Showing papers in "Spinal Cord in 1971"

Prostigmin assessment test of fertility in spinal man.

Abstract: 1. The widespread belief that patients with severe injuries of the spinal cord are completely and permanently impotent and infertile is no longer valid. 2. The distinct stimulating effect of intrathecal prostigmin on the sexual organs has opened new possibilities for clinical, physiological and biochemical research in a field where imaginative speculation and deduction on scanty grounds rather than on well-founded evidence have prevailed. 3. A variety of types and degrees of reproductive deficiency can be distinguished by the intrathecal prostigmin test. 4. Future research on the chemistry of the seminal fluid may give clues to abnormalities of the morphology and function of semen. 5. The intrathecal prostigmin test can be utilised for artificial insemination. It is essential that the female partner should undergo a thorough gynaecological and biochemical examination including pH of vaginal and cervical secretion and assessment of the most suitable time for assisted insemination. 6. Blood pressure and pulse should be examined at regular intervals during the prostigmin test from the start, especially in lesions above T5/6 to counteract excessive autonomic hyperreflexia by appropriate measures (Ansolysen, etc). 7. Patients, especially those with higher lesions should be warned about undesirable side-effects of prostigmin.

The results of laminectomy in patients with incomplete spinal cord injuries.

Abstract: happen, I mention a boy of 10 who had made an excellent adjustment to his complete paraplegia below TI I and his father came, bitterly complaining that his boy-an intelli­ gent boy-was put into a school for disabled children. I got in touch with the medical authorities and in those years they were not very helpful at all. Had there not been an understanding headmaster who took him into his ordinary school this boy would have been kept in that school for the disabled. He became an excellent pupil and won first a scholarship to Reading University in mathematics and from there he won a scholarship in mathematics to Trinity College, Cambridge! Mter his exam he became a lecturer at Nottingham University in mathematics. He is now-happily married-with a fellow­ ship at Princeton University in the U. S. A. If this boy had been kept in a school for disabled children he might be perhaps a second class clerk somewhere in an office.

Spinal cord trauma in children

Abstract: A series of spinal cord injuries in children less than 13 years of age has been presented. The seven children were admitted to the Spinal Injuries Centre for Victoria between April 1968 and July 1969. A common clinical feature of the patients was that vertebral injury was minimal or absent. A review of the literature revealed a paucity of information on the pathology of this syndrome. It is postulated that the elastic, cartilaginous spine of a young child may be grossly distorted by a flexion/rotation force, but does not disrupt through its inherent elasticity. The spinal cord, however, is unable to withstand such stretching forces, and a longitudinal injury of the spinal cord may result. The life expectation of these young patients is also discussed in the light of their good bladder function and sterile urine a short time after injury.

Clinical investigation of bone metabolism in spinal cord lesions.

Abstract: THE metabolism derangements in patients with spinal cord lesion as well as cerebral trauma have been investigated in terms of serum and urinary levels of calcium, phosphorus, creatine, creatinine, nitrogen and ketosteroids. The metabolic changes that occur in these kinds of patients (in the course of their trauma or in chronic phase) have been extensively reviewed (Freeman, 1949; Cooper et at., 1950; O'Connel, 1953, Wyse and Patee, 1954; Kapland et at., 1966). These patients present below the level of their neurological lesion an osteoporosis; it is not infrequent to observe in those a para-articular osteopathy. Recently Klein (1966) has described a sequential study of the metabolic response of the skeletal system to acute paraplegia. He reported rapid and large increase of urinary calcium and hydroxyproline excretion as well as gradual increase of serum alkaline phosphatase activity. Kinetic study of calcium metabolism by means of 45-Ca was introduced and was revealed to be the preferred method as an index of bone metabolism (Bauer et at., 1957; Bronner et at., 1963; Aubert et at., 1965). This analysis allows to express in terms of rate (mg. Ca/24 hr.) the calcium transfer in the body and mostly calcium deposition in bone, generally considered as a measure of skeleton anabolism. The measurement of total urinary hydroxyproline excretion has proved useful in the study of various bone disorders and in fracture healing (Klein et at., 1962; Dull, 1963). Hydroxyproline is a specific amino acid of the connective tissue protein (collagen and elastin) and its amount measured in the urines represent a good index of the catabolism of these proteins. The present report describes a study of the metabolism of the connective tissue in patients with spinal cord lesion. Some of these patients have been followed for 3 years from the beginning of their cord injury. We have also considered in this study patients with cerebral trauma and paraplegia due to poliomyelitis. Urinary calcium and hydroxyproline as well as kinetic studies with 45-Ca. were used as indices of bone metabolism.

