Distinctive electrophysiological features of denervated muscle in uremic patients.

Abnormal spontaneous activity is a hallmark of acute or subacute denervation of skeletal muscle, particularly in patients with uremic neuropathy. We report 5 patients in whom such activity was unexpectedly minimal or absent.

Rehabilitation potential of elderly patients with major amputations.

This study was undertaken to determine the rehabilitation potential of patients undergoing amputation for vascular disease. A total of 101 patients were studied with a mean age of 69 +/- 14 years, 26 of whom were over age 80. Operative indications were gangrene or ulceration in 80% with rest pain in 20%. Eighteen patients were bilateral amputees. Fifty per cent of the patient population had previous vascular operations. The operative mortality was 13% and was not affected by the age of the patients or the presence of diabetes. Most operative deaths were due to cardiac or septic respiratory complications. Twenty-four of 88 surviving patients were not considered candidates for rehabilitation and the major determining factor was the occurrence of a remote or perioperative stroke. None of these 24 patients was discharged from institutional care. Sixty-four patients were considered rehabilitation candidates with equal distribution in all age groups. Ninety-five per cent of these patients were discharged home with 80% of those patients over 80 being discharged. Eighty-seven per cent of the elderly rehabilitation candidates were fitted with prostheses which compares favourably to other age groups. Seventy-three per cent of the elderly reached their rehabilitation goals (most frequently ambulation with the aid of a walker) which is only slightly less than the younger amputation group. From this study we conclude that amputations which are done for ease of nursing care and patient comfort in debilitated patients have a high mortality rate and rehabilitation goals are unlikely to be met. We have demonstrated high success rates with rehabilitation including patients over age 80. The majority of these patients may be discharged home after a period of aggressive rehabilitation.

Incidence of peripheral neuropathy in the contralateral limb of persons with unilateral amputation due to diabetes.

Eighty persons with first-time, nontraumatic amputation, mean age 66.7 yrs +/- 12.6 (1 SD) were examined to determine the extent of peripheral neuropathy (PN) present in the intact limb. Thirty-eight (47.5%) of the subjects had confirmed diabetes mellitus (DM); in those subjects, vibration sense (73.3%), temperature sense (42.1%), and nociception (71.1%) were decreased or absent in the intact limb. The prevalence of sensory impairment was significantly less in nondiabetic subjects in whom vibration sense 46.5% (p < 0.02), temperature sense 16.3% (p < 0.01), and nociception 32.6% (p < 0.02) were decreased or absent. Using a scale that stages the severity of PN, a significant difference (p < 0.001) in the distribution was found between these two groups. Only one person with known DM had no evidence of PN. Twenty-eight out of 42 nondiabetic subjects had evidence of PN. Eighty percent of all subjects had PN. This study confirms the significant potential for PN in persons with DM and presents new evidence of a significant incidence of neuropathy in nondiabetic individuals with amputation. The finding of unexpected peripheral nerve compromise is an important consideration in the treatment of persons with peripheral vascular disease who are at risk for amputation and for persons with amputation who depend on the intact limb for stability and ambulation.

[Surgical treatment results in patients with severe forms of the carpal tunnel syndrome]. / Rezul'taty khirurgicheskogo lecheniia bol'nykh s tiazhelymi formami sindroma zapiastnogo kanala.

A retrospective and prospective study was undertaken to determine efficacy of carpal tunnel decompression in patients with advanced carpal tunnel syndrome (CTS). The criteria for inclusion in this study were clinical and nerve conduction studies (NCS). Between 1985-1991, 1511 NCSs performed were positive for CTS.

CO2 cystometry in myelodysplasia.

Findings on consecutive CO2 cystometry in 57 myelodysplastic children are reported. Twenty-six children had autonomous bladders and twenty had reflex bladders. Boys were equally distributed among the 2 common bladder types but girls were found to be predominantly in the autonomous bladder group. Different ancillary parameters were determined such as neurologic level, intelligence quotient, the prevalence of urinary tract infection, intravenous pyelography abnormalities and shunting, and the presence or absence of perianal sensation, bulbocavernosus reflex and erections. There appeared to be no correlation between any of these factors and bladder type except for a lower frequency of urinary infections in the autonomous bladder group.

Severe peripheral neuropathy following gastric bypass surgery for morbid obesity.

Severe weakness in the limbs developed in a young woman 3 1/2 months after successful gastric bypass surgery for morbid obesity. Electromyography confirmed the clinical impression of generalized axonal polyneuropathy. Vitamin B replacement therapy was started. The gastric bypass was not reversed, and the patient continued to lose weight while undergoing rehabilitation. After 10 months she had almost fully recovered. Her total weight loss was 76 kg. Neuropathy is an uncommon but serious complication of semistarvation that should be preventable by routine administration of vitamin B complex.

H-reflex: optimum location of recording electrodes.

