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Surgical Reconstruction of Pressure Ulcers in Patients with Spinal Cord Disease: A Prospective Study
Srivastava A,Gupta A,Taly AB,Murali T
Indian Journal of Physical Medicine and Rehabilitation , 2008,
Abstract: Objective: To study efficacy of surgery in the management of pressure ulcers in spinal cord disease.Design: Prospective, follow up study.Setting: Neurological rehabilitation unit of a tertiary centre.Sample: Patients of spinal cord diseases with grade III/IV pressure ulcers, underwent surgical reconstructionand rehabilitation in year 2005 with a minimum follow up duration of one year.Outcome measures: Ulcer healing rate, postoperative complications, ulcers recurrence rate.Statistical analysis: Frequency analysis on SPSS 13.0 for windows.Results: Surgical intervention was carried out in 25 subjects (M-19, F-6), having total 39 ulcers (stage III-16, IV – 23). Surgeries performed were: debridement - 3, split skin grafting -13 and flap mobilization andclosure - 23. Only four subjects (16.6%) had initial complications: wound dehiscence - 2 and delayed grafthealing -2. Follow up rate was 92.0% (23/25 patients), duration of 12-21 months (mean 15.4+/- 7.45m) andonly four subjects (17.3%) had ulcer recurrence.Discussion: All outcome variables showed significant improvement at follow up with good ulcer healing rate(87.0%), low initial complication (16.6%) and recurrence rate (17.3%).Conclusion: Timely surgical interventions are necessary for pressure ulcers. Reconstructive proceduresare simple & highly effective and should be an integral part of rehabilitation program.
Malignant Catatonia  [PDF]
Ayca Ozkul,Ali Akyol,Yusuf Tamam
Psikiyatride Guncel Yaklasimlar , 2010,
Abstract: Catatonia is a syndrome characterized by mutism, immobility, negativism, stereotypy, mannerisms, echophenomena, perseveration and passive obedience. The underlying causes can be psychiatric or may be associated with general medical status or neurological diseases. Additionally catatonia has two subtypes as malignant and nonmalignant catatonia. Main symptoms of malignant catatonia are hyperthermia and autonomic symptoms such as tachycardia, tachypnea and hyperhidrosis. It is important to make the diagnosis as early as possible for an appropriate medical treatment. Clinicians should be aware of the fatal outcome of the disease.
Inpatient or Outpatient Rehabilitation after Herniated Disc Surgery? – Setting-Specific Preferences, Participation and Outcome of Rehabilitation  [PDF]
Margrit L?bner, Melanie Luppa, Alexander Konnopka, Hans J. Meisel, Lutz Günther, Jürgen Meixensberger, Katarina Stengler, Matthias C. Angermeyer, Hans-Helmut K?nig, Steffi G. Riedel-Heller
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0089200
Abstract: Objective To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient) and setting-specific rehabilitation outcomes. Methods The longitudinal observational study referred to 534 consecutive disc surgery patients (18–55 years). Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%). The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale), pain intensity (numeric analog scale), health-related quality of life (Short Form 36 Health Survey), subjective prognosis of gainful employment (SPE-scale) as well as questions on rehabilitation attendance, return to work, and amount of sick leave days. Results The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%). Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%). Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56%) compared to only one third of the inpatient rehabilitees (33%) returned to work three months after disc surgery (p<.001). Conclusion The results suggest a “pre-selection” of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures and improve rehabilitation effects such as return to work.
Spina Bifida: Rehabilitation Problems in Rural Setting
Joshi GA,Dash H
Indian Journal of Physical Medicine and Rehabilitation , 2007,
Abstract: A follow up of four cases from a composite disability identification camp is presented here. The purpose of this case study is to reveal socioeconomic and access barriers for the children affected by spina bifida in the rural India. At the end are suggested some of possible ways and means to deliver rehabilitation services to them.
Catatonia Associated with Initiating Paliperidone Treatment  [cached]
Nathanael J. McKeown,James H. Bryan,B Zane Horowitz
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2010,
Abstract: We present a case of catatonia, which occurred shortly after starting a new antipsychotic,paliperidone, an active metabolite of risperidone. Catatonia may be caused by a variety of conditions,including metabolic, neurologic, psychiatric and toxic processes. Interestingly, risperidone, whichhas been thought to cause several cases of catatonia, has also been recommended as a potentialtreatment. We discuss potential mechanisms for causes of drug-induced catatonia as well as potentialtreatment options. [West J Emerg Med. 2010; 11(2):186-188.]
A clinical review of the treatment of catatonia  [PDF]
Pascal Sienaert,Dirk M. Dhossche,Davy Vancampfort,Marc De Hert,Gábor Gazdag
Frontiers in Psychiatry , 2014, DOI: 10.3389/fpsyt.2014.00181
Abstract: Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia Rating Scale, can guide the clinician through the neuropsychiatric examination. Although severe and life-threatening, catatonia has a good prognosis. Research on the treatment of catatonia is scarce, but there is overwhelming clinical evidence of the efficacy of benzodiazepines, such as lorazepam, and electroconvulsive therapy.
