Biomedical subjects

J R Bach

Publications and source records attributed to J R Bach.

At least 109 records · Page 6Linked to original sources

PubMed1991

Orthopedic surgery and rehabilitation for the prolongation of brace-free ambulation of patients with Duchenne muscular dystrophy.

The purpose of this study was to prospectively evaluate the results of a short comprehensive program involving early lower extremity musculotendinous surgery followed by a definitive course of rehabilitation on contractures and the duration of ambulation for patients with Duchenne muscular dystrophy. Seven patients were treated while ambulating with little difficulty and six were treated just before or after becoming wheelchair-dependent. Predicted post-treatment duration of ambulation was calculated from established clinical criteria. Actual prolongation of brace-free ambulation after treatment was a mean of 0.8 yr greater than predicted for the group as a whole but 0.93 yr for the group treated early by comparison with 0.63 yr for those treated according to the customary approach. The number of falls significantly decreased from 84 +/- 87 to 1 +/- 1 per month postoperatively (P less than 0.05); however, the speed of ambulation over a distance of 10 yards decreased from 10.2 +/- 4 s to 12.1 +/- 7.3 s. Three patients who had tibialis posterior transfers retained antigravity plus dorsiflexor strength and continue to wear normal footwear 2.5, 3.7 and 4.0 yr after loss of ambulation. We conclude that ambulation becomes more stable and brace-free ambulation may be prolonged by a comprehensive program of early orthopedic surgery and rehabilitation. Earlier intervention is also better tolerated.

Adolescent↗

PubMed1991

Ventilatory support alternatives to tracheostomy and intubation: current status of the application of this technology.

Intermittent positive pressure ventilation (IPPV) via tracheostomy has been the most common method of providing long-term ventilatory support since the late 1950s. Likewise, intubation for the delivery of IPPV is standard treatment for acute ventilatory failure. Because of poor patient acceptance of elective tracheostomy, numerous reports of complications by these invasive methods, and the recent development of noninvasive ventilatory assistance by intermittent positive airway pressure (NV-PAP), there has been increasing interest in all forms of noninvasive ventilatory support. This report reviews the current application of noninvasive ventilatory support alternatives in both the acute and long-term settings. Assistive technology for the noninvasive evacuation of airway secretions, which facilitates up to 24-hour, long-term noninvasive ventilatory support is also discussed. We conclude that wider familiarity with and application of these techniques are warranted.

Humans↗

PubMed1990

Fibrocartilaginous emboli to the spinal cord: a review of the literature.

Fibrocartilaginous emboli to spinal cord vessels is an apparently rare cause of spinal cord injury. A review of the medical literature reveals only 24 reported cases, none of which were noted prior to 1961. The authors have reviewed an additional, but as yet unpublished, case. The majority of patients presented with the acute onset of pain located around the vertebral column which was followed by progressive paresis/paralysis and respiratory insufficiency. Minor trauma to the vertebrae prior to onset was noted in most cases. The time to maximum neurologic deficit (typically paraplegia or quadriplegia) ranged from minutes to 24 to 48 hours. In all but one case the spinal cord injury resulted in death within 11 months of onset with a median of 2.5 to 4 months. One patient lived six years and seven months with respiratory support. In yet another case, a fibrocartilaginous embolus to a sacral nerve root was found as an incidental finding at autopsy. The incidence of both asymptomatic and clinically significant emboli may be more common and depends on the awareness of the medical community to consider this in the differential diagnosis of spinal cord injury.

Cartilage↗

PubMed1990

Study of sitting posture variations using the nose and mandible as reference points.

The purpose of this study was to examine the average sitting posture in normals and to determine how clinically observed sitting posture varies as a function of the duration of relaxed sitting, patient awareness of being observed, and other situational factors. The head, neck, and upper thorax of five naive patients demonstrated increasingly anterior and inferior displacement during five minutes of relaxed sitting. These postural alternations were instantaneously reversed when the subjects were made aware that they were being observed. We conclude that sitting posture must be assessed in relationship to the patient's length of time sitting, awareness of being observed, level of instruction on how to sit, and chair style.

Adult↗

PubMed1990

Needle electrode insertion into tibialis posterior. A new approach.

The tibialis posterior can be a valuable muscle in the electrodiagnostic evaluation of the sacral plexus, lumbosacral roots, lower extremity neuropathies and tibial nerve lesions. It may be under utilized, however, because it is generally considered to be inaccessible to needle examination. The purpose of this study was to compare the widely recommended posterior approach to this muscle to an anterior approach that we define. In six cadaver legs, the safe access to this muscle via the anterior approach was 16.8 +/- 5 mm by contrast to 9.5 +/- 2 mm by the posterior approach. We conclude that the anterior approach to needle electromyography of the tibialis posterior muscle is easier, safer and deserves more widespread practice.

