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PubMed1997

Immediate recovery of cognitive functions and resolution of fatigue by treatment with weak electromagnetic fields in a patient with multiple sclerosis.

Cognitive deficits are common among patients with multiple sclerosis (MS). The pathogenetic mechanisms underlying the cognitive impairment in MS are unknown and there is presently no effective therapeutic modality which has shown efficacy in improving cognitive deficits in MS. A 53 year old college professor with a long history of secondary progressive MS experienced, over the preceding year, noticeable deterioration in cognitive functions with difficulties in short and long term memory, word finding in spontaneous speech, attention and concentration span. Unable to pursue his academic activities, he was considering early retirement. Mental examination disclosed features of subcortical and cortical dementia involving frontal lobe, left hemispheric and right hemispheric dysfunction. Almost immediately following the extracerebral application of AC pulsed electromagnetic fields (EMFs) of 7.5 picotesla intensity and a 4-Hz sinusoidal wave, the patient experienced a heightend sense of well being, which he defined as enhancement of cognitive functions with a feeling "like a cloud lifted off my head." He reported heightend clarity of thinking and during the application of EMFs he felt that words were formed faster and he experienced no difficulty finding the appropriate words. His speech was stronger and well modulated and he felt "energized" with resolution of his fatigue. There was improvement in manual dexterity and handwriting and testing of constructional praxis demonstrated improvement in visuospatial, visuoperceptive and visuomotor functions. It is suggested that some of the cognitive deficits associated with MS, which are caused by synaptic disruption of neurotransmitter functions, may be reversed through pulsed applications of picotesla range EMFs.

Cognition Disorders↗

PubMed1996

Biosafety implications in sample introduction: module design characteristics for discrete-sample systems used in critical whole blood analyte testing environments.

Systems designed for the measurement of pH/blood gases and expanded versions of these systems that include the ability to measure electrolytes or other related quantities, all incorporate one or more sampling modules that are limited in their ability to allow for the safe handling of potentially biohazardous blood samples. Systems that provide for injection of sample from a syringe use more than the required volume for sample testing and have the potential for causing splash-back of the sample if the introduction port is blocked. The probes of aspiration-based systems require manual dexterity by the operator and present the possibility of operator injury with a contaminated probe tip or the possibility of system damage as the probe extends and the operator moves the collection device into place. Some systems have the potential for both types of biohazards. This report describes the implications for system design of the sample collection devices commonly in use, and it offers a design solution that combines the ergonomics of an injection system and the operational advantages of an aspiration system, in combination, addressing the biosafety aspects in a unique fashion.

Blood Gas Analysis↗

PubMed1991

Hearing instruments for the elderly hearing impaired. A comparison of in-the-canal and behind-the-ear hearing instruments in first-time users.

The purpose of this investigation was to compare negative and positive experiences between two matched groups of elderly first-time users of hearing instruments (HI). One group had been supplied with behind-the-ear hearing instruments (BTE), the other with in-the-canal hearing instruments (ITC). There were 20 persons in each group. All were visited in their homes. Those who needed extra help were offered follow-up at the Hearing Centre. ITC were found to be superior to BTE as regards time-of-use, operational difficulties and undesirable sound experiences. ITC were also used in more difficult listening situations. Successful instruction and follow-up was more easily achieved with ITC users than with BTE users. ITC are recommended as the preferred instrument for elderly first-time HI users, at least for hearing losses not exceeding 60 dB PTA, provided the subject's dexterity and anatomical conditions permit fitting of ITC.

Acoustic Stimulation↗

PubMed1994

Spinal cord stimulation for the treatment of progressive systemic sclerosis and Raynaud's syndrome.

