Flexicollis and "floppy head" syndrome.
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Female↗
Biomedical subjects
E W Johnson
Publications and source records attributed to E W Johnson.
Duchenne muscular dystrophy: a case with prolonged survival.
We report the case of a patient with confirmed Duchenne muscular dystrophy who lived a useful and improved life until age 34. He was first seen in our Muscular Dystrophy Clinic when he was 14; at that time he was functionally quadriplegic and required assistance for all activities of daily living. At age 17, ventilatory insufficiency developed and the patient was provided with a positive pressure device (mouthpiece) to augment his ventilation. A year later he learned the technique of glossopharyngeal breathing. After surviving acute pneumonia at age 24, he became a licensed real estate salesman and was married at age 29 to his attendant (the marriage ended in divorce). He eventually enrolled as a student at Ohio State University, lived on campus, and moved about in a powered wheelchair. He died an accidental death by drowning at age 34 when his wheelchair veered suddenly into a pond eight feet deep.
Adult↗
Ender's pinning for fractures about the hip.
In this study, we reviewed retrospectively our first 4 years of experience with treatment of hip fractures with Ender's pinning in an effort to determine the related problems and the types of fractures for which this procedure is the most effective. Of the 77 fractures in our series, 59 cases were available for follow-up evaluation. Knee pain was reported by 41% of the patients. Overall, 31% of the group underwent additional surgical procedures, primarily because of distal migration of the pins. On the basis of our results, we recommend that Ender's pinning be reserved for treatment of basilar neck and type I intertrochanteric fractures in patients who cannot tolerate a more extensive procedure.
Aged↗
Micturition alert device.
The determination of an accurate postvoid residual (PVR) is essential to a successful intermittent catheterization program. A light (40g), simple electronic device that alerts the hospital staff by means of a buzzer or an LED, when a patient is voiding, is described.
Electronics, Medical↗
Football shoulder and neck injury: a study of the "stinger".
Twenty football players with preliminary diagnosis of "stinger" were examined and treated. Of the 12 on whom EMGs were performed, all but one were proven to have C6 radiculopathy rather than lateral stretch of brachial plexus. Most frequent mode of injury was neck flexion during tackling by a linebacker. Athletes should not return to competition until abnormal neurologic signs disappear.
Adolescent↗
Wrist dimensions: correlation with median sensory latencies.
A serendipitous observation that many individuals with carpal tunnel syndrome have square wrists led to this study which correlates wrist dimensions with median sensory latencies. Results suggest that the squarer the wrist the longer the latencies.
Adult↗
Carpal tunnel syndrome: use of palmar stimulation of sensory fibers.
In early or mild carpal tunnel syndrome (CTS), where the segment of median nerve sensory fibers is neurapraxic, stimulation of the nerve distal to the carpal ligament elicits a normal response in comparison to the segment of nerve across the carpal tunnel. In 100 hands of 50 normal adults, palmar stimulation of the median sensory fibers at 7 cm was compared to that at the wrist (14cm). Mean values for latency, amplitude, and duration were obtained, and palm/wrist ratios were calculated. Fifteen patients with CTS and 6 with underlying peripheral neuropathy were studied. This technique is useful for diagnosing early CTS and also for identifying an underlying mild peripheral neuropathy, eg, in diabetes mellitus.
Adult↗
Contempo '81. Physical medicine and rehabilitation.
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Physical and Rehabilitation Medicine↗
Lumbosacral radioculopathy: review of 100 consecutive cases.
Of 100 consecutive patients with acute lumbosacral radiculopathy who were treated conservatively and the majority of whom were followed for at least 5 years, only 5% had to undergo laminectomy and diskectomy. Conservative management included complete bed rest for 2 to 3 weeks, with occasional use of anti-inflammatory drugs, and support of the lumbosacral spine, at first with a corset and later with vigorous abdominal strengthening exercises. Repeated electromyography was of value in assessing clinical weakness, providing objective guidance to management. It is concluded that in only rare instances is surgery indicated for lumbosacral radiculopathy secondary to disk derangement.
Electromyography↗
Sensory latencies to the ring finger: normal values and relation to carpal tunnel syndrome.
Sensory innervation to the ring finger (digit IV) is generally shared by the digital branches of the median and ulnar nerves. In 74 hand studies on 37 normal adults, all had a recordable response in digit IV upon stimulation of the median and ulnar nerves antidromically 14cm proximally to the recording electrodes. Comparing the median sensory latency to digit IV with the ulnar sensory latency to the same digit, the difference was 0.3msec or less in 93% of the hands. In 18 cases of carpal tunnel syndrome, the difference ranged from 1 to 2.1msec. This procedure may be of value as an easily performed and rapid technique to screen vulnerable nerve syndromes for possible entrapment and to provide baseline data for asymptomatic hands in individuals with carpal tunnel syndrome.
