Prediction of life satisfaction after spinal cord injury: A four-year longitudinal approach.

Responses to a life situation questionnaire were obtained in 1985 and 1989 from 286 adults with spinal cord injury. Multidimensional personality questionnaires were obtained in 1989 only. Multiple regression was used to identify the optimal predictors of 1989 satisfaction from predictor variables taken in 1985 and 1989. Results suggest that the predictors accounted for a greater percentage of variation in General Satisfaction compared with Economic Satisfaction. As expected, concurrent prediction was superior to the 4-yr longitudinal prediction. Adjustment measures were better predictors of satisfaction than were demographic and injury-related predictors (e.g., age, injury severity). A different pattern of predictors was identified between the 2 satisfaction areas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methicillin-resistant Staphylococcus aureus in burns patients--why all the fuss?

Carbohydrate absorption was assessed during acarbose administration to investigate the actions of this drug. In 7 healthy volunteers, breath hydrogen concentration was measured at 15-min intervals after administration of 6 g of lactulose, and continued until 4 h after the breath hydrogen level exceeded its pretreatment value by > or =10 ppm, then the amount of undigested carbohydrate was calculated following administration of various doses of acarbose and Ensure Liquid. Breath hydrogen data were also obtained before and after administration of acarbose to 8 patients with Type 2 diabetes mellitus for 2 and 4 months. After administration of 50 mg of acarbose with 250 ml or 500 ml of Ensure, the mean amount of unabsorbed carbohydrate was 5.3 g and 7.7 g, respectively, while unabsorbed carbohydrate increased to 10.8 g after 100 mg of acarbose with 500 ml of Ensure. In the diabetic patients, breath hydrogen excretion decreased to 31.6% of baseline after 2 months of acarbose administration, indicating decreased carbohydrate malabsorption. Despite this, the haemoglobin A1c level remained stable after 5 months. In conclusion, the extent of carbohydrate malabsorption depended on the acarbose dose and the carbohydrate load. Although carbohydrate malabsorption decreased with continued acarbose administration, the improvement of glycaemic control was maintained.     

Epidural spinal cord stimulation in the management of spasms in spinal cord injury: a prospective study

Forty-eight spinal cord injury victims were implanted with an epidural spinal cord stimulation system to treat spasms that had not satisfactorily responded to medical therapy. All the patients were at least 6 months after the injury. The protocol included assessment by independent examiners preoperatively and at 3, 6, 12 and 24 months after the implant. Pre- and postoperative data collection included the frequency and severity of the spasms. Combining the frequency and intensity scores into a 'severity' score provided a more accurate clinical picture. No patient observed neurological deterioration following the surgical procedure or the neurostimulation treatment. A statistically significant reduction in the severity of the spasms was observed in the follow-up evaluations, with results that progressively increased in time. It is appears that spinal cord stimulation is an effective and safe alternative in the management of spasms in spinal cord injury victims. Its exact role in relation to intrathecal baclofen infusion and ablative procedures remains to be defined.     

Methicillin-resistant Staphylococcus aureus and its relationship to antimicrobial use: possible implications for control

The control of methicillin-resistant Staphylococcus aureus (MRSA) is still an unresolved issue in numerous healthcare institutions worldwide. Guidelines for the control of MRSA in hospitals focus on measures to control cross-transmission and prevent colonization, but rarely specifically mention the control of antimicrobial use. We reviewed the different types of evidence for a causal relationship between MRSA and antimicrobial use by classifying them in four categories: consistent associations, dose-effect relationships, concomitant variations, and arguments to support a plausible biological model to explain this relationship. Although the relative participation of cross-transmission and antimicrobial selection pressure in the level of MRSA observed in a healthcare setting remains to be determined, we found lines of evidence to support the existence of a relationship between MRSA and antimicrobial use in each of the four categories. This review points out the relative lack of studies specifically designed to investigate this aspect of MRSA epidemiology and the need to implement such studies quickly. In the meantime, the results presented here should encourage the implementation of antimicrobial-use improvement programs in hospitals in addition to existing infection control measures, which are still a priority in countries with high MRSA prevalence.     