Stability of spinal fractures and fracture dislocations.

Abstract: BENASSY, J., BLANCHARD, J. & LECOG, P. (1967). Neurological recovery rate in paraand tetraplegia. Paraplegia, 4 (February), 259-263. CAREY, P. D. (1965). Neurosurgery and paraplegia. Rehabilitation (January-March), 27-29. CLOWARD, R. B. (1963). Lesions of the intervertebral discs and their treatment by interbody fusion methods. The painful disc. Clinical Orthopaedics, 27, 51-77. GUTTMANN, L. (1949). Surgical aspects of the treatment of traumatic paraplegia. The Journal of Bone and Joint Surgery, 31-B, NO. 3 (August), 399-403. HARRIS, PHILLIP (1965-66). The initial treatment of traumatic tetraplegia. Paraplegia, 3, 71-73. MUNRO, DONALD (1965-66). The role of fusion or wiring in the treatment of acute traumatic instability of the spine. Paraplegia, 3, 97-III. TAYLOR, R. G. & GLEAVE, J. R. N. (1962). Injuries to the cervical spine. Proceedings of the Royal Society of Medicine, 5, 1053. WALKER, A. EARL (1964). The neurosurgeon's viewpoint. The Journal of Bone and Joint Surgery, 46-A, No. 8 (December), 1806-1810. WHITE, R. J., ALBIN, M. S., HARRIS, L. S. & YASHON, D. (1969). Spinal cord injury: sequestial morphology and hypothermic stabilization. Surgical Forum, 10 (October), 432-434.

Orthostatic hypotension and the renin-angiotensin system in paraplegia

Abstract: Blood pressure has been studied in patients with orthostatic hypotension of several causes, including high spinal cord transection. Observations have included heart rate, the effect of angiotensin infusion, and measurement of plasma renin concentration intermittently throughout the investigation. Evidence is presented that a rise of blood pressure and also of plasma renin concentration may occur if sympathetic fibres are active. Release may, however, depend upon spinal sympathetic activity as change of posture can induce an elevation of plasma renin concentration in patients with high spinal cord transection. Such patients may have high resting values of plasma renin and the renin response to change of posture may play a part in the response to repeated change of posture for a few minutes and also in the chronic vascular adaptation which chronic paraplegics achieve.

Workload and energy expenditure during wheelchair propelling.

Abstract: In this investigation it was tried to evaluate the workload of wheelchair driving in physical units, i.e. watts or meter kg./sec. For this reason an ergometer was adapted so that subjects sitting in wheelchairs with fixed brakes, could hand frank it. They were asked to perform at a standard workload of ½ watt/kg. body weight and at 1 watt/kg. body weight for 5 minutes each. During this time heart rate, CO2 elimination, O2 uptake, minute volume of respiration and the RQ were continuously recorded or calculated. In a second procedure these subjects were asked to drive a conventional wheelchair 5 to 6 minutes at a convenient speed. During the last 2 minutes the V was measured with the Korfryani-Muller spirometer and samples of expired air were taken for O2 and CO2 analysis. The heart rate was recorded by telemetry. In a third procedure the subjects drove their wheelchairs for 5 minutes on platforms equipped with rollers so that the above mentioned parameters could be measured continuously. The data collected in the second and third parts of the experiment were projected on the graph of performance of ergometric experiments, and plotted along the X-axis to estimate the workload in watts. By this method it was possible to calculate the physical workload of wheelchair driving within a range of approximately ±5 watts.

Prevention of urinary tract infection following spinal cord injury.

