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OBJECTIVE: Deep venous thromboembolism (DVT) is an important health issue in the hospitalized geriatric population that leads to increased length of stay, morbidity, and mortality. Patients with hemorrhagic strokes are usually not placed on prophylactic therapy because of the risk of hemorrhagic extension of the stroke. The purpose of this study was to evaluate the prevalence of DVTs in hospitalized patients with hemorrhagic vs. thromboembolic strokes. DESIGN: Retrospective chart review of data obtained from the Maryland Health Services Cost Review Commission data base for 1999 to determine the prevalence of DVTs in both hemorrhagic and thromboembolic stroke patients hospitalized acutely. Multiple logistic regression was performed to evaluate possible risk factors. RESULTS: There were 1926 patients hospitalized with a primary diagnosis of hemorrhagic stroke and 15599 with thromboembolic stroke. Women in general had more strokes than men did. Older patients were more likely to have strokes as evidenced by the mean ages of 66 and 71 yr for hemorrhagic and thromboembolic strokes, respectively. A total of 37 patients (1.9%) with hemorrhagic strokes had DVTs, whereas 74 patients (0.5%) with thromboembolic strokes had DVTs. Hemorrhagic stroke was an independent risk factor for DVT (odds ratio, 2.60; 95% confidence interval, 1.49-4.55; P = 0.0008). CONCLUSIONS: DVT prevalence and risk was higher among patients with hemorrhagic strokes in comparison with patients with thromboembolic strokes. [ABSTRACT FROM AUTHOR]

There has been little attention given to the relationship between variations in normal craniofacial morphology and swallowing physiology. This preliminary investigation evaluated the relationship between the Frankfort-mandibular plane angle (FMA) and hyoid displacement during swallowing. Hyoid movement was evaluated during 12-ml and 24-ml swallows of liquid barium in 12 healthy subjects (age = 20-29 years, median = 23 years). Lateral projection videofluorography was utilized. Positions of the hyoid at maximum forward displacement, maximum upward displacement, starting position, and ending position were determined using image analysis software. The mean FMA was 28.92 degrees +/- 4.08 degrees (mean +/- SD, range = 20 degrees -34 degrees ). A Pearson correlation (

Objectives: To determine whether the proportion of patients with stroke experiencing dysphagia differs among racial groups and whether this relation can be explained by stroke type or severity., Design: Case-control study using California's Medical Information Reporting and New York's Statewide Planning and Research Cooperative System databases for 2002. Cases had primary diagnosis of cerebrovascular disease (International Classification of Disease, 9th Revision [ICD-9] codes 430-438.9, excluding transient [435-435.9] and late-effects [438-438.9]), and self-identified race was white, black, or Asian. Two comparison groups were selected: (1) Parkinson's disease (ICD-9 codes 332-332.1) and (2) oral cancer (ICD-9 codes 141-149)., Setting: Inpatient admissions in the respective states., Participants: Cases with primary diagnosis of cerebrovascular disease whose self-identified race was white, black, or Asian., Interventions: Not applicable., Main Outcome Measure: Dysphagia, defined by ICD-9 codes 787.2 (dysphagia), 507.0 (aspiration pneumonia), or presence of a feeding tube in the absence of a diagnosis of coma (Current Procedural Terminology codes 432.46 or 437.50 without ICD-9 code 780.01)., Results: In the stroke group, the adjusted odds ratio (OR) with 95% confidence interval (CI) for dysphagia was significantly higher for Asians than whites in New York (OR=1.64; 95% CI, 1.50-1.79) and California (OR=1.69; 95% CI, 1.34-2.13). The adjusted OR was slightly but significantly higher for blacks than whites in New York (OR=1.15; 95% CI, 1.03-1.28), but not in California (OR=1.08; 95% CI, 0.97-1.19). No statistically significant differences among racial groups were found in patients with Parkinson's disease or oral cancer. Other factors strongly associated with dysphagia included hemiplegia (OR=2.19; 95% CI, 2.07-2.32) and aphasia (OR=1.97; 95% CI, 1.83-2.11)., Conclusions: Asians were more likely to have dysphagia after stroke. This association was statistically significant after adjusting for age, sex, stroke severity indicators, comorbidities, and stroke type.

