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Biomedical subjects

I R Odderson

Publications and source records attributed to I R Odderson.

16 recordsLinked to original sources
PubMed1999

The National Institutes of Health Stroke Scale and its importance in acute stroke management.

The National Institutes of Health (NIH) stroke scale is a standardized neurologic examination developed to quantitate the patient's deficits in clinical trials for new stroke therapies. It is used on admission to determine patient eligibility for thrombolytic therapy, throughout the acute hospital stay, and at 3 months to assess neurologic recovery. The NIH stroke scale scores correlates with initial infarct volume, cerebral perfusion, and functional outcome.

Humans↗
PubMed1998

Axillary hyperhidrosis: treatment with botulinum toxin A.

Hyperhidrosis can be emotionally challenging and socially and professionally disruptive, and there are few effective treatments. This condition was successfully treated with botulinum toxin in two men who, since their early teens, had had excessive axillary sweating, requiring frequent shirt changes. They received bilateral axillary injections with 100 units of botulinum toxin type A, and within 5 days reported cessation of excessive sweating. Quantitative measurements before and 2 to 4 weeks after the injections demonstrated an average reduction of 71% and 76% (from 11.6 to 3.4 and from 2.5 to 0.6 mL/min m2) in axillary sweating during rest. A 96% reduction (from 42.9 to 1.7 mL/min m2) was seen in one patient during mental stress. No complications developed. This study quantitates the reduced axillary sweating achieved through chemodenervation with botulinum toxin A.

Adult↗
PubMed1998

Deep vein thrombi associated with the use of plastic ankle-foot orthoses.

Deep vein thrombosis (DVT) is a well-known complication of neurologic disorders that result in immobility, such as stroke and spinal cord injury. There is little information available, however, regarding the association of DVT with orthotic devices commonly used in this patient population. We report an unusual case in which lesser saphenous vein DVTs were associated with the use of plastic ankle-foot orthoses (PAFOs) in a patient with chronic inflammatory demyelinating polyradiculoneuropathy treated with plasmaphoresis and intravenous Ig. The possible role of PAFOs in the development of the DVTs, as well as other contributing factors such as plasmaphoresis, is discussed. The need for posthospitalization DVT prophylaxis in patients with paralysis is reviewed.

Humans↗
PubMed1998

Hyperhidrosis treated by botulinum A exotoxin.

BACKGROUND: Hyperhidrosis, or excessive sweating, can be emotionally challenging and socially and professionally disruptive, and there have been few effective treatments. Recently, botulinum toxin has been demonstrated to be an effective treatment for hyperhidrosis of the axillae and palms and for gustatory sweating. OBJECTIVE: This article reviews the current treatments and outcomes achieved with chemodenervation of the eccrine sweat glands. RESULTS: The antihydrotic response lasted 6-17 months for gustatory sweating, 2-8 months for axillary sweating, and 13 weeks to 12 months for palmar sweating. CONCLUSIONS: Intracutaneous injections of botulinum toxin offer a simple, safe, and effective alternative to other conservative and surgical options.

Botulinum Toxins, Type A↗
PubMed1997

Decline in isokinetic force with age: muscle cross-sectional area and specific force.

Humans produce less muscle force (F) as they age. However, the relationship between decreased force and muscle cross-sectional area (CSA) in older humans is not well documented. We examined changes in F and CSA to determine the relative contributions of muscle atrophy and specific force (F/CSA) to declining force production in aging humans. The proportions of myosin heavy chain (MHC) isoforms were characterized to assess whether this was related to changes in specific force with age. We measured the peak force of isokinetic knee extension in 57 males and females aged 23-80 years, and used magnetic resonance imaging to determine the contractile area of the quadriceps muscle. Analysis of MHC isoforms taken from biopsies of the vastus lateralis muscle showed no relation to specific force. F, CSA, and F/CSA decreased with age. Smaller CSA accounted for only about half of the 39% drop in force that occurred between ages 65-80 years. Specific force dropped about 1.5% per year in this age range, for a total decrease of 21%. Thus, quantitative changes in muscle (atrophy) are not sufficient to explain the strength loss associated with aging.

