The incidence rate for acute traumatic spinal cord injury in Olmsted County, Minnesota, for 1935-1981, standardizing for age, sex, and calendar year, was 54.8 per million person-years--83.4 for males and 27.7 for females. Thirty-eight per cent of cases died prior to hospitalization. The annual incidence rate for those reaching hospital alive was 34.2 per million person-years. The proportion of cases dying during initial hospitalization was 11.5%. Considering all deaths within the first year after injury, the standardized mortality rate from spinal cord trauma was 25.5 per million person-years. Automobile-related injuries constituted half of all causes of spinal cord injury and death. An increase in both incidence and hospitalization rates of traumatic spinal cord injuries in the past 17 years was observed in young men, attributable to recreational and motorcycle-related events.
Patients with symptoms suggestive of prostatitis or prostatosis who do not have pathogenic bacteria in the prostatic secretions may, in fact, not have prostatic problems. The possibility of pelvic floor tension myalgia should be considered in these patients.
Since 1971, intermittent urinary catheterization has been practiced at our institution for the bladder (2, 4) retraining of patients with neurogenic bladder dysfunction. Catheterization is done every 4 to 6 h, until bladder retraining is accomplished, usually within a period of 6 to 8 weeks.It is well known that urinary catheterization is a frequent cause ofhospital-acquired infection. When bacteriuria occurs during bladder retraining, it is our practice to terminate this aspect of rehabilitation until the infection has been successfully eradicated. This complication prolongs rehabilitation and hospitalization. Unless contraindicated, all patients are given suppressive medication (methenamine mandelate or methenamine hippurate with ascorbic acid), with daily monitoring of urine pH and weekly monitoring of urine cultures. From 1971 to 1972, we noted that at least 50% of our patients developed bacteriuria during bladder retraining (unpublished data).In 1973, we tried to reduce the incidence of bacteriuria by the routine instillation of 0.1% neomycin solution after each intermittent catheterization. This report relates our experience with neomycin in 1974 and compares it with that of a subsequent year (1975) in which neomycin was not given and when other variables did not appear to be significantly different in the patient population.
MATERIALS AND METHODSThe criterion for inclusion in the study was the absence of bacteriuria at the beginning of intermittent urinary catheterization. When patients developed bacteriuria with 10i colonies or greater per ml of urine, it was considered significant. When bacteriuria due to the same organism(s) was persistent, it was counted only once.Patient population. Group A included 53 patients (33 males and 20 females) who in 1974 received instillation of neomycin after each intermittent catheterization for a mean of 6 weeks, a range of 1 to 19 weeks, and a median of 4 weeks.Group B included 55 patients (33 males and 22 females) who in 1975 did not receive instillation of neomycin and were bladder retrained for a mean of 5.5 weeks, a range of 1 to 16 weeks, and a median of 4 weeks.Underlying diseases of the patients in both study groups are shown in Table 1, with the most frequent problem being spinal cord trauma, followed by vascular diseases, multiple sclerosis, cancer, and miscellaneous disorders.A urinary suppressive drug, either methenamine mandelate or methenamine hippurate with ascorbic acid, was administered to 92% of the neomycin-treated group and to 77% of the control group. The mean urine pH for patients from both groups was 5.7. Two-thirds of patients from both groups were receiving concomitant systemic antibiotics at some time during the study.
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