Abstract: Immediately following spinal cord injury there is a phase of spinal shock during which time the bladder is paralysed and becomes overdistended unless emptied by catheterisation. If the bladder wall is overstretched there is initial loss of contractility, followed by interstitial fibrosis within the detrusor muscle. However, if overdistension and infection are avoided during the immediate and early period after injury to the spinal cord, most patients develop satisfactory compensatory mechanisms of bladder emptying. There are two possible regimes of catheterisation, either indwelling or intermittent, both of which are associated with infection. The probability of infection with indwelling catheters is too high to be acceptable. Intermittent catheterisation also carried a considerable risk, but ways have been devised which make this method satisfactory. A trial of management techniques for the prevention and control of urinary tract infection during intermittent catheterisation was conducted on 36 acute traumatic paraplegics and tetraplegics admitted to the Royal Perth Hospital Spinal Injuries Unit during 23 consecutive months. Precautions were taken to ensure that the technique of catheterisation was of a very high standard, but this in itself did not prevent urethral bacteria from being carried into the bladder. To eradicate these micro-organisms, two bactericidal antibiotics (kanamycin and Colistin) were injected into the bladder via the catheter immediately prior to withdrawal. During the acute phase of management a total of 3036 catheterisations were performed on 27 male patients and in this time 16 episodes of significant bacteriuria occurred. The incidence of significant bacteriuria in the male patients was 1 per 190 catheterisations (0.5 per cent.). A total of 1547 catheterisations were carried out on nine female patients, resulting in nine episodes of significant bacteriuria. The incidence of significant bacteriuria in the female patients was 1 per 172 catheterisations (0.6 per cent.). Ninety-one per cent. of patients discharged were catheter-free with low residual urines and without bacteriuria and have generally remained so during follow-up.

The mode of development of urinary infection in intermittently catheterised male paraplegics.

Abstract: The mode of development of urinary infection in intermittently catheterised male paraplegics

Sexual function and dysreflexia

Abstract: The authors have discussed the case history of a tetraplegic patient with complete cord transection at C7-C8 who ejaculated after intrathecal injections of neostigmine. The ejaculations were accompanied by severe symptoms of autonomous dysreflexia consisting of hypertension and cardiac arrhythmia recorded by continuous intraarterial pressure monitoring and electrocardiography. Catecholamines were measured in blood and urine during the examination. A close relationship was found between ejaculations, blood pressure, cardiac rate, cardiac rhythm as well as calibration on one hand, and catecholamine levels on the other hand. A predominant excitation of alpha receptors is suggested.

Heterotopic ossification and the surgical treatment of serious contractures

Abstract: Top of pageAbstract A report is given of heterotopic ossification and the results obtained in twelve patients are presented. They were operated upon because of serious limitation of mobility in one or more joints.

Psycho-social aspects of sexuality in spinal cord injury patients.

Abstract: the fourth ventricle. Now, whether subsequent endeavour will reveal there is a com­ munication sometimes or not I do not know. We have taken that into consideration and it would indeed require a different approach, I am sure. With reference to the discussion about operation versus non-operation, you may recall some years ago we endeavoured to find out the results of operation on patients who were treated in Toronto, and we found out it didn't seem to matter whether you operated or not, there was no statistical difference. Nevertheless, I think that there must be cases when surgical intervention is beneficial, and I think it behoves the medical profession to find out the indications for operation and to operate on that basis. I may say that I have not been impressed by the number of people operated upon in Toronto who were made worse at the time of operation. I have often wondered when they were operated upon, however, jf there is not an optimal time for operation and if that had not been missed, perhaps through delay or perhaps it was done too soon. And, I think this matter has to be studied, and it is being studied, starting with experimental animals all over again, repeating the work of Frasier and Allen and others, and endeavouring to start back there now and find out what they can learn from experimental studies.

The role of ascorbic acid in the pathogenesis and treatment of pressure sores

Abstract: 1. In some cases of paraplegia and tetraplegia with pressure sores there exists a relative deficiency of ascorbic acid which may delay wound healing. Further investigations of histology and leucocyte vitamin C levels would appear to be indicated. 2. There appears to be a difference between the ascorbic acid status of normal subjects and some paraplegic and tetraplegic patients; the reason for this is not known.

Regulation of the cardiovascular system in patients with fresh injuries to the spinal cord--preliminary report.

Abstract: Regulation of the cardiovascular system in patients with fresh injuries to the spinal cord–Preliminary report

Vascular reflexes in spinal shock.

Abstract: Studies were made on 15 patients with injuries in the cervical region. Blood pressure, forearm and hand blood flows and heart rate in response to a deep breath, bladder distension and tilting with and without arterial cuffs were carried out. Some studies were made during the period of spinal shock, these showed that inspiratory vasoconstriction and autonomic hyperreflexia in response to filling the bladder were present. Other studies were made on patients when the spinal shock had passed. These showed that the response to tilting was a fall in the blood pressure and forearm blood flow, this was accompanied by a tachycardia. This response was modified by the application of arterial cuffs to the lower limbs. These findings were discussed and indicated that reflex autonomic control of the blood vessels could be mediated by the spinal cord isolated from the medullary centres in the stage of spinal shock.

