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Biomedical subjects

I Perkash

Publications and source records attributed to I Perkash.

At least 91 records · Page 5Linked to original sources
PubMed1984

Development and evaluation of a universal contoured cushion.

A new wheelchair seat cushion has been developed which reduces the ischaemia producing forces and redistributes them to the more tolerant areas of the posterior thighs and lateral gluteal muscles. The cushion is fabricated of foam materials and designed to stabilise the pelvis and promote proper spinal-pelvic alignment. Pressure measurements were recorded at the skin cushion interface for 66 subjects while seated on the cushion in their own wheelchair. The cushion was considered effective if maximum interface pressures recorded were: coccyx: less than 20 mmHg, ischii: less than 65 mmHg, trochanters: less than 70 mmHg, and posterior thighs: less than 80 mmHg. The cushion was considered ineffective if the interface pressure at any one location exceeded these criteria. The cushion was found effective for 52 of the subjects. The cushion was more effective (90 per cent versus 58 per cent) for subjects without certain skeletal deformities (pelvic obliquity, bony resections). Eighty-three per cent of the respondents who were followed on the cushion reported that they preferred the cushion to their previous cushions with improved posture, balance and comfort being the most commonly cited reasons. This study has shown the cushion to be a preferred alternative to other commercially available wheelchair cushions for those who are paraplegic.

Adult↗
PubMed1984

Upper limb exercise effect on tilt tolerance during orthostatic training of patients with spinal cord injury.

Twelve male patients with traumatic spinal cord injury were randomly divided into a group of six experimental and six control subjects. All subjects were tilted from 0 degree to 70 degrees by 10 degrees increments at five-minute intervals until blood pressure dropped below 70/40, hypotensive symptoms appeared, or 70 degrees of tilt was achieved. The experimental subjects performed 60 active bilateral full-range forearm flexion and extension movements per minute during the first and third minute of each tilt angle. The control patients did not perform upper limb exercises during the same orthostatic training procedure. Blood pressure and pulse rate of all subjects were recorded prior to orthostatic training, during the training at specified intervals and posttraining on each day of testing and training. Total group response was quantitated by indicating the tilting protocol step at which subjects experienced orthostatic hypotension requiring termination of the test. All subjects significantly increased their tolerance of higher tilt angles by using this protocol, but there was no significant difference between the exercise group and nonexercise group with reference to tolerance to progressive vertical tilt (Mann-Whitney U test).

Adult↗
PubMed1983

Initiation of erection and semen release by rectal probe electrostimulation (RPE).

Instrumentation and methodology are described for rectal probe electrostimulation (RPE) in human males to elicit erection and allow semen collection. This system virtually eliminates shock hazard; the simultaneous monitoring of current, voltage and impedance ensures reliability and repeatability. It was tested with 8 neurologically intact subjects, and 12 paraplegic patients with lesions between T4 and L2. Platinum electrodes delivered current (density never exceeding 0.37 mA per mm. at the electrode) at frequencies of 60 Hz, 20 Hz, and 0.25 Hz. Erection was elicited repeatably in only 1 of the intact subjects, and no seminal emissions or ejaculations occurred. Discomfort prevented current delivery beyond levels even 50 per cent of those safely acceptable. Six of 10 paraplegic patients (2 others had penile implants) developed erections with 20 Hz; the other 2 frequencies were much less effective. The extent of RPE-induced penile tumescence varied directly with electrode surface area and applied current intensity. Discomfort was minimal. Retrograde seminal emission in 5 of the 12 paraplegics was verified by post-stimulation recovery of sperm via voiding or bladder irrigation via catheter. Although motility was very low, 4 of 8 recovered bladder-urine/seminal fluid specimens indicated sperm counts and morphology consonant with use in artificial insemination. Thus, RPE, if combined with techniques to allow antegrade semen collection, may be a useful technique for spinal cord-injured men who, as part of their sexual rehabilitation, are interested in siring children.

Adult↗
PubMed1983

Transrectal sonographic voiding cystourethrography: studies in neuromuscular bladder dysfunction.

To evaluate the efficacy of transrectal real-time gray-scale sonographic voiding cystourethrography in patients with neuromuscular dysfunction of the bladder, 32 men suspected of having neuromuscular dysfunction each underwent sonographic and radiographic voiding cystourethrography and urodynamic studies. The benefits accruing from the sonographic study included: (1) patients received no radiation; (2) it was as diagnostic as, and sometimes more diagnostic than, the radiographic study; (3) drug effects were easily studied; (4) accurate measurements of urethral length could be obtained; and (5) prostate diseases that might affect these patients were visible, such as benign prostatic hyperplasia, prostatic carcinoma; and prostatic calculi. In addition, sonography made one new observation possible: The seminal vesicles were enlarged in 10 patients receiving the alpha-adrenergic blocker, phenoxybenzamine. This enlargement may cause sterility.

Humans↗
PubMed1983

Sexual experience and plasma testosterone levels in male veterans after spinal cord injury.

