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Biomedical subjects

J F Ditunno

Publications and source records attributed to J F Ditunno.

At least 73 records · Page 4Linked to original sources
PubMed1992

The role of allergen immunotherapy in the respiratory complications of quadriplegia.

Patients with traumatic quadriplegia have frequent respiratory complications. These complications may be exacerbated by the presence of common and previously well-tolerated allergic disease. Quadriplegic patients are limited in their ability to cope with upper and lower respiratory allergies by a reduced vital capacity and impairment of maneuvers needed to keep the upper and lower respiratory tracts clear. This report describes two patients with traumatic quadriplegia who were treated with allergen immunotherapy. After immunotherapy, both patients had negligible long-term postinjury respiratory complications and an improved quality of life. Allergen immunotherapy should be considered early in the management of allergic patients with traumatic quadriplegia.

Adult↗
PubMed1992

Recovery of zero-grade muscles in the zone of partial preservation in motor complete quadriplegia.

This prospective study was designed to demonstrate root level recovery in the zone of preservation by examining muscles with an initial strength of grade 0/5 in 32 motor complete (Frankel A and B) patients who had cervical spinal cord injury at the C4 through C7 levels. The biceps (C5), extensor carpi radialis (C6), triceps (C7), and flexor digitorum profundus (C8) muscles were used as key muscles when their strength at the initial manual muscle test, which was performed between three and seven days postinjury, was grade 0/5 and the muscle innervated by the cord segment directly rostral to that innervating the key muscle (grade 0/5) was grade greater than or equal to 3/5. If the biceps muscle was used, C4 pin sensation was required to be normal. Further manual muscle tests were performed weekly for four weeks, and then at 2, 3, 6, and 12 months postinjury. None, 6%, 17%, 35%, and 43% of the patients recovered to grade greater than or equal to 3/5 by 1, 2, 3, 6, and 12 months postinjury, respectively. It was also noted that in 86% of our patients, improving to grade greater than or equal to 1/5 by one month postinjury was a predictor of recovering to grade greater than or equal to 3/5 by 12 months postinjury (p less than .002). Similarly, in 100% of our patients, improving to grade greater than or equal to 2/5 by three months postinjury was a predictor of recovering to grade greater than or equal to 3/5 by 12 months postinjury (p less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Elements of academic productivity: a comparison of PM&R units versus other clinical science units.

In early 1989, the Research Committee of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) established a subcommittee to develop methods to monitor academic progress in physical medicine and rehabilitation (PM&R) units in the US. To develop an indirect baseline of academic productivity in PM&R, the rates and types of publications by PM&R researchers were assessed in eight peer review medical journals. The journals selected consisted of all issues of the following (published in calendar years 1987 to 1989): Archives of Physical Medicine and Rehabilitation, American Journal of Physical Medicine and Rehabilitation, Physical Therapy, Archives of Neurology, Pain, Stroke, Paraplegia, and Arthritis & Rheumatism. The sampling frame consisted of 3,553 journal articles. Affiliation with a PM&R unit or other clinical science unit (other unit), extramural funding sources, and type of manuscript (eg, case report or scientific investigation) were identified and coded. Sixteen percent of all articles were authored by members of PM&R units. The prevalence of scientific reports written by other unit authors (71%) was comparable to that written by PM&R authors (67%) (chi 2[3] = 5.54; p less than .20). There was a greater prevalence of funding by the US Department of Education of studies written by PM&R authors (10%) than of studies written by members of other units (2%) (chi 2[1] = 79.4; p less than .0001). Reports authored by members of other units had a greater prevalence rate of funding from all other sources--federal and private (47% vs 33%; chi 2[1] = 41.2; p less than .0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Authorship↗
PubMed1991

Spinal cord injury syndrome with motor sparing in the absence of all sensation.

