Rancho Los Amigos Medical Center Research Articles

Methicillin-resistant Staphylococcus aureus (MRSA) colonization in patients with spinal cord injury.

Methicillin-resistant Staphylococcus aureus (MRSA) colonization has been a problem in the Rancho Los Amigos Medical Center (RLAMC) since 1978. This study reviews the latest 2 years' use of a protocol to prevent the spread of MRSA while allowing spinal cord injured patients to continue to participate in the rehabilitation program. The protocol included management in a private room, bathing with hexachlorophene, monitoring positive sites and clearing patients after 3 weeks of negative cultures. Clusters of cases were investigated by obtaining nasal cultures from the personnel. Sixty-seven of 584 (11%) SCI patients were colonized from July 1989 to July 1991. The prevalence of MRSA colonization was significantly greater in the pressure ulcer management service (PMS) 49/184 (27%) than in the rehabilitation spinal injury service (SIS) 18/400 (5%). The body sites colonized were wounds (58/67), nares (37/67), throat (30/67), urine (27/67) and perineum (17/67). Oral therapy with combinations of sulfamethoxazole trimethoprim (SXT) or Novobiocin with rifampin together with topical antibiotics (nares and wound sites), used in nine patients with healing wounds or recent flap surgery, resulted in clearing of the colonization in all cases. Identification and treatment of carriers in the personnel and use of preadmission screening cultures for MRSA in patients with pressure ulcers resulted in reduced inpatient admission.

Etiology of children's spinal injuries at Rancho Los Amigos.

A review of 277 patients under the age of 16 years admitted to the pediatric spinal injury unit at Rancho Los Amigos Medical Center from 1960 to 1989 showed that 70% of the patients were male; complete and incomplete injuries were about equal; and the average age was 8.8 years. The cause of spinal injury by time period revealed that earlier time periods had etiologies similar to those reported in previously published series. Although the incidence of these traditional causes remained constant, violent injuries by gunshot steadily increased with time. In the most recent 5-year period, gunshot wounds equaled motor vehicle injuries as the most frequent cause of a child's spinal injury admitted to this hospital. Gunshot wound victims averaged 12 years old, 80% were male, and most were thoracic level paraplegics. Half of the 50 adolescents (12-16 years old) injured during the last 5 years were gunshot victims.

Energy expenditure in elderly patients using assistive devices

Chief Medical Officer Senior Research Physical Therapist Pathokinesiology Laboratory Senior Research Physical Therapist Pathokinesiology Laboratory Rancho Los Amigos Medical Center Downey, California

Rancho Los Amigos Medical Center

Rancho Los Amigos Medical Center

Heterotopic ossification as a complication of the staged total thigh muscles flap in spinal cord injury patients.

Between 1980 and 1990, 24 total thigh flap procedures were performed at Rancho Los Amigos Medical Center (Downey, CA) by the Pressure Ulcer Management Service. An unexpected occurrence was identified, that is, the rapid development of heterotopic ossification (HO) occurring in the exposed muscle flap between the first and second stages. There were 15 two-stage total thigh flap procedures on 14 patients performed between 1980 and 1990. Of these 15 flap procedures, 11 in 10 patients were found to have HO evident at the second-stage debridement/closure. In comparing our findings with those in other studies (earliest evidence of HO at 19 days), the initial presentation of HO in affected tissues might be even earlier than previously detected. The risks and technical difficulties due to development of HO associated with the two-stage total thigh flap procedure point toward future modifications in preoperative planning that may prove beneficial. Therefore, if the two-stage total thigh flap procedure is necessary, the interval between initial debridement/disarticulation (stage 1) and definitive flap closure (stage 2) should be kept to an absolute minimum. Additionally, HO medicinal prophylaxis (that is, indomethacin or diphosphonates) or radiation after the first stage of the total thigh flap procedure should be considered. Our final conclusion is that the total thigh flap procedure should be done as a one-stage procedure if possible.

