Summ aryTwo groups of patients who developed orthostatic hypotension (OH) after spinal cord injury (SCI) were studied. In the first group all patients (4 females and 6 males) were asymptomatic, whereas in the second group (1 female and 9 males) all had clinical manifestations of hypotension. All but 3 patients were tetraplegic , and these patients were paraplegic above the T6 level. For this study blood pressure (BP) , heart rate and cerebral blood flow (CBF) velocity were measured simultaneously on a tilt table at 0, 30 , 60, and 80 degrees. Cerebral blood flow in the middle cerebral artery was measured bilaterally utilising the transcranial Doppler technique. In asymptomatic patients the mean baseline (0 degrees) BP (110 ± 16/70 ± 77 mm Hg systolic/diastolic) was not significantly different from the BP (106 ± 16/68 ± 11 mm Hg) of symptomatic patients. The mean maximal change in BP during tilling in the asymptomatic group ( -23 ± 10/10 ± 7 mm Hg) was also not significantly different when compared to the symptomatic group (-29 ± 13/11 ± 6 mm Hg). CBF in the symptomatic group during the hypotensive reaction at 80 degrees was 32.5 ± 5 cm/sec, while at the same body position in the asymptomatic group it was 40·9 ± 8 cm/sec (significant at the p < 0·02). In addition, CBF decreased in the symptomatic group at 80 degrees to 55·5 ± 9·6% of baseline, while in the asymptomatic group the fall was 69·3 ± 7·2% (p < 0·001). Our data suggests that autoregulation of CBF rather than systemic BP plays a dominant role in the adaptation to OH in patients with SCI.
Sixty-three patients with paralysis secondary to spinal cord injury (SCI) were screened for heterotopic ossi®cation (HO) by bone scintigraphy 27+14 (mean+SD) days after SCI. There were four female and 59 male patients, 36 had paraplegia and 27 tetraplegia. The age of patients was 28+9 years. Bone scintigraphy was obtained with a 3-phase test using 99m-technetium labeled diphosphonate, and the positive third phase was used as a criterion for diagnosis of HO. Bone scintigraphy was negative for HO in 27 patients (14 tetraplegic and 13 paraplegic) and positive in 36 patients (13 tetraplegic and 23 paraplegic). The patients with positive HO were treated with etidronate, ®rst with an intravenous dose of 300 mg/day for 3 days, and then with an oral dose of 20 mg/kg/day for 6 months. The follow-up of patients consisted of clinical and radiographic evaluations every 2 ± 4 months. The extent of HO was classi®ed radiographically. In the treated group of patients who completed the entire course of etidronate therapy one patient developed HO, the remaining 28 (97%) patients had no radiographic evidence of HO during the follow-up of 10.6+4.5 months after initiation of therapy.Our data indicate that: (a) early HO can be detected in the asymptomatic patients using bone scintigraphy on the average of 4 weeks (27+14 days) after SCI and (b) the therapy with etidronate might be e ective in the prevention of HO in majority of patients when the treatment is initiated in an early stage of heterotopic bone formation.
A new protocol in management of heterotopic ossification (HO) was evaluated in 46 patients after spinal cord injury (SCI). A group of 24 paraplegic and 22 tetraplegic patients was involved in a prospective study. Diagnosis of HO was made by bone scintigraphy and radiographic evaluation. Patients were divided into two groups. Group I was made up of 33 patients with positive bone scintigraphy and negative evidence of HO and Group II was made up of 13 patients with positive bone scintigraphy and positive radiographic evidence of HO. Etidronate was started intravenously (300 mg/day) for three days followed by oral therapy for six months (20 mg/kg/day). Follow-up of patients was 15. 7±8 months after SCI. In Group I, etidronate therapy prevented the development of HO in 79 percent of patients; in 21 percent of patients, a low degree of tissue ossification was found which was not clinically significant. In Group II, there was an inhibitory effect of etidronate on progression of soft tissue ossification in six patients. The remaining seven patients did not respond to therapy and showed an increased growth of HO. Our data indicate that etidronate may prevent HO in the majority of patients when administered at an early stage of HO development and in higher doses than are routinely recommended . (J Spinal Cord Med 1997; 20:60-65)
This study was designed to determine the effect of methenamine on the frequency of urinary tract infections (UTI) in hospitalized patients after spinal cord injury. The study included 56 patients with neurogenic bladder dysfunction treated with intermittent catheterization. A group of 34 patients was treated with methenamine, 1g twice daily; the other group of 22 patients was the control group receiving no antimicrobial therapy. On a weekly basis urine samples from all patients were obtained for urinalysis and culture. A total of 500 urine samples were analyzed. The patients treated with methenamine had 23.4% positive urine cultures which was significantly lower than 57.5% in the untreated control group (p less than 0.001). Our data suggest that methenamine therapy is an effective prevention of UTI in paralyzed patients with neurogenic bladder dysfunction during the rehabilitation in hospital.
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