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Biomedical subjects

R R Menter

Publications and source records attributed to R R Menter.

9 recordsLinked to original sources
PubMed1998

Long-term cardiac ischemia leading to coronary artery bypass grafting in a tetraplegic patient.

With increasing survival in the spinal cord injury (SCI) population, coronary heart disease (CHD) is becoming a leading source of morbidity and mortality. Known risk factors and characteristic signs and symptoms of CHD in the general population may be altered or absent in SCI. This report describes the long-term cardiovascular course and outcome of a man with C6 American Spinal Injury Association Impairment Scale A tetraplegia secondary to a motor vehicle crash. Cardiac risk factors included male gender, mild hypercholesterolemia, and sedentary lifestyle. In retrospect, intermittent tooth pain for 13 years was likely an atypical presentation of angina. Because of severe diffuse coronary and carotid atherosclerotic disease, he underwent simultaneous four-vessel coronary artery bypass graft and carotid endarterectomy. This case demonstrates the challenges to the physiatrist in the diagnosis and management of concurrent CHD and SCI, as well as the benefit of appropriate treatment in individuals with SCI.

Carotid Stenosis↗
PubMed1993

Long-term spinal cord injury: functional changes over time.

Functional changes were assessed in a group of 279 individuals with long-term spinal cord injuries. All had sustained their initial injuries 20 to 47 years ago and all had received initial and postinjury follow-up care at one of two British spinal cord injury treatment centers. Twenty-two percent reported that the need for physical assistance from others had increased over the years. Most (45%) needed additional help with transfers; others needed more assistance with dressing, mobility, and toileting. When compared to those whose need for help had not increased, significant differences were found by age: as a group, and when separated by level and severity of injury, those needing more help were older, and those with cervical injuries needed help at younger ages than their counterparts with lower level injuries. Those needing more help also had significantly more reports of shoulder pain, fatigue and weakness, weight gain, and postural changes. They used more attendant care, and perceived their quality of life to be lower than those whose level of function had not changed over time.

Activities of Daily Living↗
PubMed1992

Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago.

Mortality, morbidity, health, functional, and psychosocial outcomes were examined in 834 individuals with long term spinal cord injuries. All were treated at one of two British spinal injury centres: the National Spinal Injuries Centre at Stoke Mandeville Hospital or the Regional Spinal Injuries Centre in Southport; all were 20 or more years post injury. Using life table techniques, median survival time was determined for the overall sample (32 years), and for various subgroups based on level and completeness of injury and age at injury. With the number of renal deaths decreasing over time, the cause of death patterns in the study group as it aged began to approximate those of the general population. Morbidity patterns were found to be associated with age, years post injury, or a combination of these factors, depending upon the particular medical complication examined. A current medical examination of 282 of the survivors revealed significant declines in functional abilities associated with the aging process. Declines with age also were found in measures of handicap and life satisfaction, but three quarters of those interviewed reported generally good health and rated their current quality of life as either good or excellent.

Adaptation, Psychological↗
PubMed1992

Sexual issues of women with spinal cord injuries.

The need for research addressing problems unique to women with spinal cord injuries is well documented. Consequently, 231 such women, ages 18 to 45, were surveyed. Demographic characteristics and data relating to physician usage, female hygiene, pregnancy, contraception and sexuality were collected. Analysis revealed that 60% of the respondents had post injury amenorrhea; the average time until menses resumption was 5 months. The group's post injury pregnancy rate was one-third its pre injury rate, but women with incomplete paraplegia had significantly more pregnancies than those with complete quadriplegia. Of 47 women who did carry babies to delivery, one-half had vaginal deliveries; 49% used no anesthesia. Problems during pregnancy included autonomic hyperreflexia, decubitus ulcers, urinary tract infections, water retention, bladder and bowel problems, anemia, spotting, fatigue, cardiac irregularity and toxemia. Many of these problems plagued the women during labor and delivery and in the post partum period as well. Sixty-nine percent of the women were satisfied with their post injury sexual experiences, although self confidence, spasticity, and lack of spontaneity were issues. Although satisfied with care received from physicians, many women were not content with the information provided during rehabilitation, and felt a need for more literature, counselling, and peer support.

Adolescent↗
PubMed1991

Impairment, disability, handicap and medical expenses of persons aging with spinal cord injury.

Data from 205 Craig Hospital patients with spinal cord injuries (SCI) were analysed with regard to level of injury, age, length of time since SCI, disability (as measured by the Functional Independence Measure), handicap (as measured by the Craig Handicap Assessment and Reporting Technique), and average annual costs for services relating to the SCI. Differences in disability, handicap, and costs of care were analysed by chronological age and length of time since injury. Older individuals showed significant increases in disability and handicap. When chronological age was added to the number of years post-injury, significant increases in disability, handicap, and costs of care were noted at all neurological levels.

Adolescent↗
PubMed1986

Long-term outlook in quadriplegic patients with initial ventilator dependency.

Traumatic spinal cord injuries frequently result in respiratory insufficiency. With intensive medical support, many of these patients live productive lives in spite of severe neurologic deficit. A ten-year review of ventilator-dependent quadriplegic patients at Craig Rehabilitation Hospital was undertaken to determine the number of patients who could be weaned from mechanical ventilation and their long-term survival rate. Ventilator dependency is defined as requiring continuous mechanical ventilatory support for 30 or more days. Of the 134 patients that were included in the study, 76 were weaned during initial hospitalization. Factors which adversely affected ability to wean include: 1) high level of neurologic injury, 2) age greater than 50 years, and 3) other associated injuries. Of the ventilator-dependent patients surveyed after leaving the hospital, survival rate at one year was 90 percent (37 of 41), 56 percent (14 of 25), at three years and 33 percent (7 of 21) at five years. We conclude that vigorous medical support and maximal efforts to wean these patients from mechanical ventilation should be undertaken to: minimize the financial and emotional burden of long term institutional care, reduce ventilator dependency, and improve overall quality of life.

Adult↗