Lumbar spinal stenosis in an elderly patient.

BACKGROUND: The general population is aging, and lumbar stenosis is one of the more frequent conditions observed in an orthopedic or neurosurgical practice. METHODS: This case presentation is of an 86-year-old male who developed lumbar spinal stenosis with a progressive neurologic deficit that caused severe leg pain, affected bladder function, and affected gait. Relevant medical literature is reviewed. RESULTS: Bladder function and gait returned after spinal surgery, and this patient's pain was greatly reduced. A multidisciplinary team applied therapy after surgery. The medical literature does not concentrate solely upon patients older than 80, but a few are included in studies of younger patients. CONCLUSIONS: This case report illustrates that a patient over 80 can have a successful outcome with multidisciplinary medical coverage of medical, surgical, rehabilitative, social, and psychological areas. More studies need to be done of these patients.

Development of an academic productivity scale for departments of physical medicine and rehabilitation.

OBJECTIVE: To determine which factors related to departments of physical medicine and rehabilitation (PM&R) might contribute to the academic productivity of members of the teaching staff of those departments, and to develop an instrument that measures them. DESIGN: Prospective, inception cohort. SETTING: University medical center, academic PM&R departments. PARTICIPANTS: PM&R academic departments. INTERVENTION: Over a 6-year period, seven PM&R departments volunteered to use this instrument to measure academic productivity at 2-year intervals. Rasch analysis was applied to the generated data. MAIN OUTCOME MEASURE: Measurable items that were included in questions of the scale fell into six categories: research funding and/or experience; scholarly productivity; equipment and facilities; quality of the training program for resident physicians; continuing education efforts in research methodologies and professional organizational participation; and departmental leadership. Rasch analysis was applied to evaluate a new outcome instrument to measure academic productivity in PM&R departments. RESULTS: Twenty-eight of the original 42 questions survived the Rasch analysis and were retained. Questions were dropped either because they did not fit the Rasch analysis (4 of 42 questions) or because application of the Rasch analysis demonstrated that they were inappropriately or outstandingly easy (10 of 42 were inappropriately or outstandingly easy). CONCLUSION: This shortened instrument of 28 questions fits the Rasch analysis, has questions that evently range from easy to very difficult, and addresses six measurable categories that are correlates of PM&R departmental influences on the academic productivity of the PM&R teaching staff.

Cerebral aneurysms: analysis of rehabilitation outcomes.

OBJECTIVE: To classify deficits after aneurysmal subarachnoid hemorrhage (SAH) and correlate rehabilitation outcomes with these findings. DESIGN: A retrospective review of medical records. SETTING: Institution-based rehabilitation hospital. PARTICIPANTS: Eighty patients admitted to a rehabilitation facility after aneurysmal SAH. MAIN OUTCOME MEASURES: For each subject, data were collected for time between surgery and admission, total inpatient days, time orientation at discharge, and level of supervision required at discharge. RESULTS: Fifty-five percent of the subjects were women and 45% were men. The average age was 47 years. Sixty percent of the lesions were right-sided and 40% were left-sided. Aneurysms were localized, in decreasing order of frequency, in the anterior communicating artery, middle cerebral artery, posterior communicating artery, internal carotid artery, basilar artery, anterior cerebral artery, and posterior inferior cerebellar artery distribution. CONCLUSION: Longer rehabilitation stays were associated with right-sided lesions (mean = 44.64 versus 33.93 days) and motor impairment (mean = 43.8 versus 31.53 days). A trend suggested that motor impairment also predicted the level of supervision required at discharge. The shorter the time between surgery and admission to rehabilitation, the more likely the patient will be oriented at the time of discharge (29.47 versus 43.29 days).

Cognitive deficits after hepatic transplantation: relevance to the rehabilitation potential.

