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Biomedical subjects

M Sarkarati

Publications and source records attributed to M Sarkarati.

At least 19 recordsLinked to original sources
PubMed1997

Constipation-related symptoms and bowel program concerning individuals with spinal cord injury.

PURPOSE: To determine the prevalence of constipation-related symptoms in individuals with chronic spinal cord injury (SCI), to describe the bowel program as reported by patients and including use of bowel medications and evacuation techniques, and to examine the clinical, functional and pharmacological risks of difficulty with evacuation. PATIENTS AND METHODS: This is a cross-sectional study of all in-patients at least 3 months beyond acute injury, on the West Roxbury/Brockton VAMC SCI Service, during a 10 month period (n = 197). Clinical, functional, and medication data were abstracted from medical and nursing records. Individual interviews were conducted with all available participants (n = 161, 82%) regarding bowel-related symptoms and treatment over the previous 1 month period. The study definition of difficulty with evacuation was spending more than 1 h per episode of bowel evacuation. RESULTS: Forty-one percent of the 161 interview responders spent more than 1 h on bowel evacuation, 50% reported abdominal distension and 38% reported abdominal pain, 27% reported headaches or sweats relieved by having a bowel movement, and 33% reported fecal incontinence at least once a month. The bisacodyl suppository was the most commonly used laxative agent, while docusate was the most popular oral agent. Subjects with difficulty with evacuation (n = 66) were compared with those who spent less than 1 h on evacuation (n = 95). Factors associated with difficulty with evacuation were tetraplegia, Frankel grade A/B, laxative use, polypharmacy, previous urinary outlet surgery, and symptoms of abdominal pain and distension. CONCLUSION: Constipation-related symptoms are highly prevalent in individuals with spinal cord injury, despite considerable laxative use. Our findings suggest that difficulty with evacuation can be predicted on the basis of a patient's clinical profile.

Adult↗
PubMed1996

Injury zone denervation in traumatic quadriplegia in humans.

In order to obtain an electrophysiological characterization of the injury zone in traumatic quadriplegia, we performed electromyography and nerve conduction studies on the upper limbs of 15 patients with cervical cord trauma. Evidence of significant axonal loss was found in multiple myotomes of all patients. In most cases, the level of the most severe denervation, as determined by the absence or diminution of the compound motor action potential and the density of fibrillation potentials, was 2-5 spinal segments below the clinically and radiologically defined injury levels. In patients with injuries, the rostral extent of which is at C5 or higher, the most obvious clinical and electromyographic denervation was seen in the intrinsic hand muscles (C8/T1), with complete loss of C8/T1 motor axons in a subset of these patients. Our results document that spinal cord trauma can cause loss of motor axons in regions several segments caudal to the rostral level of injury. This finding may have implications for the pathophysiology of secondary injury, for recovery potential, and for the design of rehabilitation strategies.

Action Potentials↗
PubMed1996

Comorbid illness is associated with survival and length of hospital stay in patients with chronic disability. A prospective comparison of three comorbidity indices.

OBJECTIVES: This study was designed to determine if comorbidity added more information than knowing only the patient's age in predicting survival and length of hospital stay. METHODS: The authors compared the relative predictive validity of three comorbidity indices: the Cumulative Illness Rating Scale, the Charlson Index, and a count of International Classification of Diseases, 9th Revision, Clinical Modification medical diagnoses in relation to survival and length of hospital stays in patients with spinal cord injury. The sample consisted of 330 longitudinally followed spinal-cord injured patients admitted between January 1989 and December 1990 who were followed for an additional 18 months. RESULTS: During the follow-up, 25 (7.5%) patients died and 249 (75.5%) were readmitted to hospital with a median of one admission (range, 1-8). The corresponding lengths of hospital stay ranged from 0 to 548 days, with a median of 7 days. CONCLUSIONS: Patients who died were not significantly older but had higher comorbidity scores. Using patients alive at the end of the follow-up period, linear regression models were fit to the data to determine if comorbidity added more information regarding length of hospital stay than knowing only the patient's age. In the model that included only age as an independent variable, there was a significant relation between age and length of stay (F(1,303) = 5.2; P = 0.012). The R2 value for this model was 0.017. In further models that included age and each of the three comorbidity scores (separately) as the independent variables, the model that included age and the Cumulative Illness Rating Scale yielded the highest R2 value (R2 = 0.062). This study is among the first to compare three different measures of comorbidity and documents that comorbidity provides more information than knowing only the patient's age in relation to survival and length of hospital stay.

Adult↗
PubMed1995

Late-life spinal cord injury and aging with a long term injury: characteristics of two emerging populations.

