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Biomedical subjects

A Adunsky

Publications and source records attributed to A Adunsky.

At least 19 recordsLinked to original sources
PubMed2001

Non-traumatic lower limb older amputees: a database survey from a geriatric centre.

PURPOSE: The purpose of this survey was to examine the characteristic of a geriatric population admitted for amputation of a lower limb and to explore some of the factors that may affect the course of their hospital stay. METHOD: The study took place in the geriatric division of a tertiary general hospital and included a close geriatric-orthopaedic liaison. Two-hundred and forty-one patients were included in the final analysis. RESULTS: Many above knee amputations were performed, which correlated with advanced age. Rates of in hospital mortality and systemic complications were 16% and 19%, respectively. Thirty-three percent of the patients were discharged back home, and only 6% were supplied with an artificial limb. The general condition of most patients remained poor. CONCLUSION: We conclude that despite a team approach to the care of the geriatric amputee a poor functional result was obtained. By encouraging earlier referrals from the community it is postulated that a reduction in the costly provision of antibiotics would be beneficial and that perhaps lower levels of amputation could be performed thereby enhancing the possibilities for ambulation.

Age Distribution↗
PubMed2001

Effect of ischemic stroke on the dynamic beat-to-beat QT-RR relationship.

The ECGs of 26 patients following ischemic stroke and 18 control patients with various orthopedic problems, all without primary heart disease, were examined to characterize the dynamic behavior of uncorrected QT interval in relation to changing RR interval during physiotherapy effort. ECG waveforms were analyzed to extract beat-to-beat QT and RR intervals. Based on performing multiple cross-correlations, the relationship between the RR and QT intervals was calculated using the following general formula QTi = c RRib-1. Linear regression was performed on the logarithms of QT and RR measurements to estimate the constant (a = log c) and the slope (b) values, reflecting the dynamic change of QT during physiotherapy effort. Having these two values, the dynamic QT extrapolated to a heart period of 1 second (QTcd) was calculated. It was found that the mean slope (b) of the linear regression line in the ischemic stroke group was significantly lower than in the control group (0.26 +/- 0.08 vs 0.33 +/- 0.08, P < 0.02), and the constant (a) was significantly higher (1.83 +/- 0.21 for the ischemic stroke vs 1.61 +/- 0.23 for the controls, P < 0.002). No significant difference was found in QTcd values between the two groups (386 +/- 27 ms for the ischemic stroke vs 392 +/- 25 ms for the controls, P > 0.05). In conclusion, hemispheric brain infarction seems to result in alteration in the autonomic activity during exercise manifesting itself as distorted dynamic behavior of the QT interval.

Aged↗
PubMed2001

[Heart rate variability in the elderly with syncope or falls of uncertain origin].

Presyncope, syncope and falls in undetermined circumstances are frequent among the elderly. They may be caused by orthostatic hypotension secondary to autonomic insufficiency. Tilt-tests and determination of catecholamines in serum and urine may establish the diagnosis, but often may not be feasible in these patients. A simple, indirect, noninvasive technique to assess autonomic insufficiency is analysis of heart rate variability during Holter-monitoring. We present 5 cases in which it proved useful in the investigation of spells of unconsciousness.

Accidental Falls↗
PubMed2001

In-hospital referral source and rehabilitation outcome of elderly stroke patients.

To date, there is no data regarding the association of patient in-hospital referral source and stroke rehabilitation outcomes. The objective of the present study was to investigate the possible relation between in-hospital referring source, whether directly from an emergency ward (EW) or indirectly through a general medical ward (GMW), and the functional outcomes achieved during rehabilitation of such stroke patients. This retrospective observational study included 315 consecutive patients, admitted for rehabilitation following the onset of acute stroke. We compared those referred directly to us from the EW, with others referred from GMWs. Functional status was assessed by Functional Independence Measure method (FIM). Functional outcome was determined by total FIM gain (efficacy) and daily FIM gain (efficiency), both absolute and relative (to potential). The two study groups were similar in terms of age, gender, and diagnosis. FIM admission scores were higher at admission in patients admitted directly from the EW, compared with those referred from GMWs (72.5 +/- 27.5 and 62.7 +/- 25.6, respectively) but similar at discharge (77.4 +/- 28.8 and 80.7 +/- 32.5, respectively). Length of stay (LOS) in the GMW group was longer as compared to the EW group. Efficacy was significantly associated with being married, younger age, hemiplegia, and admission scores between 40-60. Both absolute and relative efficacy and efficiency rates of rehabilitation were significantly lower among patients referred from the EW. We conclude that in-hospital referral source is associated with different rehabilitation outcomes in stroke patients. Direct admission of stroke patients from the EW is associated with lower rehabilitation efficacy and efficiency rates, compared with those admitted from GMWs. The findings support the implementation of different selection methods, underscoring the need of both clinicians and administrators to consider the in-hospital referral source as a potential factor associated with stroke rehabilitation outcome.