This paper describes the anatomic basis for the unusual presentation in a spinal cord injured subject of preservation of motor power in the absence of all sensation. The patient was examined at four hours, and daily thereafter, after a motorcycle accident in which he was thrown over the handle bars. He had trace ankle dorsi and plantar flexors, but light touch, pin, position, and vibratory sensation were absent below the level of C4 bilaterally. There was no physical evidence to differentiate whether he suffered a flexion or extension injury. Cervical spine films showed no evidence of fracture or dislocation, but anterior and posterior osteophytes involving C3 to C4, C4 to C5, and C5 to C6 were present. Magnetic resonance imaging showed evidence of cervical cord edema at C3 to C4 with possible hemorrhage and severe spinal stenosis at C3 to C4 and C4 to C5. This patient received a compression injury with resulting classic anterior spinal artery syndrome. Because of his spinal stenosis with a decreased anterior-posterior (AP) diameter of the canal, the posterior circulation was also compromised. The extensive pial anastomotic network provided relative sparing of the most peripheral components of the lateral corticospinal tracts. This case report demonstrates a unique clinical picture that cannot be anatomically classified by current American Spinal Injury Association (ASIA) standards as central cord syndrome. It can be explained by the lamination of the ascending and descending tracts in relation to the vascular supply of the cervical cord in conjunction with the narrowing of the AP diameter of the canal due to spinal stenosis.

Humans↗
PubMed1991

Spinal cord injury: prognosis for ambulation based on sensory examination in patients who are initially motor complete.

The purpose of this retrospective study was to document that patients with motor complete injury, but preserved pin appreciation, in addition to light touch, below the zone of injury have better prognoses with regard to ambulation than patients with only light touch preserved. Medical records were examined of all spinal cord injury (SCI) patients admitted between 1982 and 1988. Twenty-seven Frankel B patients with upper motor neuron lesions admitted within 72 hours of injury were identified. These patients were divided into two groups (B-1 and B-2). Group B-1 (n = 18) were patients who had touch sensation but no pin appreciation below the zone of injury. Group B-2 (n = 9) were patients who had partial or complete pin appreciation and light touch below the zone of injury. The charts were examined for the patient's ability to walk independently using a reciprocal gait for at least 200 feet. The data were analyzed by the Fisher Exact test. Eight of the nine Group B-2 patients ambulated as compared to two of the 18 Group B-1 patients (p less than .0002). Frankel B SCI patients with only touch preserved below the zone of injury had poor prognoses for ambulation; those with preserved pin appreciation below the zone of injury had excellent prognoses to regain functional ambulation.

Adult↗
PubMed1991

The 72-hour examination as a predictor of recovery in motor complete quadriplegia.

Twenty-nine C4 to C7 motor-complete spinal cord injured subjects were evaluated to determine whether the manual muscle test (MMT) performed within 24 hours of injury or at 72 hours after injury better predicts short-term functional muscle recovery. A single muscle in the zone of injury that had a muscle grade between 1 and 3, inclusive, was evaluated serially in each patient from admission to three months. Increase in muscle strength to grade 4 or better was defined as success. Outcomes were evaluated by the Fisher exact test. Using the less-than-24-hour MMT, 12 of 17 subjects with grade 3 muscle strength vs four of 12 subjects with grade 1 or 2 muscle strength achieved success (p greater than .05). Using the 72-hour MMT, all 11 subjects with grade 3 muscle strength vs five of the 18 subjects with less than grade 3 muscle strength achieved success (p less than .001). Short-term functional muscle recovery in the zone of injury in cervical motor-complete quadriplegia is better predicted by the 72-hour MMT than by the less-than-24-hour MMT.

Adolescent↗
PubMed1990

Age effect on prognosis for functional recovery in acute, traumatic central cord syndrome.

The purpose of this study was to determine if age is significant in functional recovery in acute, traumatic central cord syndrome (CCS). Recovery of ambulation, ADL status, and bowel and bladder function were evaluated. A retrospective study tested the hypothesis that functional recovery in 51 consecutive CCS patients was better in younger patients than in older patients. Four patients, all more than 50 years, died. Ability to ambulate independently at discharge was compared in 30 patients younger than 50 years with 21 patients 50 years or older. Results showed that 29 of 30 (97%) of the younger patients were ambulatory compared to seven of 17 (41%) of the older patients (p less than .002). The younger patients were also able to achieve independence in self-care and bowel and bladder function in a significantly greater proportion. The prognosis for functional recovery in acute traumatic CCS should consider the patient's age. The prognosis is less optimistic in older patients, but it is considerably more favorable in younger patients than previously reported.

