Biomedical subjects

R H Adkins

Publications and source records attributed to R H Adkins.

At least 37 records · Page 2Linked to original sources

PubMed1996

Effect of surgery on motor recovery following traumatic spinal cord injury.

The influence of spine surgery on motor recovery between 1 month and 1 year was assessed prospectively in a group of 269 patients following traumatic spinal cord injury (SCI) using the classification system originally developed by the American Spinal Injury Association. The Allen classification was used to categorize cervical vertebral pathology and the Denis system was used for injuries to the thoracic and lumbar spine. Gunshot injuries were classified based upon the bullet trajectory and location relative to the spinal canal. Individuals undergoing surgery were divided into various subgroups depending on the type of surgery performed: anterior decompression with or without spine fusion and instrumentation, posterior decompression/laminectomy with or without spine fusion and instrumentation and spine fusion with instrumentation. Motor score recovery between 1 month and 1 year after injury was highly dependent (P < or = 0.001) on the level and completeness of injury averaging 0.7 +/- 2.7 for complete paraplegics, 7.8 +/- 4.8 for complete tetraplegics, 11.8 +/- 8.3, for incomplete paraplegics and 22.2 +/- 10.9 for incomplete tetraplegics. Motor recovery did not significantly differ between patients categorized in various surgical subgroups or between those having surgery and those treated non-operatively. Additionally, although the sample size was small, motor recovery among tetraplegic individuals did not depend on whether unilateral and bilateral facet dislocations were reduced and in patients with incomplete lesions, those with reductions actually had a poorer outcome than those who were left in a dislocated position.

Accidents, Traffic↗

PubMed1996

Use of methylprednisolone as an adjunct in the management of patients with penetrating spinal cord injury: outcome analysis.

OBJECTIVE: Since the results of the Second National Acute Spinal Cord Injury Study were published in 1990, methylprednisolone has become a mainstay in the treatment of nonpenetrating spinal cord injury. Although potential significant relationships between the prompt administration of high-dose methylprednisolone after blunt spinal cord injury and outcome have recently been addressed, the relationship between the prompt administration of high-dose methylprednisolone after penetrating spinal cord injury and outcome remain unanswered. METHODS: To explore this relationship, we performed a retrospective nonrandomized study on a series of 252 patients with penetrating missile injuries to the spine who presented to our institution from March 1980 to July 1993. One hundred eighty-one patients (71%) were treated conventionally without adjunctive steroid therapy before 1990. Sixteen patients followed up during the 13-year study period received steroid protocols that were not consistent with the Second National Acute Spinal Cord Injury Study protocol and were excluded from the study. Since 1990, 55 patients (21%) were treated with intravenous methylprednisolone according to the Second National Acute Spinal Cord Injury Study protocol. All patients were subsequently transferred for rehabilitative care, and prospective evaluations of their neurological status were performed at admission and discharge. RESULTS: The study included 236 men and 16 women (mean age, 25.6 yr). The mean duration of stay for initial hospitalization was 94.6 days, and the mean duration of stay in rehabilitation was 78.6 days. Frankel scores were used to assess outcome (P < 0.05) and were assessed at admission and at the time of definitive discharge from the Spinal Cord Injury Care System. The hypothesis that methylprednisolone therapy significantly improves functional outcomes in patients with gunshot wound injuries to the spine was rejected. Only the total number of days in rehabilitation and the degree of neurological injury at admission contributed significantly to explaining outcome at discharge. CONCLUSION: The administration of methylprednisolone did not significantly improve functional outcomes in patients with gunshot wound injuries to the spine or increase the number of complications experienced by patients during their hospitalizations.

Adolescent↗

PubMed1995

Injury pattern effect on motor recovery after traumatic spinal cord injury.

OBJECTIVE: To determine whether type of fracture or gunshot injury correlated with extent of motor impairment at 1 month and/or with the amount of motor recovery between 1 month and 1 year. DESIGN: Prospective neurological examinations were performed longitudinally after the recommendations of the American Spinal Injury Association (ASIA). Fractures were classified by the Allen system (cervical spine) or the Denis system (thoracic and lumbar spine). Gunshot injuries were classified based on trajectory and bullet location. SETTING: Subjects were examined at a community medical center. PATIENTS: There were 278 patients with traumatic spinal cord injury who were admitted between 1985 and 1990. MAIN OUTCOME MEASURES: The ASIA motor score was the primary outcome measure. RESULTS: There were no significant differences in motor recovery based on type of injury (penetrating vs nonpenetrating), type of fracture, or bullet location. CONCLUSIONS: Injuries severely disruptive of the spinal canal were more likely to result in complete SCI. Flexion-rotation injuries in the thoracic and lumbar spine, bilateral facet dislocations in the cervical spine, and gunshot wounds in which the bullet passed through the canal were more likely to be complete. Incomplete injuries were more common among patients with preexisting cervical spondylosis who had fallen and patients with gunshot wounds in which the bullet did not penetrate the spinal canal. The primary determinant of motor recovery was completeness of injury at 1 month.