Progressive Systemic Scleroderma (PSS) is a generalized disease of connective tissue involving the skin, as well as other internal organs. The cutaneous signs are characterized by a progressive sclerosis and loss of function or dexterity in the hands. Between 1987 and 1992, 15 patients affected by scleroderma were treated by means of spinal cord stimulation (SCS) in order to reduce signs and symptoms related to vascular damage. The follow-up ranged from 12 months to 6 years. The study confirms that SCS is an effective therapy in patients with PSS and Raynaud's phenomenon because of its beneficial effects on the Raynaud episodes, ulcers, pain, vascular sclerosis and hand function. This method may have a primary role in the treatment of this chronic disorder because of the high probability of failure of other medical or surgical therapy.

Adult↗

PubMed1993

Changes in levels of IgM RF and alpha 2 PAG correlate with increased disease activity in rheumatoid arthritis during the puerperium.

In this prospective study of 24 pregnant patients with rheumatoid arthritis, quiescent disease activity in 21 patients (88%) during gestation was followed by more active disease in the puerperium in 19 patients (79%). Increased disease activity was reflected in a deterioration in manual dexterity and this was found to correlate with a post-partum rise in IgM rheumatoid factor (IgM RF) (r = 0.86) and a post-partum decline in pregnancy associated alpha-2 glycoprotein (PAG) (r = 0.44). The increase in IgM RF also correlated with increased disease activity measured by a visual analogue scale (r = 0.44). Changes in IgA RF were not observed. These results suggest that PAG and IgM RF could contribute to the modulation and pathogenesis of rheumatoid arthritis during pregnancy.

Adult↗

PubMed1987

Impairment, disability, and the ICIDH (International Classification of Impairments, Disabilities, and Handicaps) model. I: The relationship between impairment and disability.

The conceptual scheme put forward in the International Classification of Impairments, Disabilities, and Handicaps suggests that impairment should be related to disability. This paper examines the proposition that disability should be related to impairment in terms of parts of the body involved, both in the physical requirements to carry out a given activity and as regards the site and types of functional limitation, by secondary analysis of data collected in a survey of disabled people in Great Britain. Factor analysis of data on functional limitations showed that these impairments could be considered in four groups representing manual dexterity, movements of the arm, strength, and lower limb function. These were found to be correlated with ability in self-care activities depending on the part of the body involved in the activity.

Activities of Daily Living↗

PubMed1987

The functional aptitude of a natural sample of population. A new approach to handicap (Saint Cyr-sur-le-Rhône, Sept. 1984).

A survey of the total population of a small rural village was undertaken to discern the amount of impairment and disability present, using both questionnaire and examination techniques. It was confirmed that the concept of disability was applicable to such populations and that it was related to age, at both extremes of life. There was a good correlation between self-reporting and examination of locomotor and sensory impairments but it was poor when applied to prehensile or dexterity skills. This survey showed that such techniques can be applied to populations. As yet the handicap code in the International Classification of Impairment, Disability and Handicap has not been related to this population but this is seen as an important next step in the proper understanding of chronic disability in the community.

Adolescent↗

PubMedDate not supplied

Measuring arm impairment and disability after stroke.

This is a review of the problems of assessing impairments and disabilities affecting the arm after stroke, and of the various published measures already available. In routine clinical practice, motor impairment is best assessed using grip strength or the Motricity Index, and dexterity disability is best assessed using the Nine-Hole Peg Test or Ten-Hole Peg Test. No measures of sensation and tone are specifically recommended, primarily because validity and reliability has not been well established for the measures available. Other more complex tests appropriate for more detailed use in planning treatment or in research are discussed.

Arm↗

PubMedDate not supplied

Hepatic vein catheterization: a new technique in rats.

Blood samples taken directly from the hepatic veins are often required for evaluation of liver function or ischemia/reperfusion injury and for direct determination of metabolic products of the liver. In the rat, blood samples are usually obtained by direct puncture of the hepatic veins. Successful catheterization of these small vessels is only possible under direct vision because great dexterity is needed to persuade the catheter to enter the hepatic vein. In this report a procedure for hepatic vein catheterization under direct vision is described in the rat. After performing a median laparotomy, a flexible catheter (Buchbinder, 3.0 F/1 mm, as used in cardiology) with a bent end is inserted into the infrahepatic vena cava. Under direct vision through the thin walls of the inferior vena cava the bent end of the catheter is slowly pushed up until the tip slides into a hepatic vein, which opens into the inferior vena cava at a right angle. Selective catheterization of the desired hepatic vein is possible by rotating the catheter and changing the position of its tip. This is a reliable new technique of hepatic vein catheterization in rats, by which blood samples can be collected directly from the hepatic veins.