Chest movements and electromyography of the intercostal muscles in tetraplegic patients.

Abstract: Chest movements, electromyographic activity of the intercostal muscles and the volume of air breathed were studied in three patients with complete transections of the cervical cord. Paradoxical suction of the chest during inspiration associated with marked electromyographic activity was detected. Expiratory activity was found less frequently. The findings were discussed. It was suggested that this electromyographic activity was due to a stretch reflex as a result of the diaphragm pulling upon the unsupported chest wall.

Temperature regulation in paraplegia

Abstract: Patients with transection of the spinal cord run the risk of hypothermia or hyperpyrexia. They have lost the ability to shiver below the somatic level of their lesion. Heat loss mechanisms are also interrupted, the loss being complete below the autonomic dermatome level affected. Piloerection can occur below the level of the lesion; some vasoconstriction and vasodilatation can also occur below the level of the lesion in response to change in ambient temperature. Studies of paraplegics have allowed a greater understanding of human temperature regulation.

Cardiovascular reflexes in tetraplegia.

Abstract: The effects of bladder stimulation, skeletal muscle spasms and head-up tilting were observed in seven patients with complete cervical cord lesions. Measurements were made on intra-arterial blood pressure, heart rate, hand, forearm and calf blood flow and peripheral venous activity. On bladder stimulation there was an increase in blood pressure and a decrease in heart rate, calf blood flow and hand blood flow; there was venoconstriction. Skeletal muscle spasms caused similar changes. Head-up tilting caused a fall in blood pressure with a rise in heart rate. There was a decrease in forearm blood flow and there was some venoconstriction.

Abdominal 'visceral' sensation in human tetraplegia.

Abstract: Sixty-six patients with cervical, called ‘high’ lesions, were compared with 23 low thoracic, lumbar or sacral cord lesions (due in all cases to accidental spinal trauma) as to their awareness of abdominal hunger, abdominal dread and abdominal nausea before and since their injury. The changes reported suggest that such visceral sensations from the abdomen proper are mediated by the vagus and not the sympathetic supply.

Sudeck's atrophy in traumatic quadriplegia.

Abstract: In a study of 19 patients with traumatic quadriplegia admitted to the G. F. Strong Rehabilitation Centre over a one-year period, there was a high incidence of bizarre painful hands and feet coincident with a particular radiological stage of osteoporosis—spotty macular porosis (Sudeck's atrophy). Four of 5 patients with spotty macular porosis in the hands and 3 of 7 patients with spotty macular porosis in the feet complained of bizarre pain. In the only instance of unilateral spotty macular porosis, the pain was confined to the affected hand. Where the X-rays of the hands or feet showed simple osteoporosis, 1 patient had painful hands. All patients with normal X-rays of the hands and feet were asymptomatic. The neurological level of injury was at C7 in all 6 patients with coincident pain and spotty macular porosis. A further prospective study with X-rays taken at regular intervals after spinal trauma might confirm the coincidence of symptomatic painful hands and feet and radiological spotty macular porosis.

Respiratory sensations in patients with cervical cord transection

Abstract: The sensation of breath holding and the ability to detect added external respiratory resistance was investigated in nine patients with complete cervical cord lesions. (Eight patients with lesions between C5 and C7 and one patient with a complete lesion below C3.) All the patients could detect added resistive loads normally. All the patients except the one with the C3 lesion had normal sensations of breath holding. It is concluded that the information about pressure changes reached consciousness via the vagi and that the sensation of breath holding is dependent on contractions of the diaphragm.

The neurovegetative syndrome of vesical distension in paraplegics. Prevention and therapy.