Adult↗

PubMed1995

Motor recovery following spinal cord injury caused by stab wounds: a multicenter study.

A prospective multicenter study was conducted by centers participating in the National Model Spinal Cord Injury System program to examine neurological deficit and recovery patterns following spinal cord injury (SCI) resulting from stab wounds. Thirty two patients were evaluated. Sixty three percent presented with motor incomplete lesions on initial examination. In addition, four of seven who initially presented with motor complete paraplegia were motor incomplete at follow-up. Furthermore, 50% of those with motor incomplete lesions had asymmetrical motor patterns indicative of a Brown-Séquard Syndrome. Although the percentage of patients sustaining an incomplete SCI injury following a stab injury to the spine is higher than the percentage of incomplete lesions associated with other etiologies, the amount of motor recovery when controlling for level and completeness of injury is no greater than previously reported for other etiologies.

Adult↗

PubMed1995

Comparative evaluation of bone suture anchor to bone tunnel fixation of tibialis anterior tendon in cadaveric cuboid bone: a biomechanical investigation.

A multiphase biomechanical study was performed using human tibialis anterior tendons and cuboid bones, comparing the fixation of the tendon to the bone using bone anchors and bone tunnels. Twenty-six specimens were tested for ultimate load to failure comparing Mitek Superanchor fixation with no. 1 and no. 5 braided polyethelyne suture to bone tunnel fixation. Mitek Superanchor with no. 5 suture failed at 223 N, compared with Mitek Superanchor with no. 1 suture at 134 N and bone tunnel at 143 N (P = 0.033). Mitek with no. 1 suture versus bone tunnel was not significantly different. The Mitek with no. 5 suture failed at the tendon/suture interface (75%), the Mitek with no. 1 suture failed at the suture/anchor interface (56%), and bone tunnel fixation failed most commonly by fracture of the tunnel (76%). This study is the first biomechanical analysis of the pullout strengths of bone tunnels or suture anchors in the cuboid bone. We have shown that the suture anchor has a pullout strength comparable or superior to a conventional bone tunnel in an in vitro situation. We believe it is a viable alternative to fixation of the tibialis anterior tendon to the cuboid when there is insufficient tendon length or failure of the bone tunnel.

Adult↗

PubMed1995

Comparison of bladder management complication outcomes in female spinal cord injury patients.

A total of 70 female spinal cord injury patients was retrospectively analyzed for outcomes of long-term bladder management. Three groups were defined: 1) 23 patients on intermittent catheterization, 2) 25 treated by reflex voiding and incontinence padding, and 3) 22 with an indwelling catheter. Mean years of using the specific bladder management technique were 8.5 +/- 4.7, 15.8 +/- 7.3 and 16.7 +/- 9.0 for the 3 groups, respectively. All patients were evaluated for long-term complications. There were 4 major complications (17%) in the intermittent catheterization group, 10 (40%) in the padding group and 58 (greater than 200%) in the indwelling catheter group. The aggregate difference in complication rates among the 3 group was highly significant (p < 0.00001). Of comparable long-term patients (11 to 23 years) there were no major complications among 6 on intermittent catheterization, 8 among 14 who use padding and 21 among 9 with an indwelling catheter. The differences among the groups remained significant (p < 0.00001). Additional analyses showed highly significant differences between the catheter group and the other 2 groups (intermittent catheterization p = 0.0009 and padding p = 0.0005), and a difference that approached significance between the intermittent catheterization and padding groups (p = 0.085). The results strongly support intermittent catheterization as the optimal management of female patients following spinal cord injury given that other factors, in particular independent hand function or the need for appropriate assistance, are considered.

Catheters, Indwelling↗

PubMed1995

Rehabilitation of the patient with a spinal cord injury.

An overview of the individual with spinal cord injury caused by gunshot wounds is presented. In addition to the demographics of the group of patients, the cost estimates of care are discussed. The authors' experience in monitoring neurologic recovery and rehabilitation expectations and outcomes are also reported.

Cost of Illness↗

PubMed1994

Clinical significance of concomitant hepatitis C infection in patients with alcoholic liver disease.