Long-term survival in spinal cord injury: a fifty year investigation

On the model of experimental acute anaemia of rats, induced by injection of phenilhydrazine, the influence of calcium precipitate of double-stranded RNA (Ca-ds-RNA), introduced during the crise of anaemia, on the process of erythron restoration, was studied. In the presence of Ca-ds-RNA the number of pro- and erythroblasts in fission increases by 1.5 times, compared with "pure" anaemia situation, and accordingly there is a marked decrease in the share of microcytes, which play an important role in the restoration of cell number, and in the erythron recovery after the crise of anaemia. Less pronounced is the influence of Ca-ds-RNA on the macrocytosis, which keeps its value in spite of the increase in the speed of development and of the number of normocytes after Ca-ds-RNA introduction. The mechanism of Ca-ds-RNA inclusion in the system, which controls the process of erythropoiesis during anaemia, is discussed. A conclusion is drawn that Ca-ds-RNA may directly affect the inductive stage of erythropoiesis, stimulating the formation of competent erythroid cells in population of stem haemopoiethic cells and their proliferation. Further development of bone marrow cells takes place according to the known programme of erythropoiesis whose variations are stimulated by the current conditions of its realization, but not by the presence of Ca-ds-RNA.     

Isolated musculocutaneous nerve palsy in a spinal cord injury

Isolated musculocutaneous nerve palsy is rare. We report one case of a bilateral palsy of this nerve following a road accident which led to a complete thoracic level paraplegia.     

Osteoporosis after spinal cord injury

Immobilisation secondary to spinal cord injury (SCI) is associated with marked and rapid atrophy of trabecular bone. The purpose of this study was to evaluate bone mineral density (BMD) in both the upper and lower extremities following SCI sustained for various lengths of time and to correlate the BMD to the level of the lesion, time from injury, spasticity and serum calcium, phosphorus and alkaline phosphatase (ALP) levels. A study was undertaken in 41 SCI patients with a mean age of 35.8 +/- 12.7 years. A significant difference in BMD between upper and lower extremities of the paraplegics were found. BMD of upper and lower extremities were similar in tetraplegies. The BMD values were significantly different when the upper extremity scores of paraplegics and tetraplegics were compared but BMD scores of the lower extremities were similar in the two groups. The decrease in BMD was less in the spastic patients when compared to the flaccid group. There was a positive correlation between time from injury and the degree of BMD deficit in the paralysed areas. In the whole group of patients a significant positive correlation was found between the duration of SCI and serum ALP levels.     

Clinical assessment of spasticity in spinal cord injury: a multidimensional problem

OBJECTIVE: To determine the relation between various components of spasticity evaluated clinically in persons with spinal cord injury (SCI). DESIGN: Case series evaluating spasticity using clinical scales commonly referenced in contemporary literature, including the Penn Spasm Frequency Scale, the Ashworth Scale, and standard scales of tendon taps, clonus, and plantar stimulation. SETTING. A Veterans Affairs Medical Center Spinal Cord Injury Center. PATIENTS. Eighty-five spinal cord injured individuals with varying degrees of spasticity. RESULTS: Correlations demonstrated weak relationships between Spasm Frequency Scale and self-report scales of interference with function (.407) and painful spasms (.312). No clinical examination score correlated with self-report scores greater than 0.4. Three clinical examination scores correlated modestly (> 0.5)-Ashworth score with patellar tendon taps (.553), ankle clonus with Achilles tendon tap (.663), and patellar tendon tap with adductor tendon tap (.512). Two other clinical scales correlated weakly (> 0.4)-Achilles tendon tap with patellar tendon tap (.417) and plantar reflex with adductor tendon taps (.423). CONCLUSIONS: Clinical scales currently used to evaluate spasticity in SCI correlate poorly with each other, suggesting that they each assess different aspects of spasticity. The use of any single scale is likely to underrepresent the magnitude and severity of spasticity in the SCI population. In the absence of agreement among these various scales and with the absence of an appropriate criterion standard for evaluation of spasticity, assessments of spasticity, whether clinical or neurophysiological in nature, should be comprehensive in scope.     

Spinal myoclonus complicating spasticity in spinal cord injury: a case study

A case of spinal myoclonus that complicated spasticity management is presented. A 37-year-old man with a C6 American Spinal Injury Association class B spinal cord injury was referred for treatment of spasticity. He had failed previous treatments with baclofen and dantrolene but was partly relieved by diazepam, although with unacceptable side effects. Further evaluation, including simultaneous electroencephalogram, videotaping, and electromyography of the quadriceps, anterior tibialis, posterior tibialis, and medial hamstring suggested myoclonic jerks of spinal origin that initiated episodes of unsustained clonus. During the worst episodes, myoclonic jerks came once every 16 to 22 seconds and persisted for 4 to 5 hours. Each episode of clonus lasted approximately 4 to 6 seconds. Treatment with valproic acid greatly diminished the frequency of myoclonic jerks with minimal side effects. Functionally, the patient was much less fatigued and better able to maintain his full time employment.     

