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  • Plasma vitamin D, past chest illness, and risk of future chest illness in chronic spinal cord injury (SCI): a longitudinal observational study
    Spinal Cord (IF 1.898) Pub Date : 2020-01-16
    Kristopher Clark; Rebekah L. Goldstein; Jaime E. Hart; Merilee Teylan; Antonio A. Lazzari; David R. Gagnon; Carlos G. Tun; Eric Garshick

    Study design Observational study. Objective Assess associations between vitamin D levels and other risk factors on future chest illness in a chronic spinal cord injury (SCI) cohort. Setting Veterans Affairs Boston and the Boston, MA community. Methods Between August 2009 and August 2017, 253 participants with chronic SCI were followed over a median of 3.2 years (up to 7.4 years) with two to four visits a median of 1.7 years apart. At each visit, plasma 25-hydroxyvitamin D level was obtained, spirometry performed, and a respiratory questionnaire assessing chest illnesses since last visit was completed. Repeated measures negative binomial regression was used to assess chest illness risk longitudinally. Results At entry, 25% had deficient vitamin D levels (<20 nanograms/milliliter (ng/ml)), 52% were insufficient (20 to <30 ng/ml), and 23% were sufficient (≥30 ng/ml). Over 545 study visits, chest illnesses (n = 106) were reported by 60 participants. In multivariable models (including previous chest illness history), deficient vitamin D levels (compared with those with sufficient levels) were associated with future chest illness though with wide confidence limits (relative risk (RR) = 1.36, 95% confidence intervals (CI) = 0.74, 2.47). The strongest association with chest illness during the follow-up period was in persons who reported pneumonia/bronchitis after injury and a chest illness in the three years before study entry (RR = 7.62; 95% CI = 3.70, 15.71). Conclusion Assessed prospectively in chronic SCI, there was a suggestive association between deficient vitamin D levels and future chest illness. Past chest illness history was also strongly associated with future chest illness.

    更新日期:2020-01-16
  • Translating the international scientific spinal cord injury exercise guidelines into community and clinical practice guidelines: a Canadian evidence-informed resource
    Spinal Cord (IF 1.898) Pub Date : 2020-01-16
    Femke Hoekstra; Christopher B. McBride; Jaimie Borisoff; Mary-Jo Fetterly; Spero Ginis; Amy E. Latimer-Cheung; Jasmin K. Ma; Jocelyn Maffin; Lorne Mah; Christopher R. West; Rhonda Willms; Kathleen A. Martin Ginis
    更新日期:2020-01-16
  • Grip force control during object manipulation in cervical myelopathy
    Spinal Cord (IF 1.898) Pub Date : 2020-01-15
    Naoto Noguchi; Bumsuk Lee; Shoya Kamiya; Ken Kondo; Ryoto Teshima; Masatake Ino; Koji Tanaka; Tsuneo Yamazaki
    更新日期:2020-01-15
  • Exploring the receptor origin of vibration-induced reflexes
    Spinal Cord (IF 1.898) Pub Date : 2020-01-15
    Mustafa A. Yildirim; Betilay Topkara; Tugba Aydin; Nurdan Paker; Derya Soy; Evrim Coskun; Kadriye Ones; Aysenur Bardak; Nur Kesiktas; Mustafa G. Ozyurt; Berna Celik; Burcu Onder; Aysegul Kılıc; Habib C. Kucuk; Ilhan Karacan; Kemal S. Türker
    更新日期:2020-01-15
  • Correction: Clinical associations with telomere length in chronic spinal cord injury
    Spinal Cord (IF 1.898) Pub Date : 2020-01-15
    David M. Monroe; Rebekah L. Goldstein; Merilee A. Teylan; Jaime E. Hart; Immaculata DeVivo; Esther H. Orr; Eric Garshick

    An amendment to this paper has been published and can be accessed via a link at the top of the paper.

    更新日期:2020-01-15
  • Guided internet-delivered cognitive-behaviour therapy for persons with spinal cord injury: a feasibility trial
    Spinal Cord (IF 1.898) Pub Date : 2020-01-09
    Swati Mehta; Heather Hadjistavropoulos; Marcie Nugent; Eyal Karin; Nick Titov; Blake F. Dear
    更新日期:2020-01-09
  • Correction: The influence of neurological examination timing within hours after acute traumatic spinal cord injuries: an observational study
    Spinal Cord (IF 1.898) Pub Date : 2020-01-09
    Nathan Evaniew; Babak Sharifi; Zeina Waheed; Nader Fallah; Tamir Ailon; Nicolas Dea; Scott Paquette; Raphaele Charest-Morin; John Street; Charles G. Fisher; Marcel F. Dvorak; Vanessa K. Noonan; Carly S. Rivers; Brian K. Kwon

    An amendment to this paper has been published and can be accessed via a link at the top of the paper.

    更新日期:2020-01-09
  • Long term continuation with repeated Botulinum toxin A injections in people with neurogenic detrusor overactivity after spinal cord injury
    Spinal Cord (IF 1.898) Pub Date : 2020-01-08
    Katrine P. Hebert; Niels Klarskov; Per Bagi; Fin Biering-Sørensen; Marlene Elmelund
    更新日期:2020-01-08
  • 更新日期:2020-01-08
  • Changes in skin-physiology after local heat application using two different methods in individuals with complete paraplegia: a feasibility and safety trial
    Spinal Cord (IF 1.898) Pub Date : 2020-01-07
    Anke Scheel-Sailer; Nushaba Aliyev; Dominique Jud; Simon Annaheim; Yves Harder; Jörg Krebs; Alessia Wildisen; Reto Wettstein
    更新日期:2020-01-07
  • Trends in nonroutine physician visits and hospitalizations: findings among five cohorts from the Spinal Cord Injury Longitudinal Aging Study
    Spinal Cord (IF 1.898) Pub Date : 2020-01-03
    Chao Li; Jillian M. R. Clark; Nicole DiPiro; Jon Roesler; James S. Krause
    更新日期:2020-01-04
  • Prescription medication cost, insurance coverage, and cost-related nonadherence among people with spinal cord injury in Canada
    Spinal Cord (IF 1.898) Pub Date : 2020-01-03
    Shikha Gupta; Mary Ann McColl; Karen Smith; Sara J. T. Guilcher

    Study design Observational cross-sectional study. Objectives To describe the most common prescription medications used and the extent of out-of-pocket cost, insurance coverage, and cost-related nonadherence (CRNA) for those medications by people with spinal cord injury (SCI) in Canada. Setting Community in Canada. Methods It was an observational study wherein data were collected through a cross-sectional online survey from individuals living with an SCI in Canada. We used descriptive statistics to describe the extent of drug cost, insurance coverage and CRNA among study sample, and analytical statistics to find association of CRNA with sociodemographic, injury-related and medication-related characteristics of the sample. Results Individuals with an SCI (n = 160) used an average of five medications and spent a median of $49 (interquartile range: $234.75) per month on their medications. More than 90% of participants had some form of drug insurance, though 37% reported CRNA. The most common medications that were forgone due to cost included opioids, antidepressants, and drugs for genitourinary and muscular spasms. Individuals with paraplegia and nontraumatic SCI had higher drug costs, though injury-related characteristics did not influence CRNA. Sex, monthly drug expenditure, and monthly additional healthcare costs were significantly associated with CRNA. Conclusions People with SCIs are at risk of experiencing CRNA to their prescription medications despite having insurance coverage. Decision makers for the national pharmacare in Canada should account for their concerns judiciously.

