Restoration of lateral hand grasp using natural sensors.

A closed-loop control system for controlling the key grip of a C6 tetraplegic patient was developed. Natural sensors served as the source of the feedback signal. The neural signals from cutaneous receptors were picked up by an implanted cuff electrode placed around the radial branch of the median nerve innervating the lateral part of the index finger. Mechanical stress applied to the skin, like pressure and slips, resulted in an increase in amplitude of the recorded neural signal. The goal of the study was to determine whether the recorded neural signals were able to indicate the slip of an object during lateral grasp and whether the slip could be stopped by increasing the grasp force through functional electrical stimulation of the thumb adductor and flexor.

[Cryptococcal meningitis in patients without predisposing immunodeficiency]. / Kryptokokmeningitis hos patienter uden disponerende immundefekt.

Cryptococcal meningitis is a chronic or subacute meningeal infection that may have pulmonary or systemic manifestations and is caused by the yeast Cryptococcus neoformans. It has become an increasingly important pathogen in immunocompromised hosts, whereas cryptococcal meningitis is relatively rare in immunocompetent patients. The diagnosis is often delayed because of the sparse and nonspecific symptoms. We present two cases of cryptococcal meningitis in two patients without known predisposing factors. The symptomatology, diagnosis and treatment of the disease are discussed. The two cases illustrate that Cryptococcus neoformans should be considered in patients with cerebral symptoms and fever. The disease is potentially curable and early diagnosis with specific treatment are important prognostic factors.

The prevalence of hyperhidrosis in patients with spinal cord injuries and an evaluation of the effect of dextropropoxyphene hydrochloride in therapy.

The prevalence of annoying hyperhidrosis (HH) in patients with spinal cord traumatic lesions was investigated by a questionnaire. A total of 192 patients were sent the questionnaire, 154 patients answered, and 41 patients reported annoying sweating. Of these 41 patients, 13 had a somatic underlying cause and 28 indicated having annoying HH without a contributing somatic cause. Twenty-five patients with spinal cord injury (SCI) were included in a double-blind, randomized, placebo-controlled, crossover trial using dextropropoxyphene hydrochloride (DP) in a slow release form (Abalgin Retard 150 mg Benzon Pharma A/S, Copenhagen) twice a day, for the treatment of annoying HH. Nineteen patients with lesions between C4 and L4 completed the study. Eight found the active drug to be so effective that they wanted to continue the treatment while 3 preferred placebo. Six patients dropped out, 5 due to adverse effects. There was a trend towards an effect on sweating in daytime (p = 0.08-0.14). Given that the patients had a preference, which 15 of 19 had, the true frequency of patients preferring active treatment ranged from 32 to 84% (95% exact confidence limits). For those with SCI above T6 level the limits ranged from 40 to 97%. We conclude that in spite of the lack of statistically significant effect, it seems worthwhile to try DP for annoying HH, especially in patients with lesions above T6 level.

Symptoms and signs predictive of the voiding pattern after acute urinary retention in men.

Over a 9-month period 228 men were admitted for acute urinary retention to six different casualty wards in the Copenhagen area. The patients were followed in the corresponding urological departments for one year. Twenty-seven variables were registered for each patient. The cumulative rate of recurrent retention was 56% after one week and 68% after one year. Factors predictive of preserved voiding ability were a retained volume less than 500 ml, a known event provocative of acute retention, and a maximum flow rate of more than 5 ml/s after the retention. The maximum flow rate measured within the first week after the retention was reliable within the follow-up period if the voided volume was 150 ml or more. The etiology of the acute retention was infravesical obstruction in 90% of the patients, and 85% required subsequent surgical treatment. Predictive of surgical treatment for infravesical obstruction were recurrent urinary retention within one week, a volume of retention of more than 500 ml, the absence of a provocative situation prior to the retention episode and nocturia twice or more.

Acute urinary retention in women: a prospective study of 18 consecutive cases.

Over a 9 month period 18 women were admitted for acute urinary retention to six different Copenhagen hospitals, serving a population of approximately 700,000 people. Urodynamically 9 patients had underactive detrusor function, 2 had infravesical obstruction and 3 had both underactive detrusor function and infravesical obstruction. In 4 patients bladder and urethral function were not classified. In 10 patients a provocative event preceded the retention episode. Eleven patients developed recurrent retention within 3 months and 7 patients had persistent severe obstructive voiding problems. Best prognosis was found for patients with correctable infravesical obstruction and for patients with minimal symptoms prior to the retention episode.

Renal tubular acidosis following intestinal bypass: an etiological study.

Nine cases of the distal type of renal tubular acidosis (RTA) following intestinal bypass were found. Diagnosis was based on inability to acidify the urine to pH values below 5.40 despite systemic acidosis. Acidosis, if not present, was induced by giving ammonium chloride 0.1 g/kg body weight. Patients were examined for diseases known to cause RTA but no already known etiological factor was found. Hyperoxaluria was found in eight of the nine cases with RTA, while not present in patients without RTA or in obese control patients. A causal relationship between hyperoxaluria and RTA is suggested though not proved. Cases reported in the literature of renal damage following bypass are summarized and discussed in relation to presence of hyperoxaluria and RTA.