Adult↗
PubMed2000

Why knee disarticulation (through-knee-amputation) is appropriate for non ambulatory patients.

PURPOSE: To determine the reason why 79% of knee disarticulation amputees had not received a prosthesis. METHOD: A 10 year survey was carried out of all patients who had undergone a knee disarticulation at our medical centre. RESULTS: Seventeen of the 37 patients that had not received a prosthesis were recognized to be non-ambulators prior to the surgery. Four patients died after the surgery and in 16 of the patients their general condition limited functional ambulation. An effort had been made to ambulate the patients but had failed. CONCLUSIONS: From a biomechanical point of view many advantages are to be gained for sedentary and bedridden amputees when the level of amputation is through-the-knee.

Adult↗
PubMed2000

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Journal Article↗
PubMed2000

The relation of plasma total homocysteine levels to prevalent cardiovascular disease in older patients with ischemic stroke.

The objectives of this study were to describe the distribution of serum levels of total homocysteine (HCys) in a sample of older patients consecutively admitted following acute ischemic cerebral stroke, as compared with healthy controls, and to test for possible relationships of HCys levels to some of the prevalent cardiovascular diseases in these stroke patients. One hundred and thirty-seven stroke patients and 132 healthy controls (age > or =60) participated in this study. HCys levels were determined by HPLC method with fluorescence detection. Correlates of HCys levels and clinical data were examined. The results showed that stroke patients (mean age 74.6+/-9.2) had higher HCys levels as compared with controls (13.8 and 9.8 respectively, p<0.001). Advanced age, male gender, absence of diabetes and a positive history of previous myocardial infarction were the factors associated with HCys levels higher than 10 mmol/L (Odds ratio 2.72, 2.54, 3.12, 3.55, respectively). We conclude that hyperhomocysteinemia is prevalent in older patients with acute ischemic stroke. Few factors associated with increased risk for hyperhomocysteinemia in these stroke patients were identified. The study supports earlier observations regarding elevated HCys levels in stroke patients and increased prevalence of associated cardiovascular disease.

Age Distribution↗
PubMed1999

High dose morphine use in the hospice setting. A database survey of patient characteristics and effect on life expectancy.

BACKGROUND: Pain control is one of the most important goals of end-of-life care, and the use of opioids for this purpose is extremely common in hospice settings. However, it is unknown how many of the patients require high dose morphine (HDM, >299 mg/day of oral morphine equivalent), what the characteristics of these patients are, and whether the use of HDM might affect their survival. METHODS: The authors retrospectively studied the medical records of all 651 inpatients hospitalized at their center between January 1996 and December 1997. Information was collected regarding demographic parameters, medical diagnosis, pain mechanism, morphine dosage, use of rescue doses in addition to regular doses, use of coanalgesics and adjuvant treatments, and survival time in the hospice setting as associated with morphine dosage. RESULTS: The authors identified 453 patients (69.58%) who received morphine for pain relief, of whom 55 (12.14%) needed more than 299 mg/day. Morphine dosage was negatively associated with age (r = -0.35, P = 0.01). Male patients and nonwhite patients required slightly higher dosages than others. Primary breast and genitourinary cancers, as well as metastases to bone and spinal diseases, were associated with higher morphine dosages. Statistical analysis indicated a positive correlation between the log maximum of morphine dosage and the total number of rescue dosages (r = 0.307, P = 0.025). The median survival of patients on HDM was 15.6 days and did not differ from the survival of patients taking a lower dosage. CONCLUSIONS: A fairly strong correlation exists between morphine dosage and some clinicodemographic data. No significant dose-limiting adverse effects were observed, suggesting a high clinical safety profile. High morphine dosage does not affect patient survival. Awareness of the dosage factors will improve our ability to treat and predict probable HDM dosage, thus shortening the period until pain relief is reached.