    更新日期:2020-01-04
  • Thai translation and cross-cultural adaptation of the Spinal Cord Injury Falls Concern Scale (SCI-FCS)
    Spinal Cord (IF 1.898) Pub Date : 2019-12-20
    Noppol Pramodhyakul; Weeraya Pramodhyakul

    Study design Translation and adaptation study. Objectives To translate and cross culturally adapt the Spinal Cord Injury Falls Concern Scale (SCI-FCS) English version into Thai, and to examine content validity, internal consistency and test-retest reliability. Setting A tertiary rehabilitation center in Thailand. Methods The SCI-FCS was translated into Thai and culturally translated according to guidelines for the process of cross-cultural adaptation of self-report measures. Content validity was examined by the Index of item-objective congruence (IOC). Moreover, internal consistency and test-retest reliability were tested by the Cronbach’s alpha coefficient and intraclass correlation coefficient (ICC) models (3, 1), respectively. Results Three items were modified to accommodate cultural differences. After synthesis and cross adaptation, the IOC was 1.0. The Cronbach’s alpha coefficient was 0.88 (range 0.86–0.89) and the ICC of total scores was 0.99 (P < 0.001, range of the subitems 0.98–1). In addition, items that Thai participants scored as being the highest concern of falling were item 13: pushing wheelchair up/down gutters or curbs, item 14: pushing wheelchair up/down a slope, and item 12: pushing wheelchair on an uneven surface. Conclusions The SCI-FCS-Thai version is a reliable and valid outcome measure for assessing concern about falling in wheelchair users with SCI in Thailand.

    更新日期:2019-12-20
  • Lifestyle modifications and pharmacological approaches to improve sexual function and satisfaction in men with spinal cord injury: a narrative review
    Spinal Cord (IF 1.898) Pub Date : 2019-12-19
    Chloe A. R. Lim; Tom E. Nightingale; Stacy Elliott; Andrei V. Krassioukov
    更新日期:2019-12-20
  • 更新日期:2019-12-19
  • Quality of life and psychological outcomes of body-weight supported locomotor training in spinal cord injured persons with long-standing incomplete lesions
    Spinal Cord (IF 1.898) Pub Date : 2019-12-17
    Anu Piira; Anne M. Lannem; Knut Gjesdal; Raymond Knutsen; Lone Jørgensen; Thomas Glott; Nils Hjeltnes; Synnøve F. Knutsen; Marit Sørensen

    Study design Health-related quality of life (HRQOL) data from two parallel independent single-blinded controlled randomized studies of manual (Study 1) and robotic (Study 2) locomotor training were combined (ClinicalTrials.gov #NCT00854555). Objective To assess effects of body-weight supported locomotor training (BWSLT) programs on HRQOL in persons with long-standing motor incomplete spinal cord injury and poor walking function. Settings Two inpatient rehabilitation facilities and one outpatient clinic in Norway. Methods Data were merged into intervention (locomotor training 60 days) or control group (“usual care”). Participants completed questionnaires before randomization and 2–4 weeks after the study period, including demographic characteristics, HRQOL (36-Item Short-Form Health Status Survey, SF-36), physical activity (The International Physical Activity Questionnaire Short Form, IPAQ-SF), exercise barrier self-efficacy (EBSE), and motivation for training (Behavioral Regulation in Exercise Questionnaire, BREQ). Physical outcomes i.e., Lower extremity motor score (LEMS) was assessed. The main outcome was change in HRQOL. Secondary outcomes included changes in IPAQ-SF, EBSE, BREQ, and physical outcomes. Results We recruited 37 of 60 predetermined participants. They were autonomously motivated with high baseline physical activity. BWSLT with manual or robot assistance did not improve HRQOL, though LEMS increased in the BWSLT group compared with control group. Conclusions The study was underpowered due to recruitment problems. The training programs seem to benefit LEMS, but not other physical outcomes, and had minimal effects on HRQOL, EBSE, and motivation. Autonomous motivation and high physical activity prior to the study possibly limited the attainable outcome benefits, in addition to limitations due to poor baseline physical function.

    更新日期:2019-12-18
  • Motor imagery for pain and motor function after spinal cord injury: a systematic review
    Spinal Cord (IF 1.898) Pub Date : 2019-12-13
    Emmanuelle Opsommer; Odile Chevalley; Natalya Korogod
    更新日期:2019-12-13
  • Gait ability required to achieve therapeutic effect in gait and balance function with the voluntary driven exoskeleton in patients with chronic spinal cord injury: a clinical study
    Spinal Cord (IF 1.898) Pub Date : 2019-12-12
    Hiroki Okawara; Tomonori Sawada; Kohei Matsubayashi; Keiko Sugai; Osahiko Tsuji; Narihito Nagoshi; Morio Matsumoto; Masaya Nakamura

    Study design A non-randomized open-label single-arm clinical trial. Objectives To analyze the effect of body weight supported treadmill training (BWSTT) with the voluntary driven exoskeleton (VDE) in persons with differing levels and completeness of spinal cord injury (SCI) and differing walking abilities. Setting Keio University Hospital, Tokyo, Japan. Methods Twenty individuals with chronic SCI (age, 43 ± 17 years) classified as American Spinal Injury Association Impairment Scale grade A (n = 2), B (n = 4), C (n = 8), or D (n = 6) who had reached a plateau in recovery. Participants underwent twenty 60 min sessions of BWSTT with the hybrid assisted limb. The speed, distance, and duration walked in every 60 min training session were recorded. The Walking Index for SCI Scale II (WISCI-II), 10 meters walk test (10MWT), 2 min walk test, timed up and go (TUG) test, Berg Balance Scale (BBS), lower extremity motor score (LEMS), Barthel Index, and Functional Independence Measure were evaluated at pre and post intervention. Results There was a significant improvement in 10MWT, TUG, and BBS after the intervention. Walking ability significantly improved in participants with high walking ability at baseline (WISCI-II score 6–20; n = 12) but not in participants with low walking ability (WISCI-II score 0–3; n = 8). Significant improvement of BBS was also shown in participants with high walking ability at baseline. Conclusions Patients with high walking ability at baseline responded better to the training than those with low walking ability.