The significance of antibodies to hepatitis C virus in patients with chronic alcoholic liver disease is unclear. Prior studies have utilized the first-generation enzyme-linked immunosorbent assay, which is limited by problems with sensitivity and specificity. Hepatitis C virus infection in 137 patients with biopsy-proven alcoholic liver disease was assessed with second-generation hepatitis C virus antibody assays and reverse transcription-polymerase chain reaction for detection of hepatitis C virus RNA in the serum. The patients were categorized into three groups according to results of serological testing. Discriminant-function analysis was used to determine which factors (risk, biochemical and histological) could best differentiate the three groups. Thirty-three patients were reactive on second-generation enzyme-linked immunosorbent assay/second-generation recombinant immunoblot assay and RNA positive (group 1). Twelve were reactive on second-generation enzyme-linked immunosorbent assay/second-generation recombinant immunoblot assay but RNA negative (group 2). Eighty-six were nonreactive on second-generation enzyme-linked immunosorbent assay, and six were reactive on second-generation enzyme-linked immunosorbent assay but negative on second-generation recombinant immunoblot assay and negative for hepatitis C virus RNA (group 3). Seventy-six percent of patients in group 1 and 58% in group 2 had parenteral risk factors, compared with only 1% in group 3 (p < 0.00001). The mean ALT level was higher in group 1 patients (p < 0.05). The mean histologic activity index was significantly higher in group 1 (p = 0.0007).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

Motor and sensory recovery following incomplete tetraplegia.

Fifty individuals with incomplete tetraplegia due to trauma underwent serial prospective examinations to quantify motor and sensory recovery. None of 5 patients who were motor complete with the presence of sacral (S4-S5) sharp/dull touch sensation unilaterally recovered any lower extremity motor function. However, in 8 motor complete subjects having bilateral sacral sharp/dull sensation present, the mean lower extremity motor score increased to 12.1 +/- 7.8 at 1 year. In 3 of the 8 cases, functional (> or = 3/5) recovery was seen in some muscles at 1 year. Though mean upper and lower extremity ASIA Motor Scores increased significantly (p < .001) between 1 month and 1 year for the entire sample, the annualized rate of motor recovery rapidly declined in the first 6 months and then subsequently approached plateau. Eighty-seven percent (20 of 23) of patients having a lower extremity motor score > or = 10 at 1 month were community ambulators using crutches and orthoses at 1 year follow-up.

Adolescent↗

PubMed1994

Short-term prednisone therapy affects aminotransferase activity and hepatitis C virus RNA levels in chronic hepatitis C.

BACKGROUND/AIMS: The effects of corticosteroids on chronic hepatitis B have provided insight into the mechanism of liver cell injury caused by hepatitis B. In this study, this model was applied to investigate the effects of prednisone on alanine aminotransferase (ALT) and hepatitis C virus (HCV) RNA levels in chronic hepatitis C. METHODS: Ten patients with chronic hepatitis C who had increased levels of ALT and HCV RNA detectable in serum were given a 7-week course of a tapering dose of prednisone. Quantitation of serum HCV RNA was determined by polymerase chain reaction (PCR) and by branched-chain DNA amplification. RESULTS: ALT levels decreased in 8 of 10 patients during therapy. Mean ALT levels of all 10 patients decreased from 184 to 84 U/L (P = 0.002) and then rebounded in 7 of the 8 patients after discontinuation of prednisone. HCV RNA was detectable by the branched DNA technique in 9 of 10 patients. These values increased in all 9 patients during prednisone therapy. The mean serum HCV RNA levels increased from 40.9 before treatment to 414.3 Eq/mL x 10(5) during treatment (P = 0.043). Using PCR, HCV RNA titers increased one log-fold in 8 of 10 patients (geometric mean of 1:4420 to 1:23410). HCV RNA levels decreased to pretreatment values within a mean of 2.8 weeks (range, 1-5) after discontinuation of prednisone. CONCLUSIONS: These responses in ALT and HCV RNA suggest the participation of an immune-mediated mechanism in the liver cell injury in chronic hepatitis C.

Adult↗

PubMed1994

Comparison of computerized tomography parameters of the thoracolumbar spine in normal control subjects and spinal cord injured patients.

