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Biomedical subjects

I Perkash

Publications and source records attributed to I Perkash.

At least 19 recordsLinked to original sources
PubMed1992

Use of penile prostheses to maintain external condom catheter drainage in spinal cord injury patients.

This is a retrospective analysis of 79 spinal cord injury patients who have had penile implants from one to 14 years. The primary indication for implants was the loss of condom catheter with a small retractile penis. Mean period after injury to when the implants were placed was 8.24 years (range 1-21 years). Mean total length of time the implants have been followed was 7.08 years (1-14 years). Sixty patients responded to our detailed questionnaire and they have been subjected to further analysis: prior to the implant 46 patients (77%) frequently lost their condoms. Fourteen of the patients (23%) had indwelling catheters, and 3 (5%) had a suprapubic cystostomy since they could not retain an external condom for urinary drainage because of retraction of a small penis. Post implant, 81% of patients had no accidents involving condom loss, while 19% still lost condoms. All indwelling catheters could be removed except for one patient who continued with a suprapubic catheter following transurethral sphincterotomy (TURS) and a penile implant. Sixty-eight percent used the implant for sex and felt their wives were satisfied. Patient satisfaction survey showed a markedly increased self esteem, increased mobility without fear of condom loss, and an improved sex life. Overall, the long term prosthesis failure rate was 8%. The specific infection complication rate was less than 2%. The Flexirod semirigid, hinged prosthesis proved ideal in meeting the requirements for these patients.

Adult↗
PubMed1992

Deep venous thrombosis associated with heterotopic ossification.

The differential diagnosis of the swollen lower extremity in the patient with spinal cord injury includes deep venous thrombosis, fracture, cellulitis, joint sepsis, heterotopic ossification, hematoma formation, and neoplasm. A patient with an asymmetrically swollen limb who was found to have concurrent ipsilateral acute deep venous thrombosis and active heterotopic ossification is described. The diagnostic workup included various laboratory and radiologic studies. Therapy included anticoagulation with heparin and warfarin. To treat the heterotopic ossification, indomethacin, etidronate, and graded range of motion were used. We learned from this patient and several similar cases that acute deep-venous thrombosis and active heterotopic ossification may occur concurrently, and therapeutic anticoagulation did not lead to bleeding within or around the area of active heterotopic ossification. The possibility of a relationship between heterotopic ossification and deep venous thrombosis is presently being studied at our institution.

Diagnosis, Differential↗
PubMed1992

Evaluation of a vocational robot with a quadriplegic employee.

A vocational robotic workstation capable of performing activities of daily living (ADL) and vocational tasks was placed for 18 months in the work site of an employee with C4 to C5 quadriplegia. A single-subject study was conducted to evaluate the performance of the robot vs that of a human attendant. The employee preferred the robot over the attendant for performance of all vocational tasks and ADLs, with the exception of feeding. Results indicated that the robot was capable of safely replacing the attendant for two five-hour periods during the workday, thus proving to be a cost-effective alternative to full-time, on-the-job attendant care. The study demonstrated the potential of robotics technology for returning independence and control to disabled employees and for offering corporate employers a solution to the problem of reasonable accommodation in the workplace.

Activities of Daily Living↗
PubMed1991

Gastrointestinal complications of chronic spinal cord injury.

Gastrointestinal problems are important in the chronic stage of spinal cord injury. We review the literature on problems of specific segments of the alimentary tract in this setting and add observations based on clinical experience. Emphasis is placed on the colon and rectum, where most clinically apparent problems occur. While bowel management programs are often successful in the near-term, long-term dysfunctions are common and difficult to treat. Studies to determine colonic transit time and rectal physiologic responses are useful to provide scientific basis of management of such patients. More information is needed on the relative roles of extrinsic and intrinsic nervous system in GI function.

Digestive System↗
PubMed1991

Access to computers for older adults: problems and solutions.

Activity that involves a personal computer is a valuable modality for the rehabilitation of older adults. The therapist without specialized training, however, may have difficulty integrating computer use with adults with chronic health problems that impede such use. The purpose of this paper was to describe positioning, visual access, and input problems that may interfere with computer access and to identify solutions for use by the occupational therapist. Through a review of occupational therapy and adaptive computer literature, resources for adaptive computer hardware, software, and positioning devices are identified. Examples of how computer activities can be integrated into existing nursing home, day-care, and home-care programs are provided. Recommendations are made for training for the occupational therapist with limited experience with personal computers and adaptive computer technology.

