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Biomedical subjects

P R Meyer

Publications and source records attributed to P R Meyer.

At least 19 recordsLinked to original sources
PubMed1992

Complications in three-column cervical spine injuries requiring anterior-posterior stabilization.

A study was undertaken to elicit the hidden factors that, when identified, would signal the presence of cervical spine instability. Data were derived from the records and radiographs of 21 patients having sustained traumatic injury to the lower cervical spine (C3-C7) and who failed a single-stage posterior stabilization procedure necessitating a second (or combined) anterior-posterior arthrodesis. Mechanism of injury most frequently identified in this group was the distraction-flexion (locked facets) pattern (nine patients) and the "tear drop" compression-flexion injury pattern (seven patients). All 21 patients underwent a posterior wiring and bone graft stabilization procedure with persistent postoperative instability. Thus, failure to recognize the presence of "three-column" instability, the sine qua non of this group, resulted in the failure of posterior tension band stabilization as a means of gaining cervical spine stability. Three-column cervical spine instability is suspected in the presence of: 1) retrolisthesis and angulation of the superior vertebra on the next inferior vertebra; 2) distraction of the posterior interspinous ligaments sufficient to allow subluxation or dislocation of the facets; in conjunction with 3) a "shear" dislocation of one vertebra on another. Anterior shearing force through the disc space is capable of disrupting the intervertebral disc, along with disruption of the anterior and posterior longitudinal ligaments, each contributing to the presence of anterior and middle column cervical spine instability.

Adult↗
PubMed1991

Spinal cord compression from a thoracic paraganglioma: case report.

A 34-year-old man with a 4-month history of midthoracic back pain sought treatment for a recent onset of lower extremity paresthesia and stiffness. A myelogram and computed tomographic myelogram disclosed an extradural block at the level of the 8th thoracic vertebral body with involvement of the pedicles, lamina, and spinous process. A posterior decompression of the spinal cord with subtotal resection of a highly vascular tumor was performed. The tumor was identified as a paraganglioma. In a second stage, the remainder of the tumor was embolized preoperatively, and gross total excision and sequential stabilization of the spine with a Luque rectangle and sublaminar wires were performed. The patient has been symptom free and without signs of a recurrence in the spine for over 13 months. A large abdominal paraganglioma was recently resected from its probable origin from the adventitia of the abdominal aorta.

Abdominal Neoplasms↗
PubMed1991

Series of ninety-two traumatic cervical spine injuries stabilized with anterior ASIF plate fusion technique.

This report details the results of 92 patients who underwent a single anterior procedure involving appropriate anterior decompression, tricortical inlay bone grafting, and application of anteriorly applied cervical vertebral plates and screws for the treatment of their acute lower cervical spine trauma. This allowed for needed anterior spinal decompression, correction of deformity, and excellent initial stability. A lightweight SOMI orthosis was used in the immediate postoperative period and continuing for 3 months on average. Follow-up detected a less than 2% incidence of significant complications related specifically to the use of anterior hardware and an excellent fusion rate (98.9%) occurring on average at 3.2 months postoperatively. Anterior decompression, bone grafting, and metallic osteosynthesis are thought to provide a valuable means of treating acute lower cervical spine trauma.

Adult↗
PubMed1991

The use of sublaminar cables to replace Luque wires.

Sublaminar wires have been used in conjunction with posterior instrumentation to stabilize the spine. Sublaminar wiring has fallen into disfavor because of an increase in neurologic complications with the Luque technique as well as wire breakage, dural tears, and difficulty of removal. A cable system consisting of two 49-stranded stainless steel cables connected to one malleable leader was designed to overcome these shortcomings. Biomechanical testing revealed that the maximum yield strength of a single stainless steel cable loop was 2.85-2.94 times greater than a double 0.05-in. stainless steel wire loop. The fatigue tests demonstrated that the stainless steel cables required 6-22 times more cycles to failure than the stainless steel wire. Many of the titanium cables failed immediately under higher loads (0-100 lb) because of slipping of the crimp. The preliminary clinical results after a mean of 19 months of follow-up of 245 cables are encouraging. There has been no breakage or loosening of the cables and no complications associated with the use of the cables. The stainless steel cables are very strong, but more important, the cable flexibility prevents repeated contusions to the spinal cord during insertion of the rods and tightening of wires. The cable conforms to the undersurface of the lamina. This may lead to a decrease in neurologic complications.