Aged↗
PubMed1999

[Sacral insufficiency fractures and low back pain in elderly women].

Sudden low back pain is common in elderly women. It causes physical and mental stress, and results in deterioration of functional movement and in activities of daily living. Awareness of possible sacral insufficiency fracture is important; they may be demonstrated by imaging modalities, mainly radionuclide bone scan. Prognosis is good and accurate diagnosis serves to exclude malignancy and relieve fear of chronic pain and disability. We describe 4 women, aged 84, 82, 71 and 77 who illustrating the clinical and imaging findings of this disorder.

Aged↗
PubMed1999

[Polyneuropathy in critical illness].

Critical illness polyneuropathy developed in 8 patients aged 22-84 years in our intensive care units. This acute polyneuropathy, predominantly axonal and motor, develops in the setting of the systemic inflammatory response syndrome and multi-organ failure. It is found in about 50% of patients treated in intensive care units for more than 2 weeks. In those who survive, neurological and functional recovery is the rule.

Adult↗
PubMed1999

Cognitive status at admission: does it affect the rehabilitation outcome of elderly patients with hip fracture?

OBJECTIVES: To determine the effect of cognitive status at admission on functional gain during rehabilitation of elderly hip-fractured patients. DESIGN: Cohort study. SETTING: A hospital geriatric rehabilitation department. PATIENTS: Two hundred twenty-four elderly patients admitted consecutively for rehabilitation after surgery for hip fracture. MEASUREMENTS: Cognitive status was assessed by the Mini-Mental State Examination and the cognitive subscale of the Functional Independence Measure (cognFIM); functional status was assessed by the motor subscale of FIM; absolute functional gain was determined by the motor FIM gain (deltamotFIM); and relative functional gain (based on the potential for improvement) by the Montebello rehabilitation factor score (MRFS). RESULTS: A significant increase in FIM scores (19.7) occurred during rehabilitation, mainly due to motor functioning (19.1). When the relative functional gain (as measured by both motor MRFS efficacy [r = .591] and efficiency [r = .376] was compared with the absolute gain (as measured by deltamotFIM [r = .304]), a stronger association between cognFIM and the relative measures was found. In addition, motor FIM efficacy and efficiency were significantly lower in the cognitively impaired patients (p<.01). A better rehabilitation outcome was seen in patients with higher admission cognitive status, adjusting for the effects of age, sex, length of stay, and type of fracture (odds ratio = 2.2, 95% confidence interval 1.5-3.7). CONCLUSIONS: Impaired cognitive status at admission lowered the rehabilitation outcome of elderly hip fracture patients. Cognitive impairment was strongly and directly associated with functional gain in these patients. Absolute motor gain appeared to be independent of cognitive status, whereas the relative motor gain depended on it. These findings support the implementation of comprehensive rehabilitation for selected cognitively impaired elderly hip fracture patients.

Activities of Daily Living↗
PubMed1999

Infarct volume, neurological severity and PAF binding to platelets of patients with acute cerebral ischemic stroke.

Studies show that Platelet Activating Factor (PAF) is involved in the cerebrovascular response to ischemia, and that its binding to platelets may change in stroke victims. The purpose of this study was to determine whether binding of PAF to platelets of stroke patients could serve as an index for determining the volume of ischemic strokes and severity of neurological presentation. Thirteen stroke patients and 21 healthy controls were studied. The neurological severity of these stroke patients was evaluated by the Scandinavian Stroke Scale. Infarct volume was assessed by planimetric measures of brain CT. PAF binding to platelets was determined by use of radiolabelled PAF. (3H)PAF binding to platelets of stroke patients was lower than in controls (149.58 +/- 46.11 and 212.1 +/- 10.3 receptors cell-1, respectively, p < 0.001) and was significantly correlated with infarct volume (r = -0.606, p = 0.014) and with neurological score (r = 0.527, p = 0.032). No correlation was observed between neurological score and infarct volume. The study confirms the involvement of PAF in the pathogenesis of brain ischemia and neuronal damage. It shows that PAF binding to platelets of stroke patients correlates both with the extent of neuronal damage and the associated neurological impairment, and may serve as an additional index in the assessment of stroke severity and clinical outcome of stroke victims.

