Use of statistical checks as maintenance tools for TLD readers.

Although the values of different parameters may remain within permissible limits during the operation of a thermoluminescent dosemeter (TLD) reader, certain effects can become apparent only when a long-term followup of these parameters is performed. In order to ensure an accurate and reliable operation of a TLD reader, the system characteristics must be monitored continuously. Long-term statistical checks of key system parameters may give a broader insight into the operational characteristics of the TLD reader and may help for proper maintenance of the system. The photomultipliers noise, the internal reference light source stability and the A to D reference voltage were found to be critical parameters, which have a major influence on the accuracy and stability of the system. A followup of these parameters for a period of about 10 y is presented, and some problems are seen to be reflected in the distributions.

Quantifiable dose-dependent withdrawal after morphine discontinuation in a rat model.

We evaluated the intensity of the withdrawal symptoms after the discontinuation of the morphine infusion in rats. Opiate addiction was induced by progressively increasing intraperitoneal morphine infusion rates. The control group (Group 1) received normal saline. The initial morphine rates were 1, 4, and 16 mg kg(-1) h for Groups 2, 3, and 4, respectively. Infusion rates were gradually increased by a factor of 1.4, 2, 2.8, and 4 on the second, third, fourth, and fifth days, respectively. The last rate was used for 48 h and then infusions were disconnected. Weight reduction, food consumption, and water intake were used for evaluation of withdrawal. All morphine groups showed a significant reduction of body weight during the 4 postdiscontinuation days and a decline in food and water intake on the first postdiscontinuation day. All changes were dependent on the morphine infusion concentration. No changes were observed in the control group. We suggest that the rat model used in this study may be utilized for quantification of spontaneous withdrawal.

Long-term morbidity and mortality after spinal cord injury: 50 years of follow-up.

OBJECTIVE: To determine the long-term mortality rate and the types of morbidity among all people with spinal cord injuries (SCI) that occurred during the 1948 Israel War of Independence. METHOD: Chart review and telephone interviews for collecting demographic data, injury characteristics, marital status, physical activities, employment, morbidity and mortality. RESULTS: Twenty individuals with SCI (19 males, one female). There was no regular follow-up during the first 20 years post injury. The most frequent morbidities were genito-urinary, cardiovascular and decubiti. Ten (50%) had died during this overall follow-up interval. The average age at death was 60 years. The cause of death was cardiovascular in six, neoplastic disease in two, pneumonia in one, and one died from an unknown cause. CONCLUSIONS: The data analysis showed that those who died participated less in physical activity and fewer were employed as compared to the survivors.

Hybrid functional electrical stimulation orthosis system for the upper limb: effects on spasticity in chronic stable hemiplegia.

A new hybrid functional electrical stimulation orthosis system for the upper limb has been designed to allow for ease of use in the home as a daily treatment modality, as well as offer the opportunity for function enhancement. In a pilot study, the system was used by ten patients with chronic stable hemiparesis secondary to cerebral vascular accident and head injuries. The patients were referred by their treating physicians or therapists after meeting the inclusion criteria of good general health, being greater than one year after head injury, or being ten months post-stroke, with no observed neurologic changes in the prior six weeks. Each of these patients had received prolonged physical therapy, either continuous from the initial inpatient rehabilitation treatment or on an intermittent basis over a period of years. The baseline status for factors related to increased muscle tone, i.e., passive range of motion at the wrist and elbow, posture at rest, posture immediately following activity, and spasticity were quantified before the treatment protocol with the functional electrical stimulation orthosis. Active range of motion and tests of functional use of the involved upper limb were also assessed. The patients were instructed in the protocol, trained in the use of the system, and then used the electrical orthosis at home for up to several hours per day. Follow-up assessments were at six months. A statistically significant improvement was noted in all muscle tone/spasticity parameters measured. A separate report will describe the effects on voluntary motion and functional capabilities.

[Treatment of flail chest].

We present our experience in the treatment of 82 patients with flail chest (FC). They were evaluated according to the number of fractured ribs, which apparently correlates with the degree of lung contusion. Treatment methods compared were oxygen mask therapy, epidural analgesia, continuous positive airway pressure (CPAP), intermittent mandatory ventilation (IMV) plus positive end respiratory pressure (PEEP), and high frequency ventilation (HFV) plus PEEP. Oxygen therapy alone was not effective in those with more than 5 fractured ribs, while CPAP was effective in those with up to 10 fractured ribs. No significant difference was found between IMV and HFV. The purpose of respiratory support in FC is to reduce atelectasis and the resulting shunt, and to improve removal of mucus from airways. The patients were discharged without compromise in respiratory function, despite persistence of FC. We conclude that the primary mechanism of respiratory impairment in FC is not the mechanical disturbance, but rather the degree of lung contusion suffered.

Cardiac conduction defects associated with hyponatremia.