Biomechanical Phenomena↗
PubMed1991

Spinal cord injury.

The evaluation and treatment of spinal cord injury continues to evolve, enhanced by new imaging modalities. Their application in reference to the cervical, thoracic, and lumbar spine is discussed. Treatment options, both conservative and surgical, are outlined.

Humans↗
PubMed1990

Prevention of thromboembolism after spinal cord injury using low-molecular-weight heparin.

OBJECTIVE: To examine the safety and effectiveness of a low-molecular-weight heparin in the prevention of thromboembolism in patients with recent spinal cord injury and complete motor paralysis. DESIGN: Randomized evaluation of two heparin regimens in 41 consecutive patients meeting eligibility requirements for anticoagulant prophylaxis. Daily bedside examinations were supplemented by serial venous flow studies; suspicious or positive tests were confirmed by venography. INTERVENTION: Standard heparin, 5000 units subcutaneously three times a day; low-molecular-weight heparin 3500 anti-Xa units subcutaneously once daily. MEASUREMENTS AND MAIN RESULTS: Five patients in the standard heparin group had thrombotic events, including two patients with fatal pulmonary embolism; two other patients had bleeding severe enough to necessitate withdrawing the heparin. The cumulative event rate was 34.7% (95% CI, 13.7% to 55.2%). None of the patients treated with low-molecular-weight heparin had thrombosis or bleeding (CI, 0% to 14%). The difference between the two groups was significant (P = 0.006, log-rank test). CONCLUSIONS: Low-molecular-weight heparin is safe and effective in the prevention of thromboembolism in selected patients with spinal cord injury and complete motor paralysis, and is superior to standard heparin in fixed doses of 5000 units three times a day.

Administration, Cutaneous↗
PubMed1990

Diving injuries of the cervical spine.

From 1975 to 1986, 2435 patients were admitted to the Northwestern University-Midwest Regional Spinal Cord Injury Unit. Of these, 220 patients (9.0%) had documented neck fractures from diving accidents, representing the largest series of acute diving injuries yet analyzed. The average age of these patients was 21 years, and males predominated. Two hundred twelve patients (96.4%) were admitted within 48 hours of injury. Associated injuries were rare: none had intracranial mass lesions or systemic injuries, and only nine were near-drowning victims who required endotracheal intubation. The most common levels of injury were C-5 (140 fractures) and C-6 (85 fractures), with 70 patients having fractures at more than one level. Neurological injury was sustained in 154 (70.0%) patients, while 66 (30.0%) patients were neurologically intact. One hundred forty-seven (66.8%) patients underwent posterior cervical fusion, and anterior fusion was performed in 36 (16.4%), allowing for early ambulation and an average hospital stay of 17 days. Hospitalization was relatively uncomplicated, with urinary tract infection in 121 (55.0%), pneumonia in nine (4.1%), and deep vein thrombosis in 24 (10.9%). Long-term follow up averaged 5 years and was obtained in 160 (72.7%) patients. Sixteen (10.0%) improved neurologically, five (3.1%) deteriorated, and 139 (86.9%) were unchanged. Notably, this large study shows that diving accidents occur in a young, healthy population who sustain essentially no other associated intracranial or systemic injuries and have few serious hospital complications. Such patients may be mobilized early in their care after either internal or external stabilization. Subsequent long-term neurological improvement can be expected to occur in about 10% of patients. The importance of water safety and injury prevention is stressed.

Adolescent↗
PubMed1990

Spinal cord injury care system: fifteen-year experience at the Rehabilitation Institute of Chicago.

A statistical study of 15 years of the spinal cord injury care system of the Rehabilitation Institute of Chicago is reported. The Rehabilitation Institute of Chicago (RIC) is the rehabilitation component of the Midwest Regional Spinal Cord Injury Care System, a collaborative programme with Northwestern Memorial Hospital and Northwestern University. Data are reported on 1382 patients, a representative sample of the over 2000 patients treated since the inception of the centre. The sample was predominantly male (83%, N = 1147) and caucasian (64%, N = 888). The most common aetiology was motor vehicle accidents (36%, N = 505). During the 15-year period there were significant decreases in both acute and rehabilitation lengths of stay. Ninety three per cent of the patients were discharged home. Rehabilitation benefits were demonstrated by improvements in the Modified Barthel Index. The research, educational and clinical programmes are described.

