Essential gains and health after upper-limb tetraplegia surgery identified by the International classification of functioning, disability and health (ICF).

STUDY DESIGN: A questionnaire-based survey. OBJECTIVES: To describe functional gains and health following upper-limb tetraplegia surgery using the International Classification of Functioning, Disability and Health (ICF) as a reference and to explore interconnections across different dimensions of functioning and health. SETTING: A specialized center for advanced reconstruction of extremities at Sahlgrenska University Hospital, Gothenburg, Sweden. METHODS: Fifty-seven individuals who participated in a satisfaction survey were included in the present study. Besides questions concerned with the respondents' satisfaction with different aspects of surgery, the measures included perceived overall health status (EQ-VAS) and achieved grip strength. Univariate analyses were used to explore interconnections between measures. RESULTS: The gains could be subcategorized and linked to the ICF domains 'mobility', 'self-care', 'communication', 'domestic life', and 'community, social and civic life', with 'handling objects' and 'maneuvering a wheelchair' as the most frequently reported gains. The mean EQ-VAS score was 67±22. No significant correlation was shown between grip strength and activity gains, nor between grip strength and perceived overall health. The degree of satisfaction was, however, associated with self-reported overall health among participants. CONCLUSION: The functional gains achieved after tetraplegia surgery could be applied to the ICF constructs' body functions/structures and activity with possible implications on participation. The overall health perception was relatively high and could be linked to the degree of satisfaction among participants. Muscle strength is not necessarily transferable to activity performance. This emphasizes the importance of addressing factors other than strength in the post-surgical rehabilitation and assessments.

Satisfaction with upper limb reconstructive surgery in individuals with tetraplegia: the development and reliability of a Swedish self-reported satisfaction questionnaire.

STUDY DESIGN: A questionnaire-based survey. OBJECTIVES: To assess satisfaction after upper limb reconstructive surgery in individuals with tetraplegia and to determine the reliability of a Swedish satisfaction questionnaire. SETTING: A center for advanced reconstruction of extremities, Gothenburg, Sweden. METHODS: Seventy-eight individuals with tetraplegia were invited to participate in the survey assessing satisfaction with the result of surgery across various domains. Measures of reliability included stability and internal consistency of domains consisting questions regarding global satisfaction, activities and occupation/schooling. RESULTS: Fifty-eight individuals (76%) participated, among whom 47 (82%) completed the questionnaire twice for repeatability assessment. The responses in the domains relating to global satisfaction, activities and occupation/schooling were positive in 83%, 72% and 31% of participants, respectively. Ninety-five percent felt they had benefited from the surgery, and 86% felt that the surgery had made a positive impact on their life. The psychometric testing indicated that the questionnaire yields scores that are reliable by both test-retest and internal consistency, with the exception of the domain occupation/schooling that had a high prevalence of missing and neutral responses and seemingly represents separate and distinct entities. CONCLUSION: Surgical rehabilitation of the upper limb in tetraplegia is highly beneficial and rewarding from a patient perspective, leading to satisfactory gains in activities of daily living as well as enhanced quality of life. The questionnaire is a reliable instrument for measuring satisfaction after surgery. However, occupationally and educationally related aspects of the surgical outcome should constitute separate domains, and further modifications of the questionnaire are thus recommended.

Rebalancing the tetraplegic wrist using extensor carpi ulnaris-tenodesis.

Patients with cervical spinal cord injury and tetraplegia often present with a radial deviation deformity of the wrist owing to impaired active wrist flexion and extension. Tenodesis of the extensor carpi ulnaris can help optimize grip strength. The purpose of the study was to compare reconstruction of the grip with and without extensor carpi ulnaris-tenodesis, as well as evaluating the outcome of the procedure. The grip strength of the group with tenodesis of the extensor carpi ulnaris was twice as strong as of the group without the tenodesis and with similar wrist joint flexion-extension range of motion. Correction of the wrist deformity enables a more ergonomic use of the hand. This may also help prevent shoulder pain, which is common among patients with tetraplegia.

Simultaneous powering of forearm pronation and key pinch in tetraplegia using a single muscle-tendon unit.

