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Biomedical subjects

J C Honet

Publications and source records attributed to J C Honet.

At least 19 recordsLinked to original sources
PubMed1989

Regression of herniated nucleus pulposus: two patients with lumbar radiculopathy.

Thirty percent to 95% of patients with lumbar radiculopathy secondary to a bulging or herniated disc improve to a pain-free and functional level with nonsurgical treatment. What happens to the herniated disc material as this improvement occurs is unclear. We present two patients with lumbar radiculopathy documented by physical examination and electrodiagnostic testing. Both patients had herniated disc material at the L5 to S1 level on computed tomography (CT) scans corresponding to the side and level of their lesion on physical examination and electrodiagnostic testing. In both instances, the radiculopathy resolved with conservative treatment. CT scans were repeated in three months on one patient and four months on the other. The scans showed major resolution of the herniated disc material in both patients. These two cases demonstrate that in some patients with proven radiculopathy secondary to herniated nucleus pulposus, the herniated disc material will no longer be visible on CT scan and is presumed to resorb as the symptoms abate.

Adult↗
PubMed1988

Complete hemidiaphragmatic paralysis in a patient with multiple sclerosis.

We present a case history of a patient with definite multiple sclerosis who developed an abrupt onset of unilateral diaphragmatic paralysis, minor increase in lower extremity spasticity and complaint of marked neck stiffness. Her vital capacity during this episode was 600 mL and she was in impending respiratory failure. The diaphragmatic paralysis was demonstrated by radiographic plain films and fluoroscopy. Phrenic nerve stimulation was performed during fluoroscopy and the evoked motor response from the diaphragm recorded. There was a normal amplitude diaphragmatic twitch observed with an evoked motor response latency of 1 ms and amplitude of 300 microV. After high dose intravenous steroids, her neck stiffness and spasticity improved, her vital capacity improved to 1500 mL and her diaphragm regained its normal position and movement confirmed by followup radiographic plain films and fluoroscopy. We postulate the presence of a demyelinating plaque in the brainstem fibers descending to the phrenic nucleus as the etiology of the diaphragmatic paralysis. We are unaware of any other case reports of unilateral "upper motor neuron" phrenic nerve paralysis secondary to multiple sclerosis.

Adult↗
PubMed1988

Orthotic technique for dystonia musculorum deformans.

Tone reducing, inhibitive casting, and orthoses have been effectively used in patients with cerebral palsy and head injury to improve gait patterns and decrease tone. We present a patient with dystonia musculorum deformans who had severe inversion and supination of his left foot with weight bearing. He did poorly with metal double-upright ankle-foot orthoses with lateral T-strap. A tone-reducing ankle-foot orthosis (TRAFO) was successful in decreasing problems with abrasions and allowing him to walk without assistive devices.

Adult↗
PubMed1988

Calf enlargement associated with neurologic disease: two uncommon cases.

Muscle enlargement and hypertrophy are rare findings in neurogenic lesions. The two in combination have been reported in cases of peripheral nerve lesions, polyneuropathy, and poliomyelitis. True and pseudo muscle hypertrophy are the two possible etiologies, whereas infiltration, stretch, or exercise of the muscle are the causative factors. We report two cases of unilateral calf enlargement, one occurring after surgery for S1 radiculopathy with associated cramping, and the other after poliomyelitis.

Adult↗
PubMed1988

Physiatric practice characteristics: report of a membership survey.

In 1986 the Board of Governors of the American Academy of Physical Medicine and Rehabilitation commissioned a survey of the Academy's membership to determine the practice patterns of physiatrists. Responses were received from 1,115 members (75%). Approximately 65% of respondents are under 43 years old; 64% are graduates of American medical schools. Fifty-six percent practice in communities with populations of 500,000 or more persons; only 9% practice in communities of less than 50,000 people. Nearly 53% practice in a single setting and the average work week is 50.6 hours, with most of those hours spent in some aspect of patient care. The most frequent diagnosis in all practice settings is pain syndrome; consultation is the primary activity. Survey results show that physiatry is still primarily a hospital-based specialty, although significant time is spent in office-based settings. Data gleaned from this first attempt at an extensive analysis of physiatric practice characteristics will be utilized in planning how to meet future needs of the specialty, its practitioners and their patients.

Adult↗
PubMed1987

Temperature effect on antidromic and orthodromic sensory nerve action potential latency and amplitude.

The measurement of sensory nerve action potential (SNAP) latency and amplitude is often necessary to accurately diagnose disorders of peripheral nerves. The sensory evoked response can be obtained using either the antidromic (AD) or orthodromic (OD) technique. In a previous study we demonstrated that in healthy subjects the AD SNAP distal latency of median and ulnar nerves at 14 cm distance is approximately 0.2 msec slower than the OD SNAP distal latency at 32C. The AD SNAP amplitude was also two times greater than the OD SNAP amplitude. In this study we observed that these differences between the AD and OD SNAP latency and amplitude varied significantly as temperature changed. The AD median nerve SNAP distal latency was delayed by .06 msec/degree with cooling. The OD median nerve SNAP distal latency was delayed by .03 msec/degree with cooling. These values represent less of a slowing per degree centigrade cooling than has been previously noted in the literature. The median nerve SNAP amplitude was found to increase with upper extremity cooling with the AD and OD technique by 3.5 microV and 0.5 microV per degree, respectively. For accurate interpretation of SNAP latency and amplitude, the electromyographer must be familiar with the technique used and the differing effect of the temperature with each technique.

Adult↗
PubMed1986

Pneumothorax after electromyographic electrode insertion in the paracervical muscles: case report and radiographic analysis.