Action Potentials↗
Fractures in amputation stumps: review of treatment of 16 fractures.
A retrospective study of patients who sustained a fracture of the amputation stump was carried out to determine how these injuries might be prevented and to develop an optimum method of treatment. Review of the records of the Mayo Clinic from 1956 through 1978 revealed that 14 patients had a fracture in the amputation stump and 2 patients had two separate episodes of fracture, for a total of 16 fractures. Each patient's history and the available x-ray films were carefully reviewed. Fifteen fractures involved the femur or hip, and one involved the tibia and fibula. All fractures went on to union, but four of nine treated with internal fixation had comp]lications, three of which required further surgical procedures. At least five fractures in this series might have been prevented by better patient instruction and closer attention to fitting the prosthesis. Half of the fractures resulted from falls in the elderly patient. All five fractures that were treated without internal fixation healed well in a short time. The relatively high complication rate associated with internal fixation contrasted with the relatively rapid rate of union of the fractures treated without internal fixation suggests that these fractures should be treated by conservative measures if possible.
Adolescent↗
Corrective supracondylar osteotomy for painful genu valgum.
Fifty-three corrective supracondylar osteotomies were done in 46 patients who were limited by painful genu valgum. Relief was afforded when the surgery "unloaded" the lateral compartment, and this was accomplished when the anatomic axis of the femur was brought to an angle of 90 degree with the condylar line. A closing wedge osteotomy held by one staple was used in most cases. A method for computing the correction needed and for certifying this at surgery is discussed. The patients graded the results more favorably than the physicians did. The system of correction described has practical application in that guesswork is eliminated in the closing wedge osteotomy.
Adolescent↗
Controversies about Duchenne muscular dystrophy.
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Braces↗
Effect of ascorbic acid on urine pH in patients with injured spinal cords.
The ability of ascorbic acid to lower urinary pH in patients with spinal cord injury and neurogenic bladder was studied. Ascorbic acid (1 g four times daily) or placebo was administered for five days in a double-blind, crossover study to 20 patients with spinal cord injury and neurogenic bladder. Urine pH was measured for two days before and during administration of placebo or ascorbic acid. The mean decrease in urinary pH with ascorbic acid was 0.58, but this reduction was not statistically or clinically significant. Only 7 of 20 patients showed a mean urine pH of 5.5 or less (acidic) during treatment with ascorbic acid. The study suggests that an ascorbic acid dosage of 1 g four times daily should not be used to maintain an acidic urinary pH for control of urinary tract infections in patients with spinal cord injuries.
Adolescent↗
Rehabilitation in spinal cord injury: use of a patient-family group.
A 1-day group meeting for spinal cord injured individuals and their families was initiated approximately 3 years ago with emphasis on providing information and sharing mutual concerns and feelings. From the results of tests administered before and after the program and of evaluation forms filled out by all participants, the Family Group has been found to be a useful adjunct to the rehabilitation program. Family members are effectively and meaningfully involved in the total rehabilitation process with the added benefit of decreasing their feelings of anxiety, helplessness and isolation. Evaluation suggests that the Family Group increases the individual's knowledge and awareness of a disability and its implications. It has introduced important topics of discussion within the family unit and has aided in more open communication among family members surrounding these issues. All of these benefits, combined, have resulted in more effective, realistic and appropriate discharge planning for patients.
Adolescent↗
Mechanical ventilation of patients with late stage Duchenne muscular dystrophy: management in the home.
Death in the late stage of Duchenne muscular dystrophy is most frequently a consequence of respiratory failure. Since muscles of ventilation become weakened the bellows mechanism fails insidiously. Patients exhibit symptoms of ventilatory insufficiency, the first to be noticed are those associated with CO2 retention: dyspnea, nightmares, increased heart rate, and increased blood pressure. Ten patients with late stage Duchenne muscular dystrophy have been supplied with mechanical aid for ventilatory assistance. The age of onset of respiratory distress needing mechanical assistance varied from 10 to 20 years. Meaningful survival after allegedly reaching the end stage has been from 2 to 7.5 years with an average of 3.4 years. With a caring family, these patients can have a meaningful life, even though they require continuous mechanical ventilatory aid.
Adolescent↗