Alcohol abuse history and adjustment following spinal cord injury.

Objective: Examined the relation of alcohol abuse history to emotional adjustment and pressure sore occurrence during the 1st 3 years following Spinal Cord Injury (SCI). Study Design: Comparisons were made between varying levels of prior abuse and depression and disability acceptance. A model predicting pressure sore occurrence over 3 years was computed. Participants: One hundred seventy-five persons completed the self-report measures; 105 were available for pressure sore evaluations. Main Outcome Measures: The Inventory to Diagnose Depression, the Acceptance of Disability Scales, and pressure sore occurrence. Results: Alcohol abuse was not associated with depression or disability acceptance. Severe alcohol abuse history was associated with pressure sores over the 3 years. Conclusions: Persons with prior history of severe alcohol abuse may be at increased risk for pressure sore occurrence during the 1st years of SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adjustment following spinal cord injury.

Investigated specific coping strategies associated with psychological adjustment following spinal cord injury with a battery of assessments administered to 57 patients (median age 26.5 yrs) participating in a spinal cord injury rehabilitation program. Ss were divided into 3 groups based on degree of psychological distress. High-distress Ss reported using more Wish-Fulfilling Fantasy, Emotional Expression, Self-Blame, and Threat Minimization Coping strategies relative to the low and moderate distress groups. The Self-Blame Coping strategy was significantly correlated with psychological distress over and above age, time since injury, or level of injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support and depression following spinal cord injury.

Examined the associations of different social relationships with depressive behavior among 182 adults with acquired spinal cord injuries. Trained interviewers administered a social provisions scale and an inventory to diagnose depression. A cross-sectional design was used to investigate possible differential effects across time since the onset of injury. Relationships that reassured the worth of the individual were predictive of lower depression scores. To a lesser extent, relationships providing a sense of social integration were associated with lower depression scores. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive function following long-term spinal cord injury.

Although age-related changes in cognition are well documented, little is known about the effect of chronic disability on memory performance. This study investigated age differences between younger and elderly adults with long-term spinal cord injury, using a variety of measures of memory and self-assessments of cognitive abilities. Advanced age was associated with poorer memory performance, but neither level of injury on the spinal cord (cervical versus thoracolumbar lesions) nor duration of the injury predicted memory test scores. The two age groups were similar in their self-ratings of many attentional and memory abilities, as well as activity and affective level, consistent with good adjustment over long periods of disability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Employment outcomes following spinal cord injury

PURPOSE: We determined the clinical utility of proton MR spectroscopy in defining the extent of disability in benign versus secondary-progressive multiple sclerosis (MS). METHODS: Thirty patients with clinically definite MS, including 16 patients with benign MS and 14 with secondary-progressive MS, and a group of 13 healthy volunteers were studied with combined stimulated-echo acquisition mode proton MR spectroscopy and MR imaging (all patients received contrast material). RESULTS: Acute enhancing lesions of benign and secondary-progressive MS were characterized by a reduction in N-acetylaspartate (NAA)/choline and NAA/creatine and an increase in inositol compounds/creatine as compared with normal white matter. Such variations were also detected in chronic unenhancing lesions in patients with secondary-progressive MS, although they were not found in chronic unenhancing lesions in patients with benign MS. Chronic lesions of the two forms of the disease have significative differences in NAA and inositol signals. CONCLUSION: Proton MR spectroscopy is able to show metabolic changes occurring in the white matter of patients with MS. Such changes differ according to the phase (acute versus chronic) and the clinical form (benign versus secondary-progressive) of the disease.     

Substance abuse and medical complications following spinal cord injury.

This study examined relationships between medical complications resulting in hospital stays and alcohol and illicit substance use in 71 persons with recent spinal cord injury (SCI). At 5 intervals after injury, medical records were reviewed for pressure ulcers and urinary tract infections (UTIs). Abstainers with histories of drinking problems before SCI were at greater risk for UTIs from 7 to 12 months after injury and for longer hospital stays. Former drinkers may not have implemented the self-care skills that were a focus during inpatient rehabilitation. Preinjury illicit substance abuse was related to an increased risk of pressure ulcers 30 months after SCL Clinical implications are clear: Psychologists should inquire about substance use patterns, monitor psychological well-being, and explore the ways in which self-care habits are related to substance use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse and medical complications following spinal cord injury.

