Positive outcomes in traumatic brain injury-vegetative state: patients treated with bromocriptine.

OBJECTIVE: To assess the effects of multidisciplinary rehabilitation interventions and use of bromocriptine on outcome in patients with traumatic brain injury-vegetative state (TBI-VS). DESIGN: Retrospective review of clinical cases. SETTING: Free-standing rehabilitation hospital; Acute and extended rehabilitation hospital. PARTICIPANTS: Five consecutive TBI-VS patients, as well as 33 TBI-VS patients and 37 traumatic brain injury-minimally conscious state (TBI-MCS) patients reported in the literature. INTERVENTIONS: Bromocriptine administration, systematic neuropsychologic testing, sensory stimulation, and traditional comprehensive rehabilitation with physical therapy, occupational therapy, and speech therapy. MAIN OUTCOME MEASURES: Disability Rating Scale (DRS) at 1, 3, 6, and 12 months postinjury and FIM instrument scores at 1 month and 12 months postinjury, Coma Recovery Scale, and Barry Rehabilitation Inpatient Screening of Cognition. RESULTS: The 5 TBI-VS patients emerged from a VS into a MCS and regained functional status. Their recovery of physical and cognitive functioning, as rated by the DRS, was greater than previously reported in the literature for patients in a VS or MCS at 3, 6, and 12 months postinjury. CONCLUSION: Bromocriptine administration, systematic neuropsychologic testing, sensory stimulation, a comprehensive rehabilitation program, or a combination of these treatments may enhance functional recovery in this TBI-VS patient group. Further systematic study to quantify the contribution of these variables and to reproduce this data in a larger patient population should be performed.

Correlates of fatigue in HIV infection prior to AIDS: a pilot study.

Fatigue is widely recognized as a significant source of morbidity in persons with human immunodeficiency virus (HIV) infection, yet there are few data examining fatigue in this population. We present pilot data assessing the relationship between fatigue and various physical and psychosocial measures in 20 men with HIV infection prior to the clinical development of acquired immunodeficiency syndrome (AIDS). Fatigue was measured by a visual analogue scale (VAS) and the Fatigue Assessment Inventory (FAI). No statistically significant associations were found between fatigue measures and physical parameters including haemoglobin, haematocrit, albumin, total protein, and physical dimension score of the Sickness Impact Profile (SIP). The FAI correlated well with Beck's Depression Inventory and SIP-Psychosocial Dimension (r = 0.72 and 0.81, respectively; p < 0.001.) Both the FAI and VAS held moderate associations with the total SIP score. The SIP profile was similar to that observed in a sample of persons with chronic fatigue but without HIV infection, reported previously. Although the sample size is small, our data suggest a stronger association with psychosocial, rather than physical, parameters among persons with HIV infection and fatigue. The implications for clinical management and further research are discussed.

Focused review: physiatric management of HIV-related disability.

Since 1981, the epidemic of acquired immunodeficiency syndrome (AIDS), due to infection with human immunodeficiency virus (HIV), has grown and challenged health care providers in the United States. Although the total number of AIDS cases diagnosed each year appears to be reaching a plateau, cases attributable to heterosexual transmission are rising. With improved treatment, survival of persons with HIV infection is expected to increase; this change suggests that the prevalence of HIV-related physical disability will also increase. This article outlines the pathophysiology and systemic manifestations of HIV infection. The more common neuromuscular and neurological complications at each stage of the disease are presented, and appropriate rehabilitation interventions are discussed. The indications for aerobic exercise in persons with HIV infection and the approach to disability management in pediatric HIV infection are presented. Psychosocial considerations related to access to rehabilitations services, discrimination on the basis of HIV infection or membership in HIV risk behavior groups, and vocational rehabilitation are discussed. The review concludes that rehabilitation interventions in persons with HIV infection are based on functional deficits, rather than disease processes, suggesting that a general physiatric fund of knowledge should be adequate to manage most HIV disability.

Effect of chronic intracerebroventricular angiotensin II infusion on vasopressin release in rats.

Angiotensin II (AII) was infused into the lateral cerebral ventricle of rats given water, isotonic saline, or hypertonic saline ad libitum, or 40 ml water/day. Fluid intake, change in body weight, plasma [Na+], and plasma and pituitary arginine vasopressin (AVP) levels were measure. Isotonic saline or AII (1 micrograms/microliter saline) was infused at 1 microliter/h for 5 days using osmotic minipumps. AII increased fluid intake of rats given isotonic saline to drink; they consumed an average of 269 +/- 25 ml/day on day 5. AII infusions in rat given water or isotonic saline to drink decreased plasma [Na+] with no changes in plasma or pituitary AVP. However, in rats given hypertonic saline, plasma [Na+] remained at control levels while plasma AVP increased. In water-restricted rats, the effects of AII were intermediate: a small decrease in plasma [Na+] and a small increase in plasma AVP. From these results, it is suggested that although acute AII administration elicits AVP release, this effect diminishes during chronic AII infusion, coincident with reduced plasma [Na+].