This study clinically assessed the concept that both thumb flexion and forearm pronation can be restored by brachioradialis (BR)-to-flexor pollicis longus (FPL) tendon transfer if the BR is passed dorsal to the radius. Six patients [two women and four men, mean age 32.3 years (SD 4.9, range 23-56)] underwent BR-to-FPL transfer dorsal to the radius and through the interosseous membrane (IOM). Lateral key pinch strength and pronation range of motion (ROM) were measured 1 year after surgery. A group of six patients [two women and four men, mean age 31.2 years (SD 5.0, range 19-52)] who underwent traditional palmar BR-to-FPL was included for comparison. Postoperative active pronation was significantly greater in the dorsal transfer group compared to the palmar group [149 (SD 6) and 75 (SD 3), respectively] and pinch strength was similar in the two groups [1.28 (SD 0.16) kg and 1.20 (SD0.21) kg, respectively]. We conclude that it is feasible to reconstruct lateral key pinch and forearm pronation simultaneously using only the BR motor.

Current concepts in reconstruction of hand function in tetraplegia.

Several recent developments in the field of reconstructive hand surgery in tetraplegia have created a foundation for further refinements of both surgical techniques and postoperative training strategies to improve the outcome of restoration of upper extremity functions. A remarkable means of improving function is the immediate activation of transferred muscle after surgery. Early active training of new motors not only prevents the formation of adhesions but facilitates the voluntary recruitment of motors powering new functions before swelling and immobilization-induced stiffness restrain muscle contractions. A common observation internationally over the past years is that the number of incomplete tetraplegics increases. This shift towards more incomplete injuries with spasticity as a common feature in addition to the paralysis has expanded and changed the spectrum of surgeries in this group of patients and also emphasizes the need for a revisit and further development of the different strategies for reconstruction of hand function.

[Oxidative and respiratory properties of isolated human kidney mitochondria]. / Oxidative und respiratorische Eigenschaften isolierter humaner Nierenmitochondrien.

The oxidative and respiratory properties of isolated human renal mitochondria are characterized on the basis of the respiratory rates under defined conditions (active and decoupled respiration as well as respiration in rest) with the help of the respiratory control index and the ADP/O quotient. In comparison to the renal mitochondria of the rats the balances for the substrates succinate and glutamate/malate are three- to fourfold smaller.

Inhibited efficiency of kidney mitochondria isolated from rats treated with cyclosporin A.

The effect of cyclosporin A (CYA) on the respiration and phosphorylation in rat kidney mitochondria was studied. When CYA (50 mg/kg/day) was subcutaneously administered to rats for 4 days, the state 3 respiration and uncoupled respiration of succinate and glutamate/malate respiration was decreased. The respiratory control index was decreased in glutamate/malate respiration. These ex vivo effects of mitochondrial dysfunction are discussed as CYA effects on kidney mitochondria occurring in the intact cell. The nephrotoxic effect of CYA could be demonstrated by increased excretions of urinary enzymes.

Different diuresis-dependent excretions of urinary enzymes: N-acetyl-beta-D-glucosaminidase, alanine aminopeptidase, alkaline phosphatase, and gamma-glutamyltransferase.

We studied how much of the lysosomal enzyme N-acetyl-beta-D-glucosaminidase (EC 3.2.1.30) and of the brush-border enzymes alanine aminopeptidase (EC 3.4.11.2), alkaline phosphatase (EC 3.1.3.1), and gamma-glutamyltransferase (EC 2.3.2.2) was excreted in urine over 8 h after a high intake of fluid (22 mL per kilogram of body weight). The hourly excretion of all four enzymes increased with the increasing urine flow rate. The excretion rate of the brush-border enzymes was more markedly influenced than that of N-acetyl-beta-D-glucosaminidase. By relating the enzyme excretion to urinary creatinine we could reduce the variability of brush-border enzyme output and could completely compensate for the effect of diuresis on the excretion of N-acetyl-beta-D-glucosaminidase.

Multiple forms of alanine aminopeptidase, alkaline phosphatase and gamma-glutamyltransferase in urine of healthy persons, patients suffering from kidney diseases and patients with kidney transplants.

The catalytic activities of alanine aminopeptidase, alkaline phosphatase and gamma-glutamyltransferase were determined in the soluble and particulate fractions of urine, after ultracentrifugation. In healthy adults the fractional catalytic activities in the supernatants were 0.53, 0.56 and 0.24, respectively. Nearly the same proportions were found in children. In patients suffering from chronic kidney diseases there was a tendency for the proportion of catalytic activity in the soluble fraction to increase. However, the separation into the multiple forms gave no higher diagnostic reliability than the determination of total catalytic activity of the respective enzymes. The determination of multiple forms has no clinical significance in the detection of rejection episodes in renal transplant recipients.