Cadaver↗

PubMed1990

Deep peroneal sensory nerve. Standardization in nerve conduction study.

Ankle or foot pain may be due to various clinical conditions. Injury or entrapment of the deep peroneal sensory nerve is part of the differential diagnosis; however, no technique studying the deep peroneal sensory conduction velocity has been described. We describe a technique that is simple and reproducible with averaging. We electrophysiologically studied the deep peroneal sensory nerve in 40 neurologically healthy adult subjects. The latency to onset of the sensory action potential was 2.9 +/- 0.4 ms (range = 2.1-3.6 ms). The latency to the peak of the sensory action potential was 3.6 +/- 0.4 ms (range = 2.7-4.2 ms). The conduction velocity was 42 +/- 5 m/s (range = 33-53 m/s). The amplitude was 3.4 +/- 1.2 microV (range = 1.6-6.6 microV). We conclude that the deep peroneal sensory nerve is readily accessible for electrophysiologic evaluation. It may be of value in diagnosing deep peroneal nerve pathology.

Action Potentials↗

PubMed1990

Cardiac arrhythmias from a malpositioned Greenfield filter in a traumatic quadriplegic.

A case study is presented of premature Greenfield filter discharge with intracardiac migration and resulting life-threatening arrhythmias. These arrhythmias also interfered with the patient's transition from ventilatory support via orotracheal intubation to noninvasive positive airway pressure ventilatory support methods. The patient's arrhythmias were controlled by a demand cardiac pacemaker and cardiac glycoside therapy. No anticoagulants were used. She had no further filter migration nor significant complications for 16 months after hospital discharge.

Aged↗

PubMed1990

Management of chronic alveolar hypoventilation by nasal ventilation.

This is a study of the effect of nocturnal nasal intermittent positive pressure ventilation (NIPPV) on symptoms of chronic alveolar hypoventilation (CAH), sleep oxygen saturation (SaO2), and frequency of hospitalization of patients with progressive neuromuscular respiratory insufficiency or restrictive lung disease from thoracic wall deformity. The nocturnal use of NIPPV is explored in combination with other noninvasive methods of supported ventilation for daytime support as alternatives to tracheostomy and long-term tracheostomy intermittent positive pressure ventilation (TIPPV). Sixteen patients with less than 400 ml of vital capacity (VC) supine and less than 15 minutes of autonomous respiration (free time) maintained a mean SaO2 of 95.9 +/- 2.6 percent (SD) during sleep on NIPPV without added oxygen. Seventeen other patients with adequate free time for a sleep trial unaided had an average SaO2 of 81.8 +/- 11.0 percent which improved to 94.1 +/- 3.4 percent on NIPPV alone. The average length of use of NIPPV by the 42 patients who have used it for one month or more is 21 (3-67) months. All 34 patients who were not dependent on ventilatory support 24 hours a day demonstrated significant improvement and in most cases normalization of ABG when off aid. Thirteen patients were converted from IPPV via an endotracheal tube or TIPPV to NIPPV. Long-term use of a custom molded thermoplastic nasal interface for the delivery of NIPPV is reported for 17 patients. Unnecessary morbidity and hospitalizations can be avoided by early awareness and appropriate management of CAH. NIPPV can be an effective alternative to TIPPV, body ventilators, or oxygen therapy.

Carbon Dioxide↗

PubMed1990

Tracheostomy ventilation. A study of efficacy with deflated cuffs and cuffless tubes.

The purpose of this study was to evaluate the effectiveness of long-term tracheostomy intermittent positive pressure ventilation (TIPPV) with deflated cuffs or cuffless tracheostomy tubes for patients with neuromuscular ventilatory failure. One hundred four unweanable ventilator-dependent patients with neuromuscular ventilatory insufficiency were referred for pulmonary rehabilitation. Ninety-one of the 104 patients converted from TIPPV with an inflated cuff to either a deflated cuff (28 patients) or no cuff (63 patients). Arterial blood gas (ABG) and routine daytime monitoring of end-tidal PCo2 were performed on all patients during this transition. In addition, periodic daytime and continuous overnight oximetry were performed on 21 of these patients receiving TIPPV with deflated cuffs or cuffless tubes. Thirteen of the 21 patients also had continuous overnight end-tidal PCo2 monitoring. Despite a mean vital capacity of 17 +/- 12.3 percent and the fact that 16 of the 21 patients could tolerate only 60 minutes or less of autonomous respiration (free time), ABG, daytime SaO2 and end-tidal PCo2 were within normal limits for all 21 patients and mean overnight SaO2 was 94 percent or greater for all except one patient who used a cuffless tracheostomy tube. Six patients experienced very transient desaturations below 90 percent but no one had a maximum end-tidal PCo2 greater than 47 mm Hg. Patients with adequate pulmonary compliance and sufficient oropharyngeal muscle strength for functional swallowing and articulation are candidates for conversion to TIPPV with deflated cuffs or cuffless tracheostomy tubes despite little or no autonomous respiration.