Evaluated the relationship between substance use; depression and disability acceptance; and 2 preventable medical complications, pressure ulcers and urinary tract infections (UTIs), following spinal cord injury (SCI). 103 SCI patients (aged 16–63 yrs) undergoing inpatient rehabilitation, were recruited for interviews after 2-, 6-, and 18-mo of admission. 80 Ss completed all 3 evaluations, of which, 71 were followed up for 30 mo. Information was obtained on substance use, severity of drinking problems, depression intensity, and psychological aspects of post-injury adaptation. An increased risk of pressure ulcers 30 mo after injury, was associated with use of psychotropic medications, and abstinence from alcohol, with a history of drinking problems. UTIs were related to illicit substance use. Impairment characteristics were important predictors initially after injury, while abstinence with a history of drinking problems predicted ulcers later. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of emotional distress following a spinal cord injury.

Evaluated a new instrument, the Medical-Based Emotional Distress Scale (MEDS). The MEDS assesses emotional reactions (dysphoria, irritability) in response to a severe physical illness or disability, excluding symptoms that could be the direct result of a physical condition or problem, and includes subscales measuring affective reactions, behavioral changes, and cognitive distortions. A sample of 81 adults with a spinal cord injury was evaluated with the MEDS as well as the SCL-90, Zung Self-Rating Depression Scale, Hopelessness Scale, and Rosenberg Self-Esteem Scale. The MEDS subscales displayed moderately high internal consistency. Positive evidence of validity was found for MEDS subscales in the assessment of emotional distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vocational achievements following spinal cord injury in Australia

Twenty alkanediamines were designed according to structure-activity relationships drawn from previous parts of this series and synthesized. Their general structure is CH3-(CH2)n-CHNH2-(CH2)m-CHNH2-(CH2)n-CH3, (n = 2-10; m = 3-6). Twelve of them inhibited the aggregation of human blood platelets in concentrations between 3-10 micromol/L halfmaximally (Born test, inducer collagen). With increasing m a decreasing n is necessary to achieve the optimum activity. In the most active compounds (7b, 7e, 7p) it is found that m + n = 9. When the nitrogen functions are hydroxyalkylated secondary amines with similar antiplatelet effects are obtained. The conversion of the amino groups into syndronimines is accompanied by the loss of activity. The bisethoxycarbonylderivatives of 7f and 7m (8f, 8m) exhibited antithrombotic effects in rats after oral administration.     

Musculocutaneous nerve palsy following traumatic spinal cord injury

Whipple's disease is a multisystem bacterial disease usually characterized by malabsorption, diarrhea and polyarthritis. Ocular manifestations include uveitis, vitreitis, retinis, myositis, papilledema and optic atrophy. We report a case of a chronic bilateral vitreitis in a 63 year-old man who had been treated for a Whipple's disease with gastrointestinal involvement 30 years before. The jejunal biopsy was negative but the polymerase-chain-reaction (PCR) revealed the presence of Trophyrema Whippelii in the vitreous prelevement of both eye. This new, original strategy of PCR is specific and more sensitive than histological diagnosis.     

Employment following spinal cord injury: A covariance structure analysis.

120 former patients of a rehabilitation center responded to a survey that tested 2 structural models of employment status following spinal cord injury. The direct effect model provided a very poor representation of the data. The model proposed in this study provided a better fit, but also fell short of the minimum acceptable goodness-of-fit standards. Educational attainment (EA), motivation to work (MTW), social support, and driving one's own car had significant direct paths to employment status. EA and lesion level were linked to MTW. Age at injury directly predicted EA. The hypothesized link between locus of control and MTW was rejected, and subsequent investigation raised questions about its direction of causality with other variables in the model. A revised model for future research was presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eradication of urinary tract infection following spinal cord injury

A prospective study to evaluate the microbiological efficacy of antimicrobial treatment for urinary tract infection (UTI) was performed in 64 catheter-free spinal cord injured (SCI) patients who were visited monthly by a public health nurse who collected urine for culture and urinalysis. Patients also mailed urine dip slides for weekly bacterial counts. UTI was defined as a culture yielding > or = 100,000 colonies/ml. Treatment was given to asymptomatic patients only if pyuria (> or = 10 urinary leukocytes/high powered microscopic field) was present. Initial treatment was for 7-14 days (group 1). When it became apparent during the study that eradication was difficult and relapse or reinfection frequently occurred within a short time after cessation of antibiotic, a second treatment course of > or = 28 days (group 2) was given. By the end of the study, in which all patients were followed for a minimum of 30 days post treatment, 39/42 (93%) cases in group 1 and 11/13 (85%) in group 2 who had initial eradication, had relapsed or become reinfected. The median number of days and standard error for group 1 to relapse or become reinfected was 16 +/- 2.5, and for group 2 it was 27 +/- 6. Development of drug resistance was documented when bacteria isolated prior to any treatment were compared with strains isolated after > or = 28 days of antibiotics. In this study, urine sterility was achieved in a minority of treated UTIs and was relatively short lived.(ABSTRACT TRUNCATED AT 250 WORDS)     

Factors affecting employment following spinal cord injury: A qualitative study.