Objective: Black patients tend to have a greater number and severity of stroke cases. The literature on access to rehabilitative services shows mixed results ranging from no disparities to limited access among minority populations. This study evaluated the association of race and acute discharge to inpatient stroke rehabilitation in Maryland, a diagnostic related group-and postacute care prospective payment system-exempt state., Design: Data from the Maryland Health Services and Cost Review Commission database for 2000 was used to conduct a cross sectional retrospective review to determine the rate of disposition to inpatient rehabilitation facilities (IRF). Multiple logistic regression analyses evaluated factors associated with discharge to IRF in this population., Results: There were a total of 12,208 patients hospitalized with stroke in the year 2000. Compared with urban-dwelling white patients, black patients who lived in urban dwellings were more likely to be discharged to IRF, OR 1.42, 95% CI (1.06, 1.91)., Conclusion: In the state of Maryland, urban-dwelling black stroke patients were more likely to be discharged to IRF acutely after stroke. Future studies should assess whether this trend persists in states that have larger rural populations.

A simple, broadly applicable, standardized dysphagia severity scale would be useful to standardize dysphagia evaluations, to monitor recovery and efficacy of treatment and to study the consequences of dysphagia. We developed a global Dysphagia Severity Scale (DSS) from videofluorographic swallowing studies which included subjective clinical ratings of functional swallowing. We rated laryngeal penetration/aspiration (P/A) and pharyngeal retention (PR), and then assessed methods for scoring severity of P/A and PR and for combining them in a global scale. Each method was tested by correlation with overall clinical severity ratings. The highest correlations were found by: 1) scoring P/A based on which foods were aspirated (no aspiration or penetration; penetration only; thin liquid aspiration; thick liquid, pudding, or chewed solid food aspiration; 2) scoring PR based on how much food was retained (none; minimal; moderate; severe); and 3) combining P/A and PR by taking the higher of the two scores as the final DSS rating. The final global DSS score and the clinical severity rating correlated well (r = 0.71). This proposed scale shows promise for rating global dysphagia severity.

There is no empirically derived consensus as to what food consistency types and method of food delivery (spoon, cup, straw) should be included in the videofluoroscopic swallowing (VFSS) studies. In the present study, we examine the rates of aspiration and pharyngeal retention in 190 dysphagic patients given thin (apple juice) and thick (apricot nectar) liquids delivered by teaspoon and cup and ultrathick (pudding-like) liquid delivered by teaspoon. Each patient was tested with each of the bolus/delivery method combinations. The fractions of patients exhibiting aspiration for each bolus/method of delivery combination were (1) thick liquids (cup), 13.2%; (2) thick liquids (spoon), 8.9%; (3) thin liquids (cup), 23.7%; (4) thin liquids (spoon), 15.8%, (5) ultrathick liquids (spoon), 5.8%. In each comparison [thick liquid (cup) vs. thick liquid (spoon), thin liquid (cup) vs. thin liquid (spoon), thick liquid (cup) vs. thin liquid (cup), thick liquid (spoon) vs. thin liquid (spoon), and thick liquid (spoon) vs. ultrathick liquid (spoon)], the p value for chi 2 was < 0.001. These results suggest that utilizing thin, thick, and ultrathick liquids and delivery by cup and spoon during a VFSS of a patient with mild or moderate dysphagia can increase the chances of identifying a consistency that the patient can swallow without aspirating and without pharyngeal retention after swallowing.

The objective of this study was to determine the inter- and intrarater reliability in evaluating videofluoroscopic swallowing studies (VFSS). Participants included 4 physicians (3 physiatrists and 1 internist) and 5 speech-language pathologists with at least 5 years experience in evaluating VFSS. The main outcomes of the study were reliability ratios of positive and negative tests in inter- and intrarater evaluations. Raters independently rated each of 20 VFSS on two separate occasions. Traits evaluated included oral stage impairment, aspiration, pharyngeal retention, and several functional components: timing of swallow onset, adequacy of velopharyngeal apposition, laryngeal elevation, epiglottic tilt, pharyngeal contraction, and pharyngoesophageal (PE) segment opening. Reliability varied widely depending on food type and the trait under evaluation. Inter- and intrarater reliability ratios did not differ widely. Reliability ratios values typically were highest (greater than 90%) for aspiration, especially with solid food, and lowest for the functional components. It was concluded that inter- and intrarater reliability in VFSS are adequate for evaluating oral stage, laryngeal penetration, and aspiration and pharyngeal retention, but questionable for functional components.

