RESUMEN
Breast cancers are evolving, multi-scale systems that are characterized by varied complex spatial structures. In this study, we measured the structural characteristics of 33 breast tumours in patients who were to receive neoadjuvant chemotherapy using dynamic contrast enhanced MRI and fractal geometry. The results showed a significant association between fractal measurements and tumour characteristics. The fractal dimension was associated with receptor status (ER and PR) and the fractal fit was associated with response to chemotherapy, measured using a validated pathological response scale, tumour grade and size. This study describes structure measures that may be a consequence of known prognostic factors during the initial and/or maturation phase of tumour growth. These results suggest that measuring tumour structure in this way can predict an individual's response to neoadjuvant therapy and may identify those who will benefit least from neoadjuvant chemotherapy, allowing alternative treatment options to be selected in those patients.
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Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Terapia Neoadyuvante , Adulto , Neoplasias de la Mama/diagnóstico , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Pronóstico , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismoRESUMEN
OBJECTIVE: This study investigates the effect of cure rate on the mechanical properties of a common dimethacrylate dental resin formulation (75/25 wt% bis-GMA/TEGDMA). METHODS: The polymerization rate and final conversion of the exact specimens subsequently used for mechanical testing were monitored by near-infrared (near-IR) spectroscopy. The glass transition temperature (T(g)) and modulus, as a function of temperature, were determined by dynamic mechanical analysis (DMA). Iniferter initiating systems were used to create partially cured networks that did not contain any trapped radicals. By the elimination of trapped radicals from the system, the formed networks can be characterized as a function of both temperature and double bond conversion without inducing additional thermal cure during testing. RESULTS: Copolymer specimens were cured with UV and visible light initiating systems, UV light intensities that varied by over four orders of magnitude, and cure temperatures that differed by 60 degrees C. Even though the polymerization rates for these resins were vastly different, similar T(g) and modulus were measured for specimens cured to the same final double bond conversion. SIGNIFICANCE: This study shows that highly cross-linked dimethacrylate systems, such as bis-GMA/TEGDMA, exhibit similar network structure and properties as a function of double bond conversion, regardless of the method or rate of cure.
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Resinas Compuestas/química , Bisfenol A Glicidil Metacrilato/química , Fenómenos Químicos , Química Física , Elasticidad , Calor , Luz , Ensayo de Materiales , Estructura Molecular , Polietilenglicoles/química , Polímeros/química , Ácidos Polimetacrílicos/química , Espectrofotometría Infrarroja , Estrés Mecánico , Tecnología Odontológica , Factores de Tiempo , Rayos UltravioletaRESUMEN
An optimal dental restorative polymeric material would have a homogeneous cross-linking density giving it consistent mechanical strength throughout the material. When multifunctional monomers are polymerized, a pendant double bond can react intramolecularly with the radical on its propagating chain to form a loop, which results in a primary cyclization reaction. Primary cyclization does not contribute to overall network structure, causes microgel formation, and leads to heterogeneity in the polymer. Knowledge of how cure conditions control the degree of primary cyclization and cross-linking in the polymer is important in developing better dental materials. To gain more understanding about the evolving polymer network, the photopolymerization of a typical dental resin (75/25 wt% bis-GMA/TEGDMA) is modeled using a first principals approach. The overall polymerization rate behavior of 75/25 wt% bis-GMA/TEGDMA is predicted using experimentally obtained propagation and termination kinetic rate constants. The effect of chain stiffness and light intensity on the polymerization kinetics is also explored. Furthermore, the model predicts the extent of cross-linking and primary cyclization in the growing polymer network. At 45% conversion, the fraction of bis-GMA and TEGDMA pendant double bonds created that have cycled is 11 and 33%, respectively. The model shows that using a stiff monomer, like bis-GMA, in dental resins diminishes the extent of cyclization and increases the cross-linking density of the polymer. Therefore, better mechanical properties are obtained than if more flexible monomers were used.