Animals↗

PubMed1982

A comparison of Vitrathene moulded with Tweeklon ready-made wrist work splints in juvenile chronic arthritis.

A comparatiave study of purpose-made Vitrathene with a ready-made Tweeklon splint has been undertaken in 20 children with juvenile chronic arthritis who had such severe wrist and carpal involvement that a work splint was considered desirable. In half the dominant hand was splinted with Vitrathene and the other half Tweeklon. Assessments included the presence of soft-tissue swelling, extensor tenosynovitis and pain, together with the position and range of movement of the wrist, grip strength and functional tests. Tests included: maintenance of functional position, grip strength, dexterity, wear-resistance, and weight. Although the Vitrathene splint appeared better in the study, it was made by an experienced occupational therapist. The Tweeklon was applied by a physiotherapist reading the instructions which accompanied it; this took about a quarter of the time required to make the Vitrathene splints.

Adolescent↗

PubMed1993

Application of long-term bone marrow cultures for studying the leukemic transformation of myelodysplastic syndromes.

Myelodysplastic syndrome (MDS) has been thought to be an identifiable early stage in multistep leukemogenesis. Considerable numbers of patients with MDS eventually develop acute myelogenous leukemia (AML), which is very much more difficult to manage than typical denovo AML. There are several differences in both the clinical and biological behavior of AML with and without prior MDS. We have established an unique long-term bone marrow culture (LTBMC) system which allows abnormal cells to grow in preference to normal cells, based on the method originally described by Dexter et al. Leukemic transformations occur more frequently in MDS patients with abnormal karyotypes, and particularly those with multiple abnormalities. New cytogenetic abnormalities were occasionally observed at the time of transition to AML. We have applied this LTBMC system for cytogenetic and molecular studies on the leukemic transformation from MDS. Among the 32 patients with MDS studied thus far, novel abnormal karyotypes were detected during the LTBMCs in 15 patients. Furthermore, 6 out of 23 novel karyotypes detected during the in-vitro cultures emerged in vivo, one to 11 months later in 4 patients. In addition, point mutation of the N-ras proto-oncogene was observed in 3 of 18 cases. The signal of the dot-blot hybridization was increased in one examined case after 2 weeks in culture. Thus, this LTBMC system may provide some promising information with respect to understanding the multistep process from the preleukemic stage to the development of overt leukemia as well as its prognostic relevance.

Bone Marrow↗

PubMed1990

Effect of dipyridamole (Persantin) on blood flow and patency of aortocoronary vein bypass grafts.

The effect of dipyridamole was investigated in 360 patients undergoing coronary bypass surgery. They were randomly allocated to receive dipyridamole (100 mg orally q.i.d. for 2 days preoperatively, 5 mg/kg body weight/24 h i.v. peroperatively and 100 mg orally q.i.d. for 1 year postoperatively) or placebo. Withdrawn from the study were 48 patients on dipyridamole and 57 on placebo. Cardiovascular and/or cerebrovascular events or need for anticoagulant treatment were the reasons for withdrawal in 22 (13%) of the dipyridamole, and 34 (18%) of the placebo group. Logistic regression analysis of risk factors influencing graft patency showed significant relation to peroperatively measured coronary blood flow. A positive trend of treatment was observed (p = 0.08). Vein graft blood flow measured during bypass surgery (245 patients) was significantly greater in the dipyridamole group (p less than 0.01). The occlusion rate was lower in vessels with peroperative blood flow greater than 30 ml/min (vein-marginal p less than 0.01, vein-dexter p less than 0.05, vein-diagonal 0.05 less than p less than 0.1). Dipyridamole increases coronary blood flow and graft patency following coronary bypass surgery.