Adolescent↗

PubMed1990

Noninvasive options for ventilatory support of the traumatic high level quadriplegic patient.

The ventilation of 25 ventilator-dependent traumatic quadriplegic patients was supported by noninvasive means of ventilatory assistance. Twenty-four of the 25 were initially managed by endotracheal intubation, and 23 of these went on to tracheostomy intermittent positive pressure ventilation before being converted to NVA. Seventeen of the 23 patients had their tracheostomies closed. This included three patients with no significant free time except with the use of glossopharyngeal breathing. Seven of the 25 patients who used NVA for at least one year with no significant free time have employed NVA for a mean of 7.4 +/- 7.4 years (1 to 22 years). Mouth IPPV was the most common form of NVA used both during the daytime and overnight. The wrap ventilators, intermittent abdominal pressure ventilator, and GPB were also employed for long-term respiratory support. It was concluded that, in general, because of their youth, intact mental status and bulbar musculature, and absence of obstructive lung disease, patients with traumatic high level spinal cord injury are candidates to benefit from these techniques.

Adult↗

PubMed1990

Cardiovascular, pulmonary, and cancer rehabilitation. 3. Pulmonary rehabilitation.

This self-directed learning module highlights advances in pulmonary rehabilitation. It is a section of the chapter on cardiovascular, pulmonary, and cancer rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section reviews the anatomy and physiology, pathophysiology, and clinical and laboratory findings in pulmonary disorders. Therapeutic modalities for obstructive and restrictive pulmonary disorders are discussed. Advances covered in this section include the pulmonary rehabilitation of chronic obstructive pulmonary disease patients with elevated pCO2, techniques of respiratory muscle rest, pulmonary rehabilitation of the patient with paralytic restrictive respiratory disorders, and the use of noninvasive intermittent positive-airway-pressure-assisted ventilation for long-term assisted ventilation.

Bibliographies as Topic↗

PubMed1990

Fibrocartilaginous emboli to the spinal cord: a case report.

Fibrocartilaginous emboli to spinal cord vessels are a rare and fatal cause of spinal cord injury. We reviewed the medical literature and discovered only 24 cases reported, all in the last 28 years. For all previously reported patients, onset of initial symptoms to maximal neurologic deficit was from a few minutes to as much as two days. All 24 of these patients died an average of 9.6 weeks post-onset (range = three hours to 11 months) due to complications related to their spinal cord injury; in all cases, the pathologic diagnosis was made postmortem. We report a 20-year-old man with high-level quadriplegia and respiratory paralysis due to fibrocartilaginous emboli to spinal cord vessels, which occurred after a minor automobile accident. He was the longest-surviving patient reported with this diagnosis. He died six years and seven months after onset, having been on 24-hour ventilatory support. The pathologic diagnosis was not suspected before his death; it was made during postmortem examination.

Accidents, Traffic↗

PubMed1990

Strapless oral-nasal interface for positive-pressure ventilation.

A custom-fabricated strapless oral-nasal interface (SONI) is described. It was used in the long-term administration of intermittent positive-pressure ventilation (IPPV) by 18 patients with paralytic or restrictive pulmonary insufficiency. This interface is an acrylic shell which is firmly fixed to an orthodontic bite plate; it is designed to form a seal over the nose and mouth for the entry of IPPV. Eight patients were ventilator dependent 24 hours a day. The ten patients who required only nocturnal aid had improvement in daytime arterial blood gases. Although nine of these patients could manage less than 15 minutes of unassisted breathing (free time) supine, all slept supine on SONI IPPV. The 13 patients who underwent sleep monitoring maintained a mean oxygen saturation of 95.3% +/- 1.7% and acceptable end-tidal pCO2 (30 to 45 mmHg). These 13 patients have used SONI IPPV for an average of 22 months (range = 3 to 63 months). Impediments to successful long-term use of a SONI include the presence of a hyperactive gag reflex or stimulation of excessive oral secretions. When combined with mouth IPPV, glossopharyngeal breathing, the intermittent abdominal pressure ventilator, or the cuirass ventilator for daytime use, SONI IPPV is an option for the patient who prefers total ventilatory support by noninvasive means.