Objective: To compare three pillows with regard to pain intensity, pain relief, quality of sleep, disability, and overall satisfaction in subjects with benign cervical pain. The three pillows evaluated were the subjects' usual pillow, a roll pillow, and a water-based pillow., Study Design: Subjects used their usual pillows for the first week of this 5-week randomized crossover design study. They were subsequently randomly assigned to use each of the other two pillows for 2-week periods., Setting: Outpatient neurology and physiatry clinics., Patients: Forty-one subjects with benign cervical pain syndromes and free of cognitive impairments., Main Outcome Measures: Visual analog scale (VAS), Sleep Questionnaire, Sickness Impact Profile (SIP), and a satisfaction scale rating the pillows., Results: The water-based pillow was associated with reduced morning pain intensity, increased pain relief, and improved quality of sleep. The duration of sleep was significantly shorter for the roll pillow. Overall SIP findings showed a significant advantage for the water-based pillow over the roll pillow and standard pillow., Conclusions: Proper selection of a pillow can significantly reduce pain and improve quality of sleep but does not significantly affect disability outcomes measured by the SIP.

Background and Purpose: This study was conducted to determine if blacks hospitalized for cerebrovascular events had more severe cerebrovascular events than whites similarly hospitalized., Methods: Data from the Maryland Health Services Cost Review Commission were used to determine incidence of coma, death rates, age at death of those who died, and length of stay for acute hemorrhagic and occlusive stroke in hospitalized blacks and whites after adjusting for sex and, if appropriate, age., Results: With a single exception (number of patients with hemorrhagic stroke who died during short-term hospitalization), all indices indicated that blacks incurred more severe cerebrovascular events than whites (P < .05 or less)., Conclusions: Maryland state data from hospitalized patients indicate that blacks had more severe strokes than whites.

With few exceptions, epidemiology of dysphagia is unexplored, particularly with regard to risk and protective factors, and underutilized. The range of incidence of dysphagia in selected primary diagnoses often associated with dysphagia is summarized.

It is difficult to predict from clinical signs and symptoms which patients suffer from subglottic penetration of foods. Most investigators attempting to predict aspiration have used small numbers of patients and relatively unsophisticated statistical techniques. In this study, we utilized 249 patients to examine the predictive value of several clinical factors thought to be suggestive of subglottic penetration with discriminant analysis. Using this approach we were able to correctly predict about 2/3 of both those who aspirate and those who do not aspirate. This is better than others have reported but still inadequate for clinical purposes.

This paper presents a detailed protocol for performing the videofluorographic swallowing study (VFSS), and describes how it evolved from its antecedents. The objectives of the VFSS are both diagnostic and therapeutic. Preparing for the VFSS is described, including the equipment, food preparation, and a brief discussion of the clinical evaluation. The detailed description of the VFSS procedure covers the position of the patient, the foods presented, the views obtained, modifications of feeding and swallowing that are commonly employed, the standardized set of observations, and reporting the results. Criteria for deviating from the protocol or aborting the study are presented. The VFSS does not necessarily end when a patient aspirates. Indeed, the complete evaluation of aspiration, and the effects of maneuvers designed to reduce it, is a major purpose of the VFSS. Modifications of feeding and swallowing are tested empirically during the study. The modifications include therapeutic and compensatory techniques that may improve the safety and efficiency of swallowing. A rationale for deciding which modifications to test in a given patient is discussed. The protocol has been used successfully in more than 350 patients. It has improved the efficiency and quality of our videofluorographic examinations.

The "impact" of Plastic and Reconstructive Surgery was evaluated by bibliometric analysis. This technique considers the average frequency with which journal authors refer to articles published in Plastic and Reconstructive Surgery. The impact of Plastic and Reconstructive Surgery was compared with that of journals most commonly referred to within Plastic and Reconstructive Surgery as well as with that of journals read most commonly by Plastic and Reconstructive Surgery subscribers, such as the Annals of Plastic Surgery and the Journal of Hand Surgery (both American and British editions). The impact factor for Plastic and Reconstructive Surgery was at least twice as great as for any other journal related to this surgical subspecialty. With regard to other surgical subspecialties, while the impact factor for Plastic and Reconstructive Surgery was less than that of the Journal of Neurosurgery, Journal of Urology, and Journal of Ophthalmology, it was greater than those for orthopedics, otolaryngology, hand surgery, and dermatologic surgery.

