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Biomedical subjects

E J Roth

Publications and source records attributed to E J Roth.

At least 37 records · Page 2Linked to original sources
PubMed1994

Stroke rehabilitation. 3. Rehabilitation evaluation and management.

This self-directed learning module highlights rehabilitation evaluation and management. Part of the chapter on stroke rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation, this article contains sections on determining the level of rehabilitation needed after stroke, the common disabilities seen after a stroke and their evaluation and management, neurofacilitative approaches in stroke recovery, and the management of dysphagia and bladder and bowel dysfunction in the stroke patient.

Aphasia↗
PubMed1994

Stroke rehabilitation. 1. Epidemiologic aspects and acute management.

This self-directed learning module highlights the epidemiology and acute management issues for stroke. As part of the chapter on stroke rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation, this article contains sections on the epidemiologic features of stroke, including etiology and risk factors, pathophysiologic aspects of stroke syndromes, and acute medical issues in stroke.

Cerebrovascular Disorders↗
PubMed1994

Stroke rehabilitation. 2. Comorbidities and complications.

This self-directed learning module highlights the preexisting comorbid conditions and the medical complications during and after rehabilitation of the patient with stroke. Part of the chapter on stroke rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation, this article identifies several of the major associated medical problems, such as venous thromboembolism, pneumonia, seizure, and pressure sore; discusses methods of management for each of these problems; and reviews implications of associated conditions, such as heart disease, diabetes, and hypertension, and secondary complications for rehabilitation and outcome.

Cerebrovascular Disorders↗
PubMed1994

Serum albumin level as a predictor of geriatric stroke rehabilitation outcome.

This study examined the value of serum albumin level as a predictor of medical complications and functional outcomes in 79 patients, age 65 years or older, who underwent comprehensive inpatient interdisciplinary rehabilitation for a first-time, unilateral, thromboembolic stroke. We recorded serum albumin levels at the time of admission to an inpatient rehabilitation unit, reports of the medical complications during rehabilitation, and Modified Barthel Index (MBI) Scores on admission and discharge. The mean (+/- SD) serum albumin level for all patients was 3.3 +/- 0.4g/dL. Forty-two patients (53%) had a total of 69 medical complications during rehabilitation. Mean serum albumin levels were 3.2 +/- 0.4g/dL for the group with complications and 3.5 +/- 0.3g/dL for the group without complications (t = -4.34, p < 0.001). Of the 37 patients with albumin levels > or = 3.5g/dL, only 32% had complications; of the 28 patients with levels from 3.0 to 3.4g/dL, 68% had complications; of the 14 patients with levels < or = 2.9g/dL, 79% experienced complications (chi 2 = 12.4, p = 0.002). There were positive correlations between serum albumin levels and the discharge MBI Self-Care Subscores, Mobility Subscores, and Total Scores (p < 0.001). There were also correlations between serum albumin levels and the Mobility and Total MBI Improvement Scores (p = 0.002 and p = 0.008, respectively). The relationship between serum albumin levels discharge destination approached statistical significance. Neither age nor side of lesion were related to serum albumin level, medical complication rate, or functional outcomes. Serum albumin levels appear to be related to medical complication rate and functional outcome in geriatric stroke patients. This suggests that older stroke patients with hypoalbuminemia may warrant closer medical attention or therapeutic intervention before and during rehabilitation.

Aged↗
PubMed1994

Heart disease in patients with stroke. Part II: Impact and implications for rehabilitation.

Cardiac disease reduces the long-term survival of stroke patients and increases the likelihood of intercurrent medical illness during the rehabilitation phase. It remains controversial whether heart disease negatively affects functional capabilities after stroke, but most studies agree that associated cardiac disease, especially congestive heart failure, adversely affects functional outcomes after stroke rehabilitation. Reliable clinical assessment of the presence and severity of heart disease in stroke patients may be hampered by mobility limitations, communication deficits, and other problems. Therefore, specialized diagnostic methods may be needed. The development and application of effective and consistent medical and rehabilitation guidelines for proper comprehensive care may enhance the likelihood of achieving favorable outcomes and of avoiding complications in patients with stroke.