The cross-sectional area and the sagittal and transverse diameters of the spinal canal at the thoracolumbar junction were measured using high resolution thin-section computerized tomography images in 15 control subjects and 28 patients with traumatic injury to the spinal cord at the thoracolumbar junction. No significant difference between the control and study groups was found with regard to any of the three measures taken. With the exception of the sagittal canal diameter for the first lumbar vertebra, all the mean values were higher for the spinal cord injured group. The ratio of the sagittal to transverse diameter was larger for the control group; however, this difference also was not significant. These findings suggest no significant differences in the dimensions and shape of the canal at the thoracolumbar region between the spinal cord injured and control groups. In contrast to the cervical spinal canal, there appears to be no correlation between the spinal cord injury and the dimensions of the thoracolumbar spinal canal.

Adult↗

PubMed1994

Motor and sensory recovery following incomplete paraplegia.

Fifty-four individuals admitted for rehabilitation with a diagnosis of incomplete paraplegia due to trauma underwent serial prospective examinations to quantify motor and sensory recovery. Motor and sensory scoring guidelines recommended by the American Spinal Injury Association were used to assess changes. Lower extremity motor scores (LEMS) differed significantly (p < .03) between groups of patients partitioned by category of initial neurologic level of injury (NLI) with the following averages at 1 month after injury: 6.8 +/- 11.3 above T12, 15.0 +/- 8.2 at T12 and 18.3 +/- 11.4 below T12. However, the amount of motor recovery was independent of the NLI with the differences between the NLI groups remaining essentially constant from 1 month to 2 years. While the LEMS increased significantly (p < .001) an average of 11.9 +/- 8.7 points between 1 month and 1 year, the annualized rate of motor recovery rapidly declined in the first 6 months and then subsequently plateaued. All patients having a 1-month LEMS greater than 10 points (28 cases) with hip flexion or knee extension strength > or = 2/5 were able to ambulate in the community with a reciprocal gait pattern using crutches and orthoses at 1-year follow-up.

Adolescent↗

PubMed1993

Risk of cardiac dysrhythmias in chronic spinal cord injury patients.

The incidence of cardiac dysrhythmias is characterized in a group of 47 chronic SCI patients (greater than 30 days post injury; range 35-3605 days) with SCI lesions ranging from C4 to L3 who were referred for evaluation of a potential cardiac dysrhythmia by 24 hour Holter monitoring. Patients were grouped according to level of injury as paraplegic (T1 and below), n = 22, or quadriplegic (C3-C8), n = 25. No evidence of life threatening dysrhythmias was noted in either group, and no differences were evidenced in the incidence of cardiac dysrhythmias between the groups. Premature ventricular contractions (PVCs) were noted in 4/25 quadriplegics, and in 1/22 paraplegics, and right bundle branch block (RBBB) was noted in 1/25 quadriplegics and 1/22 paraplegics. A two-year chart review follow up revealed that no clinically significant cardiac dysrhythmic events occurred in these patients. These findings suggest that the risk of cardiac dysrhythmia is attenuated following the acute phases of SCI and represents a diminished concern to the clinician.

Adolescent↗

PubMed1993

Visual versus quantified digital radiographic determination of bone density.

Quantitative digital radiography (QDR) was used to assess the ability of physicians to determine bone mineral density (BMD) loss from a series of plain radiographs. Twenty-four spinal cord injured patients underwent QDR of the left knee. Seven of the 24 were selected, each of whom had bone mineral loss from 10-70% in 10% increments as assessed by comparison to average BMD of age-matched controls, and a standardized AP radiograph of the left knee was performed. Twenty-five independent examiners (orthopaedic surgeons and residents) were then asked to view the randomly arranged radiographs and visually determine the amount of BMD loss for each radiograph as compared to a control radiograph at 100%. Chi square analysis of the data revealed that the distribution of responses was significantly different than expected at the p less than .01 level. Taking into account that responses may have erred by +/-10%, the distribution of responses was again found to be significant at the p less than .01 level. An accurate determination of BMD loss was achieved only at 10% bone loss and 70% bone loss. The results of this study suggest that the visual determination of bone loss based on plain radiographs is accurate only at very low or very high levels of bone loss. Using standardized techniques, only near normal radiographs or radiographs with at least 70% BMD loss can be assessed accurately.

Bone Density↗

PubMed1993

Motor and sensory recovery following complete tetraplegia.

Sixty-one individuals admitted for rehabilitation with a diagnosis of complete tetraplegia due to traumatic spinal cord injury underwent prospective examinations for motor and sensory recovery. The amount of motor, light touch and sharp/dull (pin prick) sensory recovery was independent of the initial neurologic level of injury between C4 and C8. In the interval between one month and one year following injury, the American Spinal Injury Association Motor Score increased an average of 8.6 +/- 4.7. However, the rate of motor recovery rapidly declined in the first six months and then approached plateau. Ninety-seven percent of muscles with Grade 1/5 ("Trace") or 2/5 ("Poor") strength one month after injury recovered to > or = 3/5 ("Fair") strength by the time of first annual follow-up. Muscles with 0/5 strength one month after injury and located one neurological level below the most caudal level having motor function regained > or = 3/5 strength in only 27 percent of cases at one year follow-up and at two levels below in only 1% of cases.