    更新日期:2019-12-13
  • A comparative examination of models of service delivery intended to support community integration in the immediate period following inpatient rehabilitation for spinal cord injury
    Spinal Cord (IF 1.898) Pub Date : 2019-12-11
    Linda Barclay, Aislinn Lalor, Christine Migliorini, Lauren Robins

    Study design Qualitative study using semi-structured interviews. Objectives To describe and compare models of service delivery intended to support community integration in the immediate period following inpatient rehabilitation for SCI, and describe the characteristics of these models or approaches. Setting Spinal services from multiple international countries Methods Semi-structured interviews were completed with 12 participants from a convenience sample of ten spinal services from developed economies. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Results Three themes were identified, and are described with supporting quotations. These are: Theme One—Models of service delivery (sub-themes: staffing, peer mentors, facilitating community integration during inpatient rehabilitation; Theme Two—Services provided (sub-themes: telehealth, vocational services, groups); Theme Three—Facilitating self-efficacy and self-management. Conclusions A variety of models aimed at supporting community integration in the immediate period following inpatient rehabilitation for SCI were found. Multi-disciplinary staffing and involvement of peer mentors was common to all services. The importance of vocational rehabilitation was acknowledged by all participants, although the approaches taken to this varied. Telehealth has the potential to assist in self-management, particularly for patients who live a long distance from the spinal unit or are confined to the home for health reasons, and could be further developed. Although service models are greatly influenced by the funding context, the findings from this study can be used to inform service planning in this area.

    更新日期:2019-12-11
  • Multidrug-resistant gram-negative organisms and association with 1-year mortality, readmission, and length of stay in Veterans with spinal cord injuries and disorders
    Spinal Cord (IF 1.898) Pub Date : 2019-12-11
    Swetha Ramanathan, Margaret A. Fitzpatrick, Katie J. Suda, Stephen P. Burns, Makoto M. Jones, Sherri L. LaVela, Charlesnika T. Evans
    更新日期:2019-12-11
  • The beneficial aspects of spasticity in relation to ambulatory ability in mice with spinal cord injury
    Spinal Cord (IF 1.898) Pub Date : 2019-12-10
    Shingo Yoshizaki, Kazuya Yokota, Kensuke Kubota, Takeyuki Saito, Masatake Tanaka, Dai-jiro Konno, Takeshi Maeda, Yoshihiro Matsumoto, Yasuharu Nakashima, Seiji Okada
    更新日期:2019-12-11
  • Correction: Exploration of surgical blood pressure management and expected motor recovery in individuals with traumatic spinal cord injury
    Spinal Cord (IF 1.898) Pub Date : 2019-12-10
    Reza Ehsanian, Jenny Haefeli, Nhung Quach, Jacob Kosarchuk, Dolores Torres, Ellen D. Stuck, Jessica Endo, James D. Crew, Benjamin Dirlikov, Jacqueline C. Bresnahan, Michael S. Beattie, Adam R. Ferguson, Stephen L. McKenna

    A correction to this paper has been published and can be accessed via a link at the top of the paper.

    更新日期:2019-12-11
  • Changes in bowel function following exoskeletal-assisted walking in persons with spinal cord injury: an observational pilot study
    Spinal Cord (IF 1.898) Pub Date : 2019-12-10
    Audrey Chun, Pierre K. Asselin, Steven Knezevic, Stephen Kornfeld, William A. Bauman, Mark A. Korsten, Noam Y. Harel, Vincent Huang, Ann M. Spungen
    更新日期:2019-12-11
  • An interview based approach to the anorectal portion of the International Standards of Neurological Classification of Spinal Cord Injury Exam (I-A-ISNCSCI): a pilot study
    Spinal Cord (IF 1.898) Pub Date : 2019-12-10
    Audrey Chun, Andrew D. Delgado, Chung-Ying Tsai, Lisa Spielman, Kristell Taylor, Arianny Ramirez, Vincent Huang, Stephanie A. Kolakowsky-Hayner, Miguel X. Escalon, Thomas N. Bryce
    更新日期:2019-12-11
  • Guideline for the management of pre-, intra-, and postpartum care of women with a spinal cord injury
    Spinal Cord (IF 1.898) Pub Date : 2019-12-06
    Sue Bertschy, Markus Schmidt, Kai Fiebag, Ute Lange, Simone Kues, Ines Kurze

    The German Association of the Scientific Medical Societies guideline for pregnancy, childbirth, and puerperium in women with a spinal cord injury (SCI) addresses a range of topics from the desire to have a child to different stages of pregnancy and birth. Given that a generally accessible and evidence-based presentation of this complex issue does not yet exist, this new guideline contributes to the standardization of gynecological, obstetric, and maternal care of women with SCI. This guideline aims to provide practice-oriented support for the care and counseling of women in the pre-, intra-, and postpartum periods; to close identified gaps in medical care; foster collaboration among clinicians of relevant disciplines; and inspire research.

    更新日期:2019-12-06
  • Characteristic cerebral structural changes identified using voxel-based morphometry in patients with post-surgical chronic myelopathic pain
    Spinal Cord (IF 1.898) Pub Date : 2019-12-04
    Yosuke Horiuchi, Osahiko Tsuji, Yuji Komaki, Kanehiro Fujiyoshi, Keigo Hikishima, Tsunehiko Konomi, Narihito Nagoshi, Kota Watanabe, Morio Matsumoto, Keisuke Horiuchi, Masaya Nakamura
    更新日期:2019-12-05
  • Correction: Defining accelerometer cut-points for different intensity levels in motor-complete spinal cord injury
    Spinal Cord (IF 1.898) Pub Date : 2019-12-04
    Tobias Holmlund, Elin Ekblom-Bak, Erika Franzén, Claes Hultling, Kerstin Wahman

    A correction to this paper has been published and can be accessed via a link at the top of the paper.