Chronic Disease↗

PubMed1990

Data update.

Explore the source record for details and available documents.

Arteries↗

PubMed1990

Wheelchair-mounted robot manipulators. Long term use by patients with Duchenne muscular dystrophy.

This report relays practical clinical information about the modification and use of commercially available training robot manipulators. Such manipulators were used to increase independence in the activities of daily living of patients with advanced Duchenne muscular dystrophy. The control panels of five industrial robot manipulator training devices were modified for use by advanced Duchenne muscular dystrophy patients. Six patients with only residual finger movement, three of whom were dependent on respiratory support, mastered the use of these devices. The four patients with long-term access employed their manipulators for facilitation of activities of daily living an average of 8 h a day for 3 +/- 1.8 yr. There was approximately 3 h of estimated attendant care time saved per patient per day.

Activities of Daily Living↗

PubMed1989

Management alternatives for post-polio respiratory insufficiency. Assisted ventilation by nasal or oral-nasal interface.

Post-poliomyelitis patients may develop insidious respiratory failure. Chronic alveolar hypoventilation symptoms are often misdiagnosed and the condition is frequently treated inappropriately by oxygen therapy. Physicians are often at a loss to offer assisted ventilation by noninvasive methods and tracheostomy and long-term tracheostomy intermittent positive pressure ventilation is often refused. We studied the use of two noninvasive positive airway pressure alternatives for the nocturnal ventilatory support of 31 post-poliomyelitis patients. These methods were intermittent positive pressure ventilation via nasal access (NIPPV) and via a strapless oral-nasal interface (SONI IPPV). The use of custom fabricated interfaces was also evaluated. Practical alternatives for assisted daytime ventilation included glossopharyngeal breathing, the pneumobelt ventilator and mouth intermittent positive pressure ventilation. Overnight sleep monitoring was performed on 10 patients breathing autonomously or with body ventilators then repeated on NIPPV and/or SONI IPPV. The mean sleep oxygen saturation (SaO2) increased from 87.5 +/- 9.1% on unassisted breathing or body ventilators to 96.2 +/- 2.0% (P less than 0.01) on NIPPV or SONI IPPV. Of 12 other patients with a mean vital capacity of 472 +/- 480 ml and no significant free time supine, 11 patients also maintained SaO2 greater than 94% during sleep supine on NIPPV and/or SONI IPPV. Twenty-one patients have been on nocturnal NIPPV for an average of 23 (3-70) months. Six have been on nocturnal SONI IPPV for an average of 35 (5-66) months. All patients' hypoventilation symptoms were relieved. In conclusion, NIPPV and SONI IPPV can improve the nocturnal ventilation of post-poliomyelitis patients with chronic alveolar hypoventilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1987

Management of end stage respiratory failure in Duchenne muscular dystrophy.

There were 31 Duchenne patients placed on overnight mouth intermittent positive pressure ventilation for severe respiratory insufficiency at the average age of 19.9 years. Most patients had vital capacities less than 200 cc at their last evaluations. Of these, 23 patients are alive at the average age of 27 years and live in the community, although they are dependent on assisted ventilation 24 hours a day. There were 8 patients who died at the average age of 30 years. Although normocapnic during the day, the presence of symptomatic nocturnal hypoventilation or pCO2 over 55 mmHg documented by continuous overnight capnograph study indicates the need for introducing overnight respiratory assistance. Mouth intermittent positive pressure ventilation alone or in combination with other techniques of ventilatory assistance can prolong life while allowing optimal function, attainment of higher levels of education, and home management of patients with Duchenne muscular dystrophy.

Adolescent↗

PubMed1987

Mouth intermittent positive pressure ventilation in the management of postpolio respiratory insufficiency.

The use of mouth intermittent positive pressure ventilation alone or in combination with other noninvasive respiratory techniques as an alternative to tracheostomy in the home management of respirator-dependent postpolio persons was studied in 75 patients. The onset of polio was at an average age of 15 years. At that time, all were dependent on some form of respiratory assistance, most frequently, the iron lung. Fifty-nine percent of them remained respirator-dependent from the onset. Forty-one percent became respirator-dependent at an average of 18 years after onset of polio. Overall, they lost an average of 1.9 percent of vital capacity per year. All used mouth intermittent positive pressure ventilation as their predominant mode of respiratory assistance for an average of 14.5 years. Four of them who had no measurable vital capacity used only mouth intermittent positive pressure ventilation 24 hours per day. Of the 66 who had no significant tolerance off 24 hours per day respiratory assistance, only six had tracheostomies. Despite severe physical disability and dependence on artificial ventilation, the majority of these persons have married, have been gainfully employed, and lead useful lives in society.

Adult↗