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Biomedical subjects

S Snyder

Publications and source records attributed to S Snyder.

131 records · Page 8Linked to original sources
PubMedDate not supplied

Methylphenidate in post liver transplant patients.

Methylphenidate (Ritalin, manufacturer: Ciba/Geigy) has been shown effective for the treatment of depression in various medically ill populations, but to our knowledge its use in organ transplant patients has not been described. The authors retrospectively reviewed clinical records of the first eight inpatients who received methylphenidate for treatment of depressive and/or cognitive symptoms in the post liver transplant period at Mount Sinai Medical Center. Target symptoms included psychomotor and cognitive slowing as well as lack of motivation for recovery, poor rehabilitation effort, social withdrawal, and apathy. A positive response was noted in seven patients, and in one patient the response was equivocal. Side effects noted were increased blood pressure (N = 2) and subjective restlessness/agitation (N = 3). Methylphenidate appears to be an effective, rapidly acting agent in this setting at dosages of 10-20 mg/day, with minimal side effects. Methylphenidate may have a significant role in the care of an ever-increasing population of organ transplant recipients with multiple medical problems and associated disabilities.

Adult↗
PubMedDate not supplied

Midterm results of arthroscopic co-planing of the acromioclavicular joint.

BACKGROUND: There has been recent concern about long-term morbidity associated with arthroscopic co-planing of the acromioclavicular joint in the treatment of impingement syndrome. OBJECTIVE: The purpose of this study was to assess the results of the co-planing procedure, special attention being paid to acromioclavicular joint morbidity. METHODS: The study included 56 patients who were operated on by the senior author. Outcomes were evaluated both objectively and subjectively through physical examinations and telephone surveying. Each patient had subacromial decompression at the time of the index surgery. Other concomitant arthroscopic procedures included rotator cuff repair and labral debridement or repair. RESULTS: Average follow-up was 4 years (range, 2-7 years). Thirty-five (95%) of 37 patients had no subjective pain and no objective tenderness to direct palpation or compression of the acromioclavicular joint. The joint was not clinically hypermobile in comparison with that on the opposite side in any patient. In all, 95% of patients had good or excellent results in terms of the University of California at Los Angeles Shoulder Score. Of the 2 patients who did have pain and tenderness at the acromioclavicular joint, both had had multiple operations on their shoulders before the index procedure. Nineteen patients were not examined clinically but did complete a telephone survey; these 19 patients were not symptomatic at the acromioclavicular joint. CONCLUSIONS: To fully treat impingement syndrome, the surgeon should remove osteophytes under the lateral clavicle and medial acromion. With good technique, the surgeon can leave the anterior, posterior, and superior acromioclavicular joint capsule intact. We conclude that for appropriate clinical indications, beveling the inferior 20% to 25% of the clavicle to make it co-planar with the decompressed acromion is safe and is not an etiologic factor in acromioclavicular joint pain or instability.

Acromion↗
PubMedDate not supplied

Performance of an intramuscular electrode during functional neuromuscular stimulation for gait training post stroke.

The goal of rehabilitation for stroke patients in this research was to improve the volitional coordination of the swing phase and stance phases of gait. Functional neuromuscular stimulation (FNS) is a promising rehabilitation tool for restoring motor control. For our gait training protocols, FNS systems with surface electrodes were impractical. For the rehabilitation protocols that we defined, available implantable electrode designs did not meet desired criteria regarding fracture rate, invasiveness of placement procedures, and maintenance of position at the motor point. The criteria for the new intramuscular (IM) electrode design included minimally invasive electrode placement technique, accurate placement of electrodes, good muscle selectivity, consistency of muscle activation, good position maintenance of the electrode at the motor point, comfortable stimulus, and practical donning time for the system. A percutaneous electrode was designed for placement beneath the skin at the motor point of seven paralyzed or paretic muscles in the lower limb. A single-helical coil lead, a double-helical coil electrode, and fine wire barbs were design features that enhanced the anchoring capability of the electrode. A polypropylene core enhanced electrode durability. Implantation tools were custom-designed to enable accurate electrode placement without incision. We studied 17 subjects with a total of 124 electrodes. With the use of IM electrodes, FNS was provided for 1,413.8 electrode months. During this time, no instances of infection occurred. The measure of electrode integrity showed a 99% electrode survival rate. Throughout the treatment protocols, 93% of the electrodes delivered a good muscle response; 7% (nine electrodes) moved from the motor point and delivered a poor muscle response during the treatment protocol. Anchoring performance was higher for electrodes implanted in muscles that moved the hip (96.0%) and ankle joints (97.45%) compared with electrodes implanted in muscles that moved the knee joint (88.5%). Ninety-seven percent of the electrodes delivered a comfortable stimulus. Three percent delivered a stimulus that was uncomfortable at therapeutic levels and therefore were not used. We achieved gains in subject impairment and disability measures. The system proved to be practical for use in both clinical and home environments.

Aged↗
PubMedDate not supplied

Intradialytic parenteral nutrition in chronic hemodialysis patients.

The effects of intradialytic parenteral nutrition (IDPN) were studied in chronic hemodialysis (CHD) patients who had a normalized protein catabolic rate (PCRN) of less than or equal to 0.8 g/kg/day, and KT/V = 0.94 +/- 0.04. Intradialytic parenteral nutrition was administered during thrice weekly CHD for 3-6 months, and consisted of essential and nonessential amino acids (42.5 g), glucose (125 g), and lipid emulsion (50 g). Blood urea nitrogen, creatinine, total protein, albumin, transferrin, pre-albumin, total lymphocyte count, anthropometrics, protein catabolic rate, 3 day historic dietary protein intake, and dietary energy intake (DEI) were measured at baseline, before IDPN, during IDPN, and at completion of IDPN. Six of nine enrolled patients completed the study. Reasons for withdrawal included nausea and hyperglycemia or hypoglycemia. DPI normalized for body weight (DPIN) increased significantly from 0.75 +/- 0.1 to 1.02 +/- 0.18 (p = 0.02). Increases in PCRN (0.57 +/- 0.18 to 0.78 +/- 0.2) and DEI (1495 +/- 266 to 1681 +/- 358) did not reach statistical significance. More aggressive IDPN or a longer study period may be necessary to assess this form of nutritional intervention.

Amino Acids↗