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Bisfenol A Glicidil Metacrilato/química , Resinas Compuestas/química , Materiales Dentales/química , Modelos Químicos , Polietilenglicoles/química , Polímeros/química , Ácidos Polimetacrílicos/química , Algoritmos , Sitios de Unión , Fenómenos Químicos , Química Física , Restauración Dental Permanente , Elasticidad , Humanos , Cinética , Luz , Estructura Molecular , Docilidad , Estrés Mecánico , Propiedades de SuperficieRESUMEN
In this study, N-isopropyl, N-methacryloxyethyl methacrylamide (NIMM) is proposed as a possible reactive diluent in place of triethylene glycol dimethacrylate (TEGDMA) for dental resin mixtures. Real-time infrared spectroscopy was used to monitor the double-bond conversion as a function of irradiation time, and mixtures of 50/50wt% bis-GMA/NIMM were found to reach final conversions (95%) that were 1.5 times greater than bis-GMA/TEGDMA (65%) under visible light irradiation. In addition, samples cured to these conversions were tested with dynamic mechanical analysis. The bis-GMA/NIMM mixture (100% converted) was found to have a higher glass transition temperature and modulus at body temperature than a comparable bis-GMA/TEGDMA mixture (60% converted). Finally, the water sorption and solubility of bis-GMA/NIMM were determined to be higher than the bisGMA/TEGDMA comparison, but the values were still within the range of the ISO 9000s standard. These results suggest that bis-GMA/NIMM mixtures are a viable alternative to conventional dental resins since a greater degree of monomer conversion is obtainable without sacrificing physical and mechanical properties.
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Materiales Dentales/síntesis química , Metacrilatos/síntesis química , Resinas de Plantas/síntesis química , Materiales Dentales/química , Espectroscopía de Resonancia Magnética , Metacrilatos/química , Polímeros/química , Resinas de Plantas/química , Solubilidad , Espectroscopía Infrarroja por Transformada de Fourier , Agua/químicaRESUMEN
BACKGROUND AND PURPOSE: The aims of this study were to examine the frequency, types, and clinical factors associated with medical complications that occur during inpatient rehabilitation and to identify risk factors for complications that require a transfer to an acute care facility. METHODS: A cohort of 1029 patients consecutively admitted for inpatient stroke rehabilitation was studied. Demographic and stroke information, impairment, preexisting medical conditions, and admission laboratory abnormalities were recorded. Medical complications, defined as new or exacerbated medical problems, were documented for each patient. Complications that required transfer off rehabilitation were noted. Univariate and multiple logistic regression analyses were used to determine factors that were associated with risk of medical complications and risk of transfer off rehabilitation. RESULTS: Seventy-five percent of patients experienced >/=1 medical complication during rehabilitation. Significant factors for the development of any medical complication included greater neurological deficit (odds ratio [OR], 4.10; confidence interval [CI], 1.88 to 8.91), hypoalbuminemia (OR, 1.71; 95% CI, 1.15 to 2.52), and history of hypertension (OR, 1.81; 95% CI, 1.27 to 2.59). Nineteen percent of patients had a medical complication that required transfer to an acute care facility. Significant factors for transfers were elevated admission white blood cell counts (OR, 1.92; 95% CI, 1.32 to 2.79), low admission hemoglobin levels (OR, 1.89; 95% CI, 1.32 to 2.68), greater neurological deficit (OR, 2.46; 95% CI, 1.37 to 4.39), and a history of cardiac arrhythmia (OR, 1.79; 95% CI, 1.18 to 2.67). CONCLUSIONS: Medical complications are common among patients undergoing stroke rehabilitation. A significant number of these medical complications may require a transfer to an acute facility.
