOS (88.9 +/- 6.6 days vs 72.9 +/- 5.1 days, p less than 0.05). Readmissions were less common among patients who were discharged at Frankel class C or D (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Risk factors for median mononeuropathy of the wrist in postpoliomyelitis patients.

There is evidence that chronic cane, crutch, and wheelchair users are at increased risk for developing pain and functional compromise of the wrist and hand. This investigation examined the prevalence and risk factors for median mononeuropathy at the wrist in the postpoliomyelitis population. The medical records of 148 consecutive patients with histories of poliomyelitis were reviewed. Forty-nine percent of this cohort had complaints of wrist pain. The prevalence rate of carpal tunnel syndrome was 22% (n = 33). Age, sex, duration of disability, and work history did not significantly influence the relative risk of developing this disorder. However, the relative risk of developing this compression neuropathy at the wrist by using the combination of a cane and/or a crutch and a wheelchair was 4.86 (95% confidence interval 2.35-10.06). The high risk associated with chronic cane, crutch, and wheelchair use shows the need for developing preventive strategies.

Adult↗
PubMed1989

Factors affecting the sensitivity and specificity of the three-phase technetium bone scan in the diagnosis of reflex sympathetic dystrophy syndrome in the upper extremity.

The three-phase technetium bone scan has been recommended for use in the diagnosis of the reflex sympathetic dystrophy syndrome with a sensitivity and specificity of greater than 90%. A retrospective chart review was conducted of 63 patients who had three-phase technetium bone scan as part of a work-up for unexplained upper extremity pain, to determine the predictive value of the three-phase technetium bone scan in reflex sympathetic dystrophy syndrome, and what factors might affect it. The prevalence of definite or probable reflex sympathetic dystrophy syndrome, as assessed by Kozin's criteria, was 26% in this sample. The 3-hour delayed image demonstrated a sensitivity = 50%; specificity = 92%; positive predictive value = 67%, and negative predictive value = 84%. This was not improved using the data from the blood flow or pool phase. The sensitivity of 50% is lower than previous reports. The predictive value of the three-phase technetium bone scan was affected by the duration of symptoms and the age of the patient. Duration of symptoms less than 6 months, or ages more than 50 years substantially increased the sensitivity and positive predictive value of the three-phase technetium bone scan.

Adult↗
PubMed1989

A controlled study of neuropsychological deficits in acute spinal cord injury patients.

According to a number of studies, between 40% and 60% of acute traumatic spinal cord injury (SCI) patients demonstrate cognitive dysfunction resulting from various forms of cerebral damage, including concurrent or premorbid closed head injury, chronic alcohol or substance abuse, and other causes. However, applicability of findings from these reports has been limited due to the use of inadequate neuropsychological testing techniques and the lack of control data. In a collaborative investigation, 81 acute SCI patients and 61 non-injured control subjects between 18 and 55 years of age completed a comprehensive motor-free neuropsychological test battery, including: Halstead Category Test (HCT), Vocabulary Subtest (VOCAB) of the Wechsler Adult Intelligence Scale - Revised; Mental Control (MC) Subtest, and Initial and Recall trials of Logical Memory (LM) and Paired Associates (PA) Subtests of the Wechsler Memory Scale; and the 8 trials of the Rey Auditory Verbal Learning Test (RAVLT). Percentages of retained information on the LM and PA were also calculated. Impairment levels for each test were defined as values which exceeded two standard deviations (one-tailed) from the control mean. Based on this definition, the prevalence of neuropsychological abnormality on each test ranged between 10% and 40%. Mean performance levels of patients were significantly more impaired than those of control subjects for all tests except for the Interference trial of the RAVLT and for the percentages of retained information on the LM and PA subtests. Comparison of test results of SCI patients with those of control subjects demonstrates that poor attention span and limited initial learning ability are frequent problems among SCI patients. Other common neuropsychological deficits among these patients include poor concentration ability, impaired memory function, and altered problem solving ability. These deficits may interfere with rehabilitation following SCI.

Adolescent↗
PubMed1989

Serum creatine kinase in the post-polio population.

Elevated creatine kinase (CK) levels may be noted in neuromuscular patients as a result of muscle damage and necrosis. We measured the serum CK levels of 62 post-polio patients with chronic neurologic disease (Neuro) and 13 post-polio patients with no evidence of neurologic compromise (Control). Patient groups were comparable for age, gender and years since onset of poliomyelitis. The Neuro group had substantially increased CK levels compared with the Control group, 211 +/- 19.0 IU v 114 +/- 26.2 IU (mean +/- 1 SE; P less than 0.05). Of the Neuro group, 40% had abnormally elevated CK values, compared with 8% of the Control group. Within the Neuro group, there was a robust correlation between elevated CK values and self-reports of strenuous work and level of community ambulation (P less than 0.05). These findings support the hypothesis that chronic muscle overuse may be a contributing factor to the advanced senescence reported by post-polio patients with neuromuscular compromise.

Creatine Kinase↗
PubMed1989

Predictive value of the three-phase technetium bone scan in diagnosis of reflex sympathetic dystrophy syndrome.

