Use of alternative therapies by rehabilitation outpatients.

OBJECTIVE: To document the prevalence and patterns of use of alternative medical therapies as well as their perceived effectiveness by patients in a rehabilitation medicine outpatient practice. DESIGN: Cross-sectional survey by written questionnaire. SETTING: An urban rehabilitation medicine outpatient referral office. PATIENTS: A random sample of 103 patients referred for rehabilitation outpatient care, while waiting for their appointment, were given a questionnaire addressing their use of alternative therapies. MAIN OUTCOME MEASURES: Use of alternative therapies and their perceived effectiveness. RESULTS: One or more alternative medical therapies had been used by 29.1% of subjects in the past 12 months for their presenting problem. The most common therapies were massage, chiropractic, vitamin and mineral supplementation, and acupuncture. Musculoskeletal pain syndromes involving the spine and extremities were the most common problems for which patients sought both physiatric and alternative care. Of the patients who used alternative treatments 53% reported some degree of efficacy. CONCLUSIONS: A significant proportion of rehabilitation medicine patients use and frequently perceive a benefit from alternative therapies, particularly massage, chiropractic, vitamin and mineral supplementation, and acupuncture. Incorporating alternative therapies into physiatric practice is a desirable future direction for the specialty.

Odontoid fracture and C1-C2 subluxation in psoriatic cervical spondyloarthropathy. A case report.

STUDY DESIGN: Case presentation and review of pertinent literature. OBJECTIVES: To present an unusual case and alert other physicians to possible missed diagnoses. SUMMARY OF BACKGROUND DATA: An unusual case is presented of a young man with server psoriatic spondyloarthropathy and fusion of C2-C7 (Type II cervical psoriatic ankylosing disease) who fell at home, sustaining an unrecognized fracture of the odontoid process leading to subluxation of C1-C2 and the transitory tetraplegia. The patient presented with torticollis, and the fracture was unrecognized for a long period of time. METHODS: Case presentation. RESULTS: This patient became independent in all activities of daily living after surgery and rehabilitation despite persistence of torticollis. CONCLUSIONS: A patient who presents clinically with traumatic torticollis after minor trauma and who also has psoriasis and ankylosis of the cervical spine should be suspected of having a fracture-subluxation until definitely proven otherwise. In the present case, the late diagnosis delayed surgical stabilization.

The effect of norepinephrine infusion on oxygen delivery and consumption in the canine model.

Norepinephrine (NE) is used clinically to increase oxygen delivery (DO2) by increasing cardiac output (CO). The rate of administration of NE is usually based on frequent measurements of blood pressure (BP) and infrequent measurements of CO with little regard for oxygen delivery or consumption dynamics. Although the ultimate goal of an inotropic drug is to increase DO2 in excess of metabolic requirements (VO2), the effect of NE on the DO2/VO2 ratio has not been previously studied. In the present investigation, healthy anesthetized dogs were infused with various doses of intravenous NE. These dosages were chosen to span the range used clinically. NE administration caused a significant primary increase in VO2 which was dose dependent (P < 0.001). A similar dose-dependent increase in DO2 was observed (P < 0.001). However, the increase in DO2 minimally exceeded the increase in VO2 at lower doses of NE and the relative increase in VO2 exceeded the change in DO2 at a dose of 0.04 microgram/kg/min. Minimal advantage to oxygen utilization physiology at low doses of NE and a potential deleterious effect at a dose of 0.04 microgram/kg/min were observed, therefore, despite associated increases in mean systemic blood pressure. The effectiveness of NE administration could be most effectively monitored by the mixed venous oxygen saturation (SVO2), rather than by intermittent assessment of BP, CO, or DO2.(ABSTRACT TRUNCATED AT 250 WORDS)