Aged↗
PubMed1999

Dynamic beat-to-beat QT-RR relationship during physiotherapy effort in elderly patients without primary heart disease.

The ECGs from 18 patients hospitalized in a rehabilitation setting, following surgery for hip fracture, were examined to characterize the dynamic behavior of uncorrected QT interval in relation to changing RR interval during physiotherapy effort. ECG waveforms were analyzed to extract beat-to-beat QT and RR intervals using a computerized ECG Analyzer (CEA-1100). The method of defining the QT and RR intervals is based on performing multiple cross-correlations that enable rejection of artifacts from the analysis. The relationship between the RR and QT intervals was found using the following general formula QTi = cRRi-1b. Linear regression was performed on the logarithms of QT and RR measurements obtained to estimate the constant (a = log c) and the slope (b) values, reflecting the dynamic change of QT during physiotherapy effort. Having these two values, the dynamic QT extrapolated to a heart period of 1 second (QTcd) was calculated. The results were compared to the conventional corrected static QT according to the Bazzet formula (QTcs). The mean values of constants (a = log c) and slopes (b) over all patients were found to be 1.61 +/- 0.23 and 0.33 +/- 0.08, respectively, giving a QT (ms) heart-period (ms) dynamic relation of QTi = 41 x RR(i-1)0.33. The correlation between the dynamic QT and the static QT intervals was not significant. The mean values of the QTcd and QTcs intervals were significantly different (392 +/- 25 ms vs 434 +/- 28 ms; P < 0.0001). This dynamic measurement method of QT intervals may provide additional information on normal and abnormal cardiac repolarization in health and disease, helping in the diagnosis of cardiac disorders and arrhythmia risk.

Aged↗
PubMed1998

[Evaluation of predictive factors for stroke rehabilitation].

Our objective was to assess the functional disability of stroke patients by the functional independence measure (FIM) and to examine predictive factors for successful rehabilitation. In 127 consecutive stroke patients efficacy of FIM was 23.9 +/- 188, efficiency 0.54 +/- 0.45, and 81.9% of patients returned home. Functional improvement was statistically significant (p < 0.001) in all FIM domains. Multivariate analysis showed that improvement in FIM score was significantly greater in the younger, among the married, the hemiparetic, and those with an admission FIM of 40-60, while efficiency was related only to type of diagnosis. In addition, the hemiparetic were 3.3 times more likely to return home than the hemiplegic. We conclude that rehabilitation priorities should be directed towards patients younger than 75 years and to those with an admission FIM of 40-60 points. The results of this study reaffirm the usefulness of the FIM index in assessing stroke rehabilitation.

Activities of Daily Living↗
PubMed1998

[Orthostatic hypotension as a manifestation of malignant lymphoproliferative disease].

An 85-year-old man was admitted with 6-month history of incapacitating orthostatic hypotension. Investigation led to the discovery of sympathetic dysautonomia, sensorimotor neuropathy and malignant lymphoproliferative disease. Several attempts to treat the orthostatic hypotension or the neoplastic disease failed to improve his condition. Orthostatic hypotension precipitated by sympathetic dysautonomia may be an infrequent effect of early malignant lymphoproliferative disease.

Aged↗
PubMed1997

[Central cord syndrome in the elderly who fall: a diagnostic trap].

Acute post-traumatic spinal injury is common and usually poses no diagnostic difficulties. Following a low-energy fall, the onset of acute central cord syndrome in the elderly is not common and is frequently misdiagnosed. Men aged 60 and 81, and a woman aged 75 are described, in whom central cord syndrome was overlooked. Awareness of this condition is important to avoid incorrect diagnosis and hazardous management.

Accidental Falls↗