[Automation and dental education. Reflections on tomorrow].
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Biomedical subjects
Publications and source records attributed to G Zeilig.
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The incidence of spinal cord injury associated with blunt traumatic rupture of the diaphragm is extremely low and rarely mentioned in the numerous reports about rupture of the diaphragm. It is thought that more such cases can be found among the fatalities of aircraft accidents and presumably among the fatalities of road traffic accidents as the forces causing such injuries make it unlikely for the casualty to survive. The authors present six cases encountered at Stoke Mandeville Hospital, England, and at Sheba Medical Centre, Israel. Although the mortality of such cases, if the patient survives the original impact, is usually due to associated injuries, early diagnosis is essential as late complications increase the incidence of delayed mortality.
A 64-year-old man sustained acute quadriplegia due to a traffic accident, while in the midst of a petit mal seizure. After recovery from the initial medical complications he developed a duplicate limb phenomenon. The patient felt that another pair of upper and lower limbs had grown from his body, parallel to the paralysed limbs. To the best of our knowledge this duplicate phenomenon in all limbs has not been described before in a traumatic quadriplegic patient. It is our impression that this phenomenon is a rare example of preoccupation with the paralytic limbs, of sensory deprivation with a (possible) unusual drug reaction.
Six women with a traumatic spinal cord injury (SCI) developed hyperprolactinemia, amenorrhea and galactorrhea. Five of them had thoracic level lesions and 1 had a lumbosacral lesion. Two were postpartum and 1 was pregnant at the time of injury. Transient diabetes insipidus developed in 1 patient. Temporary administration of bromocriptine decreased prolactin levels, caused cessation of lactation and restored ovulatory cycles. The syndrome disappeared spontaneously in all 6 patients. Pituitary stalk concussion resulting from the trauma might cause this phenomenon, with the level of the cord injury playing a role. Being pregnant or early postpartum can predispose women to develop this syndrome.
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We report on a traumatic paraparetic patient, who developed acute intermittent arteriomesenteric occlusion of the duodenum after the use of Harrington's spinal instrumentation. This rare condition was treated conservatively. It is presumed that some degree of hyperlordosis of the lumbar spine by the rods was responsible for this phenomenon.
Four cases are described wherein massive centrifugal trauma caused a whirl-whiplash type injury to the spinal cord resulting in paralysis. Two patients became paraplegics and two quadriplegics. In three cases, there was a loss of one or more limbs associated with other concomitant injuries. Attention is focused on the problems facing patients with a combination of plegias and amputation.
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A new hybrid functional electrical stimulation orthosis system for the upper limb has been designed to allow for ease of use in the home as a daily treatment modality, as well as offer the opportunity for function enhancement. In a pilot study, the system was used by ten patients with chronic stable hemiparesis secondary to cerebral vascular accident and head injuries. The patients were referred by their treating physicians or therapists after meeting the inclusion criteria of good general health, being greater than one year after head injury, or being ten months post-stroke, with no observed neurologic changes in the prior six weeks. Each of these patients had received prolonged physical therapy, either continuous from the initial inpatient rehabilitation treatment or on an intermittent basis over a period of years. The baseline status for factors related to increased muscle tone, i.e., passive range of motion at the wrist and elbow, posture at rest, posture immediately following activity, and spasticity were quantified before the treatment protocol with the functional electrical stimulation orthosis. Active range of motion and tests of functional use of the involved upper limb were also assessed. The patients were instructed in the protocol, trained in the use of the system, and then used the electrical orthosis at home for up to several hours per day. Follow-up assessments were at six months. A statistically significant improvement was noted in all muscle tone/spasticity parameters measured. A separate report will describe the effects on voluntary motion and functional capabilities.
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