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Rehabilitación de Accidente Cerebrovascular , Accidentes por Caídas/estadística & datos numéricos , Angina de Pecho/diagnóstico , Angina de Pecho/epidemiología , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiología , Estudios de Cohortes , Comorbilidad , Demografía , Femenino , Humanos , Incidencia , Pacientes Internos/estadística & datos numéricos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Dolor/diagnóstico , Dolor/epidemiología , Neumonía/diagnóstico , Neumonía/epidemiología , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Resultado del Tratamiento , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/epidemiología , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/epidemiologíaRESUMEN
One of the most common combinations for the organic phase of dental restorative materials is BisGMA (2,2bis[4-(2-hydroxy-3-methacryloyloxypropoxy) phenyl]propane) and TEGDMA (triethylene glycol dimethacrylate). However, this copolymer has some drawbacks, such as volume shrinkage during cure and lack of complete double-bond conversion. If the properties of this system are to be improved, an attempt must be made to understand the underlying kinetics of the reaction. This work examines the effects of light intensity, temperature, and composition on the polymerization behavior of BisGMA/TEGDMA copolymerizations. Using differential scanning calorimetry, we monitored the rates of photopolymerization for various experimental conditions. The BisGMA/TEGDMA copolymerization behaved similarly to other dimethacrylate systems and exhibited diffusion-controlled kinetics. It was found that the maximum rate of polymerization was significantly affected by the intensity of the light, and the temperature of the polymerization affected the conversion at which the maximum rate occurred. When the composition of the mixture was varied, it was discovered that the viscosity of the system played a significant role in the polymerization rate and the onset of reaction-diffusion-controlled termination. Mixtures which contained from 50 wt% to 75 wt% BisGMA displayed the highest maximum rate. This feature suggests that TEGDMA is an excellent diluent, since it increases the mobility of the reacting medium; however, the high reactivity is due to the presence of BisGMA. Therefore, based on compositional dependence, we conclude that the BisGMA portion of the mixture largely controls the polymerization mechanisms and kinetics.
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Bisfenol A Glicidil Metacrilato/química , Resinas Compuestas/química , Materiales Dentales/química , Polietilenglicoles/química , Ácidos Polimetacrílicos/química , Algoritmos , Análisis de Varianza , Rastreo Diferencial de Calorimetría , Fenómenos Químicos , Química Física , Resinas Compuestas/síntesis química , Materiales Dentales/síntesis química , Difusión , Humanos , Cinética , Luz , Ensayo de Materiales , Metacrilatos/síntesis química , Metacrilatos/química , Polímeros/química , Temperatura , ViscosidadRESUMEN
OBJECT: Multilevel anterior cervical decompressive surgery and fusion effectively treats cervical myeloradiculopathy that is caused by severe cervical spinal stenosis, but degenerative changes at adjacent vertebral levels frequently result in long-term morbidity. The authors performed a modified open-door laminoplasty procedure in which allograft bone and titanium miniplates were used to treat cervical myeloradiculopathy in younger patients with congenital canal stenosis while maintaining functional cervical motion segments. Pre- and postoperative magnetic resonance imaging and/or computerized tomography myelography were performed to assess changes in cervical spinal canal dimensions. Pre- and postoperative flexion-extension radiographs were compared to determine the residual motion of the targeted operative segments. METHODS: Twenty younger patients (average age 37.7 years) underwent modified open-door laminoplasty for treatment of myelopathy or myeloradiculopathy related to significant cervical spinal stenosis with or without associated central or lateral disc herniation or foraminal stenosis. These surgeries were performed during a 2-year period and follow-up review remains ongoing (average follow-up period 21.6 months). Reconstructive procedures were performed on an average of 4.1 levels (range three-six). Operative time averaged 186 minutes (range 93-229 minutes). Average blood loss was 305 ml (range 100-650 ml). No cases were complicated by neurological deterioration, infection, wound breakdown, graft displacement, or hardware failure. The patients' Nurick Scale grade improved from a preoperative average of 1.8 to a postoperative average of 0.5. Pre- and postoperative sagittal spinal diameter averaged 11.2 mm (8-14 mm) and 16.6 mm (13-19 mm), respectively. The sagittal compression ratio (sagittal/lateral x 100%) increased from 48% pre- to 72% postoperatively. The spinal canal area increased an average of 55% (range 19-127%). In patients in whom pre- and postoperative flexion-extension radiographs were obtained, 72.7% residual neck motion was maintained. No patient developed increased neck or shoulder pain. Neurological symptoms improved in all patients, with total relief of myelopathy in 50% and partial improvement in 50%. CONCLUSIONS: Modified open-door laminoplasty with allograft bone and titanium miniplates effectively treats neurological deficits in younger patients with congenital and spinal stenosis. Although long-term results are unknown, short-term results are good and there is a low incidence of complications.