Cardiac conduction defects have not been previously described in association with hyponatremia, although in patients with congestive heart failure the frequency of ventricular premature beats was found to correlate to the severity of hyponatremia. We describe three patients with second-degree or complete atrioventricular (AV) block which occurred during or shortly after an episode of severe hyponatremia. The first had thiazide-induced hyponatremia while on amiodarone. In the second, definite etiology for hyponatremia which was associated with longstanding polydipsia could not be established. The third had ischemic heart disease and intermittent conversion of his first-degree to second-degree AV block while hyponatremic after diuretics use. Although it is usually difficult to single out hyponatremia as the cause of conduction defects which usually occur in the presence of cardiac disease, potent medications or other electrolyte abnormalities, we suggest that hyponatremia may play a role in the pathogenesis of conduction defects in the diseased heart.

Ciprofloxacin in the treatment of nosocomial multiply resistant Acinetobacter calcoaceticus bacteremia.

Twelve cases of multiply resistant Acinetobacter calcoaceticus bacteremia occurred in three intensive care units in three different outbreaks. All patients were mechanically ventilated, on broad spectrum antibiotics and had central lines when bacteremia occurred. The sites of primary infection were: abdominal (n = 3); respiratory (n = 4); central lines (n = 4); CNS (n = 1). In eight cases the acinetobacter strains were susceptible to ciprofloxacin only. Four other strains were sensitive to amikacin as well. All 11 patients treated with ciprofloxacin alone (seven) or in combination with amikacin (four) fully recovered from the infection. The 12th patient died before antibiotic susceptibility was available. Ciprofloxacin seems to be an excellent therapeutic agent for A. calcoaceticus infections.

Hyperprolactinemia, galactorrhea and amenorrhea in women with a spinal cord injury.

Six women with a traumatic spinal cord injury (SCI) developed hyperprolactinemia, amenorrhea and galactorrhea. Five of them had thoracic level lesions and 1 had a lumbosacral lesion. Two were postpartum and 1 was pregnant at the time of injury. Transient diabetes insipidus developed in 1 patient. Temporary administration of bromocriptine decreased prolactin levels, caused cessation of lactation and restored ovulatory cycles. The syndrome disappeared spontaneously in all 6 patients. Pituitary stalk concussion resulting from the trauma might cause this phenomenon, with the level of the cord injury playing a role. Being pregnant or early postpartum can predispose women to develop this syndrome.

Acute intermittent arteriomesenteric occlusion of the duodenum after use of Harrington's spinal instrumentation: case report.

We report on a traumatic paraparetic patient, who developed acute intermittent arteriomesenteric occlusion of the duodenum after the use of Harrington's spinal instrumentation. This rare condition was treated conservatively. It is presumed that some degree of hyperlordosis of the lumbar spine by the rods was responsible for this phenomenon.

The rehabilitation of patients with severe Guillain-Barré syndrome.

Twenty four of more than 800 patients admitted to our centre presented with a severe Guillain-Barré Syndrome. The length of hospitalisation, duration of illness, treatment, and the rehabilitation course of these patients are discussed. Suggestions are made concerning the necessity to obtain maximal rehabilitation for these patients.

Disappearance of quadriparesis due to a huge cervicothoracic aneurysmal bone cyst.

A young man who had suffered from rheumatoid arthritis developed a huge cervicothoracic aneurysmal bone cyst and progressive quadriparesis. Complete recovery occurred after "incomplete therapy," which consisted of an open biopsy and a small dose of irradiation. This tumor was observed and characterized as a blood-filled cyst excavated from the bone. Because of the controversy in the literature over the benefit of surgery vs. irradiation, this report emphasizes the fact that even "partial" treatment may beneficially affect this tumor.

Massive centrifugal multitrauma resulting in paralysis and limb loss. A report of 4 cases and discussion of the special problems in rehabilitation.

Four cases are described wherein massive centrifugal trauma caused a whirl-whiplash type injury to the spinal cord resulting in paralysis. Two patients became paraplegics and two quadriplegics. In three cases, there was a loss of one or more limbs associated with other concomitant injuries. Attention is focused on the problems facing patients with a combination of plegias and amputation.

Survival after acute endosulfan intoxication.

The clinical course following endosulfan ingestion in a suicidal attempt is described. The clinical picture comprised three stages: the acute cardiac and convulsive stage followed by subacute pulmonary and convulsive stage and finally the slow recovery stage. This is the first known survivor of endosulfan ingestion.

Familial bilateral paralysis of diaphragm. Adult onset.

At age 50 two homozygote twin brothers developed bilateral paralysis of the diaphragm. No infectious, metabolic, degenerative or proliferative disorders of the neuromuscular system and no thoracic diseases which could explain this lesion were detected during four years of follow-up. It appears thus to be an isolated lesion of genetic origin. To the best of our knowledge, no similar cases have been reported in literature.

Subclinical brachial plexopathy following median sternotomy.

In order to detect subclinical cases of brachial plexus injury following open heart surgery through median sternotomy, 15 patients were included in this prospective study. Physical and electrophysiologic examinations were performed preoperatively and postoperatively. The axillary F-loop latency was used to diagnose the brachial plexopathy. No clinical symptoms were found in this group postoperatively. Of the 15 patients, 13 (87%) were found to have a postoperative subclinical brachial plexopathy, at least on one side, and in eight of the patients, it was present on both sides.