Magnetic resonance imaging following InterStim®: an institutional experience with imaging safety and patient satisfaction.

AIMS: We retrospectively assessed patient safety and satisfaction after magnetic resonance imaging (MRI) in patients with an InterStim® unit. METHODS: The records of all patients implanted with InterStim® between 1998 and 2006 were reviewed. Nine of these patients underwent MRI following InterStim® implantation. The patients' neurologists requested the MRI exams for medical reasons. Both 0.6 Tesla (T) and 1.5 T machines were used. Patient safety, interference of implanted pulse generator (IPG) with radiological interpretation, and patient satisfaction were assessed in these patients. RESULTS: The first patient in the series had IPG failure following MRI. For this patient, the voltage amplitude was set to zero, the IPG was turned off, and the IPG magnetic switch was left on. The patient underwent MRI uneventfully; however, the IPG did not function upon reprogramming. The IPG magnetic switch was turned off for the eight subsequent patients, all of whom underwent MRI safely. In addition, all of their IPGs functioned appropriately following reprogramming. Of the 15 MRIs performed, the lumbar spine was imaged in eight studies, the pelvis was imaged in one study, and the remaining examinations involved imaging the brain or cervical spine. Neither the IPG nor the sacral leads interfered with MRI interpretation. None of the eight patients perceived a change in perception or satisfaction following MRI. CONCLUSIONS: Although we don't advocate the routine use of MRI following InterStim® implantation, our experience suggests MRI may be feasible under controlled conditions and without adverse events.

Consensus statement by hospital based dentists providing dental treatment for patients with inherited bleeding disorders.

Avoidance of dental care and neglect of oral health may occur in patients with inherited bleeding disorders because of concerns about perioperative and postoperative bleeding, but this is likely to result in the need for crisis care, and more complex and high-risk procedures. Most routine dental care in this special needs group can be safely managed in the general dental setting following consultation with the patient's haematologist and adherence to simple protocols. Many of the current protocols for dental treatment of patients with inherited bleeding disorders were devised many years ago and now need revision. There is increasing evidence that the amount of factor cover previously recommended for dental procedures can now be safely reduced or may no longer be required in many cases. There is still a need for close cooperation and discussion between the patient's haematologist and dental surgeon before any invasive treatment is performed. A group of hospital based dentists from centres where patients with inherited bleeding disorders are treated met and, after discussions, a management protocol for dental treatment was formulated.

Physical examination of the cervical spine and shoulder girdle in patients with shoulder complaints.

OBJECTIVE: To look for differences in mobility in randomly selected patients without shoulder complaints depending on age, gender and left- or right-handedness; to investigate in the patient group whether specific differences exist, depending on the diagnosis made or the afflicted side; and to detect differences between the findings on the mobility examination of the cervical and cervicothoracic spine in patients with shoulder complaints compared with the healthy population. DESIGN: Comparative study. METHOD: The physical examination findings after inclusion and after 26 wk of 101 shoulder patients were compared with those of 75 randomly selected patients without shoulder complaints and adjusted for age and gender. RESULTS: In the population of patients without shoulder complaints, the mobility in the cervical and upper thoracic spine was found to decrease with aging. Significant differences were found between the healthy and the afflicted population at the time of inclusion as well as after 26 wk, even though the majority of patients felt cured at that time. With all types of shoulder complaints, functional disorders in the shoulder girdle were found in which, at the time of inclusion, the emphasis was on pain and, after 26 wk, on restricted motion. Thus, functional disorders in the cervical spine, the higher thoracic spine and the adjoining ribs are not extrinsic causes of shoulder complaints, but an integral part of the intrinsic causes of shoulder complaints. CONCLUSION: Further study is needed to determine if this finding explains the high recurrence rate of shoulder complaints. It may be advisable to include the treatment of functional disorders of the shoulder girdle in treatment of patients with shoulder complaints.

The influence of the mobility in the cervicothoracic spine and the upper ribs (shoulder girdle) on the mobility of the scapulohumeral joint.

OBJECTIVE: To examine the influence of the cervicothoracic spine and upper ribs (shoulder girdle) on glenohumeral mobility and the development of shoulder complaints. DATA COLLECTION AND SYNTHESIS: Literature was collected by a search in Medline and Embase for English, German and Dutch publications, by further checking references in the articles found and by perusal of already collected literature regarding shoulder research. Articles referring directly or indirectly to a mutually influencing anatomical connection between the cervicothoracic spine, upper ribs (shoulder girdle) and scapulohumeral joint were selected during a consensus meeting of all reviewers. RESULTS: Eight relevant articles, differing strongly in supposition and objective, were found and subsequently classified and presented according to the anatomical relations indicated in the articles. Indications were found that suggested anatomical relations between the mobility in the shoulder girdle and the scapulohumeral joint, between the mobility in the spinal column and the first rib (shoulder girdle) and between the spinal column and the scapulohumeral joint. No relevant indications regarding the development of shoulder complaints were found. CONCLUSIONS: Although no direct evidence was found, a comparison of the results of this study with theories postulated by other researchers on this subject suggests that a certain relation does exist.

Three-dimensional head kinematics and clinical outcome of patients with neck injury treated with spinal manipulative therapy: a pilot study.

OBJECTIVE: Finite helical axis parameters (FHAP) of the cervical spine and clinical measures were obtained to evaluate neck function and the clinical effects of spinal manipulative therapy in patients with "whiplash" (WL) type neck injury. DESIGN: Descriptive case series, 1 yr follow-up. SETTING: Three private chiropractic practices. SUBJECTS: Ten consecutive new patients with a history of neck injury, nine asymptomatic, volunteer controls. INTERVENTIONS: A 6-wk regimen of short lever manually assisted adjustments with an Activator Instrument, while acute, four patients received interferential electrotherapy. MAIN OUTCOME MEASURES: Cervical FHAP during normal movements, neck pain (visual analogue scale), active cervical range of motion and follow-up questionnaire. RESULTS: Based on six patients, the FHAPs appeared to mirror the clinical condition, being markedly deviant from the patterns observed in the control group for at least one or more of the tracking tasks for all but one of the patients. Mean pain scores decreased from 44.1 to 10.5 (t = 4.93; p < .0001) and mean total range of motion increased from 234 to 297 degrees (t = 5.68; p < .0001). At 1 yr, seven respondents noted stability of their symptoms at or near the level reported immediately after the 6-wk treatment period. CONCLUSIONS: Based on these preliminary data: a) FHAPs may aid in diagnosing and monitoring treatment of neck dysfunction, b) spinal manipulative therapy may be beneficial to some patients with neck injury and future study is warranted as a means to promote recovery of patients with neck injuries.

Retrieval speed, age-of-acquisition estimates, uncertainty, and semantic-dimension comparisons with mentally retarded persons.

Age-of-acquisition estimates and ratings on seven semantic dimensions by nonretarded adults were compared with the codability and retrieval speed of those items by retarded individuals. Correlational analyses indicated that age-of-acquisition estimates, codability, and retrieval speed were highly related to each other and significantly related to most of the semantic dimensions. Regression analyses revealed that codability, meaningfulness, and imagery each contributed significantly to the variance of retrieval speed. These results were compared with those of similar studies in which the lexical retrieval speed of nonretarded persons was investigated.