Aspirin↗

PubMed2003

Examination of differences between successful and unsuccessful elderly hearing aid candidates matched for age, hearing loss and gender.

This study examined group differences on a variety of measures for three groups of elderly hearing aid candidates matched for gender, age and hearing loss. These three groups were: (1) 26 candidates who declined amplification (non-adherents); (2) 24 individuals who purchased hearing aids, but subsequently returned them (rejected HA); and (3) 26 who purchased hearing aids and continued to use their hearing aids for at least the first 6 months following delivery (accepted HA). Following demonstration of adequate reliability for these measures, using the non-adherents as the test retest study sample, group differences were examined for each pre-fit measure. The group of non-adherents who declined amplification differed from the two groups who purchased hearing aids on their scores for the Hearing Handicap Inventory for the Elderly (HHIE) and for several scales of the Communication Profile for the Hearing Impaired (CPHI) that assessed the individual's personal adjustment to hearing impairment. These findings were generally confirmed for the individual data, with the use of discriminant analysis. For the two groups who tried hearing aids, there were no group differences between those who retained them and those who did not. Discriminant analysis, however, indicated that those in the group who retained their (linear) hearing aids tended to have better finger dexterity and higher loudness discomfort levels than those who did not.

Adaptation, Physiological↗

PubMed1983

Neurological and psychophysiological sequelae following different treatments of craniopharyngioma in children.

The authors present neurological findings and data from psychophysiological tests administered during the follow-up period of 35 patients with craniopharyngioma. Group I patients who were treated by irradiation alone or by radiotherapy and conservative surgical procedures (including biopsy, cyst aspiration, and shunting), showed significantly less frontal lobe and visual perceptual dysfunction than Group II patients, in whom radical tumor resection was attempted by a subfrontal exposure. Frontal lobe dysfunction was demonstrated in sorting tests by perseverative responses, inflexibility of behavior, and lack of inhibitory control, while intelligence quotients remained relatively unaffected. Immediate memory defects and decreased manual dexterity were present, to different degrees, in both treatment groups. On the basis of these preliminary data and a maximum follow-up period of 10 years, the authors conclude that primary irradiation of a craniopharyngioma appears associated with a lower morbidity rate and may avoid the frontal lobe disorders seen in the patients with extensive tumor resection.

Adolescent↗

PubMed1986

Surgical management of aneurysms of the distal extracranial internal carotid artery.

Results, complications, and operative techniques of the surgical management of 20 aneurysms of the distal extracranial internal carotid artery (ICA) in 19 patients are reviewed. The proximity of these aneurysms to the styloid process is not considered as a chance occurrence, and the possibility is raised that these lesions are related to trauma from that structure. False aneurysms from spontaneous dissections are believed to occur only in those dissections that begin distally; they are not found in dissections that begin proximally. Treatment was individualized and dependent upon: 1) the size and location of the aneurysm; 2) symptomatology; and 3) hemodynamic considerations based upon intraoperative cerebral blood flow (CBF) measurements determined from the clearance of xenon-133 injected into the ipsilateral ICA. Methods of treatment included: resection of the the aneurysm with placement of an interposition saphenous vein graft in seven patients; resection of the aneurysm with end-to-end anastomosis of the ICA in five; ICA ligation in three; clipping of the aneurysm in one; and extracranial-to-intracranial bypass in four. One patient sustained a postoperative cerebral ischemic complication from embolization which resulted in a mild permanent impairment in right hand dexterity. There were no other cerebral ischemic complications in the group, largely attributable, it is thought, to the use of intraoperative CBF measurements and continuous electroencephalograms. Four patients had transient dysphagia from traction damage to the pharyngeal and superior laryngeal nerves, and one patient with preoperative difficulty in swallowing required a gastrostomy. Long-term results have been excellent. Use of the operating microscope facilitated the suturing of the distal anastomosis in cases in which the ICA was reconstructed by an interposition vein graft or end-to-end anastomosis.