Accidents, Traffic↗
PubMed1990

Rehabilitation outcomes in patients with complete thoracic spinal cord injury.

This paper describes the functional outcomes and lengths of stay of 184 patients discharged from comprehensive rehabilitation with complete thoracic traumatic spinal cord injuries. The 100-point modified Barthel Index (MBI) was used to assess functional abilities. There were statistically significant improvements in the mean total MBI score for the entire sample from 35.2 at rehabilitation admission to 71.0 at discharge. The mean lengths of stay were 46 days in acute care and 84 days in the rehabilitation facility. There were 79 patients with lesions between T1 and T6 ("high paraplegics") and 105 patients with lesions between T7 and T12 ("low paraplegics"). There were no significant differences in the mean MBI scores, self-care subscores, mobility subscores, acute lengths of stay or rehabilitation lengths of stay between high and low paraplegic patients. However, low paraplegic patients were more likely to walk than were the high paraplegic patients. Surgical stabilization was performed on 36% of the sample; total MBI scores were similar for surgically stabilized and nonsurgically stabilized patients. High and low thoracic paraplegic patients achieved significant functional gains during rehabilitation. These functional gains occurred in a setting which provided for the vocational, psychosocial and recreational needs of the individual, and which fostered independence, community participation and a return to a healthy and active lifestyle.

Activities of Daily Living↗
PubMed1989

Primary central nervous system lymphoma in AIDS. Results of radiation therapy.

Primary central nervous system (CNS) lymphoma is one of the clinical presentations of the acquired immune deficiency syndrome (AIDS). Ten patients had biopsy-proven high-grade lymphomas that were confirmed by further staging as limited to the CNS. All ten patients received cranial irradiation (total dose, 2200 to 5000 cGy). Six patients demonstrated complete response (CR) of the intracranial masses at the time of repeat computed tomography (CT) scan, whereas one attained a partial response (PR). Two of the CR patients died of multiple opportunistic infections, two experienced relapse of lymphoma, and died at 7 and 16 months from diagnosis, and two were alive without evidence of disease at 8 and 14 months from diagnosis. The median survival of the whole group was 5.5 months (range, 2 to 16 months). Patients with AIDS-related primary CNS lymphoma may respond to radiation treatment; however, response duration is usually short, and survival is influenced by refractory disease or systemic opportunistic infections.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Functional outcome following spinal cord injury. A comparison of specialized spinal cord injury center vs general hospital short-term care.

The functional outcomes of 185 patients with spinal cord injuries undergoing rehabilitation who were initially treated in a specialized short-term care unit (center patients) were compared with those of 153 patients initially treated in general hospitals (noncenter patients). After stabilization, all patients were admitted to the Rehabilitation Institute of Chicago (Ill) and received the same rehabilitation program. The groups were comparable in terms of demographic, injury, and medical characteristics at the time of rehabilitation center admission, but the duration from injury to rehabilitation was more than twice as long for noncenter patients. While center patients were discharged from the rehabilitation center at equivalent functional skill levels, their daily rate of functional gains during the rehabilitation center stay was significantly greater than that of noncenter patients although the length of stay at the rehabilitation center was comparable for the two groups. These results support the practice of specialized short-term spinal cord injury care as a means of enhancing rehabilitation outcome.

Activities of Daily Living↗
PubMed1989

AIDS and the heart.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Disseminated Klebsiella rhinoscleromatis infection.

A 35-year-old obese black American woman presented with nausea, vomiting, diarrhea, fever, cough, and chest pain of 2 weeks duration. She was pancytopenic and acidotic, with respiratory failure and hypotension. A diagnosis of septic shock was made, and the patient died 48 hours after admission. Blood cultures were positive for organisms that were reported to be Klebsiella rhinoscleromatis. At autopsy she had massive hepatic necrosis with numerous Mikulicz's cells. The lungs, spleen, and bone marrow were also involved. To our knowledge, this is the first report of a case of systemic infection with K rhinoscleromatis.

