1/30. Symptoms of recurrent intrathecal baclofen withdrawal resulting from drug delivery failure: a case report.A 24-yr-old, completely (T8) paraplegic male patient presenting with severe spasticity had a drug administration device implanted in April 1991 for continuous intrathecal administration of baclofen. After a period of remarkable improvement in both the spasticity level and his quality of life, the patient experienced several short-lasting episodes of increased spasticity, with severe spasms. Among the possible causes of these deleterious episodes were microcrystalluria, obstipation, a decubitus ulcer, a foreign body in the buttocks, drug tolerance to baclofen, electromagnetic interference, and erroneous filling and programing of the pump. The catheter was the most common source of intrathecal baclofen withdrawal symptoms and had to be changed four times in 5 yr. Intrathecal baclofen administered through an implantable drug administration device is a highly effective but complex and expensive procedure that requires careful patient selection and close monitoring by highly qualified and well-trained health professional. Withdrawal symptoms may be related to noncompliance on the part of the patient, erroneous filling or programing of the pump, depletion of the battery, random component failure, concomitant illness, drug tolerance, or advancement of the disease itself. When failure of the device is suspected, substitution with oral baclofen is recommended until a full work-up is performed to determine the defect.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/30. Spinal lesions, paraplegia and the surgeon.Thirty-six patients with spinal cord lesions and varying degrees of paraplegia were seen by the surgical team at the Angau Memorial Hospital, Lae, over a thirty month period. Because the continued presence of a spinal lesion may lead to progressive cord destruction and ischaemic myelopathy, prompt treatment is advocated. The depressing results that have followed treatment of fracture dislocations of the cervical spine and secondary neoplasm with paraplegia is recorded and some suggestions are made that may improve the outlook in future cases. Early and major surgery is advocated in the treatment of spinal abscesses, tumours, Pott's paraplegia and unstable fracture dislocations of the lumbar spine.- - - - - - - - - - ranking = 1.3318092541577keywords = neoplasm (Clic here for more details about this article) |
3/30. naloxone infusion and drainage of cerebrospinal fluid as adjuncts to postoperative care after repair of thoracoabdominal aneurysms.The mechanisms that produce paraplegia in patients after TAA repair are complex and involve alterations in regional blood flow to the spinal cord, CSF dynamics, and reperfusion. Although neither the minimal level of blood flow nor the maximal spinal cord pressure that can be tolerated by the spinal cord is known, adjuncts such as CSF drainage and naloxone infusions may allow longer durations of aortic cross-clamping before irreversible ischemia occurs. Because paraplegia is multifactorial and none of the recommended adjuncts alone provides complete protection of the spinal cord, a combination of treatments may be necessary to reduce the prevalence of neurological complications after thoracoabdominal aortic reconstruction. critical care nurses thus must be acquainted with the advanced monitoring techniques and the pathophysiology behind these new treatment modalities. Advanced assessment skills are also essential to recognize the potential neurological complications that may occur in these patients. Care of patients with TAA is a challenge. critical care nurses must use multidimensional skills in the areas of hemodynamic monitoring, physical assessment, and psychological counseling to effectively manage postoperative care of these patients.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
4/30. Prosthetic ambulation in a paraplegic patient with a transfemoral amputation and radial nerve palsy.Great importance and caution should be placed on prosthetic fitting for a paraplegic patient with an anesthetic residual limb if functional ambulation is to be achieved. The combination of paraplegia with a transfemoral amputation and radial nerve palsy is a complex injury that makes the rehabilitation process difficult. This article describes a case of L2 paraplegia with a transfemoral amputation and radial nerve palsy on the right side. Following the rehabilitation course, the patient independently walked using a walker at indoor level with a transfemoral prosthesis with ischial containment socket, polycentric knee assembly, endoskeletal shank and multiaxis foot assembly and a knee ankle foot orthosis on the sound side. The difficulties of fitting a functional prosthesis to an insensate limb and the rehabilitation stages leading to functional ambulation are reviewed.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
5/30. A case study in evidence-based wound management.On the first of July 1998, Frank Dobson, the then Secretary of State for health, revealed the consultation document 'A First Class Service' (Department of health (DoH), 1998). This article describes a wound management case study which showed how a first class service was provided for a patient with very severe pressure ulcers and complex medical problems. A multiprofessional approach to her complex and challenging problems was maintained. Evidence-based guidelines for the prevention and management of pressure damage were followed, supported by modern researched-based wound management and pressure relief. In addition, risk management strategies were observed, and provided the basis for planning and evaluating her individualized care.- - - - - - - - - - ranking = 2keywords = complex (Clic here for more details about this article) |