Aged↗
PubMed1991

Infertility in men with spinal cord injury.

Infertility is a significant and frustrating problem for many men after spinal cord injury. The two major causes are poor semen quality and ejaculatory dysfunction. Factors attributed to poor semen quality include stasis of prostatic fluid, testicular hyperthermia, recurrent urinary tract infections, abnormal testicular histology, possible changes in the hypothalamic-pituitary-testicular axis, possible sperm antibodies, chronic long-term use of various medications, and type of bladder management. Further work is needed to define the impact and importance of each of these factors. Ejaculations are reported to occur in only 5% of men with spinal cord injury (SCI) who have complete upper motor lesions and 18% of those who have complete lower motor lesions. Ejaculations occur in up to 70% of men with incomplete lesions. Methods that have been used to induce an ejaculate include intrathecal neostigmine, subcutaneous physostigmine, direct aspiration of sperm from the vas deferens, vibratory stimulation, electroejaculation, and direct stimulation of the hypogastric nerve. The most commonly used methods in the United States are electroejaculation and vibratory stimulation; using these two methods, ejaculates can be obtained up to 85% and 59% of the time, respectively. Each of these methods has advantages and disadvantages. Particular care needs to be given to monitoring men undergoing these procedures who are prone to autonomic dysreflexia. The future outlook is encouraging once improved technology for obtaining semen and various methods to assist reproduction, such as in vitro fertilization, are available.

Ejaculation↗
PubMed1990

Penile advancement and lengthening in spinal cord injury patients with retracted phallus who have failed penile prosthesis placement alone.

Even in the presence of a penile prosthesis, a subset of spinal cord injury patients remains unable to maintain a condom catheter securely due to inadequate penile shaft length and disappearance of the corpora beneath the pubic fat pad when in the sitting position. We describe 3 patients in whom a successful resolution to this problem has been achieved with rational surgical management, including lysis of the suspensory ligament of the penis, approximation of the infrapubic soft tissues posterior to the corpora so as to advance the corpora anteriorly and buttress against posterior migration (retraction) in the sitting position, maximizing the length and fit of prosthetic rods, and, when indicated, release of infrapubic skin tethering with a modified Z-plasty technique.

Adipose Tissue↗
PubMed1990

Electroejaculation in spinal cord injury patients: simplified new equipment and technique.

A new simplified electrostimulation system for rectal probe electroejaculation has been developed and tested 17 times in 13 patients. Seminal emissions were obtained easily from 13 of 17 studies and partial emissions were obtained in 4. Patients with cauda equina and conus lesions with partial intact sensorium also could achieve successful ejaculation by longer stimulation from 2 to 5 minutes with lower currents that could be maintained easily and were tolerated by the patient--a feature unique to our new computerized equipment. The simplicity of operation reduces the number of trained personnel for an electrostimulation procedure, which can be done even in an outpatient setting.

Adult↗
PubMed1990

Colonic transit in spinal cord-injured patients.

This report describes a study of transit time through the colon, as well as the caliber of the colon and distal small bowel, in 28 spinal cord-injured patients to see if there is a correlation between those findings and difficulty with bowel care and symptoms. In 15 of these 28 patients anorectal dynamic studies were also done. Each patient ingested 20 radiopaque markers, after which colon transit times were measured by multiple abdominal radiographs. The width of the ileum was measured and correlated with symptoms. The findings indicate that transit time was delayed in the left and rectosigmoid colon; four patients had a large and highly compliant rectum, whereas six had anorectal dyssynergia. All ten had difficulty with bowel care. The distal small bowel was dilated in ten patients, all of whom had symptoms and nine of whom had spinal cord lesions superior to T5.

Adult↗
PubMed1990

Benign versus pathologic compression fractures of vertebral bodies: assessment with conventional spin-echo, chemical-shift, and STIR MR imaging.

