Biomedical subjects
Publications and source records attributed to J L Opitz.
Patients with symptoms suggestive of prostatitis or prostatosis who do not have pathogenic bacteria in the prostatic secretions may, in fact, not have prostatic problems. The possibility of pelvic floor tension myalgia should be considered in these patients.
Postoperative physiatric treatment is an integral part of the replacement of hips, knees, ankles, shoulders, elbows, wrists, and digital joints. Neuromuscular substitution patterns and incoordination usually prevail after joint replacement because of the usual long-term expectation and experience of pain, limitation of motion, fatigue, weakness, and the unavoidable operative trauma. The goals of postoperative physiatric treatment, in line with those of joint replacement surgery, are relief of pain and reestablishment of comfortable, normal neuromuscular functions and their reasonable, safe application in appropriate activities of daily living and of locomotion. By close collaboration between the Department of Orthopedic Surgery and that of Physical Medicine and Rehabilitation, certain principles and detailed protocols of postoperative management have been developed over the last 10 years. These are described in some detail for each of the joint replacements. Optimal results can be achieved only through meticulous attention to physical and psychosocial details, with close cooperation and communication among the involved services and persons.
This study evaluated weekly urine cultures of patients with neurogenic bladder disease who underwent intermittent urinary catheterization for bladder retraining. One group of 53 patients in 1974 received regular instillations of 0.1% neomycin after each catheterization. A similar group of 55 patients in 1975 did not receive neomycin and constituted a control group. Distribution of age, sex, diagnosis, and duration of bladder retraining was comparable in both groups. Quantitative bacterial colony counts of 10(4) to 10(5) or greater per ml of urine were considered significant. There was no difference in the incidence of bacteriuria between the neomycin-treated group and the control group (53 versus 49%, respectively), and most patients in each group had colony counts >10(5)/ml. Escherichia coli was seen less frequently in neomycin-treated patients (43.4 versus 62.5%), but a greater percentage of infections due to Pseudomonas aeruginosa, group D streptococci, and yeasts was noted in the neomycin-treated group than in the control group (41.5 versus 22.5%).
Hand function, determined by a standardized test, was compared before and after total metacarpophalangeal joint replacement with the Swanson Silastic rubber metacarpophalangeal prosthesis in patients with destructive rheumatoid arthritis. Two groups of rheumatoid patients were tested. Group 1 consisted of 10 patients who were examined 3 to 4 months after surgery. Group 2 included 11 patients who were evaluated 6 to 12 months postoperatively. Each group represented 43 prosthetic replacement procedures performed on 12 hands. Results indicate substantial postoperative improvement in tip prehension and grasp, while performance remained essentially unchanged for lateral prehension, pinch force, and power grip. A postoperative program of therapeutic exercises, functional hand activities and splinting is discussed.
The management of neurogenic bladder dysfunction has been associated with a relatively high incidence of upper urinary tract infections and urosepsis. Today, the regular use of modern diagnostic tools in roentgenology and urodynamics is available. Moreover, contraindications to bladder retraining are better defined, and we have available better methods of evaluating urodynamics, superior reconstructive and corrective urologic surgery, judicious use of intermittent catheterization, and prompt detection and treatment of recurrent bacteriuria. We also know that, with an organized program of bladder retraining and follow-up, a substantial decrease in morbidity of patients with neurogenic bladder dysfunction has become possible.