Urethral cultures in female patients with a spinal cord injury

This paper tends to evaluate the effects of comprehensive prevention and treatment in COPD and cor pulmonale in the communities. A Randomized cohort with stratified design was undertaken in the rural areas with hundred thousand population in Beijing municipality, Lianning and Hubei Provinces, from spring 1992 to spring 1995. RESULTS: (1) the rates to all stratified populations under management were 85.6% among those with high risk, 87.8% among COPD and 83.6% among cor pulmonale, respectively. (2) The levels of KAB were raised more significantly in most intervention group than in control group which up +9.6% to +33.6% and -5.8% to +32.6%, respectively. (3) Comparisons between the two groups revealed: 1. Number of cigarette smokers who smoked more than before increased (20.1% vs 17.8%) but with no statistical significance. 2. The rate of smoking cessation went higher (15.5% vs. 11.3%, P < 0.01). 3. New high risk subjects were reduced (2.8% vs 3.9%, P < 0.01). 4. Number of new cor pulmonale patients decreased (19.9% vs 22.6%, P > 0.05) and mortality rate lowered (4.34% vs 4.78%, P > 0.05). CONCLUSION: preliminary results indicates that the active intervention is effective in reducing COPD and cor pulmonale among population at high risk in communities. However, it is necessary to point out that COPD and cor pulmonale are both having chronic nature which calls for patient and continuous efforts.     

Cost of traumatic spinal cord injury in a population-based registry

This prospective study examines a population based cohort of 115 Coloradans identified as having an acute traumatic spinal cord injury by the Spinal Cord Injury Early Notification System in 1989. Comprehensive medical cost and complication data were collected for the first 2 years of survival. Unlike previous cost studies, this group represents the broad spectrum of spinal cord injured persons, reflected in a truly population based sample. Nearly 22 million dollars were spent during the first 2 years post injury on behalf of these Coloradans. Care provided to the 27 persons with Frankel A, B or C tetraplegia accounted for $10.9 million (50%); $7.6 million (35%) was spent providing care for the 36 people with Frankel A, B or C paraplegia; and the remaining $3.3 million (15%) was required for services provided to the 52 persons who had resolved to either Frankel D or E at acute care discharge. Of the $6.3 million that was spent post hospital discharge, $2.5 million (39%) is directly attributable to in-home care, and another $2.0 million (32%) is directly attributable to secondary medical complications. The most expensive complications occurred in the neurological, skin, respiratory and orthopedic body systems.     

A crash course in spinal cord injury

The complex management issues related to spinal cord injury traditionally have been the purview of physical medicine and rehabilitation specialists. However, changes in the healthcare system now offer primary care physicians an expanded role in helping affected patients live a healthier and more functional life. With proper understanding of the mechanisms of spinal cord injury, primary care physicians can become important members of the medical management team. Dr Yu presents a comprehensive overview of medical care issues and common complications in spinal cord injury.     

Recovery in rats after spinal cord injury

Previous studies from this laboratory have shown evidence of regeneration of long descending spinal motor tracts in rats after spinal cord transection and treatment to modify the animals' immune response. In this study, less extensive surgical lesions were combined with the most favorable drug treatment (75 mg per kilogram of cyclophosphamide in a single dose) in an effort to improve the prospects for regeneration. Less than complete spinal cord transections in the rat were frequently followed by clinical and electrophysiologic evidence of return of function. Such return of function appears to depend on a reorganization of the nervous system that results in the use of the few remaining fibers to transmit motor information rather than on regeneration. Immunosuppressive treatment had no effect on these results.     

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)     

Pain associated with spinal cord injury

Management of pain after spinal cord injury remains a difficult clinical problem. In particular, neuropathic spinal cord injury pain, like other forms of deafferentation pain in which there is loss or modification of normal afferent sensory inputs, is notoriously resistant to currently available modes of treatment. Although there have been some advances in our understanding of spinal cord injury pain, the mechanisms of neuropathic spinal cord injury pain remain largely unknown and treatment is often ineffective. This review presents findings from recent publications that deal with the mechanisms and management of spinal cord injury pain.     

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.