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Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/cirugía , Estenosis Espinal/congénito , Estenosis Espinal/complicaciones , Adulto , Placas Óseas , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Ilustración Médica , Persona de Mediana Edad , Estudios Prospectivos , Estenosis Espinal/diagnóstico por imagen , Estenosis Espinal/fisiopatología , Titanio , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVE: To identify predictors of rehabilitation hospital resource utilization for patients with stroke, using demographic, medical, and functional information available on admission. DESIGN: Statistical analysis of data prospectively collected from stroke rehabilitation patients. SETTING: Large, urban, academic freestanding rehabilitation facility. PARTICIPANTS: A total of 945 stroke patients consecutively admitted for acute inpatient rehabilitation. MAIN OUTCOME MEASURES: Resource utilization was measured by rehabilitation length of stay (LOS) and mean hospital charge per day (CPD). METHODS: Independent variables were organized into categories derived from four consecutive phases of clinical assessment: (1) patient referral information, (2) acute hospital record review and patient history, (3) physical examination, and (4) functional assessment. Predictors for LOS and CPD were identified separately using four stepwise multiple linear regression analyses starting with variables from the first category and adding new category data for each subsequent analysis. RESULTS: Severe neurologic impairment, as measured by Rasch-converted NIH stroke scale and lower Rasch-converted motor measure of the Functional Independence Measure (FIM) instrument predicted longer LOS (F2,824 = 231.9, p < .001). Lower Rasch-converted motor FIM instrument measure, tracheostomy, feeding tube, and a history of pneumonia, coronary artery disease, or renal failure predicted higher CPD (F6,820 = 90.2, p < .001). CONCLUSION: Stroke rehabilitation LOS and CPD are predicted by different factors. Severe impairment and motor disability are the main predictors of longer LOS; motor disability and medical comorbidities predict higher CPD. These findings will help clinicians anticipate resource needs of stroke rehabilitation patients using medical history, physical examination, and functional assessment.
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Trastornos Cerebrovasculares/economía , Trastornos Cerebrovasculares/rehabilitación , Precios de Hospital/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Centros de Rehabilitación/estadística & datos numéricos , Anciano , Femenino , Recursos en Salud/estadística & datos numéricos , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Centros de Rehabilitación/economía , Estados UnidosRESUMEN
OBJECTIVES: To describe the association between impairment and disability during stroke rehabilitation and to examine the effects of rehabilitation by studying the degree of disability reduction experienced by stroke patients who did not have significant reductions in impairment levels. DESIGN: Statistical analysis of items from a database of prospectively collected information on stroke patients admitted for rehabilitation. SETTING: Large urban academic freestanding rehabilitation facility. PARTICIPANTS: Four hundred two patients consecutively admitted for comprehensive acute stroke inpatient rehabilitation. MAIN OUTCOME MEASURES: The National Institutes of Health Stroke Scale (NIHSS) was used to measure impairment and the Functional Independence Measure (FIM) was used to measure disability. Motor and cognitive subscales of the FIM instrument were evaluated. Raw NIHSS and FIM scores were converted to linear measures using Rasch analysis. METHODS: Relationships were studied between converted NIHSS and the two FIM subscales for admission, discharge, and change scores using linear regression analysis. In a second analysis, two groups of patients were identified; the 342 patients who experienced no substantial reduction of impairment comprised the "no impairment reduction (NIR) group," and the 60 patients who had a significant reduction of impairment level comprised the "impairment reduction (IR) group." Multivariate analysis of variance was used to determine and compare the amount of change in motor and cognitive FIM measures over time for each of the two groups. RESULTS: NIHSS correlated significantly with motor and cognitive FIM subscores for admission, discharge, and change measures; R2 values ranged between .02 and .36. Both the NIR group and the IR group experienced significant decreases in disability during rehabilitation. The differences in discharge FIM measures between the two groups were relatively small. CONCLUSIONS: Although stroke-related impairment and disability are significantly correlated with each other, reduced impairment level alone does not fully explain the reduced disability that occurs during rehabilitation. Even patients without substantial impairment reduction demonstrate disability reduction during rehabilitation, suggesting that rehabilitation has an independent role in improving function beyond that explained by neurologic recovery alone.