    更新日期:2019-12-04
  • Osteoporosis-related fractures after spinal cord injury: a retrospective study from Brazil
    Spinal Cord (IF 1.898) Pub Date : 2019-11-29
    Ana P. S. Champs, Gabriela A. G. Maia, Fabiana G. Oliveira, Gustavo C. N. de Melo, Maria M. S. Soares

    Study design Retrospective study Objectives To describe the epidemiological and clinical profile in a retrospective chart review of individuals with spinal cord injury (SCI) and osteoporosis-related fractures. Setting A Brazilian rehabilitation hospital. Methods This is a retrospective chart review that included 325 individuals with SCI and osteoporosis-related fractures who were admitted to a Brazilian rehabilitation hospital between January 1997 and December 2017. Results Overall, 52% were males with a mean (SD) age of 44.8 (±16.7) years at the time of first fracture. Overall, 82% had paraplegia and 56% had a thoracic neurological level. The mean (SD) time between SCI and fracture was 9.7 (±9.3) years. In 59% of cases the immediate cause of the fracture was a fall. The locations of the fractures were distal femur (27%), proximal femur (27%), and tibia and/or distal fibula (28%). The fractures occurred mostly at home (63%). Complications occurred in 19% of individuals and 25% reported worse performance in activities of daily living and 29% a deterioration in ambulation after they had recovered from the fracture. A second fracture was described in 15% of individuals, and five individuals had a third fracture. The mean (SD) level of 25 hydroxyvitamin D [25 (OH) D] was 25.6 (±15.2) ng/ml, and only 11 individuals (3%) underwent dual energy X-ray absorptiometry (DEXA), and 26 individuals (8%) were treated with antiresorptive drugs after fracture. Conclusion Little is done to prevent fractures in individuals with SCI and understanding the clinical and epidemiological profiles will help identify risk factors and establish prevention programs and appropriate treatment.

    更新日期:2019-11-30
  • Loss of work-related income impoverishes people with SCI and their families in Bangladesh
    Spinal Cord (IF 1.898) Pub Date : 2019-11-26
    Mohammad Sohrab Hossain, Lisa A. Harvey, Md. Shofiqul Islam, Md. Akhlasur Rahman, Hueiming Liu, Robert D. Herbert

    Study design Cross-sectional study. Objectives To determine the degree of impoverishment of people with spinal cord injury (SCI) and their families in Bangladesh caused by loss of work-related income following injury. Setting Spinal cord injury centre, Bangladesh. Methods A total of 410 wheelchair-dependent people with recent SCI about to be discharged from a hospital in Bangladesh were interviewed to determine the size of their families, their incomes from paid work prior to injury and the incomes of their family members. These data were used to calculate income per family unit and per family member prior to and immediately after injury. Results Ninety percent of the participants were men, 98% were from rural areas of Bangladesh and 58% were manual labours prior to injury. Median (interquartile range, IQR) family size was 5 (4–6) people. Prior to injury, 74% of participants were the main income earners for their families and 50% provided the only source of income for their families. Participants’ median (IQR) monthly income prior to injury was US$106 (US$60–US$180) per person and family members’ income was US$30 (US$19–US$48) per person. After injury, the median income (IQR) of each family member dropped to US$0 (US$0–US$18) placing 91% of families below the extreme poverty line of US$37.50 per person per month (equivalent to US$1.25 per day). Conclusion In Bangladesh, SCI have profound financial implications for individuals and their families and causes extreme poverty. This is because those most often injured are young and the main income earners for their families.

    更新日期:2019-11-27
  • Long-term urological outcomes of spinal lipoma after prophylactic untethering in infancy: real-world outcomes by lipoma anatomy
    Spinal Cord (IF 1.898) Pub Date : 2019-11-26
    Chihiro Hayashi, Yohei Kumano, Daisuke Hirokawa, Hironobu Sato, Yuichiro Yamazaki
    更新日期:2019-11-27
  • Clinical recommendations for use of lidocaine lubricant during bowel care after spinal cord injury prolong care routines and worsen autonomic dysreflexia: results from a randomised clinical trial
    Spinal Cord (IF 1.898) Pub Date : 2019-11-25
    Vera-Ellen M. Lucci, Maureen S. McGrath, Jessica A. Inskip, Shirromi Sarveswaran, Rhonda Willms, Victoria E. Claydon

    Study design Clinical trial. Objective Spinal cord injury (SCI) impacts autonomic function and bowel management. Bowel care is a potential trigger for autonomic dysreflexia (AD; paroxysmal hypertension elicited by sensory stimuli below the level of lesion). AD can be life threatening so strategies to minimise AD are prioritised after SCI. Lidocaine lubricant is recommended during bowel care with the rationale to minimise the sensory stimulus, reducing AD. The objective of this study was to assess whether lidocaine lubricant (Xylocaine 2%) ameliorates AD during at-home bowel care compared with standard lubricant (placebo). Setting Community. Method Participants (n = 13; age 44.0 ± 3.3 years) with high-level SCI (C3-T4) performed their normal at-home bowel care on two days, each time using a different lubricant, with continuous non-invasive cardiovascular monitoring. Injury to spinal autonomic (sympathetic) nerves was determined from low-frequency systolic arterial pressure (LF SAP) variability. Results Participants displayed reduced autonomic function (LF SAP 3.02 ± 0.84 mmHg2), suggesting impaired autonomic control. Bowel care duration was increased with lidocaine (79.1 ± 10.0 min) compared to placebo (57.7 ± 6.3 min; p = 0.018). All participants experienced AD on both days, but maximum SAP was higher with lidocaine (214.3 ± 10.5 mmHg) than placebo (196.7 ± 10.0 mmHg; p = 0.046). Overall, SAP was higher for longer with lidocaine (6.5 × 105 ± 0.9 × 105 mmHg • beat) than placebo (4.4 × 105 ± 0.6 × 105 mmHg • beat; p = 0.018) indicating a higher burden of AD. Heart rate and rhythm disturbances were increased during AD, particularly with lidocaine use. Conclusions At-home bowel care was a potent trigger for AD. Our findings contradict recommendations for lidocaine use during bowel care, suggesting that anaesthetic lubricants impair reflex bowel emptying, resulting in longer care routines with an increased burden of AD.

    更新日期:2019-11-26
  • Validation of a clinical prediction rule for ambulation outcome after non-traumatic spinal cord injury
    Spinal Cord (IF 1.898) Pub Date : 2019-11-25
    Rodney Sturt, Chloe Bevans, Bridget Hill, Anne Holland, Peter W. New

    Study design Prospective cohort study. Objectives To validate a Clinical Prediction Rule (CPR) for ambulation in a non-traumatic spinal cord injury population (NTSCI). Setting Tertiary spinal rehabilitation inpatient service, Melbourne, Australia. Methods Adults with confirmed NTSCI were recruited between April 2013 and July 2017. Data based on the original van Middendorp CPR (age and four neurological variables) were collected from participant’s medical records and by interview. The Spinal Cord Independence Measure item 12 was used to quantify the ability to walk at 6 and 12 months. A receiver operator curve (ROC) was utilised to determine the performance of the CPR. Ambulatory outcomes were compared for AIS A, B, C and D and aetiology groups. Results The area under the ROC curve (AUC) was 0.94 with 95% confidence interval (CI) 0.86–1.0 (n = 52). Overall accuracy was 75% at 6 months and 82% at 12 months. For the whole cohort the sensitivity at 12 months was 95% and specificity 73%. However, specificity for AIS C and D was only 50%. Conclusion The CPR correctly predicted those who did not walk at 6 and 12 months following NTSCI, but was less accurate in predicting those who would walk particularly those with an AIS C or D classification. This CPR may be useful to inform planning for future care in individuals with NTSCI, particularly for those who are not expected to walk. Further research with larger sample sizes is required to determine if the trends identified in this study are generalisable.

