Thyrotoxic periodic paralysis complicated by life-threatening acute hypercapnic respiratory failure in a Chinese male with painless thyroiditis.

CONTEXT: Thyrotoxic periodic paralysis (TPP) is a relatively common complication seen in Asian hyperthyroid patients. However, it is a rare occurrence to find a TPP case comprised of acute hypercapnic respiratory failure in patients with painless thyroiditis. PATIENT: A 29-year-old Chinese man presented with flaccid paralysis of all four limbs and he was brought to emergency room. Severe hypokalemia was found on admission. Although treatment had been initiated with potassium chloride supplementation, he went on to develop acute hypercapnic respiratory failure likely due to muscle fatigue. The patient was intubated for mechanical ventilatory support. Once his serum potassium levels were normalized, he was able to be weaned off ventilator support. Thyroid function tests showed elevated free thyroxine concentration and low thyroid-stimulating hormone concentration. He underwent a thyroid uptake scan with 131I which revealed decreased uptake rate of thyroid area. Based on the patient's clinical presentation and associated findings, we diagnosed him with TPP due to painless thyroiditis. We have reviewed TPP cases caused by painless thyroiditis and TPP cases associated with acute hypercapnic respiratory failure. CONCLUSION: It is important to note that potentially fatal complications such as acute hypercapnic respiratory failure might occur in acute attacks of TPP even in cases of TPP due to painless thyroiditis.

Nerve conduction studies in spastic paraplegia, optic atrophy, and neuropathy (SPOAN) syndrome.

INTRODUCTION: SPOAN (spastic paraplegia, optic atrophy, and neuropathy) syndrome is an autosomal recessive neurodegenerative disorder identified in a large consanguineous Brazilian family. METHODS: Twenty-seven patients with SPOAN syndrome (20 women), aged 4-58 years, underwent nerve conduction studies (NCS) of the median, ulnar, tibial, and fibular nerves, and sensory NCS of the median, ulnar, radial, sural, and superficial fibular nerves. RESULTS: Sensory nerve action potentials were absent in the lower limbs and absent in >80% of upper limbs. Motor NCS had reduced amplitudes and borderline velocities in the upper limbs and absent compound muscle action potentials (CMAPs) in the lower limbs. CONCLUSIONS: The neuropathy in SPOAN syndrome is a severe, early-onset sensory-motor axonal polyneuropathy. Normal NCS seem to rule-out this condition.

Evaluation of a wheelchair prototype with non-conventional, manual propulsion.

OBJECTIVE: To evaluate the results of a user satisfaction questionnaire on a new type of lever-propelled wheelchair designed to avoid the discomfort and potential repetitive strain injuries related to conventional hand-rim propulsion. METHODS: Seventeen participants filled out a questionnaire to rate their conventional wheelchair and the prototype (after 2 days' use) in terms of comfort, adjustability, steering/ride, manoeuvrability, stability when crossing obstacles, safety, weight, size, portability and appearance. Overall satisfaction was also scored. RESULTS: According to the user questionnaire results, the lever-propelled prototype chair was rated as significantly superior than conventional wheelchairs in terms of comfort, safety and overall satisfaction. The prototype was rated significantly inferior in terms of size, adaptability, appearance and crossing obstacles. CONCLUSION: We conclude that the prototype wheelchair is highly acceptable and comfortable and can be recommended to disabled sportspersons. The prototype's weak points are mainly related to ergonomic aspects, which could be improved in future models.

The DALY, context and the determinants of the severity of disease: an exploratory comparison of paraplegia in Australia and Cameroon.

This paper summarises the findings of an empirical investigation of some of the technical and social assumptions on which the disability adjusted life year (DALY) is based. The objectives of the study were to examine the notion that the burden of disease is broadly similar without regard to country, environment, gender or socio-economic status and to develop detailed descriptions of the experiences of the burden of disease as they related to these contextual factors. The study was a multi-factorial exploratory study employing qualitative and quantitative techniques to obtain data on the effects of country (development), environment (urban versus rural), gender and socio-economic status on people with paraplegia. The data provided an extensive and detailed compilation of context rich descriptions of living with paraplegia. Striking features of the data were the differences between countries with respect to the impact of the health conditions on functioning and highlight a context in which paraplegia of like clinical severity can be fatal in one environment and not in another. While there has been some focus on the control of social determinants of disease, there has been little work on the social determinants of the severity of disease. The underlying assumptions of the DALY, which ignore context in the assessment of the burden of disease, risk exacerbating inequalities by undervaluing the burden of disease in less-developed countries. There is a need to continue to subject the development of indicators to rigorous debate to determine a balance between the assumption of a global "average social milieu" and the treatment of each individual as belonging to their own context in the assessment of population health in order for indicators to be meaningful cross-culturally.

