Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Mar 1994
Comparative StudyDaytime oxygen saturation does not predict nocturnal oxygen desaturation in patients with chronic obstructive pulmonary disease.
Nocturnal hypoxemia occurs commonly in patients with chronic obstructive pulmonary disease (COPD). Because pulmonary hypertension and cardiac arrhythmias are associated with this phenomenon, the detection and treatment of nocturnal hypoxemia should be part of the management of COPD patients. The ability to predict nocturnal hypoxemia by evaluating an awake patient would be desirable economically and logistically because continuous nocturnal oximetry is not widely available and because it is costly and labor intensive. ⋯ The standard error of estimate was large with a value of 5.3%. These data suggest that awake SaO2 is not a good predictor of nocturnal oxygen desaturation in individual patients. The lack of a simple relationship between awake SaO2 and nocturnal SaO2 is due to a complex interplay of various physiologic and pathologic mechanisms involved in the control of breathing and oxygenation during sleep.
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The history, pathoanatomy and pathophysiology, clinical picture, differential diagnosis, diagnostic evaluation, and treatment of cervical radiculopathy are reviewed. The review is based on a 10-year Medline literature search, review of bibliographies in textbooks, and bibliographies in articles obtained through the search. Cervical radiculopathy, although recognized early in the 20th century, was first associated with disc pathology in the mid-1930s. ⋯ However, using a variety of different treatments, the radiculopathy usually improves without the need for surgery. Indications for surgery are unremitting pain despite a full trial of non-surgical management, progressive weakness, or new or progressive cervical myelopathy. Prospective studies evaluating the various treatment options would be of great benefit in guiding practitioners toward optimum cost-effective evaluation and care of the patient with cervical radiculopathy.
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Arch Phys Med Rehabil · Mar 1994
Comparative StudyComparison of indices of traumatic brain injury severity as predictors of neurobehavioral outcome in children.
This study examined the ability of early measures of traumatic brain injury (TBI) severity to predict neurobehavioral and functional skill outcomes shortly after injury and at 1 year postinjury. Ninety-eight children aged 6 to 15 years with TBI were consecutively identified on presentation to two regional medical centers. Ten measures of TBI severity were subsequently administered: initial Glasgow Coma Scale (motor, eye, verbal, and total GCS), duration of loss of consciousness, Abbreviated Injury Scale Head score, GCS motor score at 3 days postinjury, days to reach a total GCS score of 15, days to reach a GCS motor score of six, and duration of posttraumatic amnesia (days to reach a 75% performance on the Children's Orientation and Amnesia Test [COAT]). ⋯ The GCS verbal and motor scores were better predictors of outcome than the GCS eye score. However, consideration of individual GCS subscores did not improve upon prediction of outcome versus the GCS total score. These results provide strong validation for the use of duration of posttraumatic amnesia, measured by the COAT, as a measure of TBI severity and a significant indicator of neurobehavioral and functional outcome in children.
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Arch Phys Med Rehabil · Mar 1994
Case ReportsOccult radiographic fractures of the chest wall identified by nuclear scan imaging: report of seven cases.
Between 1985 and 1990 the enactment of state mandatory seat belt laws has reduced the risk of death from auto accident by at least 40% and the risk of moderate to severe injury by 45%. Although head and facial trauma has also been significantly reduced, there has not been a decrease in injuries to other parts of the body. ⋯ Nuclear scan imaging subsequently revealed that all seven had a healing fracture of either the sternum or ribs. In each instance, direct trauma to the sternum and ribs anteriorly by the chest strap itself and/or laterally displaced bending forces transmitted to the postero lateral rib margins was sufficient to produce x-ray occult fractures.