ABSTRACT
This document is part of a series of guidelines documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These reference documents focus on a particular pathology (here patients with severe TBI). They describe for each given pathology patients' clinical and social needs, PRM care objectives and necessary human and material resources of the pathology-dedicated pathway. 'Care pathways in PRM' is therefore a short document designed to enable readers (physician, decision-maker, administrator, lawyer, finance manager) to have a global understanding of available therapeutic care structures, organization and economic needs for patients' optimal care and follow-up. After a severe traumatic brain injury, patients might be divided into three categories according to impairment's severity, to early outcomes in the intensive care unit and to functional prognosis. Each category is considered in line with six identical parameters used in the International Classification of Functioning, Disability and Health (World Health Organization), focusing thereafter on personal and environmental factors liable to affect the patients' needs.
Subject(s)
Brain Injuries/rehabilitation , Critical Pathways , Brain Injuries/psychology , Brain Injuries/therapy , Disability Evaluation , Glasgow Outcome Scale , Humans , Occupational Therapy , Physical Therapy Modalities , Speech TherapyABSTRACT
This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Stroke patients are divided into four categories according to the severity of the impairments, each one being treated according to the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients.
Subject(s)
Aftercare , Critical Pathways/organization & administration , Stroke Rehabilitation , Cognition Disorders/rehabilitation , Critical Pathways/economics , Humans , Mobility Limitation , Needs Assessment , Occupational Therapy , Paralysis/rehabilitation , Physical Therapy Modalities , Postoperative Care , Severity of Illness Index , Speech Therapy , Stroke/psychology , Stroke/therapyABSTRACT
OBJECTIVE: Aortoenteric fistula is a rare and serious pathology with a high mortality rate (around 50%). The surgery's neurological complications are also rare (around 0.25% of reconstructive interventions); two-thirds are spinal cord infarcts, with the remaining one-third corresponding to cases of ischemic polyradiculopathy. The latter condition is rarely described and appears to have a better functional prognosis. METHODOLOGY: We report a patient case with aortoduodenal fistula complicated, first by acute haemorrhage and then, by polyradicular damage and a sensorimotor impairment in both legs. RESULTS: EMG revealed bilateral damage to the lumbosacral plexus but NMR did not detect any abnormalities. The motor impairment in the legs was linked to sensory damage. We monitored the patient for two years. The initial functional disability score was 68 but it worsened steadily to a maximum value of 126 two years later. CONCLUSION: The paraclinical data (EMG, NMR) and the functional worsening strengthened our diagnosis of bilateral lumbosacral plexus ischemia, which is rarely described. However, the prognosis appears to be better than for infarction of the conus medullaris, the principal differential diagnosis.
Subject(s)
Ischemia/etiology , Lumbosacral Plexus/blood supply , Paraplegia/etiology , Postoperative Complications , Aortic Diseases/surgery , Humans , Intestinal Fistula/surgery , Male , Middle Aged , Vascular Fistula/surgeryABSTRACT
OBJECTIVES: Osteopenia in lower extremity amputation is described with an increased risk of fracture and it seems to be interesting to study bone mass in a population of 99 amputees of limb. MATERIAL AND METHOD: We studied the bone mass with Dual Energy Xray Absorptiometry in patients with limb amputation, above and under knee and who have been treated in the rehabilitation department of Mulhouse's hospital and more specifically the percentage of the difference of the mesure between amputed and non amputed side and the influence on this mesure of several factors like sexe; age; diabetes mellitus; delay of amputation; aetiology and use of prosthesis. RESULTS: For all the population, we find lower values of BMD (Bone mineral density) for femoral neck -10.4% +/- 12.2 (P < 0,001) and trochanter -14.9% +/- 14.5 (P < 0,001) between amputated and non amputated side, and also comparing with normal population -19.9% +/- 18.8 (P < 0,001) for femoral neck and -8.8% +/- 22 (P < 0,001) for trochanter.There is no influence of sexe, age, and time since amputation on BMD. The study of sub-groupes shows that the loss of bone mass is depending on traumatic amputation, the level of amputation (above knee) and when prothetis doesn't fit. Arteritis or diabetis are not pejoratif factors. CONCLUSION: This work confirms the mechanical factors as an important parameter of bone loss in the limb amputation.
Subject(s)
Absorptiometry, Photon , Amputation, Surgical , Amputees , Bone Density , Bone Diseases, Metabolic/diagnosis , Leg/surgery , Adult , Age Factors , Aged , Aged, 80 and over , Amputees/rehabilitation , Artificial Limbs , Bone Diseases, Metabolic/complications , Bone Diseases, Metabolic/etiology , Chi-Square Distribution , Data Interpretation, Statistical , Female , Fractures, Bone/etiology , Humans , Male , Middle Aged , Risk Factors , Sex Factors , Time FactorsABSTRACT
Previous studies about urinary incontinence epidemiology are disparate. Incontinence affects about 7% of children between 5 and 14, without predominance of sex. Among adults, prevalence is higher for female. In male patients incontinence percentage varies between 1.4% and 2.9% according to the age, with a low increase in prevalence after the age of 40. In female population, the percentage varies between 4 and 57% according to age after 45, and menopause status. The menopause occurrence is not unanimous admitted as causal factor. Obstetrical traumatism, pelvic surgery, child enuresis, postpartum urinary incontinence increase the risk of urinary incontinence. Overall in France, we estimate that 39% of adult women have micturition disorder: 24% with urgency, 25% with pollakiurie and 21% with incontinence. A lot of studies underline that incontinence exists in young nullipara woman. Over the age of 65, prevalence of urinary incontinence is estimated between 14 and 55% (average 30%). Incontinence rate is higher in institution than at home.
Subject(s)
Urinary Incontinence/epidemiology , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Urinary Incontinence/psychologySubject(s)
Dependency, Psychological , Geriatric Nursing , Personality , Rehabilitation , Aged , Humans , Interpersonal Relations , Nursing AssessmentABSTRACT
The authors describe two cases of non parasitic cyst of the spleen of "enteroid" origin on histological examination. No similar cases have yet seen described in the medical literature that we consulted. The histology of these two cases is quite unusual in that cysts are multilocular and mucoid with a cylindrical mucus secreting epithelium similar to cystic tumours of the ovary. The outcome of the first case remains favorable four years after surgery. As in the case of mucoid or enteroid cyst of the ovary, a disembryological origin seems the most likely explanation of these cyst of the spleen.