Cerebrovascular Disorders↗
PubMed1993

Isolation of a yeast artificial chromosome contig spanning the X chromosomal translocation breakpoint in a patient with Rett syndrome.

Rett syndrome is a neurodevelopmental disorder observed exclusively in females. A de novo X;3 translocation was detected in a patient (TH) with Rett syndrome. The X chromosomal breakpoint maps to Xp21.3 between the distal end of the Duchenne muscular dystrophy (DMD) gene and the DXS28 (C7) locus. To determine if this translocation caused the Rett syndrome in this patient, our efforts focused on mapping and cloning of the X chromosomal breakpoint in this patient. Toward these goals, we generated a set of radiation-reduced hybrid cell lines for the short arm of the X chromosome to use as a source for region-specific markers. Using Alu-PCR, 13 new DNA markers were isolated from a radiation-reduced hybrid, which retained both DMD and DXS28. These markers were localized within Xp21 using DNA from males with various interstitial deletions in this region. Two new markers, K23-2p and K23b-1, were found to be closer flanking markers to the X chromosomal breakpoint than DMD and DXS28. Long range restriction mapping using K23-2p and K23b-1 determined that the maximum distance between them was 800 kb. Several of the new markers were developed into sequence tagged-sites and were used to isolate yeast artificial chromosome (YAC) clones. A total of 22 YAC clones was isolated and characterized; these YACs were then developed into 3 large contigs in the Xp21.3 region. This effort resulted in the cloning of the region containing the X chromosomal translocation breakpoint of the Rett syndrome patient in a 170-kb YAC clone.

Animals↗
PubMed1993

Yeast artificial chromosome cloning in the glycerol kinase and adrenal hypoplasia congenita region of Xp21.

The adrenal hypoplasia congenita (AHC) and glycerol kinase (GK) loci are telomeric to the Duchenne muscular dystrophy locus in Xp21. We developed a pair of yeast artificial chromosome (YAC) contigs spanning at least 1.2 Mb and encompassing the region from the telomeric end of the Duchenne muscular dystrophy (DMD) locus to beyond YHX39 (DXS727), including the genes for AHC and GK. The centromeric contig consists of 13 YACs reaching more than 600 kb from DMD through GK. The telomeric contig group consists of 8 YACs containing more than 600 kb including the markers YHX39 (DXS727) and QST-59 (DXS319). Patient deletion breakpoints in the region of the two YAC contigs define at least eight intervals, and seven deletion breakpoints are contained within these contigs. In addition to the probes developed from YAC ends, we have mapped eight Alu-PCR probes amplified from a radiation-reduced somatic cell hybrid, two anonymous DNA probes, and one Alu-PCR product amplified from a cosmid end, for a total of 26 new markers within this region of 2 Mb or less. One YAC in the centromeric contig contains an insert encompassing the minimum interval for GK deficiency defined by patient deletion breakpoints, and this clone includes all or part of the GK gene.

Adrenal Insufficiency↗
PubMed1993

Heart disease in patients with stroke: incidence, impact, and implications for rehabilitation. Part 1: Classification and prevalence.

Heart disease is found in about 75% of patients who have suffered a stroke. Cardiovascular diseases can be risk factors, etiologic mechanisms, associated conditions, or direct consequences of stroke. Cardiac comorbidity may delay initiation of rehabilitation, complicate the course and care of the patient with stroke, inhibit participation in a therapeutic exercise program, limit functional outcomes, and contribute to early mortality in the individual with cerebrovascular disease. Part 1 of this two-part article describes the various forms of heart disease that may be seen in stroke patients, and reviews the incidence figures for each type of associated cardiac condition.

