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Biomedical subjects

W H Donovan

Publications and source records attributed to W H Donovan.

54 records · Page 3Linked to original sources
PubMed1982

Neurophysiological approaches to chronic pain following spinal cord injury.

Pain occurring in patients with spinal cord injury can be classified on clinical grounds into five types: peripheral, central, visceral, mechanical and psychic. An attempt has been made to correlate each type of pain with present neurophysiological knowledge. Mechanisms as to how unpleasant sensations reach the conscious level can be deduced when clinical and neurophysiological data are pooled. Eight case histories are presented which typify each class. The authors' evaluation and treatment offered is presented for each type.

Abdomen↗
PubMed1982

Developing a system of comprehensive care for the spinal cord injured patient in Houston, Texas, U.S.A.

The authors agree with the principle, widely accepted, that spinal cord injured (SCI) individuals should receive all their acute, rehabilitative and follow-up care in a spinal cord injury centre. The evolution of rehabilitation medicine and services in the United States, however, has favoured the separation of acute and rehabilitation care for spinal cord injured patients, as well as other disabilities. This has resulted partly from specialisation of medical and allied health personnel, physical separation of acute and rehabilitation facilities, and reluctance of some funders of health care to see rehabilitation as a natural extension of medical care in these patients. In Houston the proximity of a rehabilitation facility to three acute care university hospitals, representing three medical schools, provided an opportunity to improve communication among the medical personnel. These individuals have recognised the value of early rehabilitation even while the patient is acutely ill; they agreed to institute a system of care wherein the rehabilitation physician partakes in the early management in a designated area of the acute hospitals for spinal cord injured patients and works toward early transfer to the rehabilitation hospital in as ideal a condition as possible. Surgeons, who have initial primary responsibility, also visit the rehabilitation hospital, following their patient's progress at selected conferences and at the bedside. This paper describes how, a spinal cord injury service was established, how the major barriers to early transfer were confronted, and the results of the first 6 months of operation.

Comprehensive Health Care↗
PubMed1981

Paraspinal EMG.

Explore the source record for details and available documents.

Electromyography↗
PubMed1980

Electromyographic activity in paraspinal musculature in patients with idiopathic scoliosis before and after Harrington instrumentation.

Ten patients with idiopathic scoliosis underwent electromyographic (emg) examination before and after Harrington instrumentation and fusion. Each patient had a normal emg preoperatively. At 3 weeks all 10 demonstrated spontaneous activity consistent with denervation, and voluntary activity was absent or markedly reduced. By 3 months and in some cases 6 months, denervation was significantly reduced or absent; voluntary activity had also reappeared and in most cases was equal to preoperative intensity. This rapid reversal of denervation after surgery within the paraspinal muscles in a young female population with no underlying disease suggests that interpretation of any postoperative emg should include considerations such as the time since surgery, the age of the patient, and the extent of preoperative pathology. No evidence was gained from this study that extensive posterior spinal surgery itself interfered significantly with paraspinal muscle function after 3 to 6 months.

Electromyography↗
PubMed1979

Combined intravenous miconazole and intrathecal amphotericin B for treatment of disseminated coccidioidomycosis.

A patient received a previously unreported combination of intravenous miconazole and intrathecal amphotericin B for the treatment of disseminated coccidioidomycosis with central nervous system involvement. After first having been treated with amphotericin B, followed by a course of miconazole therapy, the patient responded with remarkable clinical and serologic improvement to the combination of intrathecal amphotericin B and intravenous miconazole. The combination should be considered in the treatment of disseminated coccidioidomycosis with central nervous system involvement.

Adult↗
PubMed1977

A finger device for obtaining satisfactory voiding in spinal cord-injured patients.

Anal sphincter stretch is a technique or procedure that recently has been found effective in overcoming the problem of ineffective voiding caused by detrusor-sphincter dyssynergia in some cases and for patients with upper motor neuron lesions. This technique was made available to quadriplegic patients when a fabricated device worn over the patient's finger was used. Four C7 quadriplegics have been able to achieve consistently acceptable amounts and residual volumes when voiding.

Anal Canal↗
PubMed1977

Intermittent bladder emptying via urethral catheterization or suprapubic cystocath: a comparison study.

A prospective study was undertaken to compare patients with recent spinal cord injuries undergoing bladder training by conventional intermittent urethral catheterization with a similar group treated with the Cystocath. Our present information suggest there are no differences with respect to episodes of bacteriuria encountered or for time spent by the catheter team for each procedure. Paraplegics tended to reach balanced bladder status more easily without surgery while quadriplegics did not. The bladder training program was shorter on the average for the Cystocath group. Further investigation is necessary to determine whether this is significant. Problems encountered were minimal and fewer than reported in the literature. We find no reason not to employ the Cystocath in bladder training programs in spinal cord injured patients.

Adolescent↗
PubMed1977

Anal sphincter stretch: a technique to overcome detrusor-sphincter dyssynergia.

Intermittent catheterization has become a well-accepted method of management of the neurogenic bladder following spinal cord injury. Frequently, the presence of detrusor-sphincter dyssynergia interferes with the attainment of acceptable residual urine volumes in patients with upper-motor-neuron bladders. We have recently reported success in overcoming the problems of dyssynergia in some patients utilizing a technique called anal sphincter stretch in which relaxation of the external anal and urethral sphincters is produced by sustained distention of the anal sphincter. This has lessened the need for other measures that usually produce incontinence and has met with good patient acceptance. An update on the results of using this technique is presented. Although we have previously encountered quadriplegics who might have benefited from sphincter stretch, the lack of hand intrinsic muscle function required for the patient to perform it independently has precluded its use. We herein present a device that circumvents inadequate hand function, and which has enabled four C-7 quadriplegics to achieve satisfactory bladder emptying.

Anal Canal↗
PubMed1975

Sphincter stretch: a new technique resulting in continence and complete voiding in paraplegics.

A technique is described to facilitate voiding in the paraplegic, whereby external sphincter spasm is eliminated as a source of obstruction. Digital stretch on the anal sphincter combined with the Valsalva maneuver has resulted in satisfactory bladder emptying in 16 paraplegic patients. The technique has been found unsatisfactory in patients with contracted bladders or with incomplete lesions of the spinal cord.

Anal Canal↗
PubMedDate not supplied

A multidisciplinary approach to chronic low-back pain in Western Australia.

Fifty patients with chronic low-back pain were subjected to extensive medical, psychiatric, and psychosocial assessment by a comprehensive Low Back Pain Clinic. Most patients were found to have easily identifiable environment factors which influenced the persistence of the symptomatology. All patients were significantly functionally impaired, and whilst neurologic findings were uncovered in only 12 patients, most had restricted movement of the lumbar spine. The initiating cause of the low-back pain was usually from a minor injury or no injury at all. Thirty-two patients were given psychiatric diagnoses, but only one patient was thought to warrant psychiatric treatment. Whilst some were considered to be candidates for limited further conservative treatment, only two were subjected to further surgery (one fusion, one posterior facet rhizotomy). Only nine were admitted to an inpatient behavior modification program, and the results of this effort were modest. The major benefit was seen to be the definitive diagnosis, prognosis, and medical and social planning which was given to all 50 patients upon conclusion of the assessment. The assessment proved to be of benefit to the patient, the referring doctor, the team itself, as well as all other interested parties, such as his family, insurance company, and lawyer.

Adult↗