Safety for older adults

Fellow in Environmental Gerontology Gerontology Research Centre Simon Fraser University Vancouver, British Columbia, Canada Director, Rehabilitation Research and Training Center on Aging Co-Chief Clinical Gerontology Service Rancho Los Amigos Medical Center Downey, California Associate Clinical Professor Departments of Psychiatry and Behavioral Science and Family Medicine University of Southern California School of Medicine Los Angeles, California

Microglial association with senile plaques, extracellular neurofibrillary tangles and vascular amyloid: L.S. Perlmutter, S.A. Scott, E. Barron and H. Chang Chui ∗. Dept. Neurology; University of Southern California School of Medicine, Los Angeles, CA 90033 and Alzheimer's Disease Diagnostic and Treatment Center ∗, Rancho Los Amigos Medical Center, Downey, CA 90242

Microglial association with senile plaques, extracellular neurofibrillary tangles and vascular amyloid: L.S. Perlmutter, S.A. Scott, E. Barron and H. Chang Chui ∗. Dept. Neurology; University of Southern California School of Medicine, Los Angeles, CA 90033 and Alzheimer's Disease Diagnostic and Treatment Center ∗, Rancho Los Amigos Medical Center, Downey, CA 90242

Spinal Cord Injury from Civilian Gunshot Wounds

We performed a retrospective review of the medical records of 316 patients with spinal cord injury (SCI) secondary to gunshot wounds (GSW) admitted to Rancho Los Amigos Medical Center for rehabilitation between 1980 and 1988. There were 289 male and 27 female patients whose mean age was 25.9 years (range, 11-56 years). Of these, 238 were paraplegic (103 incomplete, 135 complete), and 78 were quadriplegic (45 incomplete, 33 complete). Forty were shot by handguns of known caliber and four by shotguns; in 272 cases, the type of weapon was unknown. A total of 230 cases sustained a single bullet wound, and 86 had multiple bullet wounds. The length of acute hospitalization, but not rehabilitation hospital stay, increased with the number of associated injuries. Rehabilitation and, hence, total length of stay was significantly less (mean, 100 and 130 days, respectively) for SCI/GSW victims than for SCI victims of motor vehicle accidents, falls, or diving accidents. The methods of calculating costs for admission were based upon Rancho Los Amigos Medical Center financial statistics. This hospital has charged for a daily occupancy fee. The fee is based upon an average of all charges for all patients. No additional fees are charged for special tests or procedures. In 1980, the average daily admission hospitalization charge was $785. In 1990, the last quoted hospital charge was $1,125. This is for the basic spinal cord injury rehabilitative stay. In general, at Rancho Los Amigos, patients are admitted for rehabilitation when all acute medical and surgical problems have been cleared and the patient is ready to participate in rehabilitation evaluation and therapy programs.(ABSTRACT TRUNCATED AT 250 WORDS)

RETURN TO FERTILITY FOR ANEJACULATORY MEN

staff nurse at the Hospital of the Good Samaritan, Los Angeles, and Carol Bennett, MD, assistant professor of urology at University of Southern California, and chief of urology, Rancho Los Amigos Medical Center, Los Angeles.

Periventricular white matter changes in patients with dementia: correlations between magnetic resonance imaging and xenon computerized tomography : H.C. Chui (1,2), A. Wang (1,2), F. Diaz (2), L. Gruenauer (3). University of Southern California School of Medicine, Los Angeles, Califonia (1); Rancho Los Amigos Medical Center, Downey, California (2); Picker International, Inc., Highland Heights, Ohio (3).

Alzheimer’s disease (AD) is the most common cause of dementia and is currently one of the biggest public health concerns in the world. Mitochondrial dysfunction in neurons is one of the major hallmarks of AD. Emerging evidence suggests that mitochondrial miRNAs potentially play important roles in the mitochondrial dysfunctions, focusing on synapse in AD progression. In this meta-analysis paper, a comprehensive literature review was conducted to identify and discuss the (1) role of mitochondrial miRNAs that regulate mitochondrial and synaptic functions; (2) the role of various factors such as mitochondrial dynamics, biogenesis, calcium signaling, biological sex, and aging on synapse and mitochondrial function; (3) how synapse damage and mitochondrial dysfunctions contribute to AD; (4) the structure and function of synapse and mitochondria in the disease process; (5) latest research developments in synapse and mitochondria in healthy and disease states; and (6) therapeutic strategies that improve synaptic and mitochondrial functions in AD. Specifically, we discussed how differences in the expression of mitochondrial miRNAs affect ATP production, oxidative stress, mitophagy, bioenergetics, mitochondrial dynamics, synaptic activity, synaptic plasticity, neurotransmission, and synaptotoxicity in neurons observed during AD. However, more research is needed to confirm the locations and roles of individual mitochondrial miRNAs in the development of AD.

Measurement of Plantar Pressure Using Fuji Prescale Film???A Preliminary Study

Gwen Ralphs is a graduate of the Orthotic and Prosthetic program at California State University Dominguez Hills and is now employed by Ortho Pro, Inc., of Nevada, as a board eligible practitioner. Thomas R. Lunsford, C.O., is Chief Orthotist at Rancho Los Amigos Medical Center, 7450 Leeds Street, Downey, California 90242, and Clinical Director of the Baccalaureate program in Orthotics and Prosthetics at California State University Dominguez Hills. Jack Greenfield is Assistant Chief of the Orthotic Department at Rancho Los Amigos Medical Center, Downey, California.

