Multicentre registry of brain-injured patients with disorder of consciousness: rationale and preliminary data.

Diagnostic accuracy and reliable estimation of clinical evolution are challenging issues in the management of patients with disorders of consciousness (DoC). Longitudinal systematic investigations conducted in large cohorts of patients with DoC could make it possible to identify reliable diagnostic and prognostic markers. On the basis of this consideration, we devised a multicentre prospective registry for patients with DoC admitted to ten intensive rehabilitation units. The registry collects homogeneous and detailed data on patients' demographic and clinical features, neurophysiological and neuroimaging findings, and medical and surgical complications. Here we present the rationale and the design of the registry and the preliminary results obtained in 53 patients with DoC (vegetative state or minimally conscious state) enrolled during the first seven months of the study. Data at 6-month post-injury follow-up were available for 46 of them. This registry could be an important tool for collecting high-quality data through the application of rigorous methods, and it could be used in the routine management of patients with DoC admitted to rehabilitation settings.

Energy expenditure and nutritional adequacy of rehabilitation paraplegics with asymptomatic bacteriuria and pressure sores.

OBJECTIVE: To measure resting energy expenditure (REE) in a group of people with postacute paraplegia, quantify the impact of asymptomatic bacteriuria and pressure sore(s) on patients' metabolic rate, and estimate the adequacy of patients' nutritional intakes to preserve patients' protein levels. MATERIAL AND METHODS: Ten males with post-acute paraplegia aged 42.1+/-18.7 years. We evaluated: height, body mass index (BMI), resting energy expenditure (REE), total daily calorie requirement (E), 24-h urine creatinine excretion (Cru), creatinine index (CI), and nitrogen balance (NB). RESULTS: Subjects with paraplegia showed high erythrocyte sedimentation rates. As a group, they had normal resting calorie consumption when REE was normalized for unit of urine creatinine (REE/Cru), it was higher in patients than in controls. Six of the 10 patients had a low calorie intake: of these only three had a negative nitrogen balance. CONCLUSION: In conclusion, the resting energy expenditure of the subjects with significant bacteriuria and pressure sore(s) of 23.7 kcal/kg/day suggests that a large portion of patients may have an inadequate calorie protein intake to preserve their nutritional status. The clinical significance of this study is that 28.5 kcal/kg/day may be the lower calorie threshold to meet the metabolic demands of people with apyretic paraplegia with bacteriuria and pressure sore(s).

[Visual reaction times in a group of patients with single cerebrovascular lesions in rehabilitation]. / Studio dei tempi di reazione visivi in un gruppo di pazienti con lesione cerebrovascolare singola in fase riabilitativa.

UNLABELLED: Approximately fifty percent of stroke survivors have neurological deficits. The evaluation of reaction times permits a study of psychomotor performance, which could be very important for a good rehabilitation outcome. AIM: The aim of the study was the evaluation of visual reaction times in a group of patients with cerebrovascular lesions, during inpatient hospitalisation in a rehabilitation centre. MATERIALS AND METHODS: 46 right-handed patients (34M, 12F) with unilateral cerebrovascular lesion, confirmed by CT or MRI, were enrolled in the study. In each patients visual Simple Reaction Times (SRT) and Multiple Choice Reaction Times (MCRT) were studied. The patients were asked to react by using the hand ipsilateral to the side of the cerebral lesion. Functional impairment of walking, upper limb and hand were measured by a tailored clinical scale with score ranging from 1 to 12. Depression was measured by a modified version of Hamilton scale, tailored for this kind of patient. RESULTS: 13 of 46 patients (28.2%) showed a pathologic reaction time. There was a lack of correlation between reaction times and age, aphasia, lesion size, time from stroke, functional impairment. Patients with hemorrhagic lesions had significantly lower SRT and MCRT. The subgroup of patients with pathologic reaction times were significantly more depressed than patients with normal reaction times. CONCLUSION: Judging from the present set of results: a) patients with hemorrhagic lesions have lower reaction times; b) the prolongation of reaction times and post-stroke depression appear to be related in stroke patients. This relationship seems to suggest that post stroke depression can negatively affect functional recovery also by means of an impairment of psychomotor performance.

Detrusor instability as an energy-saving device in prostatic obstruction.

PURPOSE: We assessed whether voiding dynamics differ in patients with infravesical obstruction from benign prostatic hyperplasia between those with detrusor instability and those with stable bladders. MATERIALS AND METHODS: A total of 50 such patients with (25) and without (25) detrusor instability was investigated urodynamically by cystometry and pressure-flow study. RESULTS: In the unstable group there was greater obstruction (as assessed by the linear passive urethral resistance relation pressure-flow nomogram) but the detrusor expended less energy (p = 0.001) for voiding the unit volume (54.4 +/- 22.8 mJ./ml versus 74.4 +/- 31.8 mJ./ml. in the stable series). Spared energy was converted into more powerful micturition contractions and more efficient voiding, with a mean maximum contraction power and mean fraction of bladder volume voided of 17.9 +/- 4.9 microW./mm.2 and 93 +/- 11%, respectively, in the unstable population versus 12.7 +/- 2.1 microW./mm.2 (p < 0.001) and 79 +/- 13% (p < 0.001) in the stable subjects. CONCLUSIONS: Detrusor instability possibly works within physiological limits as an energy-saving device, preventing voiding efficiency in patients with prostate disease from decreasing too much with increasing obstruction.

[A computerized endurance test: efficacy of pelvic floor rehabilitation treatment in patients with stress incontinence]. / Test di endurance computerizzato: efficacia del trattamento riabilitativo del pavimento pelvico in pazienti affette da stress incontinence.

In the present study the authors wanted to transfer rigorous methods of study, already in use in other sectors (sports, medicine, isokinetic work, etc.) of the validity of interventions made and their effectiveness, into an "emerging" field, that of perineal rehabilitation. 15 female patients, aged between 35 and 45, affected by stress incontinence underwent a baseline clinico-instrumental evaluation of the perineal floor including a computerized test of endurance. The patients then embarked upon a standardized rehabilitative perineal training lasting a month and at the end underwent an identical evaluation as that performed at the outset. Statistical analysis of the results obtained showed an objective improvement in the parameters considered (endovaginal pressure and its variations during a series of intermittent static contractions) quantitatively supporting clinical evidence.

[The peripheral component during dynamic muscular exertion: study of a group of basketball players]. / La componente periferica nel corso dell'esercizio muscolare dinamico: studio su un gruppo di cestisti.

The peripheral factor (PF), i.e. the ratio: artero-venous oxygen extraction to total peripheral resistences, has been studied in a total of 8 professional basket players under controlled work-load conditions. The results obtained by continuous monitoring heart rate, oxygen consumption, pulmonary ventilation, arterial blood pressure etc, have shown that from 0 to 150 watt work-load, the PF increases linearly showing a slope of 83 degrees, whereas from 150 to 200 watt the pendence reduces up to 45 degrees. The absolute value of PF from a resting value of 3.83 mlo2 X min-1 X mmHg-1 increases up to 21,64 (at 150 watt) and to a maximum of 23.45 mlo2 X min-1 X mmHg-1 at 200 watt. The slope of the first range of load (83 degrees) is quite similar to what previously observed in endurance athletes (cyclists) whereas the 45 degrees angular coefficient indicates that the increased energy demand in basket-players can be obtained only with a large cardiac load.