Abstract: BERNSTEIN-HAHN, L., CIBEIRA, J. B. & ZONZINI, J. (1966). Follow-up report on Lapides tubeless vesicostomy. International Medical Society of Paraplegia. Stoke Mandeville: Julio. BORS, E. (1963). Proc. Clin. Spinal Cord Conf., V.A. Hosp., Hines, U.S.A., p. 94. BRICKER, E. M. (1950). Bladder substitution after pelvic evisceration. Surg. Clin. N. Amer., 30, 151!. CARRENO, 0., BERNSTEIN-HAHN, L., CIBEIRA, J. B., TURTELA, F. & ALONSO, J. (1965). Derivaciones urinarias en pacientes con mielomeningocele. Actas IX Congreso Americano de Uroiogia, Torno II, 262-265. CARRENO, 0., BERNSTEIN-HAHN, L. & ZONZINI, J. (1966). Citostomia tubulada seglin tecnica de Lapides. XV Congreso del International College of Surgeons, Mexico. Sep. 27. COMARR, E. (1963). Proc. Clin. Spinal Cord. Conf. V.A. Hosp., Hines, U.S.A., p. 94. EBEL, A. (1963). Proc. Clin. Spinal Cord Conf. V.A. Hosp., Hines, U.S.A., p. 94. GUTTMANN, L. & FRANKEL, H. (1966). The value of intermittent catheterisation in the early management of traumatic paraplegia and tetraplegia. Paraplegia, 4, NO. 2, August. SMITH, E. D. (1964). Ileo cutaneous ureterostomy in children. Aust. N.Z. J. Surg., 33, 169. SWINYARD, CHESTER. (1965). Comprehensive care of the child with Spina Bifida manifiesta. New York University.

Muscle strength and electrical activity, heart rate and energy cost during isometric contractions in disabled and non-disabled

Abstract: Muscle strength and electrical activity, heart rate and energy cost during isometric contractions in disabled and non-disabled

Paraplegia due to radiation myelitis following the treatment of carcinoma of the bronchus by radiotherapy. Report of two cases

Abstract: The clinical details of autopsy findings from two cases of paraplegia following the treatment of carcinoma of the bronchus by radiotherapy are given and the pathogenesis of radiation myelitis is discussed. Histopathological examination of the spinal cords revealed necrosis without gliosis, and hyaline thickening of small arteries with some endothelial proliferation.

Thoughts about the measurements of muscle tone.

Abstract: The problem of muscle tone and its measurement is discussed. The importance of studying the patient as a whole subject is stressed. A possibility of muscle tone measurement is probably the measurement of the speed of an action and an increase in educrane.

Management of patients with myelomeningocele

Abstract: 1. Neuro-orthopaedic, urological and educational evaluation of 74 patients is reported. 2. Limb deformity was more frequent in patients with L3-L4 motor level. 3. Severe fibrosis rather than muscular imbalance provides the deforming force in a number of cases. 4. In 46 per cent. of the patients the bladder had a capacity of less than 150 cc., 50 per cent. had trabeculations, 66 per cent. had upper urinary tract dilatation. 5. In 57 per cent. of the cases the bladder had a residual urine less than 20 cc. 6. In another series of patients followed up for several years 20 urinary diversions were done in 18 patients. In view of these series we advise Bricker type of ileal bladder unless huge dilated ureters are present, in which case Lapides butterfly ureterostomy provides the best answer to the urinary problems in myelomeningocele patients. 7. Six patients had cutaneous vesicostomy with bad results. 8. In approximately 200 patients tested in our institute about 60 per cent. would benefit from schooling and vocational guidance. Eight months ago the building of a home-school was started in order to fulfil this need. The cost has been calculated to be 700,000 American dollars.

Cineradiographic studies of some bladder-sphincter dysfunctions in paraplegia.

Abstract: CINECYSTOURETHROGRAPHY has been used quite frequently on normal subjects in the past 20 years. But little has been published on paraplegia, especially where micturition is concerned. Davidson, Morales and Becker, 1966; Peha, L. J., Comarr, A. E. and Bors, E., 1968, have published reports dealing with this method of investigation. Since 1967 we have studied the bladder-sphincter function in 33 cases of paraplegia (all catheter free), either after the acute phase in Colmar or check-ups, or during the course of medical or professional rehabilitation in Mulhouse. Of these, 16 patients had a complete upper motor neurone lesion, II had an incomplete U.M.N. lesion; 2 patients had a complete lower motor neurone lesion and 3 a mixed complete U.M.N.L. and L.M.N. lesion. One patient had an incomplete lesion of the same type. All patients' lesions are of traumatic origin except for three. The aim has been to study micturition patterns in relation to the neurological status, upper or lower neurone lesion, complete or incomplete, as close as possible to the normal conditions of life of these patients and not under artificial and often error and infection inducing conditions, such as cystograms, ice-water tests and other unphysiological, but sometimes necessary, methods.