Surgical and Functional Results of Spine Fusion in Spinal Muscular Atrophy

From 1965 to 1987, 84 spinal muscular atrophy patients were followed at Rancho Los Amigos Medical Center (RLAMC). Twenty-seven patients were excluded from this study due to insufficient medical documentation (16), lack of follow-up (5), and death (6); leaving 57 patients in the general study group. Group I (34 patients) had posterior spinal fusion (PSF) with Harrington rod instrumentation (HRI); mean age at surgery was 12 years, average preoperative curve was 57 degrees, average postoperative correction was 42%, with a loss of correction of 9 degrees. The complication rate in this group was 35%. The average follow-up interval was 9 years (range, 4-19 years). Group II (six patients) underwent PSF with Luque segmental spinal instrumentation (SSI); mean age at surgery was 11 years, preoperative curves averaged 37 degrees, average postoperative correction was 42% with a loss of correction of 3 degrees. The complication rate in this group was 16%. Follow-up was 3.5 years. Physical therapy and occupational therapy evaluations were done preoperatively and postoperatively at 2- and 5-year intervals. Information was gathered in three categories: 1) ambulation, 2) equipment use, and 3) functional activities. After fusion, sitting tolerance was maintained but additional use of mobile arm supports, lapboards, and reaching aides was necessary for all patients. The ability to perform activities such as drinking, self-feeding, and self-hygiene declined during the 2 years immediately following surgery but improved by 5 years. Surgical patients never approached their preoperative skill levels. Therapy evaluations further demonstrated that there were no difference in function between either operative group.

Severe trauma to the lower extremity: long-term sequelae.

Limb salvage after major traumatic injury to the lower extremity has become commonplace in modern trauma centers. Despite initial successful limb salvage, however, long-term complications often occur. We present 121 patients who were treated for complications after major injuries to the lower limb at Rancho Los Amigos Medical Center. In general, these patients required a total of 224 surgical procedures over an average of approximately three years after injury to achieve a successful outcome. Final limb function, however, was often impaired.

Family science and geriatric rehabilitation

Co-Chief, Clinical Gerontology Service Rancho Los Amigos Medical Center Associate Professor of Family Medicine Director, Section of Geriatrics Department of Family Medicine University of Southern California Downey, California

Nursing intervention with families of geriatric patients

Head Nurse Gerontology Unit Staff Nurse Gerontology Unit Rancho Los Amigos Medical Center Downey, California

Augmentative communication: Assessment, system selection, and usage

1 Director, Communication Disorders Department Rancho Los Amigos Medical Center Downey, California 2 Supervisor, Communication Disorders Department Rancho Los Amigos Medical Center Downey, California

Certified Occupational Therapy Assistants and Microcomputers

This article deals with the continually changing role of the Certified Occupational Therapy Assistant. When the need for Registered Occupational Therapists became greater than the number of available therapists, a program was instituted for assistants. At first these aides, as they were called at that time, were delegated the tasks of transporting patients to and from therapy and setting them up for therapy. Gradually, the assistant's role grew, and with the emergence of the team approach, the assistant's role changed once again. Today the assistant is a valuable member of the team and by specializing can enhance the quality of care provided for the patient. One area of specialization is computer-assisted therapy. The assistant can enhance the quality of care provided and offer a different treatment approach. This article will review software in current use at Rancho Los Amigos Medical Center and the involvement of assistants in computer-assisted therapy.

Patient Participation Arrives in the Operating Room

Clinical Assistant Professor of Orthopaedic Surgery. University of Southern California, Rancho Los Amigos Medical Center, 7602 E. Imperial Highway, Downey, Calif., 90242.

Surgical treatment of lower extremity deformities in adult head-injured patients

Clinical Instructor Department of Orthopedic Surgery University of Southern California School of Medicine Downey, California Lawrence Leventhal, MD Co-chief Head Trauma Service Rancho Los Amigos Medical Center Downey, California

Reconstructive surgery of the upper extremity in the patient with head trauma

Assistant Professor of Surgery Chief of Hand Surgery Division of Orthopaedics and Rehabilitation University of California, San Diego, Medical Center Assistant Chief of Rehabilitation Veterans Administration Hospital San Diego, California Research Director Adult Head Trauma Service Rancho Los Amigos Medical Center Downey, California Assistant Clinical Professor Department of Orthopaedic Surgery University of Southern California School of Medicine Los Angeles, California