Differentiation of benign from pathologic compression fractures of vertebral bodies was evaluated with magnetic resonance imaging in a prospective study of 53 patients. Twenty-six patients had 34 benign posttraumatic compression fractures. Twenty-seven patients had metastatic disease to the vertebral column and seven pathologic fractures. T1- and T2-weighted spin-echo (SE) sequences (1.5 T) were performed in all patients. A presaturation technique was used to obtain "fat" and "water" images to better assess the degree of normal fatty marrow replacement in fractured vertebrae. Short inversion-time inversion-recovery (STIR) images were also obtained. Discrimination between benign and pathologic compression fractures was generally possible with the SE sequences. Chronic benign fractures demonstrated isointense marrow signal intensity (SI), compared with that of normal vertebrae with all sequences. Pathologic fractures showed low SI on T1-weighted images and high SI on T2-weighted images. Fat images revealed complete replacement of normal fatty marrow, shown as absent SI in the involved vertebral body. Water and STIR images showed diffuse high SI in pathologic fractures, with STIR images having the highest contrast between abnormal and normal marrow. Acute benign compression fractures also demonstrated high SI on T2-weighted, water, and STIR images, but the SI was less pronounced and the pattern was generally more inhomogeneous than that of pathologic compressions. In general, fat images showed only partial replacement of normal fatty marrow by low SI, in contrast to the complete absence of marrow SI typical of pathologic fractures.

Adolescent↗
PubMed1990

Gallbladder contractility in patients with spinal cord injuries: a sonographic investigation.

Approximately 30% of all patients who have spinal cord injuries have gastrointestinal symptoms. One cause is gallstone disease; indeed the literature suggests that gallstones are more common in patients with spinal cord injuries because these patients have impaired contractility of the gallbladder with a reduced ejection fraction. To test this hypothesis, we obtained gallbladder sonograms in 30 patients with spinal cord injuries (16 quadriplegics and 14 paraplegics) and in 32 uninjured age-matched control subjects. Four patients and four asymptomatic control subjects had gallstones and were excluded. The remaining 26 patients and 28 control subjects fasted for 12 hr. Longitudinal and transverse sonograms of the gallbladder were made immediately before the ingestion of 25 g of fat, and at 10, 20, 30, 45, and 60 min thereafter. Gallbladder volumes were measured by using the ellipsoid method. Resting and residual volumes and the emptying times were determined and the ejection fractions were calculated. The ejection fractions were significantly lower (p = .003) in the patients than in the control subjects because the resting volumes were lower than in the control subjects (p = .013). However, the emptying times and residual volumes were the same in the two groups. We conclude that gallbladder contractility is normal in patients with spinal cord injuries and that the lower ejection fraction found in such patients is due to a smaller resting volume.

Adult↗
PubMed1990

Colostomy as treatment for complications of spinal cord injury.

We reviewed our experience with colostomy performed in 20 spinal cord injury (SCI) patients to determine the effectiveness and safety of colostomy when it is performed for a late complication of SCI. Objective evaluation of gastrointestinal function, ie, colonic transit time and anorectal manometry, was performed in six patients with chronic gastrointestinal complaints to identify the site and severity of bowel dysfunction. Twelve patients had colostomy performed for chronic gastrointestinal problems, seven as an adjunct in the treatment of perineal pressure ulcers, and one for rectal cancer. When patients with difficult bowel evacuation or incontinence were considered, colostomy reliably simplified bowel care, relieved abdominal distention, and prevented fecal incontinence. The amount of time spent on bowel care decreased from an average of 98.6 min/day to 17.8 min/day (p less than .05) after colostomy. When performed as an adjunct in the treatment of pressure ulcers, colostomy provided a dry, clean environment, and seven of seven ulcers healed. Colostomy was well accepted by all patients; all patients with chronic gastrointestinal complaints reported that colostomy improved the quality of their lives. Objective testing differentiated between failure of the colon to adequately transport material to the rectum and inability to adequately evacuate the rectum. Testing was useful in choosing the level at which a colostomy was created, and, in one instance, it identified a specific syndrome (ischemic proctitis) which required colostomy.

Colostomy↗
PubMed1990

Chronic gastrointestinal problems in spinal cord injury patients: a prospective analysis.

