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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the severely retarded, multiply handicapped child who has a dislocated hip and severe adduction of the lower extremity, the deformity often interferes with perineal hygiene, nursing care, and positioning in bed and in a wheelchair. In twelve such patients we did an extensive resection of the proximal part of the femur, down to below the lesser trochanter, and constructed a capsular flap across the acetabulum. The quadriceps muscle was sutured around the resected end of the femur. This one-stage, uncomplicated operation allowed our patients to sit confortably and nursing care was made easy. In contrast, three patients who had single resection of the femoral head and neck had recurrence of deformity and pain.
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PMID:Proximal femoral resection-interposition arthroplasty. 15 65

Two cases of multiple sclerosis are described, in both of whom the disease started in yound adult life. This disability gradually progressed to the stage of paraplegia-in-flexion in which the lower limbs were fixed in adduction-and-flexion. Both patients developed painful muscle spasms which made life intolerable. These patients were treated by intrathecal phenol in glycerine in an effort to convert this spastic paralysis into a flaccid paralysis. The three advantages sought were: 1. To relieve the muscle spasms so that the patient could sit in a wheelchair and propel herself. 2. To relieve the pain of the spasms. 3. To allow access to the perineum for proper hygienic care of bladder and bowel function. The first patient obtained an excellent result (Figures 1, 2, 3) but blocks had to be repeated after approximately five months. The second patient after the block developed a good result in the right leg, but still had mild, but painless spasms in the muscles of the left leg (Figures 4 and 5). However, she was able to use a wheelchair and was discharged to a chronic hospital where she died of bulbar paralysis six months later. Intrathecal phenol thus appears to be a useful method for relieving muscle spasms and pain in the lower extremities in advanced cases of multiple sclerosis.
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PMID:The use of intrathecal phenol for muscle spasms in multiple sclerosis. A description of two cases. 117 28

In administering first aid on ski slopes, the principles followed are basic ones: arrest of hemorrhage, adequate immobilization of fractures, prevention of shock, and relief of pain. Respiratory and circulatory complications must of course be given priority, but in my experience such situations have not arisen.
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PMID:First aid on the ski slopes. 125 92

The aim of this study was to investigate physical impairment in patients with chronic low back pain, to develop a method of clinical evaluation suitable for routine use, and to consider the relationship between pain, disability, and physical impairment. Twenty-seven physical tests were investigated. Permanent anatomic and structural impairments of spinal deformities, spinal fractures, surgical scarring, and neurologic deficits were excluded as not relevant to the patient with low back pain in the absence of nerve root involvement or previous surgery. Three consecutive 20-patient reproducibility studies were used to develop reliable methods of examination for 23 of the tests. Only four tests were excluded as unreliable: sacral angle, pelvic tilt, and separate lumbar and pelvic extension, none of which are part of routine clinical examination or have any proven relationship to disability. The remaining 23 physical tests were evaluated in 70 asymptomatic subjects and 120 patients with chronic low back pain. Passive knee flexion, passive hip flexion, hip flexion strength, hip abduction strength, pain reproduction on each of these tests, and the prone extension strength test were excluded because they were too closely related to nonorganic and behavioral responses to examination. Eight tests successfully discriminated patients with low back pain from normal subjects and were significantly related to self-report disability in activities of daily living: pelvic flexion, total flexion, total extension, lateral flexion, straight leg raising, spinal tenderness, bilateral active straight leg raising, and sit-up. Factor analysis failed to demonstrate an underlying statistical dimension of physical impairment. However, an empirical combination of total flexion, total extension, average lateral flexion, average straight leg raising, spinal tenderness, bilateral active straight leg raising, and sit-up provided an equally satisfactory alternative. Simple cut-offs from normal subjects made the scale simple and quick to use. This final scale successfully discriminated 78% of patients and normal subjects and explained 25% of the variance of disability, with a specificity of 86% and sensitivity of 76%. This scale provides an objective clinical evaluation that meets the criteria for evaluating physical impairment, yet is simple, reliable, and suitable for routine clinical use. It should, however, be emphasized that all the tests included in the final scale are measures of current functional limitation rather than of permanent anatomic or structural impairment. This raises questions about the physical basis of permanent disability due to chronic low back pain.
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PMID:Objective clinical evaluation of physical impairment in chronic low back pain. 835 11

CC's treatment goals were all met with the exception of eliminating the AMNT sign. Slump-sit right knee extension (-15 degrees), right SLR (80 degrees coupled with dorsiflexion), and lumbar flexion (85% coupled with neck flexion) all continued to reproduce right buttock cramping and pain. Currently he is playing basketball without restriction, performing an individualized exercise program that emphasizes lower extremity muscle stretching, AMNT stretching, and advanced truncal stabilization exercises. He has a very good understanding of body mechanics and an awareness of safe SFP during activities of daily living and on the basketball court. His motivation, along with the motivation of parents, coaches, athletic trainer, and physical therapist, greatly assisted CC in returning to competitive basketball. CC is intermittently evaluated to monitor the AMNT sign and the effectiveness of the home exercise program. Currently CC's AMNT appears to regress if he is not monitored on a monthly basis; thus he warrants intermittent treatment. Monitoring of the patient is an integral aspect of long-term management of chronic discogenic disease that is often neglected. It can be hypothesized that monitoring may prevent serious complications in the future for many patients. CC is a patient who needed specific therapeutic intervention beyond rest, general instructions about body mechanics and exercise, modalities, and traditional back school. The history of this patient's problem revealed that rest and general exercises had failed, thus necessitating specific therapeutic treatment. This patient is an excellent example of how physical therapy in the form of manual therapy, specific therapeutic exercise, education through repetition of functional tasks, and the team approach to patient care can lead to a successful treatment outcome.
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PMID:Back school programs. The young patient. 153 94