    更新日期:2019-11-26
  • Validation and psychometric evaluation of the Italian version of the Spinal Cord Injury Secondary Conditions Scale
    Spinal Cord (IF 1.898) Pub Date : 2019-11-19
    Alessio Conti, Marco Clari, Sara Arese, Barbara Bandini, Lucia Cavallaro, Silvia Mozzone, Ercole Vellone, Simona Frigerio, Sara Campagna

    Study design Validation cross-sectional study. Objective To adapt the Spinal Cord Injury Secondary Conditions Scale (SCI-SCS) to Italian and to assess the validity and reliability of this instrument. Setting Multicentre study in outpatient clinics of three urban spinal units across Italy. Methods After a five-step translation/validation process, the Italian SCI-SCS was administered in a toolset composed of a sociodemographic questionnaire, the Modified Barthel Index, the Short-Form 8, the Patient Health Questionnaire 9, and the General Anxiety Disorder 7. The Italian SCI-SCS construct validity was assessed through exploratory factor analysis (EFA). The internal consistency and test–retest reliability of the instrument were evaluated using Cronbach’s α and the intraclass correlation coefficient (ICC) for the total scale and its subscales. Pearson’s correlation coefficient with all administered instruments was calculated to evaluate the concurrent validity. Results One-hundred fifty-six participants were recruited from February to October 2018. EFA suggested a three-factor structure explaining 45% of the total variance. After experts’ consideration about the clinical relevance of its components, a final version of the Italian SCI-SCS with four different subscales and 15 items was proposed. The total scale Cronbach’s α was 0.73. The ICC agreement for test–retest reliability was 0.91. Correlations of the Italian SCI-SCS with the administered instruments were statistically significant (p < 0.05), highlighting congruent hypothesized relations. Conclusion Findings of this study provided a first psychometric evaluation of the SCI-SCS. The modified Italian version of this tool may represent a valuable instrument for the longitudinal assessment of the impact of secondary conditions in people with SCI.

    更新日期:2019-11-20
  • Changes in supraspinatus and biceps tendon thickness: influence of fatiguing propulsion in wheelchair users with spinal cord injury
    Spinal Cord (IF 1.898) Pub Date : 2019-11-19
    Fransiska M. Bossuyt, Michael L. Boninger, Ann Cools, Nathan Hogaboom, Inge Eriks-Hoogland, Ursina Arnet
    更新日期:2019-11-20
  • Preoperative factors that predict fair outcomes following surgery in patients with proximal cervical spondylotic amyotrophy. A retrospective study
    Spinal Cord (IF 1.898) Pub Date : 2019-11-19
    Yasuaki Imajo, Norihiro Nishida, Masahiro Funaba, Hidenori Suzuki, Takashi Sakai
    更新日期:2019-11-20
  • Enhanced recovery after surgery in intramedullary and extramedullary spinal cord lesions: perioperative considerations and recommendations
    Spinal Cord (IF 1.898) Pub Date : 2019-07-29
    Sauson Soldozy, Parantap Patel, Mazin Elsarrag, Pedro Norat, Daniel M. Raper, Jennifer D. Sokolowski, Kaan Yağmurlu, Min S. Park, Petr Tvrdik, M. Yashar S. Kalani
    更新日期:2019-11-18
  • Reactive stepping after a forward fall in people living with incomplete spinal cord injury or disease
    Spinal Cord (IF 1.898) Pub Date : 2019-07-29
    Katherine Chan, Jae Woung Lee, Janelle Unger, Jaeeun Yoo, Kei Masani, Kristin E. Musselman
    更新日期:2019-11-18
  • Poor specificity of National Early Warning Score (NEWS) in spinal cord injuries (SCI) population: a retrospective cohort study
    Spinal Cord (IF 1.898) Pub Date : 2019-07-29
    Wail A. Ahmed, Alex Rouse, Katy E. Griggs, Johnny Collett, Helen Dawes
    更新日期:2019-11-18
  • Application of electrophysiological measures in spinal cord injury clinical trials: a narrative review
    Spinal Cord (IF 1.898) Pub Date : 2019-07-23
    Michèle Hubli, John L. K. Kramer, Catherine R. Jutzeler, Jan Rosner, Julio C. Furlan, Keith E. Tansey, Martin Schubert
    更新日期:2019-11-18
  • Osteoporosis in the lower extremities in chronic spinal cord injury
    Spinal Cord (IF 1.898) Pub Date : 2019-11-15
    Angela Frotzler, Jörg Krebs, Andrea Göhring, Kathrin Hartmann, Stefanie Tesini, Kurt Lippuner
    更新日期:2019-11-15
  • Factors associated with labor market participation of persons with traumatic SCI in Switzerland: analyzing the predictive power of social background, health, functional independence, and the environment
    Spinal Cord (IF 1.898) Pub Date : 2019-11-14
    Urban Schwegler, Carolina S. Fellinghauer, Bruno Trezzini, Johannes Siegrist

    Study design Cross-sectional study using data from the 2012 community survey of the Swiss Spinal Cord Injury Cohort Study. Objectives To identify associations between selected factors related to the social background, health, functional independence, and the environment of persons with spinal cord injury (SCI) and their labor market participation. Setting Community-based, Switzerland. Methods Labor market participation (i.e., involvement in paid work or not) was determined for a sample of 966 persons with traumatic SCI who were of employable age at the time of the survey. Applying an exploratory approach, potential predictors of labor market participation were selected based on the literature and using a bidirectional stepwise variable selection approach. Descriptive statistics were calculated and weighted bootstrapped multiple logistic regressions were applied to describe the associations between the selected predictor variables and labor market participation, controlling for sociodemographic and SCI-related characteristics. Results A total of 568 (58.8%) of the participants were involved in paid work at the time of the survey. From the 17 selected predictor variables, general functional independence and Swiss citizenship showed a significant positive association, and chronic pain a negative association with involvement in paid work. Conclusions Beyond previously established sociodemographic and injury-related risk factors such as female gender, low education, and high lesion severity, functional independence, chronic pain, and nationality proved crucial for labor market participation. These factors should receive particular attention in medical and vocational strategies striving for a sustainable work integration of persons with SCI.