The Hoffmann (H) reflex was measured from a grid of 31 locations on the calves of 20 healthy volunteers. In 17 cases the maximum amplitude of response was found at a site more distal than at the conventional midcalf recording location. Three quarters of the distance between the popliteal crease and the flare of the medial malleolus, the waveform was found most consistently triphasic. At this site the latency was, on the average, 1.4msec longer than at the midcalf location. These results may be related to the more distal origin of the H-reflex dipole when compared to the M (motor) wave or T (tendon) reflex response, and indicate that a distal recording site is preferred if the H-reflex per se is to be assessed.

Doppler ultrasonography for detection of deep vein thrombosis in lower extremities.

Doppler ultrasonography, a rapid, noninvasive and portable technique, has been available to clinicians for more than 10 years, but its accuracy in detecting deep vein thrombosis (DVT) has been questioned. A consistent and detailed method for testing venous circulation in the lower extremities is described. This method was used in a prospective study in which results of 50 phlebograms were compared with those of the Doppler test. A specificity of 92% and sensitivity of 100% were demonstrated, indicating that Doppler ultrasonography is a useful and accurate screening test for DVT.

Methotrimeprazine in the treatment of agitation in acquired brain injury patients.

Medical management of the agitation associated with acquired brain injury (ABI) has been proble matic. At least 12 distinct drugs are currently recommended in the medical literature. In recent years, on the ABI in-patient rehabilitation unit, methotrimeprazine (MTZ) has come to be the preferred drug and is used routinely for effective treatment of agitation. The objective of this paper is to describe the use and safety of MTZ in the rehabilitation of ABI patients. A retrospective chart review of all patients discharged from the ABI unit over a course of 2 years was conducted. In addition to demographics such a aetiology of ABI, sex, age, length of stay, Glasgow Coma Scale, length of posttraumatic amnesia and others, a detailed analysis was made of the multidisciplinary progress notes to determine the daily agitation status and the daily use of psychotropic medication. All notes on side effects and adverse reactions were carefully documeneted. 120 first admission recent ABI patients were discharged in the 2 year study period. Of these, 69 (57%) had some level of agitation and 56 (48%) were treated with MTZ, in doses of 2-50 mg up to four times daily. Agitation was controlled in most cases. In only two cases were significant side effects noted. While MTZ has been used as a safe and effective neuroleptic in psychiatry for over 40 years, this is the first report of its use in treating agitation in ABI.

Intramuscular recording in neurodiagnostic studies.

Intramuscular (IM) recordings are often used in nerve conduction studies involving deep or proximal muscles and in other electrodiagnostic tests. Little is known of how various needle electrode configurations and placements influence the characteristics of the evoked responses and their clinical interpretation. The present set of investigations sought to characterize the amplitude, waveform, consistency, latency and muscle discrimination capabilities of IM recordings from a variety of muscles using monopolar, concentric and bipolar electrodes. Results indicate that 1) all forms of IM electrodes studied show marked changes in response waveform with changes in position of the electrode tip, but the monopolar electrode configuration shows the least amount of change; 2) the concentric electrode does not differentiate well between deep and superficial muscle responses; 3) the latency of the evoked response does not change with the depth of penetration within a muscle; 4) the latency of response recorded from IM electrodes may be longer, the same or shorter than that recorded from surface electrodes; and 5) monopolar electrodes should be used when onset latency or waveform is the critical parameter to be recorded from deep or atrophied muscles.

Rehabilitation in a rural community in Ukraine--a pilot project.

The World Health Organization has promoted the concept of community-based rehabilitation as a means of fulfilling the needs of disabled persons in their home environment, and at the same time decreasing the costs of tertiary rehabilitative care. This paper reports on the 10-year experience of a village rehabilitation hospital in rural Ukraine. The hospital was converted to a rehabilitation facility by provision of rehabilitation space, training of local medical and allied health personnel in the principles of rehabilitation, provision of modalities, exercise, hydrotherapy, apiotherapy, and obtaining the necessary physical medical equipment. The cost of this conversion was quite modest and was more than compensated for by the efficient utilization of the facility in the region together with the significant saving in tertiary care costs, including travelling time for patients.

Intramuscular recording of H-reflexes from muscles of the posterior compartment of the lower leg.

This study was designed to elucidate the role of different muscles of the posterior compartment of the lower leg in the generation of the surface-recorded H-reflex. H-reflexes were evoked through percutaneous stimulation of the posterior tibial nerve and recorded concurrently, using monopolar electrodes from the soleus (SOL), medial and lateral gastrocnemii (MG and LG), tibialis posterior (TP), flexor digitorum longus (FDL), and flexor hallucis longus (FHL). There were significant (P less than 0.01) differences in the amplitudes, latencies, and modified H:M ratios of the responses recorded from the different muscles. The SOL modified H:M ratios were consistently the highest (x = 1.02), while the H:M ratios for MG (x = 0.34) and LG (x = 0.37) were consistently the lowest. Latencies of H-reflexes obtained from proximal recording sites (x = 29.2 ms) were significantly shorter than those from the most distal site (x = 31.5 ms). These results establish the contribution made by various deep and superficial muscles to the conventionally recorded H-reflex and help explain the differences in H-reflex amplitudes and latencies when recordings are made from different sites.