A 49-year-old housewife had suffered from classical seropositive rheumatoid arthritis for 24 years. The shoulders and hands were involved but the most severs pain and deformity were in both elbows and knees. Consequently, she was unable to sit on wheel chair and was confined to a bed. And then, she was admitted to the Chiba Rehabilitation Center in September, 1986 for bilateral total knee replacement. In April 1987, she had an operation upon the right knee and in June, she had an operation upon the left knee. About 6 weeks after surgery, she felt numbness in bilateral hands. The diagnosis was cubital tunnel syndrome. This was confirmed by electromyographic studies. Surgical release was undertaken without delay. The day following operation the patient remarked on the absence of numbness in bilateral hands.
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PMID:[Ulnar nerve palsy in a RA patient after total knee replacement: a case report]. 159 7

During a brief period from March 1988 to January 1990 we were faced with 13 patients with malignant vertebral neoplasms (metastasis) of the thoracic spine. Nine of these had progressive extradural spinal cord compression with motor, sensory and sphincter involvement of varying degrees and duration. After proper evaluation these 9 cases were aggressively managed by preoperative embolisation of the tumour, transpedicular decompression and a same stage posterior metallic fixation. The immediate results were encouraging, with 2 patients showing total recovery and 3 showing partial recovery. All of the 9 operated cases were pain free postoperatively and could sit up unaided and be easily transferred to the Cancer Institute for back up chemotherapy and radiotherapy. They also improved psychologically, and cooperated well in their subsequent rehabilitation programme.
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PMID:Preoperative embolisation, transpedicular decompression and posterior stabilisation for metastatic disease of the thoracic spine causing paraplegia. 162 1

Back pain due to vertebral collapse is the main symptom of postmenopausal osteoporosis. The clinical picture in these crush fractures varies, depending on the type and the location of fracture, but in general, a new vertebral crush fracture gives rise to severe pain that immobilizes the patient and necessitates bedrest. In this double-blind controlled clinical trial, 56 patients who had recently (within the last 3 days) suffered an osteoporotic vertebral fracture were hospitalized for a period of 14 days. Salmon calcitonin (100 IU) or placebo injections were given daily. Pain was rated daily on a 10-point scale by the same observers. Blood and urinary parameters were also evaluated. The results showed a significant (P less than 0.001) difference in pain intensity between the calcitonin group and the placebo group. This beneficial effect was generally apparent from the second day of treatment onward, and over the following 2 weeks, the patients were able to sit and stand, and gradually started to walk again. A significant decrease in urinary hydroxyproline and urinary calcium was also noted in the calcitonin group. It is concluded that calcitonin exerts a beneficial effect on back pain following a vertebral crush fracture.
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PMID:Analgesic effect of salmon calcitonin in osteoporotic vertebral fractures: a double-blind placebo-controlled clinical study. 181 59

The study was designed to compare five opioid analgesic regimens administered after cesarean delivery in a routine hospital setting with respect to patients' perceptions of their pain relief and the impact of analgesic technique on recovery and hospital costs. After cesarean delivery, 684 patients received one of the following: epidural morphine, alone (EM,n = 128), or with fentanyl (EM + F,n = 245); subarachnoid morphine (n = 48); intramuscular meperidine (n = 165), or patient-controlled analgesia using meperidine (PCA, n = 98). On the first three postoperative days (Days 1-3; day of operation is Day 1) patients were surveyed regarding their impressions of their analgesia, the incidence of side effects, times to resume normal activities and satisfaction with their technique. Information regarding drug interventions and costs was obtained from anesthetic records and nursing charts. Patients receiving intramuscular and PCA opioids reported significantly more severe pain during the first 16 hours than those receiving intraspinal opioids (p less than 0.05); differences were minimal for the remainder of Day 1. Among the intraspinal groups, analgesia was best overall with EM; specifically, fentanyl did not decrease early postoperative pain. Analgesia with PCA and intramuscular opioids was similar during the first 16 hours; however, PCA patients felt they had less pain thereafter. Side effects were common in all intraspinal groups and were least frequent with PCA (p less than 0.05 versus all intraspinal groups). Times to sit, walk and drink were similar in all patients except those receiving intramuscular opioids after general anesthesia, who experienced a several-hour delay. Other aspects of recovery did not differ among the groups. Satisfaction parallelled pain relief and was better with intraspinal than with systemic opioids. Costs were greatest with PCA, although differences were small (less than 1%) relative to total hospital charges.
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PMID:Analgesia after cesarean delivery: patient evaluations and costs of five opioid techniques. 188 71

Two hundred ninety-four women were randomly allocated to a group in which the use of a birthing stool (experimental group) or a conventional semirecumbent position (control group) was encouraged. The birthing stool was 32 cm high and allowed the parturient to sit upright and to squat. The husband could sit close behind his wife and support her back. No differences were observed between the two groups regarding mode of delivery, length of the second stage of labor, oxytocin augmentation, perineal trauma, labial lacerations, or vulvar edema. Infant outcome measured by Apgar scores at 1 and 5 minutes postpartum and numbers of neonatal intensive care unit transfers was the same in both groups. Mean estimated blood loss and the number of mothers with a postpartum hemorrhage 600 ml or more were greater in the experimental group than in the control group. Women in the experimental group reported less pain during the second stage of labor, and they and their spouses were more satisfied with the birth position than were parents in the control group. Midwives were less satisfied with their working posture in the experimental group.
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PMID:A randomized trial of birthing stool or conventional semirecumbent position for second-stage labor. 200 63


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