摘要:

AbstractFor centuries, maggot therapy (MT) has been recognized as an aid to wound healing. By including live blowfly larvae in wound dressings, earlier physicians noted thorough debridement which hastened wound healing. We initiated a prospective controlled study to evaluate the utility of maggot therapy for treating pressure ulcers in spinal cord injury patients in the modern era. Eight of our patients received MT after a baseline assessment of healing under conventional therapy (defined as any therapy prescribed by the patient’s primary care team). Surface area, tissue quality and healing rates were monitored weekly. MT debrided most of the necrotic wounds within one week, which was more rapid than all other non-surgical methods. Wound healing was more rapid during MT than during antecedent conventional therapy (p=0.01). No complications were seen. We have demonstrated that MT can be beneficial in the treatment of pressure ulcers in persons with spinal cord injuries. MT was significantly more effective and efficient than the current, conventional treatment alternatives being used. MT was also safe, simple and inexpensive. MT can be a valuable modality in the treatment of pressure ulcers.(J Spinal Cord Med. 18.71–74)

ISSN:1079-0268    

DOI:10.1080/10790268.1995.11719382

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

AbstractAutonomic dysreflexia (AD) is a clinical phenomenon that affects patients with spinal cord injury (SCI) above the major sympathetic outflow tract. The lesion is most often at or above the T-6 level. Any noxious stimuli below this level initiate reflex sympathetic activity resulting in life threatening hypertension uncontrollable by the feedback parasympathetic activity. The episodes of hypertension generally persist until the offending stimulus is removed.Absence of higher control over reflex sympathetic activity due to transection of the cord is an anatomical explanation of the phenomenon. Current evidence suggests additional factors such as supersensitivity and possibly increased numbers of spinal alpha adrenoreceptors and peripheral microvascular adrenoreceptors as well as accumulation of substance P below the lesion. It has been suggested that substance P acts as a modulator, initiating the sympathetic event to produce a strong, slow and prolonged excitatory action. Autonomic dysreflexia is further accentuated by the absence of gamma amino benzoic acid (GABA), norepinephrine (NE) and 5-hydroxytryptamine (5-HT) below the lesion. GABA is an inhibitory neurotransmitter. It has been suggested that either NE or 5-HT may also act as an inhibitory neurotransmitter. Resetting of the baroreceptors at a lower level also plays an important role. The anatomical transection at or above T-6 then helps in maintaining and accentuating the biochemical changes that develop in patients with high spinal cord lesions.The current article reviews the pathophysiology and management of this potentially life threatening, yet easily treatable, phenomenon.(J Spinal Cord Med;18:75–87)

ISSN:1079-0268    

DOI:10.1080/10790268.1995.11719383

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

AbstractThis effort represents a subset analysis of the long-term Multicenter North American Trial of the UroLume sphincter stent prosthesis to determine the effect of the sphincter stent prosthesis in SCI men afflicted with detrusor-external sphincter dyssynergia (DESD) and chronically managed with an indwelling urinary catheter. Forty-one of 153 male patients in this study were evaluated urodynamically before and after placement of the sphincter stent prosthesis. Of the 41 patients, 34 (81 percent) suffered cervical-level injury while 10 patients (25 percent) had been treated previously with external sphincterotomy. Forty patients (98 percent) were troubled with recurrent urinary tract infections (UTI), with a mean of 4.6±3 episodes of UTI per year. Seven patients (17 percent) demonstrated hydronephrosis prior to stent placement.Follow-up ranged from six to 44 months. Voiding pressures decreased from a mean of 77±23 cmH20 preoperatively to 35±18 cmH20 at 12 months (n=34) and 33±20 cmH2Ûat 24 months (n=22) after stent insertion (p=0.001). Post-void residual urinary volume decreased from 202±187 ml preinsertion to 64±69 ml at 24 months (p=0.001) postinsertion. Maximum cystometric capacity remained constant at 201±144 ml preinsertion to 203±79 ml at 24 months (p=0.75) postinsertion. No significant changes in any of the urodynamic parameters occurred after 24 months of follow-up between patients with (n=10) and without (n=31) previous external sphincterotomy.Neither hemorrhage requiring blood transfusion, obstructive hyperplastic epithelial overgrowth, stent encrustation or stone formation, nor soft tissue erosion occurred in any patient. No deleterious effects were observed on erectile function. Hydronephrosis resolved in four, and improved in three, of seven patients with hydronephrosis preoperatively. Eighty-two percent of the patients demonstrated complete stent epithelialization after six months, while 96 percent were epithelialized two years after stent insertion. In three patients, stent migration required repositioning or removal within the first month. In another two patients, the stent prostheses were removed one year postinsertion because of problems with condom catheter drainage.The sphincter stent prosthesis is an attractive, potentially reversible treatment option for DESD in men managed with an indwelling catheter, even if external sphincterotomy has been performed previously.(J Spinal Cord Med;]8:88–94)

ISSN:1079-0268    

DOI:10.1080/10790268.1995.11719384

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

AbstractWe present a cross-sectional study designed to screen and evaluate 19 male patients with acute or chronic spinal cord injury for the presence of carpal tunnel syndrome (CTS) and radial neuropathies (RNP) in order to establish the prevalence of CTS and RNP, to compare characteristics of persons with spinal cord injury who do not have these neuropathies, to evaluate the effects of their activities and to define the causation of these neuropathies in order to prevent their occurrence during and after the rehabilitation process. Patients admitted to the Spinal Cord Injury Service with acute and chronic spinal injury (below C3) were included in the study. The level of activity was determined with the Functional Independence Measure (FIM) Score. Patients underwent neurological examination. Neurophysiological studies were done in all cases to determine the presence, nature and duration of CTS and RNP. As longevity of the spinal cord injured population is increasing, heightened awareness of the prevalence of CTS and RNP are necessary to develop strategies to prevent and manage these neuropathies which may adversely affect the patient’s quality of life.Of 19 patients studied, three had clinical CTS, confirmed by neurophysiological testing. Of the remaining patients, 11 had no neuropathies and five had non-CTS neuropathies. No RNP was found, but one patient in the non-CTS group had symptomatic left ulnar neuropathy also confirmed by neurophysiological exam.(J Spinal Cord Med;18:95–97)

ISSN:1079-0268    

DOI:10.1080/10790268.1995.11719385

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

AbstractBladder responses to percutaneous electrodes were investigated with stimulation in three male spinal cats. The animals had been spinalized (T1 level lesion) 10 weeks prior to these studies and had been instrumented with chronic bladder wall electrodes and suprapubic bladder catheters for filling and pressure recording. Percutaneous stimulation in tethered animals was conducted with hook electrodes inserted with a needle in the abdomen bilaterally adjacent to the bladder trigone. Stimulation was conducted with 40 Hz pulse trains of 10 to 30 mA for three seconds. Stimulation with both percutaneous and chronic electrodes induced high bladder pressures and voiding. In addition, with chronically implanted electrodes, impedance monitoring of bladder volume was found to be an effective recording technique.(J Spinal Cord Med; 18:98–102)

ISSN:1079-0268    

DOI:10.1080/10790268.1995.11719386

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

ISSN:1079-0268    

DOI:10.1080/10790268.1995.11719387

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

ISSN:1079-0268    

DOI:10.1080/10790268.1995.11719388

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor