Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0599766 (functional recovery)
 13,441 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiopulmonary resuscitation (CPR) was developed as a preventive measure for sudden and unexpected death. This excellent technique has been misguided. It has been turned into an unmerited and cruel ritual in the horizon of all who are to die. CPR is particularly ineffective in the elderly. Of 503 patients age 69 or over subjected to CPR in 5 medical centers in Boston only 19 (3.8%) were alive at discharge. In 68.8% or them death occurred in less than 3 days. Only 2 of 244 patients who arrived at the hospital with a cardiorespiratory arrest survived; the 209 who arrived without vital signs died. One of 37 patients with an oxygen tension less than 63 torr left the hospital alive but connected to a respirator. All patients (204) with one or more of the following laboratory findings died: Hematocrit less than 35%, creatinine more than 1.5 mg/dl or a BUN more than 65 mg/ml, serum albumin less than 2.7 gr/dl. The rights of patients over their life and their history are violated when CPR is applied without their consent. In a recent study 63% of 104 hospitalized patients and 73% of 922 Puerto Rican doctors and nurses preferred not be subjected to CPR unless there was an opportunity for a complete functional recovery. Six percent would not have CPR under any circumstance. Health professionals should not continue avoiding their moral responsibilities shielded by institutional policies or hiding behind a simplistic religiosity. It is immoral to prolong the agony of dying patients. Let us cease the useless resuscitation of the dead.
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PMID:[Let us not resuscitate the dead]. 129 5

Working rat hearts were perfused for 15 minutes at 37 degrees C before switching to a Langendorff perfusion (60 mm Hg aortic pressure) at 10 degrees C for 40 minutes of hypothermic arrest. Ventricular function was allowed to recover for 15 minutes at 37 degrees C by reestablishing the prehypothermic conditions. The perfusate was Krebs-Henseleit bicarbonate buffer containing 3% bovine serum albumin and either glucose (11 mmol/L) or glucose (11 mmol/L) plus palmitate (1.2 mmol/L) and gassed with 95% O2 and 5% CO2. In hearts receiving glucose alone as substrate, coronary flow was maintained constant during the 40 minutes of hypothermic arrest and returned to prehypothermic rates with rewarming. Ventricular function, as estimated by peak systolic pressure and heart rate, recovered to the prehypothermic level. When palmitate was added, coronary flow decreased continuously throughout the hypothermic perfusion (22% decrease by 40 minutes), and ventricular pressure development was lower throughout the rewarming perfusion. Tissue levels of adenosine triphosphate and creatine phosphate were well maintained and long-chain acyl coenzyme A and acyl carnitine decreased during hypothermia regardless of the substrate provided. With rewarming, tissue levels of adenosine triphosphate and creatine phosphate decreased in those hearts receiving palmitate. Omission of fatty acid either during hypothermia or during the first 5 minutes of rewarming improved recovery of function. Addition of oxfenicine to inhibit fatty acid oxidation, or inhibition of Ca2+ overload by verapamil and low perfusate Ca2+, prevented the effects of palmitate on ventricular function.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Fatty acids suppress recovery of heart function after hypothermic perfusion. 192 62

The nutritional status was analyzed in 37 patients being treated with staged anterior and posterior spinal reconstructive procedures. Using stringent criteria for nutritional and immunologic incompetency, 31 patients (84%) became malnourished during hospitalization. Although the serum albumin on admission had been normal for all patients, it became significantly depressed in 77% following anterior and posterior spinal procedures. In a similar fashion, the total lymphocyte count became significantly depressed in 92%. The postoperative complications were clearly more extensive in patients who were malnourished and immune-deficient using these criteria--15 patients with urinary tract infections, four patients with bacterial sepsis, four patients with wound infections, and four patients with pneumonia (vs. one with a wound infection in the adequately nourished group). The length of hospitalization following the second operative procedure was significantly longer in the malnourished group: 16.2 days versus 12.4 days (p less than 0.05). The main purpose of this study is to create awareness of the ongoing nutritional demands placed on patients treated by two-stage spinal reconstruction surgical procedures. More aggressive nutritional intervention can reduce postoperative complications and length of hospital stay and improve the speed of functional recovery.
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PMID:Nutritional deficiencies after staged anterior and posterior spinal reconstructive surgery. 340 99