Adult↗
PubMed1997

Dysphagia complications of the Minerva brace.

The effects of cervical bracing on swallowing function have not been evaluated in neurologically intact individuals. An 83-year-old woman fell, striking her head, and suffered C1, odontoid, and C3 fractures. She had no neurologic deficits and was placed in a Minerva brace. Subsequently, she developed coughing during her meals, a low-grade fever, and transient hoarseness, and complained of stiffness in the facial muscles. Aspiration pneumonia in the left lower lobe was diagnosed. In the absence of any neurologic condition, this was attributed to the Minerva brace. Less than 1 week later, the brace was replaced with a halo-vest, and the dysphagia resolved. This case shows that dysphagia and aspiration pneumonia may be caused by wearing a cervical brace and illustrates the importance of assessing swallowing in individuals who wear such braces. Particular attention should be paid to swallowing and cervical bracing in patients with additional risk factors for dysphagia such as advanced age or neurologic deficits.

Aged↗
PubMed1995

Swallow management in patients on an acute stroke pathway: quality is cost effective.

OBJECTIVE: To assess the effects of swallowing management in patients with acute nonhemorrhagic stroke placed on a clinical pathway, and to evaluate whether swallow function on admission can be used as a predictor of length of stay (LOS) and outcome disposition. DESIGN: Intervention study to reduce complications of dysphagia in patients with acute stroke. SETTING: Urban community hospital. PATIENTS: Data were collected on 124 patients with acute nonhemorrhagic stroke admitted from January to December 1993. INTERVENTIONS: A swallow screen was completed within one day of admission and before any oral intake. MAIN OUTCOME MEASURES: Dysphagia and functional independence measure (FIM) scores on admission, occurrence of aspiration pneumonia, LOS, outcome disposition and cost effectiveness analysis. RESULTS: Thirty-nine percent of all patients (p < .05) failed the initial swallow screen and required altered dietary texture and intervention. No patients developed aspiration pneumonia. Of those with dysphagia, 21% recovered intact swallowing by discharge; 19% required gastrostomy tube placement. Patients with dysphagia had lower admission FIM scores than nondysphagia patients. The LOS was longer for the dysphagia group (8.4 +/- 0.9 days) compared with patients without dysphagia (6.4 +/- 0.6 days, p < .05). Patients with dysphagia were less likely to be discharged to home (27%) than were nondysphagia patients (55%), and twice as likely to be discharged to a nursing home (p < .05). CONCLUSIONS: This study demonstrates that early swallow screening and dysphagia management in patients with acute stroke reduces the risk of aspiration pneumonia, is cost effective, and assures quality care with optimal outcome.

Cerebrovascular Disorders↗
PubMed1995

From muscle properties to human performance, using magnetic resonance.

Our goal is to show how muscle properties can be used to understand the exercise performance limitations of the elderly. We show that magnetic resonance (MR) imaging and spectroscopy are useful for noninvasively characterizing the structural and energetic properties of muscle in vivo. Determination of muscle volume and cross-sectional area is easily and rapidly accomplished by applying quantitative morphometric methods to MR images. New MR spectroscopic techniques provide a noninvasive "biopsy" of the oxidative, glycolytic, and contractile capacities of muscle fibers. We show how the structural and energetic properties measured by MR can be used to define the functional capacity of muscle and the contribution of this capacity to the performance of the whole body (e.g., VO2max). Finally, we relate these laboratory measures of muscle properties and performance to activities meaningful to the functioning of the elderly in everyday life, such as sustained walking and stair climbing.

Activities of Daily Living↗
PubMed1994

Stroke in the spinal cord injured.

Advances in treatment of patients with spinal cord injury (SCI) have contributed to prolongation of their life expectancy. As a result, this population is becoming more prone to the diseases commonly associated with advanced age and a sedentary lifestyle. The purpose of this study was to test the hypothesis that the SCI population has an increased incidence of stroke, and to identify stroke risk factors unique to SCI patients. A retrospective, computer assisted medical chart review of all admissions from 1980 to 1990 was conducted. Of more than one thousand patients who had a stroke and two thousand paraplegic/quadriplegic patients, we identified only two instances involving stroke in patients with traumatic SCI. We conclude that the SCI population does not appear to have a higher incidence of stroke, although further prospective studies involving a larger patient population are recommended. Possible protective factors and causes for under-reporting stroke in the SCI population are discussed.

