ABSTRACT
STUDY DESIGN: A case-control study was conducted. OBJECTIVE: The aim of the study was to test the hypothesis that the increase in hydrostatic pressure on the abdominal wall may be the major determinant of vital capacity (VC) improvement in tetraplegic subjects during water immersion, despite the blood volume shifts from the legs and abdomen to the thorax. SETTING: The study was carried out in the Rehabilitation Center, Brasília/DF, Brazil. METHODS: In total, 11 men with tetraplegia (complete motor lesion, C4-7, 30.4 years old) and 12 healthy controls were studied. Hematocrit level and spirometry values were obtained on dry land and at each level of immersion (the pelvis, xiphoid and neck). RESULTS: Baseline spirometry value of tetraplegic subjects showed reduced VC (53.3+/-17.4% of predicted), whereas all control subjects had >80% of predicted values. Neither group showed significant changes in VC at the pelvic and xiphoid levels of immersion. In tetraplegic subjects, VC increased by 27.2% at the neck level (+/-25.8, P<0.008), whereas in healthy subjects it decreased by 6.3% (+/-5.0, P<0.008). Both groups showed significantly increased inspiratory capacity only when immersed to the neck. Hematocrit level of tetraplegic subjects fell significantly with immersion to the xiphoid and neck levels (P<0.017), which occurred in controls only at the xiphoid level (P<0.017). CONCLUSIONS: Hydrostatic compression may be the main contributor to improving VC in tetraplegic subjects immersed in water. This improvement occurs despite increased plasma volume during immersion.
Subject(s)
Hydrotherapy/methods , Plasma Volume/physiology , Respiratory Paralysis/physiopathology , Respiratory Paralysis/therapy , Spinal Cord Injuries/physiopathology , Vital Capacity/physiology , Adult , Case-Control Studies , Hematocrit , Hemodynamics/physiology , Humans , Hydrostatic Pressure , Immersion , Inhalation/physiology , Male , Quadriplegia/etiology , Quadriplegia/physiopathology , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , Respiratory Paralysis/etiology , Spinal Cord Injuries/complications , Spirometry , Thorax/anatomy & histology , Thorax/physiopathology , Treatment OutcomeABSTRACT
During 20 year period (1972-1992) 56 patients with a diagnosis of schistosomal myeloradiculopathy were admitted in three hospitals of Belo Horizonte-Minas Gerais. Data from patients were collected retrospectively from their medical records. In all cases, the diagnosis was inferred in a presumably way and was based on the following considerations: 1) the finding of low thoracic/upper lumbar neurological symptoms; 2) positive epidemiology for schistosomiasis; 3) demonstration of exposure to schistosomiasis through parasitologic or serologic techniques; and 4) the exclusion of other known causes of transverse myelitis and myeloradiculitis. Several clinical and epidemiological aspects were studied to determine the diagnosis profiles of the schistosomal myeloradiculopathy in this sample and are presented in this paper. In recognizing the many problems in diagnosis of schistosomal myeloradiculopathy we emphasize how important is thinking about this entity and criteria to improve diagnostic evaluation are suggested.
Subject(s)
Neuroschistosomiasis/diagnosis , Schistosomiasis mansoni/diagnosis , Spinal Cord Diseases/diagnosis , Adolescent , Adult , Brazil/epidemiology , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Neuroschistosomiasis/complications , Neuroschistosomiasis/epidemiology , Retrospective Studies , Schistosomiasis mansoni/complications , Schistosomiasis mansoni/epidemiology , Spinal Cord Diseases/epidemiology , Spinal Cord Diseases/parasitologyABSTRACT
BACKGROUND: Dynamic cardiomyoplasty has been considered to be an effective method of surgical treatment of patients with end-stage heart failure, and is an alternative to heart transplantation. METHODS: We critically evaluated the long-term course of 52 patients with dilated cardiomyopathy who underwent dynamic cardiomyoplasty and were followed-up for up to 110 months. RESULTS: Dilated cardiomyopathy was due to undetermined cause in 42 patients (80.8%), Chagas disease in 8 (15.4%), viral infection in 1 (1.9%), and peripartum cardiomyopathy in 1 (1.9%). In the nonchagasic group the survival rates were 79.5% +/- 6.1%, 67.8% +/- 7.1%, 53.7% +/- 8.3%, 49.9% +/- 8.3%, 14.9% +/- 12.2%, and 14.9% +/- 12.2%, respectively, at 12, 24, 48, 60, 80 and 110 months of follow-up. In the chagasic patients the survival rates were 37.5% +/- 17.1%, 12.5% +/- 11.7%, 12.5% +/- 11.7% and 0%, respectively, at 12, 24, 48, and 60 months of follow-up, making chagasic cardiomyopathy a possible contraindication for dynamic cardiomyoplasty. CONCLUSIONS: There was no correlation between the clinical improvement and hemodynamic data. Ventricular fibrillation was a frequent cause of immediate and late death, suggesting the need for prophylactic use of antiarrhythmic drugs or implantable cardioverter/ defibrillators.