A bibliometric analysis based on the Journal Citation Reports distributed by the Institute of Scientific Information was made of the Archives of Physical Medicine and Rehabilitation and related journals to determine the relative ranking of the Archives in several bibliometric categories. It was hoped that this process would yield objective evidence for the strengths and weaknesses of the Archives. Bibliometric indices that were compared included the impact factor (a reflection of how often a journal's articles are cited) and the cited half-life and immediacy (both of which deal with the timeliness of a journal's articles). The overall rankings of the Archives in 1988 compared to all journals indexed were 1,887 of 4,020 for impact factor, 2,633 of 2,683 for cited half-life and 1,793 of 4,020 for immediacy. In general, the Archives ranked higher in most of these indices than most rehabilitation journals but lower than other journals widely cited in the Archives, including general journals, other specialty journals, and a basic science journal.

Eleven patients with previously documented aspiration underwent a radioisotopic swallowing study to detect and quantify airway penetration. In those subjects able to complete a rapid-acquisition phase during swallowing, no laryngotracheal penetration was seen despite previous evidence of aspiration. However, sequential static pulmonary imaging showed significant aspiration in three individuals. Attempts were made to measure the percentage of ingested material aspirated and the clearance rate from the airways. Eight patients (73%) failed to show definite evidence of aspiration on scintigrams. It is hypothesized that the lack of scintigraphic detection in previously proven aspirators was due either to interval improvement of the dysphagia or to difficult-to-detect laryngotracheal aspiration. Isotopic imaging during swallowing appears to have little utility; however, after ingestion, the technique can demonstrate more distal penetration not detected on videofluoroscopy. More studies are suggested to better define the sensitivity and specificity of scintigraphy in aspiration detection and to determine whether these techniques have prognostic value that could alter patient management.

Evidence is given to support the thesis that minimal pyelocaliectasis and ureterectasis are of little clinical significance in spinal cord injured patients. Such renal changes almost always improve or remain stable on sequential examinations. Since moderate or severe pyelocaliectasis is usually detected by renal scintillation procedures, these findings support its use as a urinary tract screening examination along with an abdominal radiograph to detect calculi. The need for long-term serial examination of the urinary tract in spinal cord injury is emphasised.

We conducted a study to determine if effective renal plasma flow routinely measured by hippurate clearance during a comprehensive renal scintillation procedure is a relevant measure for assessing renal function in spinal cord injury patients. All subjects had spinal cord injury and had had contemporaneous comprehensive renal scintillation procedures and excretory urograms on 2 occasions 24 months or less apart. Each of the 469 kidneys was placed into 1 of 5 quintiles on the basis of its effective renal plasma flow at the first examination. The percentage of the kidneys that had clinically significant pyelocaliectasis or in which the pyelocaliectasis significantly worsened was 20.4 per cent in the lowest (first) quintile and 9.3, 2.2, 5.4 and 3.2 per cent in the second, third, fourth and fifth quintiles, respectively. Analogous data for ureterectasis were 16.1, 8.2, 2.2, 3.3 and 3.2 per cent. There was a significant (p less than 0.01) correlation between effective renal plasma flow and renal parenchymal thickness. Kidneys with renal calculi averaged effective renal plasma flows about 25 per cent lower than those of kidneys free of calculi. We conclude that effective renal plasma flow is a relevant measure for assessing renal function in spinal cord injury patients.

This study compared the effect of (1) continuous, (2) intermittent, and (3) graded exercise on the cardiopulmonary responses of 12 acutely injured paraplegic individuals having neurologically complete spinal lesions, between T7 and T12, and seven able-bodied control subjects. Continuous exercise consisted of cranking an arm ergometer at a constant rate of 30W. Intermittent exercise consisted of arm ergometry at 60W for 30-second periods interspersed with 30-second rest periods. In graded exercise, subjects worked for consecutive two-minute periods at rates of 10, 20, 30, 40, and 50W with no rest periods between work periods. Subjects exercised for 10 minutes or until they reached subjective fatigue. Heart rate (HR) and oxygen consumption (VO2) were measured during rest and work. Paraplegic subjects performed 4.93, 4.89, and 4.95 watt-hours of continuous, intermittent, and graded exercise respectively. Comparable figures for control subjects were 4.98, 4.91, and 4.96 watt-hours. There was a high degree of correlation between HR and VO2 in both paraplegic (r = 0.80) and normal (r = 0.85) subjects. Both VO2 and HR were highly correlated with work load in each group. Paraplegic subjects had significantly higher HRs (p less than 0.001), respiratory quotients (p less than 0.05), and ventilatory volumes (p less than 0.05) than control subjects. Graded exercise produced a significantly higher HR than continuous or intermittent exercise (p less than 0.001) during the final data collection period. Oxygen consumption during graded exercise was higher than VO2 for continuous or intermittent exercise (p less than 0.01) during the final data collection period.(ABSTRACT TRUNCATED AT 250 WORDS)