Previous studies have found that social support may reduce mortality after myocardial infarction and reduce overall mortality among the elderly. To determine whether social support also influences the recovery of function among patients who have had hip fractures and to describe other potential predictors of recovery after hip fracture, 111 patients with hip fractures were interviewed and examined before discharge from the hospital. The functional status of surviving patients was assessed again 6 months later. Patients who had a greater number of social supports had more complete recovery of their prefracture level of function (r = .21; P = .04). This association was strongest for patients over 60 years old (r = .31; P = .006); among these patients, this association remained statistically significant after adjustment for other significant (P less than .05) predictors of recovery: arm strength, mental status, and serum albumin. Additional studies should be done to test whether interventions to increase social supports can improve the recovery of function among elderly patients with hip fractures and other illnesses. In the meantime, health professionals should counsel elderly patients about the potential rehabilitative and preventive benefits of social supports.
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PMID:Recovery of function after hip fracture. The role of social supports. 341 Oct 63

A young man, who was admitted to hospital acutely ill following the ingestion of half a mouthful of carbon tetrachloride, was investigated for the degree and duration of hepatic and renal damage, using various tests of function. On the basis of the serum bilirubin and enzyme activities, the acute hepatic damage had subsided after 15 days from the time of the accident, but the serum albumin and total proteins returned to normal only after a considerably longer time interval (between 33 and 129 days). There was no evidence of residual hepatic damage after this time. Acute renal damage reached a maximum about a week after the accident, and recovery of function in respect of the kidneys' power to reabsorb sodium and chloride and to secrete potassium and acid recovered almost completely after three weeks. However, the power of the kidneys to reabsorb water, ie, to produce a concentrated urine, approached normal only after 139 days. Residual renal damage was not evident after this time interval as indicated by the clearance values for creatinine and inorganic phosphate. The significance of the results is discussed.
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PMID:Hepatic and renal complications arising from accidental carbon tetrachloride poisoning in the human subject. 542 Jul 37

This prospective randomized controlled clinical trial compares the effects of early parenteral nutrition and traditional delayed enteral nutrition upon the outcome of head-injured patients. Thirty-eight head-injured patients were randomly assigned to receive total parenteral nutrition (TPN) or standard enteral nutrition (SEN). Clinical and nutritional data were collected on all patients until death or for 18 days of hospitalization. Survival and functional recovery were monitored in survivors for 1 year. Of the 38 patients, 18 were randomized to the SEN group and 20 to the TPN group. Demographically, the two groups of patients were similar on admission. There was no significant difference in the severity of head injury between the two groups as measured by the Glasgow Coma Scale (p = 0.52). The outcome for the two groups was quite different, with eight of the 18 SEN patients dying within 18 days of injury, whereas no patient in the TPN group died within this period (p less than 0.0001). The basis for the improved survival in the TPN patients appears to be improved nutrition. The TPN patients had a more positive nitrogen balance (p less than 0.06), and a higher serum albumin level and total lymphocyte count. More adequate nutritional status may have improved the patients' immunocompetence, resulting in decreased susceptibility to sepsis. The data from this study strongly support the favorable effect of early TPN on survival from head injury.
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PMID:The favorable effect of early parenteral feeding on survival in head-injured patients. 640 49

Neurologic and audiologic sequelae produced by bilirubin toxicity are preventable by appropriately timed therapeutic intervention. To understand the timing and reversibility of the neural dysfunction that follows exposure to bilirubin, we recorded brainstem auditory evoked potentials (BAEP) in the Gunn rat model of bilirubin encephalopathy. Abnormal BAEP occur in jaundiced Gunn rats after injection of sulfadimethoxine (sulfa) 100 mg/kg intraperitoneally, which displaces bilirubin from blood albumin binding sites and promotes the net transfer of bilirubin into brain tissue. Reversal of BAEP abnormalities with injection of human serum albumin (HSA) 2 g/kg intraperitoneally was studied in 17- to 20-d-old jaundiced Gunn rats. One animal from each of 14 litters was randomly assigned to one of the following treatment groups: 1) sulfa alone, 2) sulfa + HSA at 2 h, 3) sulfa + HSA at 8 h, or 4) saline alone. BAEP were recorded in each rat before and 0.1, 4, 8, 24, and 48 h after injection of sulfa or saline. BAEP I-II interwave intervals increased in all sulfa groups (p < 10(-9) to 0.27 ms (21%) above baseline at 8 h for the two sulfa groups not receiving treatment before that time (p = 0.0002), but increased less for the sulfa group given HSA at 2 h compared with untreated animals (p = 0.02). Partial recovery of function occurred at 24 and 48 h for both HSA-treated groups compared with their 8-h values (p = 0.001), and there was increased mortality at 24 h for the sulfa group not treated with HSA (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Reversible brainstem auditory evoked potential abnormalities in jaundiced Gunn rats given sulfonamide. 828 1