A patient developed pneumothorax after needle electrode examination of the paracervical muscles. Because such a complication appeared unlikely and had not been reported previously, we studied cadavers and examined cervical spine radiographs to assess the vulnerability of lung tissue to paracervical muscle needle insertion. Radiographs of the cervical spine were used to determine the depth and location of lung tissue. In five of 23 patient radiographs studied, lung tissue extended above the clavicle with a distance from skin surface to lung tissue of approximately 3.3 cm. The electromyographer examining the paracervical musculature should be aware that needle electrode penetration of lung tissue is possible. Examination must be conducted with care, especially in thin patients with long necks. Needle insertion close to the midline is the safest technique.

Adult↗
PubMed1985

Dynamic approach in the diagnosis of thoracic outlet syndrome using somatosensory evoked responses.

The clinical diagnosis of thoracic outlet syndrome (TOS) is controversial. Objective documentation of this disorder is often unobtainable, even with electrodiagnostic techniques. This preliminary report describes an objective diagnostic method of evaluating TOS using somatosensory evoked potential testing (SEP) and dynamic arm positioning. Evoked potentials were recorded over the brachial plexus (N9) and C7 cervical vertebra (N13) after distal stimulation of the median and/or ulnar nerves. This was performed with the arm both at the side (anatomic position), and then positioned in abduction and external rotation. Absolute and interpeak latencies were measured in both positions. Of 14 patients clinically suspected of having TOS, six showed normal N13 evoked responses in the anatomic position despite a disappearance of this potential when tested with the symptomatic arm in the dynamic position of abduction and external rotation. Fourteen control subjects had normal responses with the arm tested in both positions. The SEP coupled with the dynamic stress of the nerves coursing through the thoracic outlet may be helpful as a new objective aid in the diagnosis of TOS.

Adult↗
PubMed1985

Cheiralgia paresthetica and linear atrophy as a complication of local steroid injection.

Cheiralgia paresthetica, a mononeuropathy of the superficial branch of the radial nerve, is an uncommon problem, usually resulting from local trauma to the wrist. This report describes a 27-year-old patient who developed subdermal atrophy following local hydrocortisone injection as a treatment for deQuervain's tenosynovitis. Subsequently, she developed linear skin atrophy, a rare complication of steroid injection thought to result from lymphatic spread of the steroid suspension, extending proximally from the initial atrophic area in her hand into her forearm. Soon after wearing a wristwatch on the affected wrist, she developed symptoms of cheiralgia paresthetica. Linear atrophy was found to traverse the superficial radial nerve and was considered to contribute to the symptoms. It is important to be aware that subcutaneous atrophy may follow the lymphatics with injections of steroid.

Adult↗
PubMed1984

Manpower planning for physical medicine and rehabilitation: comment on GMENAC process.

Although physical medicine and rehabilitation (PM&R) was not analyzed by the Graduate Medical Education National Advisory Committee (GMENAC) Delphi Adjusted Needs Based Modeling process completed in 1980, a provisional manpower requirement estimate of 3,200 physiatrists was included in the final report. In late 1981 and early 1982, the GMENAC model was used and an official 1990 estimate of 4,060 physiatrists needed, with only 2,400 physiatrists available, was determined. This report summarizes the initial correspondence and the assessment study methods for PM&R utilized to attain these estimates. Considerable variability of the numbers determined by the Delphi Panel is apparent. These estimates have been accepted by the Office of Graduate Medical Education and although no official action has ensued, the results are on record for future manpower planning and may be a factor in the current interest of medical students in the specialty of PM&R.

Delphi Technique↗
PubMed1984

Hajdu-Cheney syndrome: rehabilitation after decompression of cervical spinal cord compromise.

Cervical spinal cord compromise can be caused by many pathologic conditions. In this case report, a patient with Hajdu-Cheney syndrome, an exceedingly rare disorder of bony elements which led to basilar skull invagination and subsequent cervical cord compression, is described. Postoperatively, the patient continued to have difficulty with self-care and ambulation and required an extensive rehabilitation program which included mat activities, progressive resistive exercises, activities of daily living, and gait training. She was able to become independent in transfers, ambulation, and activities of daily living. The patient's rehabilitation course after cervical spinal cord decompression is presented, along with a brief description of the clinical features of this unusual disease process.

Adult↗
PubMed1983

Hemidiaphragmatic paralysis: an unusual complication of cervical spondylosis.

Clinical investigations of a patient having shortness of breath and a paretic left hemidiaphragm revealed compromise of the left C3-4 neural foramen and signs of spondylitic spinal cord compression at that level. After laminectomy, the patient's symptoms and radiologic evidence of hemidiaphragmatic paralysis resolved. This case illustrates the importance of evaluating patients with hemidiaphragmatic paralysis for cervical spondylosis and of evaluating patients with cervical spondylosis for phrenic nerve compromise.

Aged↗
PubMed1977

Carpal tunnel syndrome or trigger finger associated with neck injury in automobile accidents.

Among 450 patients examined for neck pain following automobile accidents, carpal tunnel syndrome (CTS) was diagnosed in four and trigger finger (TF) in three. All seven patients sustained cervical sprains and were drivers or passengers in automobiles which received impacts from the rear. All seven patients reported the onset of hand symptoms during or shortly after the accident. This unusual occurrence, not previously reported, appears to be related to the events which occurred at the time of the accident. The mechanism of injury for CTS is hypothesized to be median nerve compression by momentary acute hyperflexion or hyperextension of the wrist(s), while tightly grasping the steering wheel or bracing for impact. The cause of TF is suspected to be direct trauma to the flexor tendon and sheath by compression against bony prominences when the finger is hyperflexed or hyperextended. This can occur during the accident while forcefully grasping the steering wheel with acutely hyperflexed fingers.

Accidents, Traffic↗