Two hundred and fifty spinal cord injury patients were studied on each of two occasions, 12 to 24 months apart, to determine which urological findings could be used to predict the subsequent development of clinically significant pyelocaliectasis. An equation was developed which correctly classified 90% of the patients who remained free of clinically significant pyelocaliectasis and 82% of the patients who subsequently developed clinically significant pyelocaliectasis. The statistically significant risk factors were renal calculi, bladder diverticula and a decrease in effective renal plasma flow. This study suggests that the presence of these risk factors warrants careful monitoring of renal function in these patients and appropriate management of bladder dysfunction.

The validity of the antibody-coated bacteria test and Fairley washout procedure to determine whether urinary tract infections were of kidney or bladder origin in spinal cord injury patients was assessed by comparing test results with those obtained from culture of ureteral urine specimens. It was concluded that neither the presence of antibody-coated bacteria nor a positive bladder washout test can be considered as definitive evidence that bacteriuria is of renal origin in these patients.

The present study was conducted to determine the effects of skeletal muscle relaxants on contractions of bladder smooth muscle. Rat, rabbit and human bladder muscle strips were incubated in a 50 ml. organ bath filled with physiological salt solution, aerated with 95 per cent O2, 5 per cent CO2 and maintained at 37C. Contractions were induced both electrically and with acetylcholine. Contractile strength was measured before and after 30 to 70 minute incubations with diazepam (0.25 to 1.0 microgram./ml.), dantrolene sodium (4 micrograms./ml.) or baclofen (4 micrograms./ml.). Neither baclofen nor dantrolene sodium had any effect (p greater than 0.3) on electrically or acetylcholine-induced contractions in any of the 3 species tested but diazepam potentiated both electrically induced (115 per cent of predrug contractile strength, p less than 0.05) and acetylcholine-induced (122 per cent of predrug contractile strength, p less than 0.01) contractions of rat, but not rabbit or human, bladder muscle. In rabbits diazepam significantly reduced maximal bladder pressures in vivo (p less than 0.05) but had no effect on bladder capacity. Dantrolene sodium had no effect on rabbit bladder pressure or capacity in vivo. While diazepam is thought to exert its effects on skeletal muscle through CNS inhibition, these results suggest that diazepam may affect rat but not rabbit or human bladder smooth muscle directly.

A mobile instrument system was used to measure energy consumption by indirect calorimetry at rest and during ambulation in 25 unimpaired subjects, 6 unilateral below-knee (BK) amputee patients, 6 unilateral above-knee (AK) amputee patients and 4 bilateral AK amputee patients. To prevent the introduction of gait difficulties among the impaired subjects, each subject was permitted to walk at his own comfortable speed. Since speed thus varied among subjects, ambulation data were expressed in units of energy per foot traveled. Statistical analyses of the mean oxygen costs indicated several significant differences among the groups. In comparison to unimpaired subjects, the mean oxygen consumption was 9% higher in unilateral BK amputee patients, 49% higher in unilateral AK amputee patients and 280% higher in bilateral AK amputee patients.

Insensible weightlosses (IWL) were determined in each of 24 patients with physiologically complete spinal cord transection. The patients were placed on a bed balance with an accuracy of +/- 5 g in an environmental chamber maintained at 24 degrees C. dry bulb and 17 degrees C. wet bulb temperature. Bihourly weight changes, corrected for food and fluid ingestion, were determined for a total of 24 hours. Tetraplegics have significantly lower (P less than 0.05) IWL than paraplegics. The IWL of paraplegics are in the range of IWL of normal persons reported in the literature. We conclude that a lower allowance for IWL should be for tetraplegics than for paraplegics or persons with intact spinal cords.

Forty-six industrial workers performed a total of 653 1-h work bouts over a wide range of work rates )142-273 W/m2) and environmental temperatures (11-35 degrees C corrected effective temperature) in the summer and winter seasons. Simultaneous measurements of heart rates and rectal temperatures were made at the end of each work period, and the relationship between heart rate and rectal temperature was computed with standard multiple linear regression techniques. The overall regression equation is: heart rate (beats/min) = 29.3 (beats/min. degrees C) x rectal temperature (degrees C) - 988.6 (beats/min). The relationship is significantly altered by work rate and job- and season-acquired acclimatization of the subjects. These data suggest that the average heart rates of industrial workers during prolonged work can be predicted from rectal temperatures with a reasonable degree of confidence if the degree of acclimatization and work rates are known. For a rectal temperature of 38.0 degrees C the expected heart rate during prolonged work ranges from 109 beats/min in acclimatized men working at low rates to 143 for unacclimatized men working at heavy rates.

