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Recent abstracts posted in SCI (Clinical) Forum

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  • Recent abstracts posted in SCI (Clinical) Forum

    I was noticing that almost nobody had been seeing any of the abstracts that I have posed in the SCI (Clinical Forum) over the past two weeks. Let me point out some highlights.

    Scivoletto, et al. (2004) describes the ASIA scores of 284 patients admitted to an Italian spinal cord injury center. It was interesting that only 30% of the patients were ASIA A. This is consistent with the general tendency around the world for more people with spinal cord injury to be admitted with "incomplete" injuries. The degree of recovery of the patients is also of great interest. Close to half of the patients recovered to "functional status", e.g. ASIA D.

    Carhout, et al. (2004). This is a study from Herman's group in Arizona. They had earlier reported that epidural stimulation will activate the locomotor pattern generator in humans and that this stimulation gave a person with cervical spinal cord injury who was a household walker ability to become a practical walker, i.e. a person who was able to walk over a kilometer with much less effort. Now, they report that use of the L2 lumbar epidural stimulator remarkably facilitated locomotor function in a person who was undergoing weight-supported ambulation treadmill training, and improved the transfer of treadmill-induced walking to overground walking so that the person doubled his overground walking speed to 0.35 m/sec and was able to walk over 325 meters. This is persuasive evidence that epidural lumbar stimulation should be combined with treadmill training.

    • Coselli, et al. (2004) reported a very surprising result. For nearly a decade now, surgeons have been saying that it is important for surgeons to protect the spinal cord while repairing aortic aneurisms by bypassing blood to the lower aorta. However, this study of 341 patients (the largest study to date) suggest that there is no difference between patients who were repaired with bypass versus those who did not have a bypass. The study recommended a return to the clamp-and-sew repair method. I actually disagree with this recommendation... For more see the discussion.

    • Anderson, et al. (2004) from Edinburgh found that 10% of people with spinal cord injury have other associated skeletal fractures involving the arms and legs. They suggest that there should be a high index of suspicion for broken bones and therefore the need to x-ray the extremities routinely in people with spinal cord injury.

    • Subramonian, et all (2004) in England reports that the incidence of bladder cancer in 1334 people with spnal cord injury is not different from that of the general population. Previous studies of these have come mostly the VA population where there may be other confounding variables (such as smoking and high incidences of urinary tract infections) that may account for higher rates of urinary tract infections.

    • Butler, et al. (2004) reports a very interesting result where the extent of thumb motor control in people with cervical spinal cord injury is influenced by low blood pressure. This is, to my knowledge, the first time this has been suggested, that low blood pressure may contribute to muscle fatigue.

    • Livshits, et al. (2004). This Israeli study reports successful bridging of thoracic nerves to bladder nerves in patients with low spinal cord injuries with restoration of some bladder function.

    • De Mello, et al. (2004) found that both physical therapy and dopaminergic agonists reduct periodic leg movements (spasms) in patients.

    • Borzyskowski, et al. (2004) addressed an issue that I had not considered before, that there may be psychological issues associated with intermittent catheterization in children with spina bifida. Anyway, the study suggests that although bladder problems created stress for the family, the intermittent catheterization itself did not cause major emotional or behavioral problems in the children.

    • Reitz, et al. (2004) from Switzerland report that an oral nitric oxide donor reduces bladder spasticity. This is the first novel treatment of bladder spasticity in a long time.

    • Kadyan, et al. (2004) reviewed the costs of doing duplex ultrasound scans for deep vein clots in people with spinal cord injury. They conclude that it is worthwhile.

    • Steldt & Schmidt (2004) reports that sinusoidal hip movement of people with spinal cord injury helps activate coordinated leg movements. This is of interest because it provides a rationale for devices that induces hip movements and that sinusoidal hip movements may help facilitate ambulation training on treadmills.

    • Jim Guest from the Miami Project reports successful use of an endoscopic (minimally invasive) approach to transplanting cells into the spinal cord. Although this sutdy was done in pigs, I thought that this was relevant enough to put into the clinical section.

    • Jim Guest also examined the benefits and risks of hypothermia during spinal surgery. Lowering body temperature has long been suggested to be neuroprotective and much animal research supports this suggestion. He showed that hypothermia did not seem to change complication rates and suggested that hypothermia is reasonably safe but the duration should be minimized. Because the study was not randomized and the number of patients were too few, it was not possible to tell whether or not hypothermia improves surgical results or neurological recovery. It also illustrates how difficult it is to design clinical studies to find out whether certain surgical practices are beneficial or risky.

    There are many more studies...


  • #2
    Subramonian, et all (2004) in England reports that the incidence of bladder cancer in 1334 people with spnal cord injury is not different from that of the general population.

    now I likethat outcome!!
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