Allowing a patient's nutritional state to deteriorate through the perioperative period adversely affects measureable outcome related to nosocomial infection, multiple organ dysfunction, wound healing, and functional recovery. Careful preoperative nutritional assessment should include a determination of the level of stress, an evaluation of the status of the GI tract, and the development of specific plans for securing enteral access. Patients already demonstrating compromise of nutritional status (defined by > 10% weight loss and serum albumin level < 2.5 g/dL) should be considered for a minimum of 7 to 10 days of nutritional repletion prior to surgery. Widespread use of total parenteral nutrition in unselected patients is unwarranted, may actually worsen outcome, and should be reserved for preoperative nutritional support only in severely malnourished patients in whom the GI tract is unavailable. Compared with the parenteral route, use of perioperative enteral feeding has been shown to provide more consistent and beneficial results, and can be expected to promote specific advantages in long-term morbidity and mortality.
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PMID:Preoperative issues in clinical nutrition. 1033 36

Axons in the CNS of higher vertebrates generally fail to regenerate after injury. This lack of regeneration is crucially influenced by neurite growth inhibitory protein constituents of CNS myelin. We have shown previously that a monoclonal antibody (mAb IN-1) capable of binding and neutralizing Nogo-A, a myelin-associated inhibitor of neurite growth, can induce long-distance axonal regeneration and increased structural plasticity with improved functional recovery in rat models of CNS injury. In this paper we demonstrate that a partially humanized, recombinant Fab fragment (rIN-1 Fab) derived from the original mAb IN-1, was able to promote long-distance regeneration of injured axons in the spinal cord of adult rats. When infused into a spinal cord injury site, regrowth of corticospinal fibers in 11 of 18 animals was observed after a survival time of 2 weeks. Regenerating fibers grew for >9 mm beyond the lesion site and arborized profusely in the distal cord. Regenerated fibers formed terminal arbors with varicosities in the spinal cord gray matter, strongly resembling synaptic points of contact to neurons in the spinal cord distal to the lesion. In animals that had received a bovine serum albumin solution or a recombinant IN-1 fragment that had been mutated in the antigen binding site (mutIN-1 Fab), no significant growth beyond normal lesion-induced sprouting was observed. Neutralization of endogenous nerve growth inhibitors represents a novel use of recombinant antibody technology with potential therapeutic applications after traumatic CNS lesions.
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PMID:Regeneration of lesioned corticospinal tract fibers in the adult rat induced by a recombinant, humanized IN-1 antibody fragment. 1105 Jan 27

A study has been carried out in our geriatric rehabilitation wards, to know better the role of cognitive dysfunction in treatment outcome and processing, mainly functional recovery and comorbidity. We analyzed 478 frail inpatients, 2/3 of them were females, aged 78.7 + 9.2 years, consecutively admitted to the unit. Assessment of cognitive function was performed by the mini mental state examination (MMSE), of functional status by Barthel index (BI), of co-morbidity by cumulative illness rating scale (CIRS) both at the admission and discharge for each patient, together with the usual clinical parameters and social outcome. More than one people in three lived alone and showed some communication problems; one in seven needed modifications in food preparation or nutritional system;more than one in five had pressure sore >/= 2 (EPUAP = European Pressure Ulcers Advisory Panel classification). The mean (+/- SD) levels of the admitted were: MMSE = 20 +/- 7.2; BI total score = 45.5 +/- 28.9; CIRS class = 4 +/- 2, CIRS severity score = 1.9 +/- 0.4. Of the patients, 74.5% were discharged to home. Mean functional gain was 20 points at BI: 65.6 +/-30.7; MMSE improved to 21.6 +/- 7.1 (p = 0.00005 for both comparisons, by Wilcoxon test).MMSE was positively correlated to BI (r = 0.6, p = 0.0005) and negatively correlated (p =0.0005) to CIRS comorbidity (r = -0.33) and severity (r = -0.26), and to age (r = -0.38, p =0.0005) both at admission and at discharge. MMSE at admission was correlated neither to functional gain, nor to improvement of clinical indicators, nor to measures of functional and clinical efficiency. MMSE at discharge showed similar results. In a stepwise multiple correlation analysis, taking the gain in BI as the dependent variable, while BI, serum albumin level, MMSE, CIRS severity and comorbidity indexes at admission as independent variables, MMSE together with BI admission total score and CIRS severity index retained a strong association with functional gain, whilst admission serum albumin levels and CIRSindex lost it. Consistently with some literary data, we showed the actual possibility of functional and clinical gains for people cared in a geriatric rehabilitation ward, all through a wide range of MMSE score, including subnormal scores. Poor cognitive status bears heavily on frailty, but does not hamper the outcomes of genuine rehabilitative efforts in geriatrics.
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PMID:The impact of cognitive impairment on the rehabilitation process in geriatrics. 1520 1


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