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Biomedical subjects

L Reinstein

Publications and source records attributed to L Reinstein.

32 records · Page 2Linked to original sources
PubMed1980

Peripheral neuropathy after cis-platinum (II) (DDP) therapy.

A 56-year-old man developed a malignant fibrous histiocytoma in the left antecubital space in THE LEFT ANTECUBITAL SPACE IN September 1974. He underwent local resection, local radiation therapy, and chemotherapy with Adriamycin and Levamisole with resolution of the disease. In January 1977, a recurrent mass developed in the left antecubital space and electrophysiologic studies revealed segmental demyelination of the left median nerve across the tumor site. In July 1977, a Cis-diamminedichloplatinum (II) (DDP) therapy was instituted and 5 months later the patient developed paresthesias in both hands and both feet. Repeat nerve conduction studies revealed abnormalities in all 4 extremities consistent with a mixed sensorimotor peripheral neuropathy. Serial studies at 2-month intervals during DDP therapy showed further deterioration in nerve conduction. Following completion of DDP therapy, the patient's symptoms improved and subsequent nerve conduction studies done over an 11-month period showed improvement in nerve conduction with values approaching normal.

Cisplatin↗
PubMed1980

Extremity amputation: disseminated intravascular coagulation syndrome.

There are occasional reports in medical literature of peripheral gangrene and subsequent extremity amputation following systemic infection. Although the authors of these case reports speculated that the gangrene was due to septic embolization, pathologic study of the amputated tissue failed to reveal evidence of septic emboli. In reviewing reports of amputation following scarlet fever, varicella, pneumococcemia, and appendicitis, we found cases with clinical, hematologic, and pathologic evidence of disseminated intravascular coagulation (DIC). We describe 2 patients who required extremity amputation following an acute, systemic infection: transmetatarsal and Lisfranc amputation following meningococcal meningitis and bilateral below-knee amputation following pneumococcal meningitis. Both of these patients had clinical, hematologic, and pathologic evidence of DIC. Following amputation, both of these patients had significant problems with skin healing and prosthetic fitting. The presence of an acute systemic bacterial or viral infection, coagulation abnormalities and pathologic tissue indicative of DIC, and skin lesions of the extremities progressing to dry gangrene and ultimately requiring bilateral amputation are the key clinical features of this syndrome. We conclude that DIC is a major pathophysiologic mechanism responsible for peripheral gangrene following systemic infection.

Adult↗
PubMed1979

Electromyographic abnormalities in osteosarcoma arising in Paget disease of the vertebral column.

The case of a patient with low back pain and Paget disease of the L5, S1 vertebrae is presented. Electromyography revealed dysfunction in both the paraspinal and gluteal muscles. Postmortem examination showed sarcomatous transformation of the vertebrae with nerve root compression and skeletal muscle infiltration by tumor. The electromyographic abnormalities are correlated with the pathologic findings. The clinical features of neurologic dysfunction in Paget disease of the vertebral column and in osteosarcoma arising in Paget disease of the vertebral column are reviewed. Electromyography can provide valuable information in the evaluation of the patient with Paget disease of the vertebral column who is suspected of having neurologic dysfunction.

Electromyography↗
PubMed1979

Rehabilitation of the trauma patient.

Many rehabilitation methods are directed at prevention during the acute management of the trauma patient. Their success is measured by the absence of secondary disabilities. Their cost in relation to health care can be estimated. Figures from 1972 showing cost estimates for treatment of common complications are as follows: Decubitus ulcers $7,000, Urinary tract infection 5,000, Kidney stones 5,000, Thrombophlebitis with pulmonary embolism 4,000, Pneumonia 3,000, Contractual deformities 2,000. Current inflation would revise the above costs at least 25%. It is also important to note that the cost of such complications to the individual is immeasurable in time and energy and quality of life.

Bed Rest↗
PubMed1978

Sexual adjustment after lower extremity amputation.

Sexual adjustment following lower extremity amputation was evaluated by interviewing 60 adults with recent amputations, 39 men and 21 women, after they had become independent in ambulation with a prosthesis. Among the men, 77% reported a substantial decrease in the frequency of sexual intercourse following amputation, while only 38% of the women reported a decrease. The decreased frequency was greater for nonmarried men than for married men, greater for men with above-knee amputations than for men with below-knee amputations, and greater for male amputee patients in whom phantom phenomena persisted compared to those in whom phantom phenomena no longer existed. The decreased frequency of intercourse for male amputee patients was unrelated to the patient's age, education, and etiology of amputation. There was no significant change in other aspects of sexual activity, including oral-genital relations, masturbation, homosexuality, and extramarital relations.

Adolescent↗
PubMed1977

Problem-oriented medical record: experience in 238 rehabilitation institutions.

Since Lawrence Weed introduced the Problem-Oriented Medical Record (POMR) nine years ago, several individual rehabilitation institutions have reported their experiences with POMR. As the author was interested in learning of the experiences of other rehabilitation institutions throughout the United States, questionnaires were sent to 253 such institutions. Replies were received from 238 (94%), 132 University-Affiliated Departments of Physical Medicine and Rehabilitation (UAD) and 106 Free-Standing Rehabilitation Centers (FSRC). Some experience with POMR was reported by 155 institutions (65.1%), including 94 (39.5%) which currently use POMR. A comparison between UAD and FSRC revealed statistically significant differences in experience with POMR, the use of POMR for medical and rehabilitation problems, the use of functional evaluation systems and POMR, and professional areas of responsibility. There were no statistically significant differences between UAD and FSRC in the use of POMR for medical audit, the need for formal workshops to orient staff to POMR concepts, the advantages of POMR, and the principal reason an institution was not using POMR. The implications of these findings for patient care, medical education, record keeping, and research are discussed in detail.

Humans↗
PubMed1975

A rehabilitation evaluation system which complements the problem-oriented medical record.

The traditional medical history and physical examination format is disease rather than disability oriented. It has been shown to be incomplete for the total evaluation of rehabilitation patients. Direct applications of Weed's Problem-Oriented Medical Record have proven to be formidable and cumbersome due to the complexity and diversity of rehabilitation. Therefore, we have developed the Rehabilitation Evaluation System (RES) to document functional rehabilitation management and progress during inpatient hospitalization and outpatient follow-up. The system identifies 18 key rehabilitation areas, each with an individual and objective four-point scale. Utilization of this system in our department has been invaluable in formulating goals and continually evaluating the on-going rehabilitation process. We used the RES with equal facility on 46 rehabilitation inpatients including stroke, amputation, spinal cord injury, multiple sclerosis, orthopedic-trauma, rheumatoid arthritis and poliomyelitis. The mechanics of the RES are presented in detail with a specific patient-example of hemiplegia. Its complimentary use with the Problem-Oriented Medical Record is discussed. Practical advantages are seen in patient care, medical student and resident education, record keeping and research.

Disability Evaluation↗
PubMedDate not supplied

Video techniques for on-line portal imaging.

The application of on-line portal imaging techniques to the verification of treatment precision is reviewed. The design parameters for a video portal imaging system are described, and the optimization of image quality is discussed with particular emphasis on photon noise. On-line images are presented for a head phantom imaged on a 4 MV linac, and compared with a conventional portal film. The relative advantages of an on-line system are compared with conventional portal film analysis.

Humans↗