    更新日期:2019-11-14
  • The associations of acceptance with quality of life and mental health following spinal cord injury: a systematic review
    Spinal Cord (IF 1.898) Pub Date : 2019-11-12
    Anders Aaby, Sophie Lykkegaard Ravn, Helge Kasch, Tonny Elmose Andersen
    更新日期:2019-11-13
  • Study protocol of a double-blind randomised placebo-controlled trial on the effect of a multispecies probiotic on the incidence of antibiotic-associated diarrhoea in persons with spinal cord injury
    Spinal Cord (IF 1.898) Pub Date : 2019-11-11
    W. X. M. Faber, J. Nachtegaal, J. M. Stolwijk-Swuste, W. J. Achterberg-Warmer, C. J. M. Koning, I. Besseling-van der Vaart, C. A. M. van Bennekom
    更新日期:2019-11-13
  • Gene expression changes are associated with severe bone loss and deficient fracture callus formation in rats with complete spinal cord injury
    Spinal Cord (IF 1.898) Pub Date : 2019-11-07
    Mariana M. Butezloff, José B. Volpon, João P. B. Ximenez, Kelly Astolpho, Vitor M. Correlo, Rui L. Reis, Raquel B. Silva, Ariane Zamarioli
    更新日期:2019-11-08
  • Use of Appraisals of DisAbility Primary and Secondary Scale-Short Form (ADAPSS-sf) in individuals with pediatric-onset spinal cord injury
    Spinal Cord (IF 1.898) Pub Date : 2019-11-07
    Kyle C. Deane, Kathleen M. Chlan, Lawrence C. Vogel, Kathy Zebracki

    Objectives To investigate the psychometric properties and utility of the Appraisals of DisAbility Primary and Secondary Scale-Short Form (ADAPSS-sf), a measure of cognitive appraisals, among adults with pediatric-onset SCI. To examine the relation of the ADAPSS-sf to demographics, injury characteristics, and secondary health and psychosocial outcomes. Study design A structured telephone interview was conducted to obtain measures of ADAPSS-sf, pain, sleep, secondary health complications, and psychosocial functioning. Setting Community in United States and Canada. Participants Individuals who sustained an SCI at 18 years of age or younger (N = 115) were initially interviewed at age 19 years or older and followed annually. Results Study findings support sound psychometrics of the ADAPSS-sf. The measure demonstrated strong test–retest reliability and internal consistency. There were no differences on ADAPSS-sf scores in relation to current age, gender, race, etiology, injury severity, or injury level. Individuals who sustained SCI at an older age were more likely to endorse negative appraisals of their injury. Results suggest that higher negative SCI-related appraisals were related to higher mental health difficulties. Negative SCI-related appraisals were associated with sleep difficulties, pressure injuries, pain, distress from pain, and poor overall subjective ratings of health. Conclusions This study confirms the use of the ADAPSS-sf in a pediatric-onset SCI adult population by demonstrating its good internal validity, test–retest reliability, convergent and face validity, and brevity. Moreover, the current study revealed that such appraisals are associated with both psychosocial and secondary health outcomes, further supporting the ADAPSS-sf as a valuable tool for clinicians and researchers.

    更新日期:2019-11-07
  • 更新日期:2019-11-07
  • Employment status, hours working, and gainful earnings after spinal cord injury: relationship with pain, prescription medications for pain, and nonprescription opioid use
    Spinal Cord (IF 1.898) Pub Date : 2019-11-01
    James S. Krause, Clara E. Dismuke-Greer, Karla S. Reed, Chao Li

    Study design Cross-sectional self-report assessment. Econometric modeling. Objectives Identify the relationship of multiple pain indicators, prescription pain medication, nonprescription opioid use, and multiple indicators of quality employment among those with spinal cord injury (SCI). Setting Data were collected at a medical university in the Southeastern United States (US). Methods Participants included 4670 adults with traumatic SCI of at least one-year duration who were enrolled in a study of health and longevity. They were identified from three sources including a specialty hospital and two population-based state SCI surveillance systems. Econometric modeling was used for three outcome variables: employment status, hours per week spent working, and earnings. Results Several pain parameters were significantly related to multiple employment outcomes. Prescription medication to treat pain was associated with lower odds of employment, fewer hours working, and lower conditional earnings. Nonprescription opioid use was only related to fewer hours working. Painful days, number of painful conditions, and pain intensity were all related to employment outcomes, but the pattern varied by outcome. The number of painful conditions was most consistently related to employment. Multiple demographic, injury, and educational factors were related to employment, with better outcomes among those with less severe SCI and greater educational achievements. Conclusions The presence of significant pain and use of either prescription pain medications or the use of nonprescription opioids may have a significant adverse effect on both the probability of employment and quality of employment. Rehabilitation and vocational professionals should routinely assess pain and associated medications in vocational and career planning.

    更新日期:2019-11-01
  • Correction: Prevalence of chronic health conditions and hospital utilization in adults with spinal cord injury: an analysis of self-report and South Carolina administrative billing data
    Spinal Cord (IF 1.898) Pub Date : 2019-10-31
    Nicole D. DiPiro, David Murday, Elizabeth H. Corley, James S. Krause

    An amendment to this paper has been published and can be accessed via a link at the top of the paper.

    更新日期:2019-11-01
  • Long-term evolution of blood lipid profiles and glycemic levels in patients after spinal cord injury.
    Spinal Cord (IF 1.898) Pub Date : 2003-03-18
    J Vidal,C Javierre,F J Curià,E Garrido,M-A Lizarraga,R Segura

    OBJECTIVE To analyze the lipid and glycemic profiles in relation to age, time elapsed post injury and the level of injury in a group of patients with SCI. SUBJECTS 2135 subjects with SCI were recruited during the annual routine health check-up carried out at the Institut Guttmann of Badalona, in Spain. The patients were classified according to the level of SCI and their age. METHODS Serum lipid profiles and glycemic (glucose) levels were determined. Data was collected between 1996 and 2001, all biochemical analysis being performed by the same laboratory. RESULTS Serum cholesterol levels show a statistically significant correlation with patient's age(P<0.001) and with time elapsed after injury (P<0.05). Differences can be observed between the values obtained from the different injury level groups (F=22.14; P<0.001). LDL-c shows a statistically significant difference between the four different age groups (F=3.51, P<0.05). There is an increase in plasma triglycerides related to the increase in age of the patients without observable differences between the injury level groups. The concentration of serum glucose increases with age (P<0.001) and also with the time elapsed after injury (P<0.05). CONCLUSION There is a direct relationship between various biochemical parameters (total cholesterol, LDL-c and glucose) and the age of the patients, but not with the severity or time of evolution of the spinal cord injury.