Impact of minority status following traumatic spinal cord injury.

OBJECTIVE: To interpret the data from the Spinal Cord Injury-Model Systems as it applies to demographics, incidence and functional outcomes of minority patients with spinal cord injury. DESIGN: Retrospective analysis of patients admitted to acute inpatient rehabilitation Spinal Cord Injury Model Systems Centers. RESULTS: Descriptive statistics including means, standard deviations, and proportions were computed for all relevant variables. Participants were grouped into two categories for purposes of analysis, non-minorities (white) and minorities, who were >90% African American. Differential statistics were used for comparisons with regard to demographics, etiology, sponsor of care, length of stay, charges, ASIA Motor Index scores, and FIM scores. Categorical data was analyzed using chi-square analyses while continuous data were analyzed using ANOVA procedures. Analyses revealed significant differences between minorities and non-minorities in terms of age at injury, gender, marital status, employment status, education level, health insurance provider, injury severity, etiology, and discharge disposition. CONCLUSION: Analysis of the data indicates that violence is the leading single cause of spinal cord injury in minority patients admitted to the model systems centers. The majority of patients who sustained spinal cord injury secondary to violence were minorities with the following demographics: young, single, unemployed males, with less than a high school education, residing in an urban area.

Firearm versus motor vehicle related spinal cord injury: preinjury factors, injury characteristics, and initial outcome comparisons among ethnically diverse groups.

OBJECTIVE: To determine the extent to which individuals with spinal cord injuries caused by firearms differed from those caused by motor vehicle crash (MVC) in terms of selected preinjury factors, injury characteristics and related treatment, and outcomes at discharge from rehabilitation; and to determine the effect of ethnicity on preinjury factors and outcome. DESIGN: Survey including interview of former rehabilitation inpatients and medical records review. SETTING: Model Spinal Cord Injury Care System centered at an urban, public rehabilitation medical center. PARTICIPANTS: Volunteer convenience sample of 164 men who were between the ages of 18 and 35 years at the time of injury and who were injured by firearm or MVC between January 1, 1980 and December 31, 1989. Subjects had completed rehabilitation at a rehabilitation center; they were non-Latino White, African-American, or Latino. Subjects were contacted by mail and telephone. The sample was comprised of 26% of the potential participants; however, differential follow-up rates were highly consistent with distribution of primary characteristics within the population of potential candidates. MAIN OUTCOME MEASURES: The Functional Independence Measure (FIM) and total and rehabilitation lengths of stay were the outcome measures. Groups and outcomes were also compared in terms of preinjury education, employment, and indicators of antisocial behavior, as well as neurological deficit, associated injuries, and surgical treatment. RESULTS: The firearm and MVC groups were different in terms of ethnic distribution. There were no non-Latino Whites in the firearm group and few African-Americans in the MVC group. With the exception of preinjury education, nonparametric and univariate tests showed differences between the firearm and MVC groups in terms of preinjury employment and indicators of antisocial behavior, associated injuries, surgical treatment, neurological deficit, and lengths of stay. Changes in FIM scores, however, were not different between etiologic or ethnic groups. Multiple regression indicated that injury severity accounted for the largest variance in outcomes and that preinjury factors, etiology, and ethnicity did not contribute significantly to the variance in outcome measures. CONCLUSIONS: Although preinjury factors are associated with ethnicity and minorities have higher proportions of SCI caused by firearms, these factors do not significantly influence rehabilitation outcomes at discharge. The primary factors influencing rehabilitation outcomes are related to the deficits, associated physical injuries, and related treatments common to the causes of the injury.