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Trastornos Cerebrovasculares/rehabilitación , Estado de Salud , Anciano , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND: An audit of the management and outcome of major trauma patients was carried out to determine ways in which the system of care may be improved. METHODS: The Major Trauma Management Study (MTMS) collected data prospectively on all consecutively admitted major trauma patients at eight major hospitals during a 12-month period. Outcome was studied using trauma and injury severity score (TRISS) and a severity characterization of trauma (ASCOT) analyses, as well as a preventable outcome analysis, which looked at survivors with complications or with a Glasgow Coma Score < 15 on discharge from hospital, as well as studying deaths. RESULTS: The group of 859 patients was more severely injured than most described previously, with a mortality of 14.8% and a mean injury severity score of 19.8. Formal ASCOT analysis indicated 2.25% fewer survivors than would be predicted by Major Trauma Outcome Study norms. Extrapolating the TRISS and ASCOT process to include those patients with missing data, and then comparing groups of matched severity with the norms, gave no statistically different outcome in the MTMS group of patients. Preventable outcome analysis revealed rates of preventable and potentially preventable (P/PP) outcomes of 32% among deaths and 8% among survivors. The types of management deficiencies responsible for P/PP outcomes are identified. CONCLUSIONS: The points of deficiency in a system of care have been identified, and the development of an integrated trauma system in Victoria, based upon these facts, is recommended. Children, the elderly, patients with head injuries and patients being transferred between hospitals would benefit from improvements to the system of care. The calculation of efficacy rate (0.95 for the MTMS patients) is recommended to accurately assess the system of care. Preventable Outcome Analysis is more relevant to auditing a system of trauma care in detail, than is ASCOT or TRISS. The MTMS has refined and defined the process so that it is reproducible in further comparative studies.
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Servicios Médicos de Urgencia/organización & administración , Auditoría Administrativa , Evaluación de Resultado en la Atención de Salud , Índices de Gravedad del Trauma , Heridas y Lesiones/terapia , Vías Clínicas/organización & administración , Humanos , Tiempo de Internación , Estudios Prospectivos , Centros Traumatológicos , Heridas y Lesiones/mortalidad , Heridas y Lesiones/rehabilitaciónRESUMEN
BACKGROUND: Reported outcomes in patients undergoing surgical procedures for lumbar disc herniation are poorer in patients eligible for workers' compensation or with pending litigation. In the civilian community, the amount of compensation for one's disability is variable and thus its influence on surgical outcome is difficult to quantify. In the military, all members are covered by a standardized workers' compensation system, and have generally standardized work requirements, a standard pay scale, and third party evaluation of disability based on the Veterans Affairs rating system. This made the military a good system in which to study the effect of potential compensation on surgical outcome. METHODS: The study population consisted of active duty military members who underwent sequential lumbar microdiscectomies over a 31-month period. Omitted were lumbar fusions, decompressive laminectomies, and far lateral discectomies. Clinical and demographic variables, along with financial data for each patient were derived from these data. A good result was defined as return to active military duty. RESULTS: Three hundred forty-nine lumbar discectomies were performed in 348 active duty military members. Overall, 75.3% (262) of the 348 patients were able to return to full military duty after surgery, and 24.7% (86) received disability compensation. Chi-square univariate analysis showed higher compensation incentive was a significant determinant of poor surgical outcome (p = 0.0021). The influence of compensation incentive was proportional to the amount of anticipated payout, and relative to a military service member's usual income. In mutivariate analysis, lower base pay (0.0005) and female gender (p = 0.038) were predictive of poor outcome. CONCLUSIONS: Secondary gain in the form of disability pay has a proportionally adverse effect on outcome following lumbar disc surgery. Although studying this issue in the military system allowed standardization of secondary gain values, the influence of other factors could not be eliminated entirely. Potential disability pay is proportionally greater in lower ranked service members. Thus, other variables such as income level, education, and job satisfaction may contribute to the poorer results in this subgroup of military members.
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Discectomía/economía , Hospitales Militares/economía , Personal Militar/psicología , Modelos Psicológicos , Indemnización para Trabajadores/estadística & datos numéricos , Discectomía/psicología , Femenino , Estudios de Seguimiento , Humanos , Región Lumbosacra , Masculino , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , Resultado del Tratamiento , VirginiaRESUMEN
Endoscopic carpal tunnel release is increasingly performed to treat median nerve entrapment neuropathy at the transverse carpal ligament. Proponents of these procedures claim that there are early postoperative advantages to be gained by the patient in the form of decreased pain and weakness, thus facilitating an earlier return to function. However, serious complications associated with the use of these techniques have been reported, especially during the surgeon's purported initial steep learning curve. A prospective analysis of the authors' first 51 cases using a two-portal endoscopic technique was conducted to determine whether these learning curve complications occurred. The authors did experience a learning curve; however, it was not significant. They encountered no serious complications and patient satisfaction was very high. It is concluded that the procedure is relatively easy to learn and safe to perform.