    更新日期:2019-11-01
  • Rugby union.
    Spinal Cord (IF 1.898) Pub Date : 2003-02-01
    J P R Williams

    更新日期:2019-11-01
  • Evaluation of upper extremity motor function tests in tetraplegics.
    Spinal Cord (IF 1.898) Pub Date : 2002-04-05
    J H van Tuijl,Y J M Janssen-Potten,H A M Seelen

    OBJECTIVE To provide an overview of arm-hand function tests useful in tetraplegic subjects. Considerations for selection of an appropriate test are also provided. DATA SOURCES A Medline literature search was conducted covering the period from 1967 to March 2001. Relevant references cited in the selected papers were also considered, regardless of the year of publication. STUDY SELECTION This review was restricted to strength tests, functional and ADL tests. Only general tests and tests designed specifically to test tetraplegic persons written in English, or in Dutch were included in the review. RESULTS Information is provided on four types of strength tests, 10 general and five specific functional tests and eight ADL tests. CONCLUSION Many tests are available to measure upper extremity motor function in tetraplegics. Selection of a test is at first determined by the outcome value in which the investigator is interested. When the type of outcome value has been determined, the most suitable test has to be selected from the range of available tests. When two tests appear to be equally suitable, the availability of information on psychometric properties of the test when used in tetraplegic patients is a decisive factor. When information on the reliability, validity and sensitivity of a test is missing, it should be gathered before using the test.

    更新日期:2019-11-01
  • Mid-line clefts of the atlas: a diagnostic dilemma.
    Spinal Cord (IF 1.898) Pub Date : 2002-04-03
    R C Prempe,J C Gibson,J J Bhattacharya

    Congenital clefts and other developmental anomalies of the atlas vertebra are rarely encountered. They are incidental findings discovered while investigating the cervical spine following trauma. Differentiation of developmental variants of the atlas from the burst fracture of Jefferson is essential to prevent unnecessary medical intervention.

    更新日期:2019-11-01
  • An implantable upper extremity neuroprosthesis in a growing child with a C5 spinal cord injury.
    Spinal Cord (IF 1.898) Pub Date : 2001-06-13
    B T Smith,M J Mulcahey,R R Betz

    OBJECTIVES To implement a functional electrical stimulation (FES) hand neuroprosthesis called the Freehand System in a growing child with spinal cord injury (SCI) using extra lead wire to accommodate limb growth, and to evaluate the performance of the Freehand System during the subject's maturation. SETTING Pediatric orthopedic hospital specializing in SCI rehabilitation. SUBJECT Ten-year-old female patient with a C5 level SCI. METHOD The Freehand System was implanted. Eight electrodes were implanted to targeted forearm and hand muscles to provide grasp and release function. The lead wire associated with each electrode was pathed subcutaneously up the arm with 4 cm of extra lead distributed throughout the path to accommodate expected limb growth. All leads were attached to a stimulator placed in the upper chest. Measures of lead unwinding, limb growth, stimulated muscle strength, and hand function were made at 6 and 16 months after implant. RESULTS By 16 months post implant, the upper limb growth plates were closed and humeral and radial bone growth combined was 2.7 cm from the time of surgery. For all eight leads, lead unwinding in the upper arm was approximately 1.2 cm and was comparable to humeral bone growth (1.4 cm). Lead unwinding in the lower arm was also measurable for the two electrodes in hand muscles. Six of eight electrodes maintained grade 3 or better stimulated muscle strength throughout the growth period according to a manual muscle test. Of the two other electrodes, one appeared to have lost function due to depletion of excess lead. However, hand function with FES was comparable at 6 and 16 months post implant suggesting that growth did not negatively impact performance with the FES system. Hand function with FES was improved over voluntary hand function as well. Using the Freehand System, a pinch force of approximately 15 N was achieved compared to 1.3 N of voluntary tenodesis pinch force. Scores on the Functional Independence Measure (FIM) increased by 9 points when FES was used as compared to voluntary function. Improvements occurred primarily in eating and grooming. Independence in writing was achieved only with FES. CONCLUSIONS For this child, hand function with the Freehand System was sustained over the growth period and was a significant functional improvement over voluntary hand function. By using excess lead wire, the Freehand System was successfully implemented before skeletal maturity, affording the child improved hand function earlier than would be otherwise indicated.

    更新日期:2019-11-01
  • The role of plasma transglutaminase (F XIII) in wound healing of complicated pressure sores after spinal cord injury.
    Spinal Cord (IF 1.898) Pub Date : 2001-06-13
    S W Becker,F Weidt,K Röhl

    STUDY DESIGN A case report. OBJECTIVES To demonstrate stimulating action of F XIII in wound healing of complicated pressure sores. SETTING A Spinal Cord Injury Center in Germany. METHODS Clinical exam, clinical and photographic wound control, biochemical serum monitoring. RESULTS Recurrent pressure sores in plegic patients are common complications requiring long-standing conservative or operative therapy. Additional risk factors such as diabetes increase the complication rate for surgery. Surgery itself may be difficult in recurrent pressure sores due to limited remaining soft tissues. We report the case and treatment of a 47-year-old patient with long-standing and recurrent ulcers and complications after flap surgery. As a final option we added plasma transglutaminase (factor XIII) to our treatment scheme which changed the course of the disease dramatically and we achieved complete and rapid healing. CONCLUSION Our experience suggests that F XIII has a positive role in treating pressure sores as shown already in several other surgical fields. Its use is giving the surgeon an additional tool in complicated cases.

    更新日期:2019-11-01
  • Consequences of neck manipulation performed by a non-professional.
    Spinal Cord (IF 1.898) Pub Date : 2001-06-13
    U K Misra,J Kalita,D Khandelwal

    Case report. Documentation of complication of neck manipulation by an untrained person. Tertiary care referral teaching hospital at Lucknow, India. Clinical evaluation, plain radiography of cervical spine, spinal MRI.A 30-year-old man who fainted after neck manipulation by a barber and developed spinal cord and brainstem dysfunction. His MRI revealed an extramedullary, intradural dumbbell shaped mass on the right side at C1 and C2 level compressing the spinal cord. Public awareness should be increased about the danger of neck manipulation by an untrained person especially in the communities where it is commonly practiced.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • One-stage posterior decompression and fusion using a Luque rod for occipito-cervical instability and neural compression.
    Spinal Cord (IF 1.898) Pub Date : 2001-06-13
    H J Chen,M H Cheng,Y C Lau