Examined factors that differentiated persons with spinal cord injury (SCI) who returned to work from those who did not. Ss were 6 employed persons with SCI matched with 6 unemployed persons with SCI on the basis of education, race, age, gender, time since injury, and level of function. Semistructured interviews 1 to 2 hrs in length were completed and transcribed. The responses of the employed were compared with those of the unemployed using grounded theory. The theory is inductively derived from the qualitative data. Psychological and environmental factors were the most salient factors affecting employment in this matched sample. Key psychological factors associated with employment were optimism, self-esteem, achievement orientation, and role models. Key environmental factors were monetary incentives, disincentives, access, and accommodation. Conclusions: The development of increased optimism may promote employment for persons with SCI. Employment barriers and the perception of these barriers as insurmountable need to be decreased. Policies that promote return to work with former employers are likely to improve employment rates for persons with SCI A more intensive job exploration process using job shadowing of peers and positive peer models may also improve employment after SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mechanical and thermal allodynia in chronic central pain following spinal cord injury

The interstitial cells of Cajal (ICC) are found in a number of different locations in the gastrointestinal tract, where they form close associations with both muscle cells and nerve terminals. In this study we examined the embryological origin of ICC in the mouse intestine to determine whether they arise from the neural crest or from the intestinal wall. Segments of intestine were removed from embryonic mice either before or after the arrival of neural crest cells (the precursors of enteric neurons and glial cells) and transplanted under the renal capsule of host (adult) mice and allowed to develop for 18-41 days. In the mouse intestine, antibodies to c-kit protein selectively label ICC at a variety of locations, and antibodies to the NK1 receptor (the receptor for substance P) labels ICC at the level of the deep muscular plexus in the small intestine and a subpopulation of enteric neurons in the large intestine. The presence of neurons in the explants was examined using antisera to neuron-specific enolase, substance P, and calretinin. In segments of small and large intestine explanted after the arrival of neural crest cells, immunoreactive neurons and c-kit- and NK1-immunoreactive ICC were present with a distribution similar to that seen in control tissue at a similar developmental age. In segments of large intestine explanted before the arrival of neural crest cells, neurons were not present; however, c-kit-immunoreactive ICC were present in these aneuronal explants, indicating that ICC do not arise from the neural crest. The source of ICC in mammals is therefore likely to be the mesenchyme of the gut.     

Coping and adaptation following acute spinal cord injury: a theoretical analysis

Coping and adaptation theory is used to synthesis existing data concerning psychological recovery from acute spinal cord injury. Psychological reactions to spinal cord trauma are similar to those of mourning and other situations of severe loss. Each reaction plays a specific role in fostering or hindering recovery depending upon when it occurs. Premorbid personality and the influence of significant others play a central role in coping with injury. These factors partly explain why some patients cope better than others to equally serious disability. A critique of research methodologies and suggestions for new studies are provided.     

Axonal sprouting following incomplete spinal cord injury: an experimental model

Estrogen replacement therapy in postmenopausal women is associated with a decreased mortality and morbidity from stroke. The present study was undertaken to investigate the effects of estrogen on endothelial cell glucose transporter 1 (GLUT 1) and on the cell viability during focal ischemia in a rat model. Female rats were ovariectomized (OVX) and 2 weeks later 17beta-estradiol (E2) was injected subcutaneously at a dose of 100 microg/kg 2 h before unilateral middle cerebral artery (MCA) occlusion. Ischemic lesion size was quantified using 2,3,5-triphenyl tetrazolium chloride (TTC) staining and GLUT 1 protein was analyzed by Western blotting. E2 treatment decreased ischemic lesion size in slices taken at 9 and 11 mm posterior from the olfactory bulb by 46.3% and 44.1%, respectively (P < 0.05). GLUT 1 protein decreased in both OVX and E2 groups by 24.6% and 22.7% respectively (P < 0.05) compared with the non-lesioned side in the core ischemic region, including the basal ganglia. GLUT 1 protein was increased in the E2-treated group compared with the control group (23.3%, P < 0.05) in the penumbral ischemic region of the cortex. Primary rat brain capillary endothelial cell (BCEC) cultures were established as an in vitro model for ischemic effects on endothelial cells. Estrogen reduced BCEC loss by 35.9%, 28.4% and 23.5% (P < 0.05) when glucose in the culture medium was reduced to 50%, 20% and 10%, respectively; and by 28.4% and 18.4% (P < 0.05) following 1 or 4 h of anoxia, respectively. This study demonstrates that estrogen treatment increases GLUT 1 transporters and protects BCEC loss which may in turn reduce focal ischemic brain damage.     

