The present report concerns investigation of bladder disturbances in 31 juvenile diabetics. It was shown that: 1. The predominant lesion is one of neuropathy.-2. Vesical involvement such as increased capacity and atony was demonstrated by cystometry in 27 out of the 31 cases (87%).-3. 4 cases had neck hypertrophy.-4. The most striking symptom was a large volume of first morning urine. This information was elicited from the patients. They had no urological complaints.-5. A high incidence of impotence was seen in diabetics with neurogenic bladder.-6. The possible causes of such lesions and the value of certain therapeutic measures was discussed. Vessie neurog~ne asymptomatique ehez des diabdtigue~ ]eunes Rdsumd. Le prdsent travail coneerne une investigation sur les troubles de la vessie chez 31 diabdtiques jeunes. I1 a @t6 dgmontrd que: 1. La 16sion pr6dominante est une 16sion de neuropathie.-2. Des signes v@sicaux tels que la capacitd accrue et l'atonie mesur6es par cystom@trie, ont 6t4 d6montr6s darts 27 cas sur les 31 (87%).-3. 4 cas avaient une hypertrophie du col.-4. Le symptome le plus frappant 6tait l'important volume de la premiere urine du matin. Ceci a 6t6 indiqu6 par los patients. Ils ne se plaignaient d'aucun trouble urologiquc.-5. On trouve une haute frdquence d'impuissance chez les diab@tiques ayant une vessie neurog6ne.-6. Les causes possibles de telles 16sions et la valeur de eertaines mesures th@rapeutiques sont diseutges. Asymptomatische neurogene BlasenstSrung bei jugendlichen Diabetilcern Zusammenfassung. Es wird fiber Blasenst6rungen bei 31 jugendliehen Diabetikern berichtet. Es konnte gezeigt werden, dal3: 1. die Neuropathie die vorherrschende StSrung darstellt ; 2. bei 27 yon 31 F~llen (87%) eine Blasenbeteiligung (gesteigerte Kapazit~t und zytometrisch nachweisbare Atonie) vorlag;-3. bei 4 F~llen eine Blasenhalshypertrophie bestand;-4. hervorstechendes Syruptom war die grol]e Harnmenge bei der ersten morgcndlichen Blasenentleerung, fiber das die Patienten auf Anfrage beriehteten. Sic iiul~erten keine urologischen Beschwerden;-5. Bei vielen Diabetikern mit einer neurogenen Blasenst6rung ist eine Impotenz festzustellen;-6. Die fiir diese Lfisionen in Frage kommenden Ursachen und der Weft einiger therapeutiseher Ma2nahmen werden diskutiert.
Outpatient Attendance. All cases that can be brought back for medical re-examination are seen at regular intervals at our outpatient clinics and are re admitted for full routine annual investigation. Those too far afield where it is impracticable to return to the Centre are supervised by the nearest provincial hospital or a general practitioner or district surgeon and are referred back to the Centre if necessary. Outpatient attendance figures are unfortunately not avail able for the entire period under consideration, but a comparison of the figures for 1967 with those of the previous year show a marked increase-297 in 1967, 102 in 1966. It is encouraging to see how well the majority of the discharged patients manage once out of hospital, a relative minority return with sores or urinary complications. SUMMARY An analysis of 300 new lesions admitted to the Spinal Injuries Centre, Conradie Hospital, Cape Town, which was officially opened in November 1963. Statistics given relate to the following: I. Mode of transport to the Centre. 2. Age and sex distribution. 3. Cause and frequency of spinal cord lesions. 4. Neurological classification-incidence and extent. 5. General nursing care. 6. Plastic repair of sores. 7. Incidence of automatic and autonomous bladders and treatment. 8. Orthopaedic procedures. 9. Tracheostomy. 10. Death rate. I I. Discharges. 12. Outpatient attendance.
IN 1970, Crue published his 20 years' experience with a conservative approach in 87 patients, pointing out that surgical fusion had not been proved to be a pro cedure of choice.In our own experience of over 25 years, we have dealt with almost twice the number of cases. In every case treated conservatively, spontaneous fusion followed as a rule, without interfering with the rehabilitation programme. Although the conservative approach was deliberately chosen as a means of treatment, there were a number of cases in which surgical fusion would have been technically and mechanically unsound.A large number of cases that came to our hands after laminectomy followed by anterior or posterior fusion or both, never showed any improvement as a direct result of the operation. One of the arguments that has been claimed for early surgical fusion is, that it facilitates the immediate rehabilitation of the patient. Early rehabilitation of the patient can be started immediately without any surgery. If skull traction is applied, apart from being mobilised every two hours, the patient is also encouraged to rotate his head, both as an exercise and to determine for himself the most comfortable position.We have found that skeletal traction by means of a de Anquin or Urrutia stirrup has not only been very well tolerated by the patient, but also facilitates the periodical turning and does not interfere with the continuous nursing care. The patient will soon start active flexo-extension exercises. In doing so, by the time the traction is discontinued-four to six weeks-he will be able to hold his head in any desired position.In recent cases, the dislocation is easily reduced. Traction has been kept for periods varying from 20 to 45 days. Once traction is discontinued, an adjustable leather collar or a minerva plaster jacket, depending on the case, is worn for several weeks. When active exercises are encouraged, the reduced position is maintained and X-ray examination will soon show spontaneous fusion due to ossification of the anterior longitudinal ligament.We do not agree with the minerva plaster jackets which immobilise the fore head, as they only lead to the necessity of liberating the chin to perform masticatory movements, the immediate consequence being the loss of the all important hold under the mandibular area. With the type of plaster that we advocate, the patient can freely open his mouth by raising his head. After a few days or weeks, they can even lift the chin from the plaster. The possibility of lifting the head will not 203 204 PARAPLEGIA impair immobilisation, but on the contrary this active movement will strengthen the muscles and enhance bone formation achieving auto-stabilisation.The treatment of fractures of the odontoid process has given rise to many a controversy. Those who maintain that the dens unites under adequate immobilisa tion, find opposition among the admonishers of surgical fusion.When there are clinical signs of a fracture of the dens, it is of the utmost importance to get X-ray films of excellent quality ...
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