RESUMEN
BACKGROUND AND PURPOSE: The scale of stroke impairment characteristics by Brott and associates, the National Institutes of Health (NIH) Stroke Scale, has been used widely in various studies of stroke outcome; however, the measurement properties of the items applied to patients during medical rehabilitation have not been evaluated thoroughly. This study evaluated the extent to which scale items cohere to define a unidimensional construct and have a useful range for application to patients during medical rehabilitation. METHODS: Rating scale (or Rasch) analysis of the 15 NIH Stroke Scale items was conducted using the BIGSTEPS computer program to evaluate (1) the range of impairment assessed by the items, (2) the items' coherence with an underlying construct of impairment, and (3) range of impairment measured in rehabilitation patients. We sought to maximize the range of impairment measured by conducting analyses recursively; at each subsequent step, the worst fitting item was deleted or rescored. The sample comprised 1291 admission and discharge records from 693 rehabilitation inpatients with stroke. RESULTS: Thirteen items arrayed the sample across a sufficient range of impairment. The limb ataxia item fit poorly and was deleted; lower ratings for this item were associated with higher scores on the total scale. Pupillary response was also deleted because ratings reflected poor congruence with the total score. Best language was rescored because intermediate ratings were inconsistently related to the total score. Patients with hemorrhagic strokes had poorer fitting measures than did patients with ischemic strokes. CONCLUSIONS: The items in a revised NIH Stroke Scale worked well together to define the severity of impairment resulting from stroke that is observed during medical rehabilitation. Directions regarding limb ataxia should be modified to indicate untestability due to hemiplegia.
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Trastornos Cerebrovasculares/diagnóstico , Trastornos Cerebrovasculares/rehabilitación , Evaluación de la Discapacidad , Anciano , Trastornos Cerebrovasculares/fisiopatología , Femenino , Humanos , Masculino , National Institutes of Health (U.S.) , Estados UnidosRESUMEN
Erectile dysfunction is a common complication of spinal cord injury. Of the 68 spinal cord injured men in whom treatment with papaverine was initiated a therapeutic dosage was determined in 50 (74%). Papaverine was injected into the base of one corpora cavernosum. The dose started at 3 mg and was increased at weekly or longer intervals until an effective dose was determined. There were 15 (30%) men with tetraplegia and 35 (70%) men with paraplegia. The dosage of papaverine did not relate to the level or extent of injury. Doses of 12 mg or less were used in 56% of patients. Low dose papaverine is a safe and effective means of restoring erections in spinal cord injured men.
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Disfunción Eréctil/tratamiento farmacológico , Papaverina/uso terapéutico , Adulto , Relación Dosis-Respuesta a Droga , Disfunción Eréctil/complicaciones , Humanos , Masculino , Conducta Sexual , Traumatismos de la Médula EspinalRESUMEN
The value of routine chest roentgenograms has come under increasing scrutiny in the medical literature. In this retrospective study we investigated the value of routine chest radiographs obtained on admission to a rehabilitation unit after an acute spinal cord injury. The charts of all patients admitted for rehabilitation after a traumatic spinal cord injury during a 1-year period were reviewed and 79 patients fulfilled criteria for inclusion into the study. Of the 79 patients, 12 had findings on routine admission films, 9 of which were felt to be significant (11.4%). All 9 patients with abnormal admission films had experienced cardiopulmonary complications during their acute hospitalization (P < 0.001). Fourteen patients with normal chest roentgenograms on admission had repeat films performed during their rehabilitation stay, 4 of which were abnormal. All 4 had experienced cardiopulmonary complications during their acute hospitalizations (P < 0.01). Our findings would support the selective use of admission chest roentgenograms in spinal cord-injured patients with clinical indications or a history of cardiopulmonary complications during their acute care stay.