Malignant Catatonia Mimicking Pheochromocytoma  [PDF]
Sophia Wong,Barbara Hughes,Morris Pudek,Dailin Li
Case Reports in Endocrinology , 2013, DOI: 10.1155/2013/815821
Abstract: Malignant catatonia is an unusual and highly fatal neuropsychiatric condition which can present with clinical and biochemical manifestations similar to those of pheochromocytoma. Differentiating between the two diseases is essential as management options greatly diverge. We describe a case of malignant catatonia in a 20-year-old male who presented with concurrent psychotic symptoms and autonomic instability, with markedly increased 24-hour urinary levels of norepinephrine at 1752?nmol/day (normal, 89–470?nmol/day), epinephrine at 1045?nmol/day (normal, <160?nmol/day), and dopamine at 7.9?μmol/day (normal, 0.4–3.3?μmol/day). The patient was treated with multiple sessions of electroconvulsive therapy, which led to complete clinical resolution. Repeat urine collections within weeks of this presenting event revealed normalization or near normalization of his catecholamine and metanephrine levels. Malignant catatonia should be considered in the differential diagnosis of the hypercatecholamine state, particularly in a patient who also exhibits concurrent catatonic features. 1. Introduction Malignant catatonia (MC) is an uncommon and highly lethal neuropsychiatric condition first reported by Calmeil in 1832 [1]. Since then, it has been described in the medical literature by a litany of names, among them pernicious catatonia, lethal catatonia, and acute fulminating psychosis [2]. Similar to MC, pheochromocytoma is also a potentially fatal disease, and the two conditions can present with overlapping clinical and biochemical traits. It is vital that these pathologies be differentiated, as therapeutic options greatly diverge between the two. 2. Case Presentation A 20-year-old male was seen by the internal medicine service for fever and hypertension NYD (not yet diagnosed). The patient initially presented to the hospital for abnormal behavior, hallucinations, and delusions. He had become increasingly withdrawn over the past few months and began to experience auditory and visual hallucinations several days prior to admission. The patient denied any chills or rigors. He had a chronic productive cough and a persistent sore throat but no other infectious symptoms. There was no history of headaches or seizures. He was started on sertraline 25?mg daily three days before his hospitalization, although his compliance was questionable. He recently completed a full course of amoxicillin and clarithromycin for pharyngitis, but these provided minimal alleviation of his complaints. He was not on any other regular medications at home. The patient was a nonsmoker and had not
Sarcopenic Obesity: Correlation with Clinical, Functional, and Psychological Status in a Rehabilitation Setting  [PDF]
Lorenzo M. Donini, Eleonora Poggiogalle, Silvia Migliaccio, Alessandro Pinto, Carla Lubrano, Andrea Lenzi
Food and Nutrition Sciences (FNS) , 2014, DOI: 10.4236/fns.2014.520213
Abstract: Obesity and sarcopenia combination, appropriately defined as sarcopenic obesity (SO), due to disproportionally reduced/low lean body mass compared to excess fat mass, may lead to disability. Aims: The aim of our study was to investigate the relationship among sarcopenic obesity, physical performance, disability, and quality of life in a rehabilitation setting. Methods: Participants were recruited among obese patients (BMI > 30 kg/m2) admitted to the rehabilitation facility at the Department of Experimental Medicine, Medical Physiopatology, Food Science and Endocrinology Section during a 1-year period. A multidimensional evaluation was performed through bioelectrical impedance analysis and anthropometry, handgrip strength test, Short Physical Performance Battery (SPPB), 6-minute walk test (6MWT) and blood chemistry parameters. Psychological status (SCL-90 questionnaire), quality of life, and comorbidity (Charlson comorbidity index score) were also evaluated. Obesity was diagnosed as increased fat mass by 35% in women and by 25% in men. Sarcopenia was defined if lean body mass (LBM) was <90% of the subject’s ideal LBM. Results: 79 patients (48 women and 31 men; mean age: 60.1 ± 11.5 years, and 58.6 ± 10.8 years, respectively) were enrolled. Results showed a high prevalence of SO (54.4%) in our samples of obese subjects. Sarcopenia was present not only among older obese adults but also among younger obese subjects, and was related to reduced functional performance, to inflammatory status and to worse psychological status and quality of life.
Therapeutic management of catatonia  [cached]
Management in Health , 2010,
Abstract: Catatonic states occur in the context of a wide variety of both psychiatric and medical conditions. Since 1992 benzodiazepines represent a first-line treatment in catatonia, because they offer several advantages: a wide margin of safety, a rapid response, and they are easily administered. Other treatments include atypical antipsychotics, antiglutamatergic drugs, lithium. Lorazepam and other GABA-A promoters (benzodiazepines, zolpidem) increase GABA activity as their mechanism of action.
Recurrent opisthotonus in catatonia: An atypical presentation  [cached]
Manjunatha Narayana,Mehta Urvakhsh,John P
Indian Journal of Medical Sciences , 2009,
Abstract: Opisthotonus is known to occur in tetanus, rabies, cerebral malaria, neurosyphilis, acute cerebral injury and other medical conditions. Opisthotonus, so far, has not been reported in any major psychiatric disorder. Authors report a case of recurrent opisthotonus presenting concurrently with other catatonic signs which showed dramatic response to combination of lorazepam and electroconvulsive therapy (ECT). Clinicians should consider the possibility of catatonia in the differential diagnosis of opisthotonus since catatonia can be treated easily with benzodiazepines and ECT.
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