Fifty men with spinal cord injuries (SCI) were asked to complete a questionnaire concerning their sexuality before and after injury. Medical examination confirmed the location and completeness of the injury and extracted information about genitourologic status. The respondents rated sexuality highly as a concern in living, and a wide variety of sexual techniques were reported. A marked decrease in sexual activity, satisfaction, and feelings of sexual adequacy was reported after injury, as compared to retrospective "before injury" responses, lack of opportunity being reported as causative by 66% of the subjects and insufficient personal satisfaction by 59%. Seventy-five percent of the subjects experienced sexual arousal from genital stimulation, and several methods of eliciting erection were cited. Orgasm was described by a variety of terms. Significant differences were found between quadriplegic and paraplegic patients in answers to several items, though there was generally no difference between cervical and thoracic groups, which were more specifically broken down with respect to motor or sensory/complete or incomplete lesions. Plasma testosterone levels were found to fall well within the normal adult male range, as were levels of free testosterone and serum sex binding protein. The resulting information demonstrated more sexual concern among men with SCI than the literature previously indicated.

Adult↗
PubMed1982

Warning mat to signal air seat cushion failure.

A warning mat that signals partial or total deflation of a pneumatic wheelchair cushion has been developed. The purpose of this device is to prevent pressure sores that occur when an inflatable seat cushion loses air gradually and causes ischial tuberosities of a spinal cord injured patient to "bottom out," ie, to come to rest on the hard wheelchair seat. Resulting ischemic necrosis in this anesthetized area is prevented when localized high seating pressure triggers a pressure sensitive warning mat under the wheelchair cushion to produce a high-pitched audio signal warning the patient to reinflate the cushion or leave the chair. Efficacy of this device has been demonstrated in clinical trials, but prevention of decubiti will need to be substantiated by a long-term controlled study.

Equipment Safety↗
PubMed1981

Reexamination of the intraurethral pressure determination using CO2 perfusion: its monitoring mechanism, standardization, and employment for the determination of the urethral constitutive property.

Urethral closure pressure profile is intended to provide an index of urethral resistance to bladder output, enable an assessment of urinary continence, provide distinction between a distensible and fibrotic sphincter urethral segment, and contribute information to enable characterization of detrusor-sphincter dyssynergia. However, the intraurethral pressure is a function of the catheter size, the hole size through which fluid is perfused, the fluid perfusion rate and the distensibility of the urethral sphincter segment; for want of standardization, it is difficult to functionally interpret the value of the peak urethral pressure taken with a certain catheter at a given perfusion rate. We have catered to this lacunae by developing (i) the urethral closing pressure, as the peak intraurethral pressure for theoretical limiting cases of zero perfusion rate and urethral diameter, and (ii) the urethral stiffness as a relation between its wall tension and tensile strain. Their detailed analyses and clinical interpretations are provided.

Carbon Dioxide↗
PubMed1981

Stability of the upper lumbar spine following progressive disruptions and the application of individual internal and external fixation devices.

UNLABELLED: Five fresh human cadavera were tested to determine range-of-motion measurements at the interspace of the first and second lumbar vertebrae after progressive disruption of the joint followed by internal and external stabilization. The disruption progressed from posterior to anterior, leaving the anterior longitudinal ligament and anterior part of the annulus fibrosus intact. Flexion-extension range of motion was most sensitive to progressive disruptions and was significant following disruption of the facets. The Taylor-Knight brace was effective for limiting lateral motion, fair for limiting flexion-extension, and not effective for rotation. The three-point hyperextension brace was fairly effective for flexion-extension only. The body cast was effective in limiting all motions. Wire loops partially cut through the spinous processes in all cases with extreme flexion. Harrington distraction rods were effective in limiting motion if under proper tension, but they dislodged in three of the five specimens. CLINICAL RELEVANCE: Data from this study show that flexion of the second lumbar vertebra on the first of 20 degrees or a lateral bend of 10 degrees seen on a routine roentgenogram without vertebral fracture indicates that all posterior ligaments and at least part of the annulus fibrosus must be disrupted. Because internal fixation failed on occasion, we strongly urge the use of external fixation and careful mobilization of the patient to prevent flexion and rotation if internal stabilization is used for disruptions of the upper lumbar spine. The body cast was the most effective in limiting motion of the external fixation devices tested.

Aged↗
PubMed1980

Problems of decatheterization in long-term spinal cord injury patients.

There were 50 men with a mean age of 43.5 years subjected to urodynamic analysis and decatheterization. Of these 50 patients 41 had had indwelling catheters from 1 to 29 years, with a mean of 7.3 years, and 9 had suprapubic catheters from 1 to 14 years, with a mean of 9.8 years. Previous attempts at decatheterization in about 70 per cent of these patients had failed owing to severe autonomic dysreflexia and fear of progressive upper tract damage. Of the 50 patients 15 (30 per cent) had had vesicoureteral reflux and 16 (32 per cent) had been treated repeatedly for bladder and kidney stones. Detrusor-sphincter dyssynergia was detected in 58 per cent of the patients. All patients with suprapubic tubes had a contractile bladder, compared to only 33 per cent of the patients with indwelling catheters. After transurethral sphincterotomy all patients were decatheterized, which resulted in marked general improvement, amelioration of autonomic dysreflexia and easy control of urinary tract infection in 80 per cent of the cases.

Adult↗