Cerebrovascular Disorders↗
PubMed1993

Cough in spinal cord injured patients: comparison of three methods to produce cough.

Pulmonary complications are the major causes of morbidity and mortality for persons with cervical spinal cord injury. Diminished ability to cough constitutes a major contribution to the high incidence of pulmonary morbidity in this population. This article reports preliminary results for a new technique for providing assisted cough in this population. In this study, efficacy of cough (as measured by peak expiratory flow rate) was measured under three conditions: volitionally with no assistance, with manual assist of a therapist, and with electrical stimulation of abdominal muscles. Coughs produced by electrical stimulation were approximately as effective as manually assisted coughs. The results suggest this technique is worthy of more detailed study and may be a potentially effective new modality for assisting spinal cord injured persons to clear their airways.

Abdominal Muscles↗
PubMed1993

The critical path method in stroke rehabilitation: lessons from an experiment in cost containment and outcome improvement.

This study tested the effects of a project network technique called the Critical Path Method (CPM) on the costs and outcomes of inpatient team stroke rehabilitation. On admission to a large, academic, inpatient rehabilitation hospital adults who had a recent (< 120 days) stroke were randomly assigned to receive rehabilitation services from a team trained in CPM (N = 53) or from usual care teams (N = 68). Results showed no significant difference between groups in length of stay, hospital charges, or functional status at discharge. CPM may be effective in patient care services that are less influenced by specialization, professional issues, and external regulation and in settings where patient outcomes are relatively fixed and predictable, and medical care is integrated across institutions.

Activities of Daily Living↗
PubMed1993

A high resolution deletion map of human chromosome Xp22.

We have developed a 32-interval deletion panel for human chromosome Xp22 spanning about 30 megabases of genomic DNA. DNA samples from 50 patients with chromosomal rearrangements involving Xp22 were tested with 60 markers using a polymerase chain reaction strategy. The ensuing deletion map allowed us to confirm and refine the order of previously isolated and newly developed markers. Our mapping panel will provide the framework for mapping new sequences, for orienting chromosome walks in the region and for projects aimed at isolating genes responsible for diseases mapping to Xp22.

Base Sequence↗
PubMed1993

Comparison of semen quality obtained by vibratory stimulation and masturbation.

Six normal males underwent both penile vibratory stimulation and masturbation in order to compare the quantity and quality of semen produced by each method. There was no significant difference in the quantity and quality of the ejaculates produced by vibratory stimulation of the penis and masturbation. In addition, biochemical analysis of the seminal fluid collected by both procedures revealed similar values between all specimens for nine organic constituents, seven inorganic constituents and seven metabolic enzymes. None of the subjects demonstrated retrograde flow of semen. These findings indicate that vibratory stimulation is a 'physiological' means of inducing ejaculation, and can produce semen of normal quality.

Ejaculation↗
PubMed1992

Metal thiolate coordination in the E7 proteins of human papilloma virus 16 and cottontail rabbit papilloma virus as expressed in Escherichia coli.

The oncogenic E7 proteins of human papilloma virus (HPV 16) and of cottontail rabbit papilloma virus (CRPV) have been purified from an expression system in Escherichia coli. The proteins as purified from E. coli contain one tightly bound Zn(II) ion per molecule. The metal site shows facile exchange with either Cd(II) or Cu(I). The HPV 16 E7 maximally bound one Cd(II) or two Cu(I) ions, while the CRPV E7 bound two Cd(II) or three Cu(I) ions. The Cd(II) and Cu(I) E7 molecules exhibited optical transitions in the ultraviolet suggestive of metal:thiolate coordination. E7 proteins from HPV 16 and CRPV contain 7 and 8 cysteines/molecule, respectively. Reaction of the E7 proteins with the sulfhydryl reagent, dithiodipyridine, revealed that all the cysteinyl sulfurs are present in the reduced thiol state. Cu(I)-E7 molecules are luminescent with maximal emission at 570 nm. The observed emission at room temperature is indicative of metal coordination within a compact protein environment shielded from solvent interactions. The emission maxima occurs at the same wavelength (570 nm) as Cu(I)-cysteinyl sulfur clusters in Cu(I)-metallothioneins. The single Zn(II) atom in each protein can be removed from E7 in the presence of EDTA. The resulting apoE7 molecules remain soluble and can be partially reconstituted with Cd(II) to regain the ultraviolet charge transfer transitions.