    STUDY DESIGN Original article. OBJECTIVE The authors present seven cases who underwent one-stage suboccipital, C1 and/or C2 posterior decompression and fusion by Luque rod, wiring and autogenic bone graft for occipito-cervical instability and neural compression. SETTING Chang Gung University and Medical Center at Kaohsiung, Taiwan. METHOD Since January 1996, 20 cases of craniovertebral and upper cervical spinal instability were encountered. Seven of these cases had no neurological improvment under Cone-Barton Skeletal traction. Imaging studies revealed poor reduction with persistent neural compression. One patient underwent unsuccessful anterior trans-oral vertebrectomy for decompression. All patients underwent posterior suboccipital craniectomy, C1 and/or C2 laminectomy for decompression. Contoured Luque rod with wiring and autogeneic bone graft was used for craniocervical fusion. After surgical treatment, halo-vest or sterno-occipito-mandibular immobilizer (SOMI) was used for 3-6 months. RESULTS Suboccipital craniectomy and C1 laminectomy could afford a 30-50% increment of anteroposterior diameter in the neural canal and effective decompression of the low medulla and cord. All patients made neurological improvement. The ASIA-MIS scores improved from pre-operative 49 (mean) to 78. Four patients can walk without any support. There were no major complications except for one case requiring readjustment of the halo-vest brace. CONCLUSION The authors recommend this procedure as one choice for relieving craniocervical instability with neurological compromise. A programmed rehabilitation will afford better neurological improvement.

    更新日期:2019-11-01
  • The spinal cord independence measure (SCIM): sensitivity to functional changes in subgroups of spinal cord lesion patients.
    Spinal Cord (IF 1.898) Pub Date : 2001-06-13
    A Catz,M Itzkovich,E Agranov,H Ring,A Tamir

    BACKGROUND The spinal cord independence measure (SCIM) is a newly developed disability scale specific to patients with spinal cord lesions (SCL). Its sensitivity to functional changes in a whole cohort of SCL patients was found to be better than that of the functional independence measure (FIM). OBJECTIVE o compare the sensitivity to functional changes of the SCIM and the FIM in SCL subgroups. DESIGN A comparative self-controlled study. SETTING The Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel. SUBJECTS 22 SCL inpatients. INTERVENTIONS Monthly SCIM and FIM assessments of the subgroups. MAIN OUTCOME MEASURES Functional change detection rate (FDR) and mean differences between consecutive scores (DCS). RESULTS The outcome measures of the SCIM were higher than those of the FIM for tetraplegia and paraplegia, complete and incomplete lesions (the FIM missed 25-27% of the functional changes detected by the SCIM; DSC 8.2-11.4 vs 5.2-9; P<0.05 in most comparisons). The SCIM did not exhibit this advantage, however, in the functional areas of self-care and mobility in the room and toilet. Further subgrouping yielded similar results. CONCLUSIONS The SCIM is more sensitive than the FIM to functional changes in the subgroups studied, and has the potential to serve as a universal tool for disability assessment of SCL patients.

    更新日期:2019-11-01
  • Vesico-ureteric reflux in adults with neuropathic bladders treated with Polydimethylsiloxane (Macroplastique).
    Spinal Cord (IF 1.898) Pub Date : 2001-06-13
    N Shah,M J Kabir,T Lane,S Avenell,P J Shah

    OBJECTIVE To establish the efficacy of Macroplastique in treating vesico-ureteric reflux (VUR) in adults with neuropathic bladder dysfunction. PATIENTS AND METHODS Fifteen patients (12 male and three female), age range 19 to 80 years (mean age 38) were included in this study. Diagnosis was confirmed by videourodynamics. In seven patients reflux was present bilaterally. Twenty-two refluxing ureters were treated. Twelve patients had detrusor hyper-reflexia, two had areflexic bladders and one had loss of bladder wall compliance. According to the International Grading System, 10 ureters had grade IV reflux, five had grade III reflux, five had grade II reflux, and two had grade I reflux. Macroplastique (0.5-1.5 ml) was injected submucosally under each ureteric orifice to convert the opening to a slit like shape. The patients were followed up from 9 to 68 months. RESULTS VUR was completely resolved in 72.7% (16) ureters following a single injection and in a further 4.5% (1) ureter following a second injection. 9.1% (2) ureters were improved and treatment failed in 13.7% (3) ureters. Two patients showed a recurrence of reflux 1 and 4 years after primary injection and subsequently had a curative second injection. Most of the patients in whom VUR was cured or improved showed a reduction in laboratory proven urinary infection rates. CONCLUSION Macroplastique produced an excellent result (86% with complete resolution or improvement of reflux) in treating VUR in adult neuropathic bladders. This is comparable to larger studies carried out on the paediatric population. This is an easy procedure, which avoids major surgery and can be performed as a day case. In cases of failure or recurrence, repeat injection or open surgery can be undertaken without any added complications.

    更新日期:2019-11-01
  • Prophylaxis of thromboembolism in spinal injuries--results of enoxaparin used in 276 patients.
    Spinal Cord (IF 1.898) Pub Date : 2001-06-13
    K Deep,M V Jigajinni,A N McLean,M H Fraser

    OBJECTIVE To evaluate the results of thromboembolic prophylaxis using enoxaparin in acute spinal injury patients. BACKGROUND Deep vein thrombosis and pulmonary embolism are major causes of morbidity and mortality in patients with acute spinal injuries. A wide range of thromboprophylactic measures have been proposed. The present study describes the outcome of a regime of enoxaparin and antithromboembolic stockings in acute spinal injuries irrespective of neurological damage. SETTING Scotland, UK. METHODS Eighteen-month retrospective review of acute spinal injury patients admitted to a national spinal injuries unit. A thromboembolic prophylactic regimen of early mobilisation, use of antithromboembolic stockings, and subcutaneous administration of enoxaparin 40 mg once a day until patients could be mobilised for more than 4 h per day, was used. Patients with clinical suspicion of deep venous thrombosis or pulmonary embolism were investigated as appropriate. RESULTS Out of 146 (53% of total) patients with spinal injuries with no neurological deficit only one patient (0.4%) developed clinical evidence of pulmonary embolism and out of 130 (47% of total) with spinal cord injury two (0.7%) developed clinical evidence of deep venous thrombosis while still on enoxaparin. Four patients (1.5%) developed deep venous thrombosis and one (0.4%) pulmonary embolism after discontinuing enoxaparin. There were no fatal pulmonary emboli and one suspected intraspinal bleeding. CONCLUSIONS The present study suggests that, in addition to physical and mechanical measures, low molecular weight heparin in the form of enoxaparin 40 mg administered once daily compares favourably with previous studies for thromboprophylaxis in acute spinal injuries.

    更新日期:2019-11-01
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