We conducted 202 trials in 161 male hospital patients to determine if prophylactic administration of ascorbic acid or antibacterials (trimethoprim-sulfamethoxazole, nalidixic acid, methenamine hippurate or nitrofurantoin macrocrystals) would prevent bacteriuria infections in spinal cord injury patients who had had at least 1 bout of bacteriuria. None of the drugs tested appeared to be statistically effective in the doses used in preventing bacteriuria in these patients. Moreover, sensitivities were lost to several drugs other than those used prophylactically. We conclude that use of prophylactic doses of ascorbic acid or antibacterials has not proved to be beneficial in spinal cord injury patients free of indwelling catheters.

Energy metabolism data were collected in a series of 8 male paraplegic patients with neurologically complete spinal cord lesions between T4 and T12 (1 patient had complete motor paralysis with incomplete sensory function). Energy costs were measured at the subject's seated basal rate (mean = 17.12cal/min/kg) and during 2 separate trials at ambulation using Craig-Scott braces. The rates of ambulation reflected the patient's perceived comfortable rate and ranged from 2.2 to 44.8m/min. (mean = 14m/min). The subjects ambulated in a straight line, with the data collection instrumentation (the Mobile Automatic Metabolic Analyzer) moving alongside. Mean O2 consumption was 0.1867ml/sec/kg and mean energy cost was 52.96 cal/min/kg, which when compared to a mean of 17.12 cal/min/kg at their resting state, represents a 3-fold increase in their energy cost. Three cases were further measured for O2 debt, which ranged from 1483 to 3112 ml and was repaid completely within 10 minutes post-walk.

The purpose of this study was to determine the effects of an inflatable abdominal corset and bilateral pneumatic leg splints on certain physiologic parameters during and after postural change in 27 quadriplegic patients. Data reflecting respiratory rate, tidal volume, heart rate, systolic and diastolic blood pressure were collected and analyzed. Measurements were acquired with patients in supine, 20 degrees head-up, 45 degrees head-up, and 20 degrees head-down positions. The study population was divided into 2 groups of cervical spinal cord injured patients: group I included 13 patients with C6 or C7 lesions; group II included 14 patients with C4 or C5 lesions. The mean time between injury and data collection was 47 days. Several trends were identified: (1) the neurologic level of lesion in quadriplegics appears relatively unimportant in determining cardiopulmonary response to postural change; (2) the use of assistive compressive devices does not improve pulmonary ventilatory parameters during postural change, although such devices do help maintain cardiovascular parameters; and (3) the abdominal corset appears more effective than pneumatic leg splints in maintaining blood pressure at pretilt levels. A tidal volume of 350ml to 400ml is most easily maintained by placing patients in a supine position and eschewing assistive compressive devices. Because the pneumatic devices proved successful in helping quadriplegic patients maintain cardiovascular stability during postural changes, therapeutic modalities, such as tilt table treatments, may be initiated at an earlier stage in the rehabilitation process.

This study was conducted to determine (1) if serum creatinine levels (SCL) in spinal cord injury (SCI) patients are influenced by neurologic level of lesion, sex, age, or time since injury, and (2) if SC values are a sensitive indicator of renal function (as reflected by renal plasma flow [RPF]) in these patients. The overall SC mean and SD were 0.9 +/- 0.2mg/dl (n = 141). There was no difference in SC values between patients with higher injuries (T-6 or above) and patients with lower injuries (T-7 or below), nor was there any difference between patients with lesions less than 3 months, 10-14, 22-26, 34-38, 46-50, or 58-62 months in duration. Age and gender each accounted for less than 5% of the variation in SC. There was no significant correlation between RPF and SC (unless the patient also had moderate or severe pyelocaliectasis) nor between change in serum RPF (from the previous examination, usually 12 months earlier) and change in SC, suggesting that SCL does not reflect the functional status of the kidney in these patients.