Gastric myoelectrical activity in patients with cervical spinal cord injury

OBJECTIVE: Dyspeptic symptoms are common in patients with cervical spinal cord injury (SCI). The supraspinal control of sympathetic innervation to the stomach is interrupted in these patients. Gastric emptying has been reported to be delayed in some patients with cervical SCI. Gastric myoelectrical activity is known to regulate gastric motility and is correlated with gastric emptying. The change in gastric myoelectrical activity after cervical SCI is unknown; our aim was to investigate it. METHODS: The study was performed in 12 cervical SCI patients and 14 healthy controls. Gastric myoelectrical activity was recorded using surface electrogastrography for 30 min in the fasting state and 1 h after a standard test meal. Spectral analysis was performed to compute the following parameters from the electrogastrogram; investigated were the percentage of 2-4 cycles/min (cpm) slow waves, the instability coefficient (IC) of the dominant frequency, the postprandial increment of dominant frequency (deltaF), and its power (deltaP). RESULTS: In both fasting and fed states, regular and stable gastric slow waves were observed in both the control group and patients with cervical SCI. The percentage of normal 2-4 cpm slow waves (preprandial, 80.7+/-3.6% vs 91.5+/-3.7%, p > 0.05; postprandial, 82.0+/-4.4% vs 87.2+/-4.2%, p > 0.05) and IC (preprandial, 0.19+/-0.04% vs 0.28+/-0.05%; postprandial, 0.24+/-0.04% vs 0.27+/-0.02%, p > 0.05) were not significantly different between the two groups. The dominant frequency and its power were also similar between the two groups, no matter whether in the fast (frequency, 2.92+/-0.3 vs 2.93+/-0.06 cpm; power, 30.05+/-1.29 vs 29.08+/-1.23 dB, p > 0.05) or fed (frequency, 3.17+/-0.07 vs 3.02+/-0.06 cpm; power, 32.55+/-0.90 vs 32.07+/-1.18 dB,p > 0.05) state. The postprandial response measured by deltaF (0.25+/-0.09 vs 0.09+/-0.07 cpm, p > 0.05) and deltaP (2.52+/-1.10 vs 2.24+/-1.20 dB, p > 0.05) were also similar between the two groups. CONCLUSION: Gastric myoelectrical activity was not altered after cervical SCI.     

Effect of hypertonic saline on leukocyte activity after spinal cord injury

STUDY DESIGN: The effect of intravenous administration of hypertonic saline on leukocyte adhesion after compression injury of the spinal cord was evaluated. OBJECTIVES: To investigate changes in leukocyte adhesion after spinal cord injury and to evaluate the effect of hypertonic saline on this process. SUMMARY OF BACKGROUND DATA: Leukocytes have been thought to exacerbate tissue injury after ischemia-reperfusion. Downregulating and reducing the number of circulating leukocytes has attenuated tissue damage in various models of cerebral ischemia. Recently, investigators have reported that leukocytes exacerbate injury in the spinal cord after trauma. Other recent findings have indicated that hypertonic saline may play a role in decreasing leukocyte adhesion and activation. METHODS: Sprague-Dawley rats were anesthetized, and a C3-C5 laminectomy was performed. Injury was caused by 35 g of compression applied to the cord for 10 minutes. Animals were divided into three groups: sham treated, untreated, and treated. The treated animals received 7.5% hypertonic saline (5 mL/kg, intravenously) 5 minutes after the injury. Sticking leukocytes and shear rate were measured using fluorescence microscopy. RESULTS: Administration of 7.5% hypertonic saline after injury significantly decreased the number of sticking leukocytes in the venules and arterioles. Shear rate was unchanged between the groups. CONCLUSIONS: The results show that an increase in leukocyte adhesion after a compressive injury is attenuated by the administration of 7.5% hypertonic saline. The decrease in adhesion cannot be attributed to changes in the shearing forces, because no significant change was observed in the shear rate. Hypertonic saline may interfere with leukocytes directly by interfering with their ability to swell and thus may prevent activation.