Detailed interviews of 127 consecutive patients seen by our spinal cord injury service were performed in order to determine the prevalence and characteristics of chronic gastrointestinal problems in spinal cord injury (SCI) patients. Chronic gastrointestinal problems were defined as recurring symptoms that were significant enough to alter lifestyle or require chronic treatment. Thirty-four (27%) of the patients had a significant chronic gastrointestinal problem. The limited manner through which SCI patients can manifest symptoms resulted in complaints which were characteristically quite vague. The most common problems that impaired quality of life were poorly localized abdominal pain (14%) and difficulty with bowel evacuation (20%). Hemorrhoids (74%), abdominal distention (43%), and autonomic hyperreflexia arising from the gastrointestinal tract (43%) were also very common, but had a lesser impact on lifestyle. Twenty-three percent of our population required at least one admission to the hospital for a gastrointestinal complaint following their injury. The prevalence of chronic gastrointestinal symptoms increased with time after injury, suggesting that these problems are acquired, and may therefore be avoided by the adoption of certain chronic care routines. Chronic gastrointestinal problems in SCI patients merit more study because they are: 1) very different from those in the general population, 2) responsible for a disproportionately great amount of morbidity in these patients, 3) potentially preventable.

Adult↗
PubMed1989

Clinical evaluation of a desktop robotic assistant.

A desktop vocational assistant robotic workstation was evaluated by 24 high-level quadriplegics from the Palo Alto Veterans Affairs Spinal Cord Injury Center. The system is capable of performing daily living and vocational activities for individuals with high-level quadriplegia via voice control. Subjects were asked to use the robot to perform a repertoire of daily living activities, including preparing a meal and feeding themselves, washing their face, shaving, and brushing teeth. Pre- and post-test questionnaires, interviews, and observer assessments were conducted to determine the quality of the robot performance and the reaction of the disabled users toward this technology. Results of the evaluations were generally positive and demonstrated the usefulness of this technology in assisting high-level quadriplegics to perform daily activities and to gain a modicum of independence and privacy in their lives.

Activities of Daily Living↗
PubMed1989

Vacuum tumescence: an option for spinal cord injured males with erectile dysfunction.

Vacuum tumescence with constriction/retention bands is an option for management of male erectile dysfunction. The appropriateness of this system for individuals with spinal cord injury was evaluated at the Palo Alto, California, Veterans Administration Medical Center, Spinal Cord Injury Center. Following a structured educational program and use of the system for at least 2 months, 13 male subjects and 9 female partners responded to a questionnaire evaluating their satisfaction and the safety of the device. Findings indicate an increase in frequency of intercourse and increased sexual satisfaction with use of the device without occurrence of significant physical problems for the subjects or their partners.

Erectile Dysfunction↗
PubMed1988

Difficulties in laser Doppler measurement of skin blood flow under applied external pressure.

During the course of a study of skin blood flow under applied external pressure, it became apparent that decreasing blood flow by loading the skin surface reveals problems that are fundamental to the method of laser Doppler flowmetry. These problems have to do with the fact that the laser Doppler is extremely sensitive to red cell motion of any kind, whether associated with the ordered red cell motion of blood flow or the random red cell motion associated with changes in temperature or vessel occlusion. This effect becomes increasingly important whenever blood flow is compromised (a situation of considerable clinical significance), since the random portion of the signal then becomes significant in comparison with the diminished blood flow. Experiments have been conducted in living animals and with stationary drops of blood which clearly show the importance of these effects with regard to the interpretation of laser Doppler signals. Significant laser Doppler flow signals were repeatedly observed after manipulations which could reasonably be expected to reduce blood flow to zero.

Animals↗
PubMed1987

Ultrasonographic detection of false passages arising from the posterior urethra in spinal cord injury patients.

We report on false passages arising from the posterior urethra in 10 male spinal cord injury patients, of which 9 were well visualized on transrectal sonography, with real-time linear array equipment that was used to monitor a urodynamics catheter being introduced into the prostatic urethra. The only false passage not detected was at the bladder neck. Nevertheless the data show that transrectal sonography is an excellent tool to demonstrate false passages arising from the prostatic urethra. All 10 false passages were unroofed successfully with excellent results.

Humans↗