Adolescent↗

PubMed1993

Gait performance after spinal cord injury.

Physiologic and mechanical gait parameters were measured in 36 spinal cord injury (SCI) patients to quantify gait impairment. Average age of the 30 males and six females was 29.0 +/- 10.1 years. Patients were tested at the time of discharge from initial rehabilitation (mean, 0.5 +/- 0.7 years postinjury). Compared with able-bodied subjects tested in the same laboratory, the SCI patients walked 52% slower (41.1 m/minute versus 79.8 m/minute, respectively), the rate of oxygen consumption was 23% higher (14.9 ml/kg.minute versus 12.1 ml/kg.minute), and the oxygen cost per meter was 240% higher (0.52 ml/kg.m versus 0.15 ml/kg.m). Peak axial load on upper extremity walking aids averaged 21.7% of body weight, and the ambulatory motor index (AMI), derived from lower limb strength grades, was 52% of normal strength. The AMI closely correlated with the peak axial load and the percent increase in the oxygen rate above normal. Differences in the AMI among patients accounted for changes in physiologic parameters; therefore, the AMI can be used as a clinical predictor of functional mobility. Annual follow-up studies were performed on ten of the 36 patients. Compared with the initial testing, these patients walked faster (59.9 m/minute versus 40.4 m/minute), more efficiently (0.26 ml/kg.m versus 0.40 ml/kg.m), with slower heart rates (115 beats/minute versus 133 beats/minute), and the peak axial load was less (18% of body weight versus 26% of body weight).

Adult↗

PubMed1992

Osteoporosis after spinal cord injury.

Dual-photon absorptiometry characterized bone loss in males aged less than 40 years after complete traumatic paraplegic and quadriplegic spinal cord injury. Total bone mass of various regions and bone mineral density (BMD) of the knee were measured in 55 subjects. Three different populations were partitioned into four groups: 10 controls (healthy, age matched); 25 acutely injured (114 days after injury), with 12 reexamined 16 months after injury; and 20 chronic (greater than 5 years after injury). Significant differences (p less than 0.0001) in bone mass mineral between groups at the arms, pelvis, legs, distal femur, and proximal tibia were found, with no differences for the head or trunk. Post hoc analyses indicated no differences between the acutely injured at 16 months and the chronically injured. Paraplegic and quadriplegic subjects were significantly different only at the arms and trunk, but were highly similar at the pelvis and below. In the acutely injured, a slight but statistically insignificant rebound was noted above the pelvis. Regression techniques demonstrated early, rapid, linear (p less than 0.0001) decline of bone below the pelvis. Bone mineral loss occurs throughout the entire skeleton, except the skull. Most bone loss occurs rapidly and below the pelvis. Homeostasis is reached by 16 months at two thirds of original bone mass, near fracture threshold.

Absorptiometry, Photon↗

PubMed1992

Emergency cervical-spine immobilization.

STUDY OBJECTIVE: To determine the effectiveness of a cervical-spine immobilization using a rigid cervical extrication collar and an Ammerman halo orthosis with and without spine boards. DESIGN: A mixed model multivariate design with one within factor (device type) and one between factor (spine board application). SETTING: Radiology suite. TYPE OF PARTICIPANTS: Twenty normal men with a mean age of 29.6. INTERVENTIONS: Unrestrained cervical motion was compared with motion in a cervical extrication collar and an Ammerman halo orthosis with and without a spine board. MEASUREMENTS: Photographic measurement of head and neck motion during maximal flexion-extension, lateral bending, and rotation. Radiologic measurement of maximal intervertebral flexion-extension. MAIN RESULTS: Both cervical extrication collar and Ammerman halo orthosis significantly reduced motion in all planes (P less than .001) with the Ammerman halo orthosis reducing these motions significantly more (P less than .001). With the use of a spine board these motions were restricted even more (P less than .001). The Ammerman halo orthosis with a spine board provided the greatest immobilization, equivalent to that provided by an halo-vest. CONCLUSION: A rigid cervical collar and a spine board provide significantly better immobilization than the collar alone. Further immobilization is provided by an Ammerman halo orthosis.

Adult↗