Adult↗
PubMed1993

A model for management of patients with stroke during the acute phase. Outcome and economic implications.

BACKGROUND AND PURPOSE: The purpose of the study was to develop a clinical pathway for patients with nonhemorrhagic stroke during the acute hospital phase to improve the quality of care and reduce costs. METHODS: The pathway included standard admission orders and a swallow screen on day 1 of hospitalization. Physical therapy, occupational therapy, speech therapy, and social worker assessments were done on day 2. A physiatry consult was performed on day 3 if indicated, and by day 4 a discharge target date and disposition were addressed. RESULTS: Outcomes for 121 patients during the first year of pathway implementation are reported. The average length of stay on the acute service decreased from 10.9 days to 7.3 days (P < .05), reducing the charges per patient by 14.6%. Complications in the form of urinary tract infections and aspiration pneumonia rates decreased by 63.2% (P < .05) and 38.7%, respectively. CONCLUSIONS: We conclude that the implementation of a clinical pathway for patients with acute, nonhemorrhagic stroke resulted in a significant reduction in length of stay, charges, and complications while improving the quality of care.

Acute Disease↗
PubMed1992

Localization of nerve depolarization with magnetic stimulation.

The specific location on the magnetic stimulation (MS) coil that may correspond to the area of nerve depolarization has not been determined. In order to localize such an area, MS with 9-cm and 5-cm diameter coils was compared with conventional percutaneous electric stimulation (ES). On the 9-cm coil the distribution of points of nerve depolarization corresponded to that quarter of the coil which was placed over and parallel to the median nerve, whereas on the 5-cm coil, this area also extended outside the coil. The points of median nerve depolarization with MS were distributed over a distance of 7 cm on the stimulator head and was nearly identical for the 2 coil sizes at the wrist and elbow. Ulnar nerve costimulation was less frequent with the smaller coil at the wrist. A calculated reference point on the coil is suggested for more accurate NCV determinations.

Adult↗
PubMed1991

Gel wheelchair cushions: a potential cold weather hazard.

Paraplegia and quadriplegia with concomitant impairment of cutaneous sensation predisposes to secondary skin damage, most commonly due to pressure or heat. Cold exposure, however, can also damage the skin. This report describes a 19-year-old man with myelodysplasia and L3 incomplete paraplegia who sustained extensive freeze burns of the buttocks from sitting on a gel wheelchair cushion that had been left outside in freezing weather. When he initially presented for medical care, the lesions were described by his physician as ischial pressure sores. On careful further questioning, prompted because of the unusual margins of the lesions, the true etiology was determined. The medical and surgical management of this patient's cold thermal injury, the thermomechanical properties of gel wheelchair cushions, and the literature pertaining to cold injury in the population with impaired spinal cord function are discussed.

Adult↗
PubMed1990

Reflex sympathetic dystrophy in an amputee: case study.

Reflex sympathetic dystrophy (RSD) has been described primarily in the upper extremity and is infrequently considered part of the differential diagnosis of postamputation pain. The manifestations of autonomic dysfunction may mimic other potential diagnoses of postoperative stump pain. We report a 47-year-old man who developed RSD of the knee during the mobilization phase after below-knee amputation for atherosclerotic peripheral vascular disease. The diagnosis was made by clinical examination, radiography, and scintigraphy without the need for any invasive studies. The characteristic diagnostic findings for the knee during the acute phase are emphasized and the therapy described.

Amputees↗
PubMedDate not supplied

Involuntary masturbation as a manifestation of stroke-related alien hand syndrome.

Alien hand syndrome is a perplexing and uncommon clinical diagnosis. We report an unusual manifestation of alien hand syndrome in a 73-yr-old man with a right anterior cerebral artery infarct affecting the right medial frontal cortex and the anterior portion of the corpus callosum. We conclude that alien hand syndrome should be considered in patients who present with a feeling of alienation of one or both upper limbs accompanied by complex purposeful involuntary movement.

Aged↗