We classified 204 patients with acute spinal cord injury into 1 of 5 groups according to the initial form of urological management. Group A patients were placed on an intermittent catheterization program within 36 hours of injury, group B received a suprapubic trocar within 36 hours of injury, group C had urethral catheters in place for more than 36 hours before intermittent catheterization was begun, group D was on indwelling urethral catheter drainage throughout the hospitalization and discharged from the hospital with indwelling catheters, and group E was placed on intermittent catheterization in a community hospital. There were no statistically significant differences among the groups in the incidence of chills and fever, rate of urinary infections (excluding group D), incidence of upper tract changes, genitourinary complications or frequency of urological procedures at 1 year after injury. We conclude that the method of initial bladder management is relatively unimportant in determining the urological prognosis after spinal cord injury.

Computer-assisted renal scintigraphy was performed on 160 acute and 240 chronic spinal cord injury patients, and 287 noninjured controls. Concurrently, measurements of global and individual kidney effective renal plasma flow, time of maximum activity in each kidney, ratio of maximum counts to the counts at 27 minutes after injection over each kidney and number of counts in each kidney at 1 to 2 minutes after injection were made. The time of peak activity over the kidney and differential function at 1 to 2 minutes after injection were not affected significantly by age, sex or spinal cord status. Global and individual effective renal plasma flows were significantly affected by all of these factors. Both plasma flow measures generally were higher for male than for female patients. Effective renal plasma flow decreased steadily after early adulthood and, except for the youngest and oldest patients, values were lower for spinal cord injury patients than for normal controls. The ratio of peak to 27-minute counts was affected significantly by age and spinal cord injury but not by sex. In patients without obvious pathological conditions followup scintigrams 1 to 3 years after injury showed no significant changes owing to interval since injury on any parameter studied. Lower limits of basal scintigraphic parameters are given for evaluation of renal status in neurologically intact or spinal cord injury persons.

The prescriptive zone is the range of climates in which man's body temperature is independent of climatic conditions. The environmental temperatures which define the upper limit of the prescriptive zone (ULPZ) at different work rates were determined in 46 clothed, healthy, male industrial workers; some of the men were job acclimated to heat and some were not. They performed a total of 653 work bouts of low, medium, or high intensity in environments ranging from 11 to 35 degrees C corrected effective temperature (CET) (8-37 degrees C wet bulb globe temperature). Heart rates (HR) and rectal temperatures (Tre) were measured after 1 h of work. The ULPZ was calculated from Tre data. HR's showed a similar pattern of response as Tre's except that the inflection point corresponding to the ULPZ occurred at different environmental temperatures at most of the experiment conditions. About one-third of the work bouts were performed in the summer months and the remainder in the winter. The ULPZ decreased with increasing work rates. At high, but not low, work rates, men who were exposed to heat in the performance of their jobs were more heat tolerant than men who were not heat acclimatized. Both groups were found to be more heat tolerant in the summer months than in the winter.

The R(-) and S(+)-isomers of 2,5-dimethoxy-4-methylamphetamine (DOM) produce a dose-dependent hypothermia in rats kept in the cold (6 degrees C). 2 This hypothermia was linearly dependent upon ambient temperature and the R(-)-isomer was considerably more potent than the S(+)-isomer. 3 A statistically significant tachyphylaxis was observed when R(-)-DOM was administered on two successive days. The response seven days after the second injection was similar to that on the first day of injection. 4 The hypothermia induced by R(-) and S(+)-DOM was antagonized by methysergide but not by p-chlorophenylalanine (PCPA) or pimozide. Methysergide, PCPA or pimozide alone did not elicit hypothermia at the doses used. The results indicate that R(-) and S(+)-DOM act at post-synaptic 5-hydroxytryptamine receptors.

This study was designed to help clinicians establish objective guidelines for meeting the nutritional requirements of spinal cord injury (SCI) patients during their initial hospitalizations. The nutritional status of 51 SCI patients treated between 1983 and 1986 was assessed at two, four, and eight weeks after injury. Nutrient deficiencies such as albumin (100% of patients), carotene (62%), transferrin (37%), ascorbate (25%), thiamine (24%), folate (20%), and copper (11%) were documented most frequently at two weeks postinjury. There was an average of 2.0, 1.6, and 1.2 nutrient abnormalities per patient at two, four, and eight weeks postinjury, respectively. Although most depressed nutrient parameters improved with time, diet-dependent plasma proteins such as albumin and transferrin remained low throughout the entire eight-week period. Mean body weight declined 1.3 +/- 3.9 kg during the first two weeks, 2.0 +/- 4.4 kg between two and four weeks, and 0.4 +/- 2.0 kg between four and eight weeks after injury. Significant findings also included a strong correlation between plasma albumin, ascorbate, and carotene levels and maximal inspiratory and expiratory pressure (p less than .05). Although nutrient status usually improved with time and was not definitely associated with an increased risk of secondary medical complications, prudence dictates that these deficiencies should be prevented by appropriate intervention.