Activities of Daily Living↗
PubMed1990

Atelectasis and pneumonia in acute spinal cord injury.

The purpose of this study was to demonstrate the high incidence of atelectasis or pneumonia (A/P) in the left lung of acute spinal cord injured (SCI) patients. The study group consisted of 46 consecutive motor complete (Frankel A or B) SCI patients admitted within 48 hours of injury. The ages of the patients ranged from 15 to 72 years. Neurologic levels ranged from C3 to T11. There were 19 high-level quadriplegic patients (HLQ; C3-C5), 11 low-level quadriplegic patients (LLQ; C6-C8), and 16 paraplegic patients (Para; T1-T11). The patients were followed during the first 30 days postinjury for radiographic evidence of A/P lasting more than three days. The time of onset, duration, and location of A/P was determined. Fifty percent (23 of 46) of the patients developed A/P in the first 30 days after their spinal cord injury. The incidence was higher in the HLQ than in the LLQ and Para (74% vs 33%; p less than 0.02 using the Fischer exact test). There was a preponderance (4:1 ratio) of left-sided involvement for A/P in this population (p = 0.01 using the two-tailed binomial test). Sixteen patients had left-sided A/P, four patients had right-sided A/P, and three patients had bilateral findings. There was no relationship between level of injury and side of involvement. The high incidence of left-sided pulmonary involvement in the acute SCI patient may be due to the tendency to retain secretions in this period combined with the increased difficulty of clearing secretions from the left lung.

Adolescent↗
PubMed1990

Spinal cord injury: a ten-year report.

In the past 10 years, the RSCICDV has had a unique opportunity to serve and expand the bounds of knowledge regarding this most devastating injury. The RSCICDV has collaborated with other model SCI systems in research regarding the incidence of respiratory complications, the value of removing bullet fragments lodged within the spinal canal, the survival/cause of death following spinal cord injury, the cost of spinal cord injury care, and the recovery of motor strength after quadriplegia. Key on-site research efforts have focused on preventing deep vein thrombosis and in documenting the course of motor recovery after spinal cord injury. The identification of electrical stimulation plus low dose heparin as a prophylaxis has been a major breakthrough in the prevention of deep vein thrombosis. The documentation of motor recovery after injury has led to the designation of Thomas Jefferson University as a federally-funded National Rehabilitation Research and Training Center in Neural Recovery and Functional Enhancement (1988-1993). It cannot be stressed enough, however, that the accomplishments of the Regional Spinal Cord Injury Center of Delaware Valley would have been quite impossible without the cooperation and support of the many physicians who have referred their patients to this regional center program. Continuing and expanding this cooperative effort should result in even greater achievements for persons with spinal cord injury in the years to come.

Accidental Falls↗
PubMed1990

Recovery of strength at the zone of injury in motor complete and motor incomplete cervical spinal cord injured patients.

This study compared the time of recovery at the zone of injury between motor complete (Frankel A and B) and motor incomplete (Frankel C and D) cervical spinal cord injured patients for the biceps (C5), extensor carpi radialis (C6), and triceps (C7) muscles. Manual muscle testing was performed initially three to seven days postinjury, then weekly for four weeks, and then monthly for six months. Subjects between the ages of 15 and 70 years with C4, C5, C6, or C7 neurologic levels were classified according to whether their selected muscle was greater than 0/5 and less than 3/5 grade (n = 32) or greater than or equal to 3/5 grade (n = 28) at initial evaluation. Subjects were further classified based on their Frankel score. Motor incomplete patients with muscle strength less than 3/5 had an average time of recovery to grade 3/5 of 0.9 months (median = 2 weeks), and all seven patients achieved grade 3/5 by two months postinjury. Motor complete patients had an average time of recovery to grade 3/5 of 1.8 months (median = 2 months), and 18 of 25 patients achieved grade 3/5 by two months postinjury (p = 0.1). For muscles greater than or equal to 3/5, motor incomplete subjects had an average time for improvement of one full grade of 1.5 months (median = 2 months), and motor complete subjects had an average time for improvement of one grade of 2.3 months (median = 1 month, p = 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Deep vein thrombosis: prophylaxis in acute spinal cord injured patients.

