[Modern technology and the rehabilitation of the disabled].
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Biomedical subjects
Publications and source records attributed to A Ohry.
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This study examines long-term adjustment following war captivity. 164 former prisoners-of-war (POWs) and 189 other combatants of the Yom Kippur War (1973) filled out a battery of questionnaires, assessing post-traumatic stress disorder (PTSD), trauma-related intrusive and avoidance tendencies, psychiatric symptomatology, and social functioning. Almost 2 decades after the war, 13% of former POWs suffer from diagnosed PTSD. Moreover, long-term residuals of war captivity are not limited to trauma-specific disorders. Former POWs reported more severe psychiatric symptomatology and more problems in functioning than the other combatants.
The combination of paraplegia with an above-knee amputation is a complex injury that makes the rehabilitation process difficult. This article describes a case of T12 paraplegia and an above-knee amputation. After the rehabilitation course, the patient achieved full ambulatory independence with an ischial containment, contoured adducted trochanteric controlled alignment method (CATCAM) prosthesis and a knee ankle foot orthosis (KAFO). Difficulties in fitting a functional prosthesis to an insensate limb and the rehabilitation stages leading to functional ambulation are reviewed.
A review of 1300 patients with spinal cord injury (SCI), over a period of 14 years, revealed 12 patients with an 'acute abdomen'. Seven events occurred during the initial admission, ranging from 10 days to 9 months from injury, and five during readmission of 'chronic' SCI patients. Four were in the acute stage 10-30 days from injury, all with peptic ulcer perforations. The remainder had either an intestinal obstruction, appendicitis or peritonitis. All of the neurological levels were above T6 except for one patient who had a low level paraplegia. The classical signs of an 'acute abdomen' may be missing in such patients thus delaying diagnosis by 1-4 days. The most important signs were autonomic dysreflexia, referred shoulder tip pain, abdominal pain, abdominal distension, increased spasticity and abdominal pain with nausea and vomiting. Less importance was given to the classical signs of abdominal tenderness, abdominal muscle rigidity, rebound, fever and of leukocytosis. Prompt diagnosis and treatment will minimise morbidity and mortality.
Pulmonary embolism is a major complication after spinal cord injury and difficult to diagnose in any patient. Supraventricular tachycardia (SVT) is an unusual presentation for pulmonary embolism (PE). This article documents the records of a 60-year-old patient who was undergoing comprehensive rehabilitation after traumatic spinal cord injury and multitrauma. His treatment programme was interrupted by a PE with SVT as the only presenting symptom. This article outlines the clinical approach to the diagnosis of pulmonary embolism. A high index of suspicion of PE should always be kept in mind when SVT occurs in a spinal cord injured patient.
Three patients with paraplegia following corrective surgery for idiopathic scoliosis, using the Cotrel-Dubousset (CD) instrumentation, were admitted to our department over a period of 22 months. They were operated on by three different surgeons and they were the first serious neurological complications in these surgeons' careers. The monitoring method was the "wake-up" test, applied at the end of the correction maneuver with the instrument. One patient presented paraplegia at the "wake-up" test and the other two were paraplegic shortly after ceasing anesthesia. Electrophysiological spinal cord monitoring during surgery may reduce the risks of complications.
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This is an 18-year follow-up of 164 former prisoners of war (POWs) and 190 controls. The study examined long-term morbidity, psychophysiological complaints, and illness-related behaviors. Psychophysiological complaints were found to be significantly higher among the POWs than among the controls. A significant association was also found between such complaints and symptoms of posttraumatic stress disorder (PTSD). The individual's degree of impairment was associated with both objective and subjective characteristics of captivity. The authors outline differences in types of illness observed in POWs in the current study and in studies conducted in other countries, and consider the implication of characteristics of captivity and culture.
OBJECTIVE: The aim of this study was to assess the long-term impact of war captivity and combat stress reaction on rates of posttraumatic stress disorder (PTSD) in Israeli veterans of the 1973 Yom Kippur war. METHOD: One hundred sixty-four former prisoners of war (POWs), 112 veterans who had had combat stress reaction, and 184 combat veteran comparison subjects filled out the PTSD Inventory, a self-report scale based on the DSM-III-R criteria for PTSD. The inventory diagnoses past and present PTSD, assesses its intensity, and provides a symptom profile. RESULTS: Thirty-seven percent of the veterans who had had combat stress reaction, 23% of the former POWs, and 14% of the comparison subjects had had diagnosable PTSD at some time in the past. The current rates were 13%, 13%, and 3%, respectively. The results showed different recovery rates over time: almost two-thirds of the veterans with combat stress reaction who had had PTSD in the past recovered, while less than one-half of the POW group showed this improvement. CONCLUSIONS: These findings indicate that small but significant proportions of the POWs and veterans with combat stress reaction were still suffering from PTSD almost two decades after the war. The different recovery rates in the two groups may reflect the differences in duration and severity of stressors, the impact of immediate intervention on long-term adjustment, or both.
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Acute acalculous cholecystitis (AAC) is an uncommon, but serious, and potentially lethal complication that may occur among patients suffering severe trauma, including surgical trauma, burns, and bacterial sepsis. Because clinical findings are often nonspecific or misleading, AAC causes a particular diagnostic problem when occurring after unrelated surgery or trauma. We report two patients who suffered AAC following spinal cord injury (SCI). We review the etiology, diagnosis, and management of this disorder. Increased awareness of this problem by the physiatrist and rehabilitation community is important, because of the apparent increasing occurrence of AAC and the potential for significant morbidity and possible mortality when not promptly diagnosed.
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