Reflex sympathetic dystrophy syndrome (RSDS) is a painful and disabling problem, the diagnosis of which can be difficult to confirm by objective measures. The three-phase technetium bone scan (TPBS), with a combined sensitivity and specificity of greater than 90%, has been recommended for use in the diagnosis of RSDS. The purpose of this study was to determine the predictive value and usefulness of the TPBS in the diagnosis of RSDS and to discover how the predictive value might be influenced by demographic and medical factors (eg, duration of symptoms). A retrospective chart review was conducted of 119 patients who underwent a TPBS as part of a workup for unexplained limb pain. Twenty-five patients met the Kozin criteria for definite or probable RSDS. All patients were injected with technetium-99m methylene diphosphonate and scanned using established criteria. The three-hour delayed image demonstrated a sensitivity of 44%, a specificity of 92%, a positive predictive value of 61%, and a negative predictive value of 86%. The blood-flow and pool-imaging phases added no further sensitivity or specificity to that achieved by the uptake scan in patients with upper-extremity involvement. Blood-flow and pool-imaging did improve the predictive value of the TPBS in patients with involvement of the lower extremities. We conclude that a more cost-effective approach to diagnosis of upper-extremity RSDS is to use the uptake scan alone.

Adult↗
PubMed1989

Gastroparesis following traumatic brain injury and response to metoclopramide therapy.

Most studies on nutrition in patients with traumatic brain injury (TBI) have focused on the hypermetabolic state immediately after trauma, or the swallowing disorders that frequently follow acute TBI. A less well-known sequela, however, is gastroparesis, which generally manifests itself when patients have advanced from nasogastric to oral feeding programs. Case histories of four patients are reported, all of whom responded to therapeutic intervention with metoclopramide. Results of a radionuclide gastric emptying study, before and after metoclopramide therapy, are presented. The etiologic and physiologic mechanisms behind this disorder are unclear, but demonstration of this disorder and other clinical trials with metoclopramide appear to deserve further consideration in the nutritionally compromised TBI patient.

Brain Injuries↗
PubMed1988

The spectrum of closed-head injuries in facial trauma victims: incidence and impact.

Little is known of the incidence of closed-head injury (CHI) associated with facial trauma. To study this problem, we conducted a retrospective review of 200 consecutive admissions to the University of Michigan Medical Center Emergency Department from 1980 to 1985 for treatment of acute facial fractures. All patients were admitted within 48 hours of injury (93% within 24 hours). Medical records were reviewed for age, sex, description, and circumstances of facial injury; assessment of loss of consciousness and anterograde amnesia; and associated intracranial or extracranial injuries. Seventy-three percent of the patients were men (mean age, 27.8 years). Etiologies, in descending order, were road traffic accidents (52%), assaults (22%), sports (14%), falls (7%), other injuries (3%), and gunshot wounds (2%). The incidence rate of CHI in our study was 55%. More than 90% of the head injuries were associated with the loss of consciousness of less than one hour. Risk factor analysis failed to demonstrate that an increased risk of CHI is associated with age, sex, or number of facial fractures. However, there was a one and one-halffold increased risk associated with patients involved in automobile accidents.

Accidents, Traffic↗
PubMed1988

Closed head injury in acute traumatic spinal cord injury: incidence and risk factors.

Investigators estimate that 15% to 50% of all patients with spinal cord injury (SCI) also incur a closed head injury (CHI), but studies have been hampered by design flaws, including retrospective assessment and inconsistent definition of CHI. We conducted a prospective study of combined CHI and SCI among 82 SCI patients consecutively admitted at two hospitals within 24 hours of injury. The purpose of the study was to determine the incidence and duration of loss of consciousness and posttraumatic amnesia (PTA), and to establish the risk factors for combined CHI and SCI. The overall incidence of CHI as defined by the presence of PTA of any duration was 49%. There was a significantly increased risk of CHI for patients involved in traffic accidents (risk ratio = 3.7; 95% confidence interval 1.8 to 7.2). There was no increased risk associated with level of injury (quadriplegic vs paraplegic; risk ratio = 1.2; 95% confidence interval = 0.8 to 1.8). All SCI patients, regardless of level of injury, deserve systematic evaluations for CHI in their acute care evaluations.

Adult↗
PubMed1988

Galveston Orientation and Amnesia Test: its utility in the determination of closed head injury in acute spinal cord injury patients.

The incidence of closed head injury (CHI) associated with acute spinal cord injury (SCI) has been estimated at 40% to 50%. Closed head injury can be defined as the presence of loss of consciousness (LOC) and/or posttraumatic amnesia (PTA). Consequently, one of the difficulties in establishing a diagnosis of CHI is determining the existence of PTA in those patients without documented LOC. Previous work described the inconsistent evaluation of PTA in the SCI population. This study was conducted to evaluate the utility of the Galveston Orientation and Amnesia Test (GOAT) in establishing the diagnosis of CHI in a series of acute traumatic SCI patients. The GOAT was administered serially for three to five days to 34 patients admitted to our hospital. When information derived from the GOAT was added to that derived from review of medical records alone, the observed incidence of PTA (and by implication CHI) increased significantly (McNemar statistic = 6.4; p = 0.01). The GOAT is a quick, simple, and reproducible evaluation of spheres of orientation, which is extremely helpful in diagnosis of PTA in this population. This instrument should be used to evaluate patients at high risk for head injury. Although abnormalities in the GOAT evaluation may also be attributable to factors other than CHI (eg, hypoxia, medication effects), such findings provide evidence suggestive of CHI. This will help determine which patients require a more detailed neuropsychologic assessment.

Adult↗