The purpose of this prospective, randomized study was to evaluate the efficacy of low-dose heparin, alone or in combination with electric stimulation, in the prevention of deep vein thrombosis (DVT) in C2 to T11 motor complete and incomplete-preserved motor, nonfunctional spinal cord injured patients. The tibialis anterior and gastrocnemius-soleus muscle groups were stimulated bilaterally, using 50 microsecond pulses given at 10Hz with a four-second "on" and an eight-second "off" cycle for 23 hours daily over a 28-day period. Forty-eight patients, less than two weeks after injury, were randomly assigned to saline placebo (n = 17), low-dose heparin (5,000U, subcutaneous every eight hours) (n = 16), and low-dose heparin plus electric stimulation (n = 15). A normal 125-I fibrinogen scan and impedance plethysmography were required for entry into the study. Surveillance for DVT was evaluated by daily 125-I fibrinogen scanning. Venography was performed to confirm a positive impedance plethysmography and/or 125-I fibrinogen scanning tests for two consecutive days and at the completion of the study. The incidence of DVT was 8 of 17 in the placebo group, 8 of 16 in the low-dose heparin group, and 1 of 15 in the electric stimulation plus low-dose heparin group. The use of electric stimulation plus low-dose heparin significantly (p less than 0.05) decreased the incidence of DVT compared to the other treatments.

Electric Stimulation Therapy↗
PubMed1987

Muscle atrophy in rheumatoid arthritis.

The purpose of this paper is to describe some research opportunities in the area of muscle atrophy secondary to arthritis. Future research should utilize quantitative methods of evaluating muscle atrophy such as computerized tomography or ultrasonography. The gross muscle atrophy should be further characterized by muscle fiber type measurements. These techniques as well as biochemical determinations should be utilized to identify mechanisms of muscle atrophy as well as determine ideal methods for reversing muscle atrophy and weakness.

Arthritis, Rheumatoid↗
PubMed1987

Wrist extensor recovery in traumatic quadriplegia.

Wrist extensor recovery is of major functional significance in many quadriplegic patients. In this retrospective study, we investigated a method for prognosticating wrist extensor recovery and the underlying mechanisms for improvement in strength. Thirty-five quadriplegic patients at the C4, C5, and C6 neurologic levels, admitted over a four-year period, were examined at one week, two months, and eight months postinjury for biceps and wrist extensor strength. Initial biceps strength was compared to final wrist extensor strength. All 16 C5 patients whose initial biceps strength was grade 3 showed wrist extensor improvement to grade 3; only three of 16 C4 patients showed the same improvement. We concluded that initial biceps strength is a reliable indicator of wrist extensor recovery, and most, if not all, C5 neurologic patients will gain one full motor level. This improvement may be due to compensatory factors, such as overwork hypertrophy and peripheral sprouting of nerves within the muscle, rather than to recovery of a root level.

Accidents↗
PubMed1987

Overwork-induced axonal hypertrophy in the soleus nerve of the rat.

Effect of overwork, induced by synergistic tenotomy (bilateral tenotomy of the gastrocnemius and the plantaris muscles) of the soleus muscle, was evaluated on areas of the large myelinated axons (LMA) (greater than 19.5 micron 2), in the soleus nerve (the tibial nerve branch innervating the soleus muscle) of the rat. Three lots (n = 12-16) of young adult male (body weight of 275 to 325 g), Sprague-Dawley rats were used. One lot of 16 animals was kept as normal, while the other two underwent bilateral L4 or L5 spinal nerve sectioning. Six to seven animals each from the normal, L4-, and L5 neurectomized animals underwent bilateral synergistic tenotomy of the soleus so that the soleus was retained as the sole plantar-flexor of the ankle joint. The remaining animals were kept as normal or neurectomized control groups. Thus, the six groups studied were normal control (n = 9); normal synergistically tenotomized (n = 7); L4 neurectomized control (n = 8); L4 neurectomized and synergistically tenotomized (n = 6); L5 neurectomized control (n = 8); and L5 neurectomized and synergistically tenotomized (n = 7). Seven days after surgery, the soleus muscles were used to evaluate the muscle weights. The soleus nerves were evaluated for the number plus areas of the LMA by computerized planimetric procedures. The data revealed a 13.9% (p less than 0.05) increase in areas of the LMA in the L5 neurectomized control group; whereas the L5 neurectomized and synergistically tenotomized group showed a 39.6% (p less than 0.01) increase in areas of the LMA.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Electrical stimulation of sciatic nerve of rats after partial denervation of soleus muscle.