Animals↗
PubMed1992

Lower limb paralysis: its effect on the recanalization of deep-vein thrombosis.

Fifty patients with lower limb deep-vein thrombosis (DVT) confirmed by venography were studied prospectively to determine the time required for recanalization. The patients were anticoagulated with heparin and warfarin for at least three months; impedance plethysmography, Doppler, and duplex scans were repeated at scheduled intervals. The 24 patients who were paralyzed took longer for recanalization than did the 26 nonparalyzed patients; this difference was statistically significant between the paraplegic-quadriplegic and nonparalyzed groups (54 vs 33 days; t = 2.12, p = .04). Patients with motor complete paraplegia or quadriplegia took longest for recanalization (57 days). Although most variables were not statistically significant on comparison, a somewhat longer recanalization time was seen in men and in those with DVTs located more proximally. Because of delay in recanalization, patients with lower limb paralysis may have persistent swelling due to venous insufficiency and may be at greater risk for development of the postphlebitic syndrome.

Adult↗
PubMed1992

The older adult with a spinal cord injury.

Sixty-two consecutive acute spinal cord injury (SCI) patients who were aged 55 years or older were studied and compared to 296 SCI patients of age less than 55 years. Compared to younger patients, the older group had significantly more females (29%), preexisting medical conditions (87%), associated injuries (55%), incomplete quadriplegic patients (63%), and persons whose injuries resulted from falls (53%). There were no differences between groups in frequency of ventilator use, occurrence of medical complications, or acute length of stay, but older patients tended to have fewer surgical spinal fusions (40%), shorter rehabilitation stays (66.5 days), more indwelling urethral cathteters (31%), and more nursing home discharges (19%). With other factors being controlled, advancing age was predictive only of nursing home discharge, and not of acute or rehabilitation lengths of stay. Among older SCI patients, those with complete injuries were nearly 3 times as likely to have been discharged to nursing homes in our series compared to older patients with incomplete lesions. Although many aspects of the presentation, course, and care of older SCI individuals are similar to those of younger patients, there are several unique features of older adults with a SCI.

Adult↗
PubMed1992

A second traumatic spinal cord injury: associated risk factors. Case report and review.

Despite advances in acute care and long term management, traumatic spinal cord injury remains a devastating and disabling event. This report describes the case of a second traumatic spinal cord injury in a previously rehabilitated and functionally independent paraplegic. Factors potentially associated with the second spinal cord injury in this patient include wheelchair use, previous spinal fusion, alcohol use and sensation-seeking behavior. These factors, which are common to many spinal cord injured patients, could potentially be risk factors for a second traumatic spinal injury.

Accidents, Traffic↗
PubMed1992

Galactorrhea: a complication of spinal cord injury.

Galactorrhea, a secretion of milk or milk-like products from the breast in the absence of parturition, has been reported to occur in women with spinal cord injuries in association with amenorrhea and hyperprolactinemia. Four cases of galactorrhea in association with spinal cord injury are reported. Galactorrhea developed in four spinal cord injured women who had thoracic paraplegia. The onset of galactorrhea was from one month to five months after injury. Although the onset of galactorrhea may have been related to prescribed medications in all four cases, insufficient data exist to draw conclusions. The three women whose galactorrhea persisted declined treatment and galactorrhea continuing for more than two years in one instance. We conclude that galactorrhea with or without amenorrhea may develop after a spinal cord injury and that spinal cord injured women may have an enhanced sensitivity to medication-induced galactorrhea.

Adult↗