Adult↗

PubMed1994

Quality of long-term survival in young children with medulloblastoma.

The reported success of treatment for children with medulloblastoma must be balanced against the effect that treatment has on the quality of life of long-term survivors. The outcome of long-term survivors reported in previous studies has been conflicting. The authors evaluate the mental and behavioral skills of a group of medulloblastoma survivors from their institution, all of whom had survived for more than 5 years postdiagnosis. A review of the institutional records yielded 32 patients. Twenty-three families were interviewed by telephone and, of these, 13 subjects came to the hospital for detailed neuropsychological and neurological evaluations. Intelligence quotient (IQ) was less than 90 for all participants tested, and patients diagnosed before the age of 3 years had lower IQ scores on average than those diagnosed later. Mean IQ and achievement test scores in reading, spelling, and mathematics were all higher in survivors who had undergone shunting. Achievement test results were often not in accord with intellectual potential, and individual intellectual skills varied widely. Perceptual-motor task performance was below average in more than 50% of the participants, but motor dexterity was more severely affected than perception. Problems in learning and a delay in both physical growth and development were seen in a majority of participants. This study directs attention to the serious difficulties faced by long-term survivors of medulloblastoma and their families, and underscores the importance of routine neuropsychological testing. Moreover, the study provides further impetus to seek alternatives to irradiation in the treatment of malignant brain tumors.

Adolescent↗

PubMed2001

Patterns of functional magnetic resonance imaging activation in association with structural lesions in the rolandic region: a classification system.

OBJECT: Functional magnetic resonance (fMR) imaging of the motor cortex is a potentially powerful tool in the preoperative planning of surgical procedures in and around the rolandic region. Little is known about the patterns of fMR imaging activation associated with various pathological lesions in that region or their relation to motor skills before surgical intervention. METHODS: Twenty-two control volunteers and 44 patients whose pathologies included arteriovenous malformations (AVMs; 16 patients), congenital cortical abnormalities (11 patients), and tumors (17 patients) were studied using fMR imaging and a hand motor task paradigm. Activation maps were constructed for each participant, and changes in position or amplitude of the motor activation on the lesion side were compared with the activation pattern obtained in the contralateral hemisphere. A classification scheme of plasticity (Grades 1-6) based on interhemispheric pixel asymmetry and displacement of activation was used to compare maps between patients, and relative to hand motor dexterity and/or weakness. There was 89.4% interobserver agreement on classification of patterns of fMR imaging activation. Displacement of activation by mass effect was more likely with tumors. Cortical malformations offer a much higher functional reorganization than AVMs or tumors. High-grade plasticity is recruited to compensate for severe motor impairment. CONCLUSIONS: Pattern modification of fMR imaging activation can be systematized in a classification of motor cortex plasticity. This classification has shown good correlation among grading, brain lesions, and motor skills. This proposal of a classification scheme, in addition to facilitating data collection and processing from different institutions, is well suited for comparing risks associated with surgical intervention and patterns of functional recovery in relation to preoperative fMR imaging categorization. Such studies are underway at the authors' institution.

Adolescent↗

PubMed2003

Thalamic deep brain stimulation for disabling tremor after excision of a midbrain cavernous angioma. Case report.

Thalamic deep brain stimulation (DBS) has been demonstrated to be effective for the treatment of parkinsonian or essential tremor. To date, however, few data exist to support the application of this method to treat midbrain tremor. A 24-year-old right-handed man underwent radiosurgery and subsequent resection of a recurrently hemorrhaging cavernous angioma located in the left side of the midbrain. The surgery exacerbated severe choreoathetotic resting and action tremors of his right extremities and trunk. The patient underwent placement of a deep brain stimulator into the left ventral intermediate nucleus of the thalamus (Vim). Postoperatively, decreased truncal ataxia and right-sided choreoathetotic tremor were demonstrated, with a 57% increase in dexterity as measured by task testing. The authors demonstrate that DBS can be an effective treatment modality for disabling tremor after resection of a midbrain cavernous angioma.

Adult↗