Asunto(s)
Anestésicos Intravenosos/administración & dosificación , Hipnóticos y Sedantes/administración & dosificación , Trastornos Migrañosos/tratamiento farmacológico , Propofol/administración & dosificación , Administración Intravenosa , Adolescente , Adulto , Anciano , Niño , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
OBJECT: Randomized clinical trials have established that lumbar selective dorsal rhizotomy (SDR) reduces lower-extremity tone and improves functional outcome in children with spastic cerebral palsy. Significant data exist to support a secondary effect on upper-extremity function in patients with upper-extremity spasticity. The effects of SDR on upper-extremity tone, however, are not well characterized. In this report, the authors sought to assess changes in upper-extremity tone in individual muscle groups after SDR and tried to determine if these changes could be predicted preoperatively. METHODS: The authors retrospectively reviewed 42 children who underwent SDR at Columbia University Medical Center/Morgan Stanley Children's Hospital of NewYork-Presbyterian between 2005 and 2011. Twenty-five had upper-extremity spasticity. All underwent pre- and postoperative examination for measuring tone (Modified Ashworth Scale) and assessing functional outcome. Follow-up examinations with therapists were performed at least once at a minimum of 2 months postoperatively (mean 15 months). RESULTS: In the upper extremities, 23 (92%) of 25 patients had improvements of at least 1 Ashworth point in 2 or more independent motor groups on the Modified Ashworth Scale, and 12 (71%) of 17 families surveyed reported increases in motor control or spontaneous movement. The mean Modified Ashworth Scale scores for all upper-extremity muscle groups demonstrated an improvement from 1.34 to 1.22 (p < 0.001). Patients with a mean preoperative upper-extremity tone of 1.25-1.75 were most likely to benefit from reduction in tone (p = 0.0019). Proximal and pronator muscle groups were most likely to demonstrate reduced tone. CONCLUSIONS: In addition to improvements in lower-extremity tone and function, SDR has demonstrable effects on upper extremities. Greater than 90% of our patients with elevated upper-extremity tone demonstrated reduction in tone in at least 2 muscle groups postoperatively. Patients with a mean Modified Ashworth Scale upper-extremity score of 1.25-1.75 may encounter the greatest reduction in upper-extremity tone.
Asunto(s)
Parálisis Cerebral/fisiopatología , Parálisis Cerebral/cirugía , Espasticidad Muscular/terapia , Rizotomía/métodos , Extremidad Superior/fisiopatología , Adolescente , Niño , Preescolar , Femenino , Humanos , Vértebras Lumbares , Masculino , Periodo Posoperatorio , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the effects of focused, extracorporeal shock wave therapy (ESWT) on the healing of wounds of the distal portion of the limbs in horses. DESIGN: Randomized controlled trial. ANIMALS: 6 healthy adult horses. PROCEDURES: In each horse, a 4-cm-diameter full-thickness wound that included underlying periosteum was created on the dorsomedial aspect of each metacarpus and two 3-cm-diameter full-thickness wounds that included underlying periosteum were created on the dorsomedial aspect of each metatarsus. One randomly selected metacarpal wound and a randomly selected pair of metatarsal wounds were treated once weekly with ESWT at an energy flux density of 0.11 mJ/mm(2). For metacarpal wounds, swab specimens were collected for bacterial culture on days 1, 2, and 3 and area of epithelialization and extent of wound contraction were measured at 3- to 4-day intervals. Metatarsal wounds were biopsied after 2 and 4 weeks, and immunohistochemical staining for vascular endothelial growth factor, transforming growth factor-beta1, and insulin-like growth factor-1 was performed. RESULTS: Results of bacterial culture, area of epithelialization, and percentage of wound contraction did not differ between treated and untreated wounds; however, healing time for treated wounds (mean, 76 days) was significantly shorter than healing time for untreated wounds (90 days). Staining intensity of growth factors did not differ significantly between treated and untreated wounds. CONCLUSIONS AND CLINICAL RELEVANCE: Findings suggested that ESWT may stimulate healing of wounds of the distal portion of the limbs in horses, although the mechanism by which healing was stimulated could not be identified.
Asunto(s)
Extremidades/lesiones , Ondas de Choque de Alta Energía/uso terapéutico , Caballos/lesiones , Cicatrización de Heridas/efectos de la radiación , Animales , Biopsia , Extremidades/patología , Tejido de Granulación/patología , Tejido de Granulación/efectos de la radiación , Procesamiento de Imagen Asistido por Computador , Inmunohistoquímica/veterinaria , Factor I del Crecimiento Similar a la Insulina/análisis , Factor de Crecimiento Transformador beta/análisis , Factor A de Crecimiento Endotelial Vascular/análisis , Cicatrización de Heridas/fisiología , Heridas y Lesiones/microbiología , Heridas y Lesiones/terapia , Heridas y Lesiones/veterinariaRESUMEN
The use of discrete variable representations is now commonplace in chemical dynamics calculations. In this paper, we employ spectral difference methods to speed up these calculations. We present five new spectral difference weight functions and compare them with those that already exist in the literature for two different bound state problems. We find that one particular weight we propose, based on a Gaussian function, outperforms all other weights.