Adult↗
PubMed1989

Prediction of functional outcome by motor capability after spinal cord injury.

The relationship between early motor status and functional outcome after spinal cord injury (SCI) was evaluated prospectively in 52 quadriplegic and 26 paraplegic patients. Motor status was measured within 72 hours of injury and quantified with the Motor Index Score (MIS). Functional status was evaluated with the Modified Barthel Index (MBI). A senior physical therapist completed the MIS and the MBI when each patient was admitted to the spinal cord intensive care unit and every 30 days during rehabilitation. Early motor function was correlated with average daily improvement in functional status including self-care and mobility (p = .001). The initial MIS strongly correlated with functional status of quadriplegics at admission (p = .001), at 60 days, and at rehabilitation discharge (p = .001). In paraplegics, the overall MBI at admission, after 60 days of rehabilitation, and at discharge was not correlated with early motor function. However, the MIS correlated significantly with the MBI self-care subscore at 60 days and at discharge (p = .01), but not with the mobility subscore. The initial MIS was also significantly correlated to functional status at discharge in patients with complete lesions (p = .001), but was not related to functional status at discharge in patients with incomplete lesions. The MIS appears to be a useful tool in predicting function during rehabilitation, although individual differences in ambulation, particularly for patients with paraplegia, limit the predictive utility of this index.

Activities of Daily Living↗
PubMed1988

Fixed- vs adjusted-dose heparin in the prophylaxis of thromboembolism in spinal cord injury.

Thromboembolism is a common and occasionally catastrophic complication in patients with spinal cord injury and complete motor paralysis. We, therefore, evaluated the efficacy and safety of two prophylactic regimens, using heparin in either fixed doses of 5000 U given subcutaneously twice daily or in doses adjusted to prolong the activated partial thromboplastin time (APTT) to approximately 1 1/2 times control. Patients were monitored with daily clinical examinations, serial impedance plethysmography, and Doppler flow studies. All events suspected to be thromboembolic were confirmed by venography, ventilation-perfusion scans, or pulmonary angiography. Seventy-five patients were randomized, and 58 (29 in each group) either remained in the study for more than seven weeks or experienced a thrombotic or hemorrhagic event. Patients on the adjusted-dose regimen received a mean (+/- SD) of 13,200 +/- 2200 U of heparin per dose and had an APTT 1 1/2 times higher than those on the fixed-dose regimen. Thromboembolism was detected in nine (31%) of 29 patients randomized to the fixed-dose regimen and two (7%) of 29 on the adjusted-dose regimen. While no patient who received the adjusted dose and whose APTT reached the target level had a thrombosis, bleeding occurred in seven patients. No patient on the fixed-dose regimen bled. We conclude that patients with spinal cord injury who can be maintained on doses of heparin sufficient to prolong their APTT to 1 1/2 times control values will be spared thromboembolic complications, but these patients are at high risk of bleeding, especially if they have trauma to other tissues in addition to their spinal cord injury.

Adolescent↗
PubMed1988

Autopsy findings in AIDS-related lymphoma.

Autopsies in 20 patients with the acquired immune deficiency syndrome (AIDS)-related lymphoma were studied retrospectively to ascertain the precise cause of death and the extent of lymphomatous disease. Eight patients had primary central nervous system (CNS) lymphoma: two of them were diagnosed antemortem; CNS lymphoma was suspected in three others by computerized tomographic (CT) scan and was confirmed at autopsy. The remaining three were diagnosed incidentally at autopsy. All had concurrent infections at autopsy, including opportunistic infection in six and pyogenic infections in two. Opportunistic infections at autopsy in these patients outnumbered those diagnosed clinically. Twelve patients had systemic lymphoma. Three were diagnosed only at autopsy, two of whom had extensive Kaposi's sarcoma (KS) as well. Eight patients were treated with chemotherapy, but died with disseminated disease. Opportunistic infections were found at autopsy in five patients. Secondary involvement of the CNS by lymphoma was frequent (66%) and was not related to previous bone marrow involvement. The authors conclude that the incidence of lymphoma occurring in AIDS may be more frequent than diagnosed clinically. Similarly, multiple opportunistic infections occur in these patients which are not diagnosed premortem and may contribute to early death.

Acquired Immunodeficiency Syndrome↗