Modern care of patients with spinal cord injury is leading to greater numbers of individuals surviving into old age and the emergence of a cohort that has sustained injury at an advanced age. The clinical characteristics of either group of patients has not been well characterized. Analyses from the Aging with a Long-Term Disability Research Program database, which is enriched by the presence of a high quality Spinal Cord Injury Service, revealed a population of 510 recently assessed individuals with a mean age of 50 years, ranging from 16 to 84 years. Twenty-three percent of the patients were at least 65 years of age. Spinal cord injuries were usually the result of automobile accidents in individuals injured younger than 50 years of age and falls in individuals injured when older than 50 years of age. Patients surviving late life injury are much more likely to have incomplete injuries predominantly affecting the cervical spine. A number of conditions were found to be more prevalent in older patients. These included carpal tunnel syndrome, chronic obstructive pulmonary disease, myocardial infarction, diabetes, kidney stones, pressure ulcers and hypertension. The development of diabetes, kidney stones and perhaps pressure ulcers was directly related to aging with SCI, but not just to aging alone. The better functional outcomes in late life spinal cord injury may be secondary to selective survival. The excess morbidity associated with late life spinal cord injury has significance for future planning of healthcare needs for the spinal cord injured patient.

Adolescent↗
PubMed1992

Recurrent inhibition is increased in patients with spinal cord injury.

Mechanisms underlying the development of spasticity after spinal cord injury are not understood. One spinal interneuron likely to be affected is the Renshaw cell, which acts to produce recurrent inhibition in motor neurons as well as inhibiting Ia interneurons. Descending pathways exert both excitatory and inhibitory control over Renshaw cell activity. We studied Renshaw cell activity in normal subjects and in patients with varying levels of spasticity after spinal cord injury using the conditioned H-reflex technique of Pierrot-Deseilligny and Bussel. A submaximal stimulus to the tibial nerve is presented prior to a supramaximal stimulus so that action potential collision permits an H reflex (H') to be elicited in response to the supramaximal stimulus. The amplitude of this H' reflex is affected by activity in recurrent inhibitory pathways. Patients with both complete and partial spinal cord lesions were studied; date of injury ranged from 1 month to 216 months prior to evaluation. In the 18 patients in whom H reflexes could be recorded, H' reflexes were absent in 13, in contrast to their uniform presence in normal subjects. We conclude that recurrent inhibition via Renshaw cell activity is increased in spinal cord injury, and that measures of recurrent inhibition may correlate well with some clinical measures of spasticity.

Adult↗
PubMed1989

Respiratory mechanics in acute quadriplegia. Lung and chest wall compliance and dimensional changes during respiratory maneuvers.

We measured lung and chest wall compliance as well as rib cage and abdominal dimensions in the supine position in five acute C4-7 quadriplegics. Studies were performed serially from 1 to 12 months after injury. Results were compared with those of control groups of chronic (greater than 1 yr after injury) quadriplegics and normal volunteers. We found that lung compliance was lower in acute and chronic quadriplegics (0.129 +/- 0.023 and 0.176 +/- 0.043 L/mm Hg, respectively) than in normal subjects (0.278 +/- 0.086 L/mm Hg) and that these changes apparently occurred within 1 month of injury. Specific lung compliance appeared to be reduced to a lesser degree, suggesting that the changes in lung compliance were partly due to reduced lung volumes and partly to altered mechanical properties of the lung. During respiratory maneuvers, abdomen and rib cage dimensional changes demonstrated rib cage distortion. This distortion was less severe in chronic than in acute quadriplegics. The improvement in chest wall stability was likely due to increased strength of cervical accessory muscles of respiration and improved coupling of the various rib cage elements in chronic quadriplegics.

Acute Disease↗
PubMed1987

Experience in vibratory and electro-ejaculation techniques in spinal cord injury patients: a preliminary report.

More than 90 per cent of complete spinal cord injury patients have major fertility problems, depending upon the site and type of injury. During the last 5 years 34 patients were treated by vibratory and/or electrostimulation at our center, and semen was produced in all but 5. In 8 patients ejaculation was attempted by vibratory stimulation alone and in 22 electrostimulation also was used. Vibratory stimulation is the easier and less cumbersome of the 2 methods. No major side effects were noted with either technique. Stimulation was performed by a rectal electrode incorporated in a silicone finger glove with a current of 0.1 msec. in duration, a frequency of 30 Hz. and an average of 60 volts. Vibratory stimulation was applied to the frenulum and/or glans penis with a specially constructed vibrator at a frequency of 80 Hz. and a peak-to-peak oscillation of 1.6 to 2.4 mm. Semen obtained during the first 6 months after injury was not of a quality consistent with successful fertilization owing to poor motility. However, semen quality and motility were better in patients who had been injured for more than 6 months. Repeated electro-ejaculation did not improve the quality of semen. The effects of bladder outlet surgery and autonomic blockers were noted in 5 patients.

Adolescent↗
PubMed1986

Upper and lower rib cage deformation during breathing in quadriplegics.