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Pruebas Diagnósticas de Rutina , Radiografía Torácica , Traumatismos de la Médula Espinal/rehabilitación , Adulto , Cardiomegalia/diagnóstico por imagen , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Enfermedades Respiratorias/diagnóstico por imagen , Estudios Retrospectivos , Traumatismos de la Médula Espinal/complicacionesRESUMEN
Sixty-two consecutive acute spinal cord injury (SCI) patients who were aged 55 years or older were studied and compared to 296 SCI patients of age less than 55 years. Compared to younger patients, the older group had significantly more females (29%), preexisting medical conditions (87%), associated injuries (55%), incomplete quadriplegic patients (63%), and persons whose injuries resulted from falls (53%). There were no differences between groups in frequency of ventilator use, occurrence of medical complications, or acute length of stay, but older patients tended to have fewer surgical spinal fusions (40%), shorter rehabilitation stays (66.5 days), more indwelling urethral cathteters (31%), and more nursing home discharges (19%). With other factors being controlled, advancing age was predictive only of nursing home discharge, and not of acute or rehabilitation lengths of stay. Among older SCI patients, those with complete injuries were nearly 3 times as likely to have been discharged to nursing homes in our series compared to older patients with incomplete lesions. Although many aspects of the presentation, course, and care of older SCI individuals are similar to those of younger patients, there are several unique features of older adults with a SCI.
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Traumatismos de la Médula Espinal/epidemiología , Adulto , Factores de Edad , Anciano , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Paraplejía/epidemiología , Cuadriplejía/epidemiología , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/terapia , Resultado del TratamientoRESUMEN
Many laboratory demonstrations have been reported on standing or walking with the aid of electrical stimulation. These demonstrations have typically been in small numbers of selected spinal cord injured individuals. The extent to which this technology might ultimately be applicable to the spinal cord injured population at large is not presently known. This study reports estimates of the size of the potential user population of a specific surface electrical stimulation device and protocol. The medical records were reviewed of 192 patients with traumatic thoracic, lumbar, or sacral spinal cord injury resulting in paraplegia. Based on the inclusionary criteria, between 20 and 48 patients (10.4% and 25%) of this sample population could be considered eligible for this surface stimulation protocol. As approximately 45% of the USA population of spinal cord injured individuals have paraplegia, the results suggest that between 4.7% and 11.25% of all spinal cord injured persons in the USA might be potential users of this particular electrical stimulation technology.
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Terapia por Estimulación Eléctrica/métodos , Paraplejía/terapia , Postura , Adulto , Terapia por Estimulación Eléctrica/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismos de la Médula Espinal/terapia , TóraxRESUMEN
Several systems exist for classifying pressure ulcers, though none of them have been evaluated for interrater reliability. A new grading scale was compared with the commonly used Shea classification. This new scale was developed to provide a more complete description of pressure ulcer healing. The advantages of this scale include a classification of red areas as ulcers to help prevent further deterioration and classification of healed sores to note potential problems. The Yarkony-Kirk scale classifies a red area as a grade 1 ulcer, and involvement of the epidermis and dermis with no subcutaneous fat observed as a grade 2 ulcer. Grade 3 indicates exposed subcutaneous fat with no muscle observed. Exposed muscle without bone involvement is classified as a grade 4 ulcer, and grade 5 describes exposed bone with no joint space involvement. Grade 6 indicates joint space involvement. There is a classification of pressure sore healed to indicate a healed pressure ulcer. Interrater reliability was assessed by two nurses. In spite of an increased number of categories for the Yarkony-Kirk scale, there was no decline in reliability. Reliability was excellent with an interrater correlation of 0.90 for the Yarkony-Kirk scale and 0.86 for the Shea classification when measured for 72 patients. Eighty-five percent of the ratings for the Yarkony-Kirk scale were identical, whereas only 68% were identical for the Shea classification. Three percent of the ratings for the Shea classification were greater than +/- 1 category; 6% of the ratings for the Yarkony-Kirk scale were greater than +/- 1 category. This scale appears to possess good reliability and to describe pressure ulcers more completely. This scale may also be used to teach prevention activities as well as ulcer classification.
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Úlcera por Presión/clasificación , Humanos , Úlcera por Presión/patologíaRESUMEN
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.
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Centros de Rehabilitación , Traumatismos de la Médula Espinal/rehabilitación , Accidentes de Tránsito , Chicago , Femenino , Humanos , Tiempo de Internación , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Paraplejía/etiología , Cuadriplejía/etiología , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/etnología , Población BlancaRESUMEN
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.