The purpose of this study was to determine the effect of electrical stimulation of the sciatic nerve on the recovery of the weight and tension of partially denervated rat soleus muscle. Electrodes were implanted unilaterally adjacent to the sciatic nerve in 30 adult female Wistar rats. Fifteen rats underwent bilateral partial nerve section (PNS) of the sciatic nerve to stimulate the plantar flexors. Both the normal and partially nerve sectioned animals were stimulated unilaterally with 4 ms, 2-4 mA current given at 10 pulses per second. Groups of five normal and five partially denervated animals were stimulated for two, four or eight hours per day, five days per week for six weeks. The soleus muscles were evaluated for muscle weight (MW), twitch (Pt) and tetanic (Po) tension, contraction time (CT) and fiber areas of the type 1 and type 2 fibers. The MW, Pt, Po, CT and area of the type 1 and 2 muscle fibers of the normal soleus muscles were 114 +/- 15 mg, 21 +/- 4 mg, 95 +/- 20 mg, 95 +/- 21 ms, 1532 +/- 84 microns m2 and 1267 +/- 136 microns m2 respectively. The electrical stimulation had no effect on the normal soleus muscles. The MW, Pt, Po, CT and area of type 1 and 2 muscles fibers of the partially denervated control soleus muscles were 59 +/- 12 mg, 9 +/- 4 mg, 22 +/- 14 mg, 104 +/- 32 ms, 1028 +/- 514 microns m2, and 849 +/- 292 microns m2 respectively. Two hours of electrical stimulation significantly increased the MW (87 +/- 17 g), Pt (17 +/- 6g), and Po (49 +/- 23 g) but not the type 1 and 2 fiber areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Capillary fiber ratio and electrolyte content of compensatory hypertrophied rat soleus.

Capillary-to-fiber ratio and the content (mu moles/g muscle) of Na, K, Mg, Ca and Zn was measured in compensatory hypertrophied (CH) soleus muscles of adult Sprague-Dawley rats. The soleus hypertrophy was induced by unilateral tenotomy of the gastrocnemius and the plantaris muscles. Seven days after synergistic tenotomy the compensatory hypertrophied Soleus muscles showed no difference in the capillary-fiber ratio, Sr-extractable calcium ([Ca]Ext.) or the total content of Na, K, Mg and Zn. However, compared to the contralateral control side, the CH muscles showed an increase in the wet muscle weight (31.6%, P less than 0.01) and a significant decline (57.1%, P less than 0.05) in the residual calcium ([Ca]Res.) and 43.2% (P less than 0.05) decrease in the total calcium ([Ca]Total) content. It is concluded that during compensatory hypertrophy of skeletal muscles, the residual Ca reserves are significantly depleted, which may lead to a lower isometric tension generation in the muscle.

Animals↗
PubMed1986

Muscle atrophy and histopathology of the soleus in 6-mercaptopurine-treated rats.

In this study, male and female Sprague-Dawley rats were treated neonatally with 6-MP-treatment (2 mg/kg s/c, between 2 and 22 days after birth) and evaluated at six months of age. Compared to the normal controls, the 6-MP-treated male and female rats showed similar sciatic nerve conduction to the soleus. However, there was a significant muscle atrophy (57-60%, P less than 0.01) and a decrease in areas of the type I (42-54%, P less than 0.05) and type II (41-71%, P less than 0.01) muscle fibers. The number of type II fibers declined significantly (7.4-14.8%, P less than 0.05). It is proposed that the soleus muscle atrophy and histopathology in 6-MP-treated rats is unrelated to nerve conduction defects and may be related to growth inhibition caused by an interference of the drug during normal differentiation of muscle fibers.

Animals↗