Alteration in central nervous system function is a well-known sequela of liver failure, but has been thought to be transient after transplantation surgery. We present two cases of cerebral pontine myelinosis complicating liver transplantation. Both of these cases presented with specific post-surgical cognitive deficits assessed by neuropsychological testing. These cognitive deficits altered the ability of each patient to become functionally self-sufficient and thus modified the rehabilitation potentials of these two patients significantly.

Publishing characteristics of chairpersons of physical medicine and rehabilitation departments.

Previous studies note that specific factors intrinsic to an academic department of physical medicine and rehabilitation influence the academic productivity of individual faculty members. To determine whether one of these factors is related to the productivity of departmental chairpersons, this issue was studied for the period from 1983 to 1993. The productivity of chairpersons serving 4 or more consecutive years in the same department significantly declined. Moreover, the productivity of long-term chairpersons (greater than 10 years) was significantly below that of the group of high-frequency publishing chairpersons. Departments with long-term chairpersons also had fewer publications than departments with high-frequency publishing chairpersons. The academic productivity of the chairperson is a factor likely to influence the productivity of the department.

Glucose oxidase sticks and cerebrospinal fluid rhinorrhea.

The recognition of cerebrospinal leakage from a fistula is an important consideration for any physician caring for a head-injured population. Several procedures including radiographic, intrathecal dye, nuclear medicine tracer studies, computerized tomography with metrizamide injection, and immunological fixation have been reported to help in the diagnosis. Introduction of glucose oxidase test sticks has been traditionally touted to be a reliable bedside indicator of CSF rhinorrhea; this case study demonstrates a falsely negative result from glucose oxidase sticks.

Posterior interosseous neuropathies: natural history.

Fifteen patients with unilateral posterior interosseous neuropathies were observed and 12 were followed for five years. Seven patients had had closed injuries to the elbow and eight had had spontaneous onset associated with heavy tennis or racquetball activity. All had electrodiagnostic abnormalities consistent with a posterior interosseous neuropathy. All injuries responded to conservative therapy and resolved with time.

Rotator cuff rupture: management with suprascapular neuropathy.

In patients with shoulder pain, weakness, and limitation of motion from rupture of the rotator cuff, there may be concomitant suprascapular neuropathy. In five patients with partial tears and one postsurgical patient with a complete tear of the rotator cuff, confirmed by arthrography, shoulder pain and weakness persisted 6 to 10 weeks after trauma. Electrodiagnosis in all six patients demonstrated prolonged suprascapular distal nerve latencies to the involved infraspinatus muscles. During the first 5 months after trauma, clinical recovery was much more rapid than later. Eight months after injury, despite conservative therapy, some discomfort remained and electrodiagnostic values had not completely returned to normal. The combination of a torn rotator cuff and a suprascapular neuropathy can present a complex diagnostic and management challenge, suggesting the importance of alertness to the possibility of such a combination in patients with tears of the rotator cuff.

Urosonography in spinal cord injury patients.

Urosonography, ultrasound of the urinary tract, is a noninvasive imaging method used to evaluate renal masses, renal parenchymal disease, hydronephrosis, bladder volume and calculi. The applicability of ultrasound was studied in 54 spinal cord injury patients by correlating uroradiological examinations with ultrasound. Emphasis was placed on ultrasonic imaging of ureterectasis and vesicoureteral reflux. Ultrasound confirmed all positive radiographic findings of renal and bladder abnormalities (renal calculi, chronic pyelonephritis, trabeculated bladder and bladder calculi), and yielded additional information in 27 per cent of the kidney and 13 per cent of the bladder studies. Ultrasound was used to confirm vesicoureteral reflux in 56 per cent of the patients and ureterectasis in 33 per cent. It is recommended that spinal cord injury patients undergo a baseline excretory urogram followed by periodical ultrasound examinations to detect hydronephrosis, renal parenchymal disease, and renal and bladder calculi, and to measure bladder volume and residual urine. Whenever real-time equipment and experienced ultrasonologists are available ultrasound can be used as an alternate to voiding cystourethrography to detect vesicoureteral reflux.