Effective renal plasma flow was measured in acute spinal cord injury patients for up to 10 years after injury to determine the extent of renal deterioration in these patients and to identify the factors associated with a loss of renal function. The over-all mean decrease in effective renal plasma flow for all patients as a whole was 4.5 ml. per year. Factors associated with a statistically significant reduction in effective renal plasma flow included age, gender, renal calculi, quadriplegia, and a history of chills and fever. Other factors examined but not found to be statistically significant included years since injury, presence of severe decubiti, bladder calculi, bacteriuria and extent of injury. This study suggests that renal function usually can be preserved in spinal cord injury patients if the treatable risk factors are managed properly.

This study examines, from an epidemiologic perspective, a series of 359 consecutive admissions to a Model Regional Spinal Cord Injury Center located in the south-eastern United States. An extensive data set which captures medical, demographic, social and psychological information, on each patient, has been statistically analysed. The appropriateness and utility of epidemiologic methodology applied to the phenomena of spinal cord injury is demonstrated and the findings resulting from the analyses are discussed.

Year-to-year variations in effective renal plasma flow (ERPF) measurements were determined in 78 patients with spinal cord injury who had no urologic complications or surgery or bouts of chills and fever between consecutive annual follow-up examinations. The effects of age, gender, level and degree of lesion, and time since injury on the degree of variability were also determined. None of the factors considered had a statistically significant effect (P greater than 0.05) on year-to-year variations in ERPF. About 90 per cent of the individual kidney ERPF measurements were within 100 ml/min of the measurement made in the previous year, and 90 per cent of the total ERPF measurements were within 175 ml/min of the previous year's measurement. Follow-up of patients whose year-to-year variability exceeded these limits showed that most subsequently regressed toward the mean spontaneously. These data suggest that kidney blood flow varies considerably from year to year in otherwise healthy patients with spinal cord injury and that changes of 100 ml/min or more for an individual kidney or 175 ml/min or more for both kidneys together are common, but probably of little clinical significance, provided the absolute levels of ERPF remain within normal limits.

Patients with upper and lower motor neuron spinal cord injuries were observed to determine whether cystography immediately before excretory urography induced iatrogenic dilatation of the upper urinary tract that was indistinguishable from true pathological dilatation. Evidence is given that such dilatation occurs. This iatrogenic dilatation is not seen in patients with normally innervated urinary tracts and appears to be caused by exaggerated bladder reflexes in patients with upper motor neuron lesions. Bladder spasms precipitated by cystographic contrast material also may create vesicoureteral obstruction and lead to dilatation of the upper urinary tract. Consequently, it is suggested that cystography should not immediately precede excretory urography. When such a sequence is necessary, room or body temperature contrast medium should be used for the cystogram, the bladder should be emptied before the excretory urogram is started and a 1-hour interval should be allowed between the 2 procedures. The findings also suggest that any factors that induce repeated or continuing bladder spasms may contribute to progressive dilatation of the upper urinary tract.

Forty-six industrial workers completed a total of 653 one-hour work bouts requiring an average of 122-235 kcal/M2/hr in an environmental chamber maintained at heat stress levels ranging from 8-37 degrees C wet bulb globe temperature (WBGT). Heart rates (HR) and rectal temperatures (Tre) were measured at the end of each work bout. Environmental heat stress levels were divided into two groups - those above and those below the permissible exposure limits (PEL). The PEL is the proposed maximum environmental thermal stress to which industrial workers can be exposed without endangering their health. The number of observations in each of these regions was further divided into those which were above the recommended limits of a World Health Organization study group (HR less than or equal to 110 bpm, Tre less than or equal to 38.0 degrees C) and those which were not. The number of "safe" (HR less than or equal to 110 bpm, Tre less than or equal to 38.0 degrees C) observations in environments with heat stress less than or equal to the PEL ranged from 100% to 2.4% depending on subject acclimatization and work rate. The degree of protection was always less in the winter than in the summer and was less for higher work rates. Men who normally worked in hot environments had fewer "excessive" HR's and Tre's than those who did not.