ABSTRACT
Weakness and spasticity of chest wall muscles are known to adversely affect pulmonary function in spinal cord-injured patients. To test the assertion that impaired strength and increased tone contribute to ventilation deficits, 52 patients with recent acute traumatic cervical and high thoracic spinal cord injury underwent complete pulmonary function testing. Regression analyses were performed to determine relationships between spinal cord injury level and pulmonary function test results and between Ashworth scale tone ratings and pulmonary function test results. Level of injury was found to be significantly correlated with expiratory reserve volume (and percent predicted expiratory reserve volume), residual volume/total lung capacity ratio, and negative inspiratory pressure but not with vital capacity, forced expiratory volume in one second, forced expiratory volume in one second/vital capacity ratio, inspiratory capacity, total lung capacity, functional residual capacity, residual volume, or positive expiratory pressure. There were significant correlations between Ashworth Scale tone ratings and negative inspiratory pressure but not between tone ratings and any of the other pulmonary function test results. It appears that muscle strength may be a more important factor than muscle tone in determining pulmonary function in spinal cord-injured patients and that both strength and tone are closely related to negative inspiratory pressure.
Subject(s)
Respiration , Respiratory Muscles/physiopathology , Spinal Cord Injuries/physiopathology , Adolescent , Adult , Female , Humans , Male , Middle Aged , Regression Analysis , Respiratory Function Tests , Vital CapacityABSTRACT
A 55-year-old woman with stage IV-B nodular sclerosing Hodgkin's lymphoma presented to the emergency department with fever and lethargy of 12 hours' duration. The patient developed massive intravascular hemolysis secondary to Clostridium perfringens sepsis and cardiac arrest unresponsive to transfusions and cardiac pulmonary resuscitation, and died within 4 hours of presentation. The differential diagnosis of massive intravascular hemolysis, as well as the pathogenesis and treatment of C perfringens-induced hemolysis, are discussed.
Subject(s)
Bacteremia/etiology , Clostridium Infections/etiology , Clostridium perfringens , Hemolytic-Uremic Syndrome/microbiology , Hodgkin Disease/complications , Diagnosis, Differential , Emergency Service, Hospital , Fatal Outcome , Female , Hemolytic-Uremic Syndrome/diagnosis , Hemolytic-Uremic Syndrome/therapy , Humans , Middle AgedABSTRACT
Spinal cord injury (SCI) causes restrictive ventilatory changes, with reductions in vital capacity, functional residual capacity, and expiratory reserve volume. Vital capacity (VC) often is used as an indicator of overall pulmonary function in these patients. In an effort to determine the extent to which VC correlates with other pulmonary function tests, 52 patients with recent acute traumatic SCI underwent complete pulmonary function testing. Statistical relationships were determined between VC and nine other tests. VC was found to be significantly correlated with forced expiratory volume in 1 s, inspiratory capacity, expiratory reserve volume, functional residual capacity, residual volume (RV), total lung capacity (TLC), and RV/TLC ratio, but not with maximum positive expiratory pressure nor with maximum negative inspiratory pressure. The excellent correlations between vital capacity and nearly all of the other pulmonary function tests support the use of VC as a single global measure of overall ventilatory status in SCI patients.
