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To discover the frequency of pyrexia in spinal cord injury (SCI) patients in the Hospital for Medicine of the Locomotor System (HMLS/SARAH), a review study was undertaken. For a period of 3 months, all new episodes of fever were recorded. During the study 221.3 patients/month were observed. The age ranged from 14 to 60 years and time of lesion from 1 to 6,264 days: 85 patients were paraplegia or paraparetic, and 44 tetraplegic or tetraparetic. At the beginning of the study 10.8% of the patients had fever. During follow up, we observed a rate of 33. 9 new incidences per 100 patients/month. In 77. 3% only one cause was identified, and in 8% no cause could be defined. The commonest causes were urinary tract infection (UTI) (44.3%), and soft tissue infections (11.4%). Frequent causes of fever in the acute stage other than UTI were complications related to the initial trauma and thromboembolic disease (p < 0.05). These results demonstrate the high incidence of fever in patients with SCI, in addition to providing a useful approach for diagnosis and management.

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Traumatic spinal cord lesions have a worldwide high morbidity and mortality, and in many developed countries the problem has received special attention, based on epidemiological studies. In Brazil these studies have been restricted to institutional data. In 1988 a survey conducted by the Integrated System of Traumatology and Orthopaedics, covering 36 public hospitals from 7 Brazilian capitals, revealed a point prevalence of 8.6% (108 patients) with spinal cord injury, aged from 6-56 years; 81% were men. The most frequent causes were traffic accidents (42%), firearms (27%) and falling from heights (15%). The main complications were pressure ulcers (54%) and urinary infections (32%).

Cardiac autonomic dysfunction expressed by reduced baroreflex bradycardia was detected in rats chronically infected with T cruzi, as in human Chagas' disease. The disturbance, shown for the first time in an animal model of chagasic infection, resulted primarily from impaired efferent parasympathetic activity caused by intrinsic neuroganglionar lesions.

Study design: Transversal. Objectives: The few studies concerning maximal static mouth respiratory pressures in patients with spinal cord lesions suggest a marked reduction. We studied the correlation of these parameters with the motor level of injury. Setting: Rehabilitation Center, Brası´lia/DF, Brazil. Methods: One hundred and thirty-one patients with traumatic spinal cord injury (C4-L3) were recruited. The participants were assessed by standard spirometry and maximal static mouth respiratory pressure. Results: Forced vital capacity was most reduced in tetraplegics (subgroup C4-C5, 49%725 predicted) and increase successively for each descending subgroup (C6-C8, 61%722 predicted; T1-T6, 70%715 predicted), becoming normal in low paraplegia (T7-L3, 84%715 predicted). There is no evidence of an obstructive disturbance throughout all groups. The lowest average percent predicted of maximal static inspiratory pressure (MIP) was in the subgroup C4-C5 (50%723). The average percent predicted of maximal static expiratory pressure (MEP) improved from 19%714 in the C4-C5 subgroup to 51%719 for T7-L3 subgroup. The average percent predicted of all participants for MIP was 74%730 and for MEP was 37%721. In patients with complete motor lesion, the correlation with the level of injury was stronger for MEP (r ¼ 0.81, Po0.0001; r 2 ¼ 0.65) than for MIP (r ¼ 0.62, P ¼ 0.004; r 2 ¼ 0.38). No correlation was found among incomplete motor lesion patients. Conclusions: The linear regression equations for the relationship of percent predicted MIP or MEP to level of injury are applicable only to complete motor lesions and may be useful to establish normative association between them.

-Objective: Heterotopic ossification (HO) is a complication of the spinal cord injury (SCI). It can result in anchylosis, harming the rehabilitation and quality of life. Previous publications had not elucidated the relation between possible independent variables, the aim of this study. Method: From 230 patients with SCI, admitted in 1998 at Hospital SARAH Brasilia, 33 with HO (14.3%; CI95% 10.1-19.6) were compared with 33 controls. The risk factors had been tested in bivariate analysis and in a model of logistic regression. Results: Spasticity (odds ratio=3.8; CI95% 1.15-12.30), number of pressure ulcers (2.1; CI95% 1.08-3.89) and time lapsed since the injury (1.1; CI95% 1.02-1.24) were independently associated with HO. There was a confounder effect among these variables, without interaction. Conclusion: Spasticity, pressure ulcer and time of injury are associated with HO in spinal cord injury. The first two factors can be prevented and treatable.Key wORdS: heterotopic ossification, spinal cord injuries, pressure ulcer, muscle spasticity, risk factors, multivariate analysis. fatores de risco da ossificação heterotópica na lesão medular traumáticaResumo -Objetivo: A ossificação heterotópica (OH) é uma complicação da lesão medular traumática (LMT). Pode resultar em anquilose, prejudicando a reabilitação e a qualidade de vida. estudos prévios não elucidaram a relação entre as potenciais variáveis independentes, propósito desse estudo. Método: de 230 pacientes com LMT, admitidos em 1998 no Hospital SARAH Brasília, 33 tiveram o diagnóstico de OH (14,4%; IC95% 10,1-19,6), que foram comparados a 33 controles. Os fatores de risco foram testados de forma bivariada e num modelo de regressão logística. Resultados: espasticidade (razão de chances 3,8; IC95% 1,15-12,30), número de escaras (2,1; 1,08-3,89) e tempo de lesão (1,1; 1,02-1,24) encontraram-se associadas, de forma independente, à presença de OH. Havia um efeito confundidor entre essas variáveis, porém sem interação. Conclusão: espasticidade, escaras e tempo de lesão estão associados à OH na lesão medular traumática. Os dois primeiros são passíveis de prevenção e tratamento. PALAvRAS-CHAve: ossificação heterotópica, traumatismos da medula espinal, úlcera de pressão, espasticidade muscular, fatores de risco, análise multivariada. Heterotopic ossification is a common complication of traumatic spinal cord injuries with a prevalence ranging from 5 to 50%, depending upon the studies design and the diagnosis method [1][2][3][4] . The progression of heterotopic ossification may lead to decreases in the range of motion and anchylosis and has a negative impact on the rehabilitation processes 3 . The most affected joints are the hips (60%-70%) and knees (20%-30%) 1 . The etiology and pathogenesis of heterotopic ossification are still unknown, but some factors appear to favor its onset in patients with traumatic spinal cord injuries: gender, age, completeness of the injury, presence of spasticity and decubitus ulcers [5][6][7][8] . However, various confounding and int...

It is reported our diagnosis and therapeutical experience with a patient that presented clinical, radiological and tomographical manifestations of paracoccidioidomycosis with involvement of lungs, brain and spinal cord. Besides being a rare case the authors call attention for the extreme difficulty in defining the final diagnosis, which was achieved only after laminectomy and surgical biopsy of the intra spinal cord tumor at the C5 level. The patient received two series of treatment with ketoconazole (400-600 mg/day). After both the patient presented tonic and clonic convulsive disorders. We speculated about a possible perigranulomatous inflammatory response related to the therapeutical intervention, not yet described in literature.