6/30. carcinoma in isolated bladder after ileoconduit diversion.A thirty-six-year-old Caucasian male paraplegic of sixteen years' duration, who was found to have carcinoma of the bladder about twenty-three months after an ileoconduit diversion had been performed for decompensated neurogenic bladder is presented. Chronic infection and residual urine may irritate or accelerate the process of neoplastic change in transitional epithelium. Obviously the supravesical diversion of urine in this patient did not avoid the occurrence of cancer. A plea is made for periodic checks using bladder exfoliative cytology and cystoscopy of the isolated bladder for early detection of vesical neoplasm.- - - - - - - - - - ranking = 1.3318092541577keywords = neoplasm (Clic here for more details about this article) |
7/30. New controller for functional electrical stimulation systems.A novel, self-contained controller for functional electrical stimulation systems has been designed. The development was motivated by the need to have a general purpose, easy to use controller capable of stimulating many muscle groups, thus restoring complex motor functions (e.g. standing, walking, reaching, and grasping). The designed controller can regulate the frequency, pulse duration, and charge balance on up to 16 channels, and execute pre-programmed and sensory-driven control operations. The controller supports up to eight analog and six digital sensors, and comprises a memory block for including history of the sensory data (time series). Five independent timers provide the basis for the multi-modal and multi-level control of movement. The PC compatible interface is realised via an IR serial communication channel. The PC based software is user friendly and fully menu driven. This paper also presents a case study where the controller was implemented to restore walking in a paraplegic subject. The assistive system comprised the novel controller, the power and output stages of an eight-channel FES system (IEEE Trans Rehabil Eng, TRE-2 (1994) 234), ankle-foot orthoses, and a rolling walker. Stimulation was applied with surface electrodes positioned over the motoneurons that innervate muscles responsible for the hip and knee flexion and extension. The sensory system included goniometers at knee and hip joints, force-sensing resistors built in the shoe insoles, and digital accelerometers at the hips. A rule-based control algorithm was generated following a two-step procedure: (1) simulation and (2) machine learning as described in earlier studies (IEEE Trans Rehab Eng, TRE-7 (1999) 69). The paraplegic subject walked faster, and with less physiological effort, when automatic control was applied as compared to hand-control. This case study, as well as a previous one for assisting grasping (The design and testing of a new programmable electronic stimulator. N. Fisekovic, MS thesis. University of Belgrade, Belgrade, 2000) indicate that the novel control unit is effectively applicable to FES systems.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
8/30. Hypercoagulable state leading to paraplegia in a middle-aged man.A 37-year-old man presented with an unusual thrombotic disorder characterized by acute paraplegia and the absence of palpable pulses due to extensive arterial thrombosis of the aorta and its distal branches. The patient had an extremely complicated course that necessitated multiple revascularization procedures over a 1.5-year period. This case is unusual not only because of its complexity but also because of the patient's relatively young age, his lack of risk factors for vascular disease, and the presence of a neurologic deficit that improved when circulation was restored. More unusual, however, is the fact that all diagnoses were excluded except for a high lipoprotein(a) level. To our knowledge, this is the 1st reported case in which aortic thrombosis has been related to hypercoagulability.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
9/30. Event-related brain potentials in a patient with akinetic mutism.The clinical pattern of complete akinetic mutism (AM) was observed in a patient with a bilateral infarction of the anterior cerebral arteries extending to the rostral cingulate cortex and the supplementary motor areas. Since the patient was unable to produce any overt response, event-related brain potentials (ERPs) were used to obtain information about cortical processing of stimuli. Oddball tasks with simple acoustical stimuli and semantic categories were used. Verbal processing was further assessed by comparing event-related potentials to words compatible versus incompatible to the semantic context. Although the pattern of cortical responses was abnormal, differential responses were clearly obtained to semantically different word classes. Thus, the hypothesis about cortical non-responsivity of AM patients, drawn from several previous reports, was not supported. An ERP examination in AM patients can deliver information about their mental state, provided that the stimuli and tasks possess a wide range of informational complexity and motivational value.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
10/30. Unusual presentation of posterior mediastinal chordoma in a 2-year-old boy.chordoma is a rare and slow-growing malignant neoplasm that arises from the embryonic notochord. It is rare to see a thoracic chordoma presenting as a posterior mediastinal mass with pleural seeding in a child. The authors report a chordoma of the thoracic spine with posterior mediastinal extension and pleural seeding in a 2-year-old boy who presented with asymmetric bilateral hand temperature and lower limb paralysis. The clinical course progressed rapidly, resulting in death.- - - - - - - - - - ranking = 1.3318092541577keywords = neoplasm (Clic here for more details about this article) |
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