In quadriplegia, the anteroposterior diameter of the rib cage (RC) decreases during inspiration. Our aim was to characterize this paradoxical motion further and to determine to what extent it was due to a diminished inspiratory effect of the diaphragm on the RC because of abdominal muscle paralysis. In six quadriplegics, upper and lower RC (URC, LRC) displacements were studied in various postures with and without extrinsic abdominal support. LRC was in its relaxed configuration at all lung volumes studied in three subjects before and four subjects during abdominal compression. URC distorted most and, despite improvement during abdominal compression, was never in the relaxed configuration during tidal inspiration. Thoracic distortability was further studied by noting the effect on URC and LRC of a cephalad force applied to the RC at the costal margin. This produced distortion similar to that observed during spontaneous inspiration. It was concluded that during spontaneous inspiration in quadriplegics lack of abdominal support does not entirely explain the RC distortion which occurs, and high abdominal pressure results in diminished RC distortion, an effect which we attribute to an increase in the area of diaphragmatic apposition to the RC.

Abdomen↗
PubMed1986

Changes in lung volume and rib cage configuration with abdominal binding in quadriplegia.

Previous studies suggest that abdominal binding may affect the interaction of the rib cage and the diaphragm over the tidal range of breathing in quadriplegia. To determine whether abdominal binding influences rib cage motion over the entire range of inspiratory capacity, we used spirometry and the helium-dilution technique to measure functional residual capacity (FRC), inspiratory capacity, and total lung capacity (TLC) in eight quadriplegic and five normal subjects in supine, tilted (37 degrees), and seated positions. Combined data in all three positions indicated that, with abdominal binding, FRC and TLC decreased in normal subjects [delta FRC = -0.33 + 0.151 (SD) P less than 0.01); delta TLC = -0.16 + 0.121, P less than 0.05]. In quadriplegia there was also a reduction in FRC with binding (delta FRC = -0.32 + 0.101, P less than 0.001). However, TLC increased in quadriplegia (delta TLC = 0.07 + 0.061, P less than 0.025). In an additional six quadriplegic and five normal subjects, we used magnetometers to define the influences of abdominal binding on rib cage dimensions and TLC. In quadriplegia, rib cage dimensions were increased at TLC with abdominal binding, whereas there was no change in normals. Our data suggest that this inspiratory effect of abdominal binding on augmenting rib cage volume in quadriplegia is greater than the effect of impeding diaphragm descent, and thus abdominal binding produces a net increase in TLC in quadriplegia.

Abdomen↗
PubMed1985

Cervical spinal cord injury complicating ankylosing spondylitis.

Within a period of 12 years 466 patients with acute spinal cord injury were admitted to our Centre, seven of these having ankylosing spondylitis (AS). A history of alcohol consumption preceding the accident was present in five patients, and in four there was a history of neurological deterioration before their admission. An epidural hematoma was found in one patient and four expired within 3 months of their injury. The incidence of ankylosing spondylitis in cervical cord injury was 1.5%, and an associated epidural hematoma was present in some 14% of the patients. The mortality rate was 57%. There was a high incidence of alcoholic use before the accident. Neurological deterioration commonly occurred before admission.

Aged↗
PubMed1984

Management of neurogenic bladder in female spinal cord injury patients.

Twenty-two female spinal cord injury patients were admitted to the Spinal Cord Injury Service at the West Roxbury VAMC during a period of 17 years (1965-1982). Bladder status and means of drainage were evaluated. Twelve patients (55%) required no means of drainage, nine of them were dry all the time, while the other three needed pamper support to counteract occasional wetness. Seven were on constant indwelling catheters, two were on self-catheterization, while one had an intestinal loop diversion. It appears that female spinal cord injury patients depend more on constant indwelling catheters than their male counterparts. In some instances, female paraplegics do well on self-catheterization. Catheter complications in female spinal cord injury patients appear to be less than in males.

Adolescent↗
PubMed1984

Colorectal carcinoma and myelopathy.

The incidence and pathological features of colorectal carcinoma in a population of veterans disabled by myelopathy were examined by record review. Thirteen cases of colorectal carcinoma were found among the 1023 such individuals (99 percent male) who were hospitalized and subsequently followed between April 1, 1973 and September 22, 1983. The age adjusted incidence rates ranged from 316 per 100,000 person years in the sixth decade to 1886 per 100,000 person years in the ninth decade of age. These rates were two to six times the highest reported rates for general male populations (P less than 0.05). The location of carcinoma was proximal to the rectosigmoid colon in 62 percent of the 13 paralyzed patients, but in only 12 percent of 31 nonparalyzed male patients with colorectal carcinoma diagnosed at the same hospital in 1977-1979 (P less than 0.001). The stage of the tumor at diagnosis was Dukes Kirklin C in 83 percent of paralyzed patients and 48 percent of the nonparalyzed patients (P less than 0.001). We conclude that colorectal carcinoma is more common, more proximal in location, and more advanced at diagnosis in male subjects with myelopathy than in nonparalyzed male subjects.

Adolescent↗