Mortality, morbidity, health, functional, and psychosocial outcomes were exa mined in 834 individuals with long term spinal cord injuries. All were treated at one of two British spinal injury centres: the National Spinal Injuries Centre at Stoke Mandeville Hospital or the Regional Spinal Injuries Centre in Southport; all were 20 or more years post injury. Using life table techniques, median survival time was determined for the overall sample (32 years), and for various subgroups based on level and completeness of injury and age at injury. With the number of renal deaths decreasing over time, the cause of death patterns in the study group as it aged began to approximate those of the general population. Morbidity patterns were found to be associated with age, years post injury, or a combination of these factors, depending upon the particular medical compli cation examined. A current medical examination of 282 of the survivors revealed significant declines in functional abilities associated with the aging process. Declines with age also were found in measures of handicap and life satisfaction, but three quarters of those interviewed reported generally good health and rated their current quality of life as either good or excellent.
Abstract. The purpose of this study is to investigate the use of a three-phase bone scan for early detection of HO formation and as a method of evaluating Didronel treatment.A marked vascular blush and blood pool was noted about the hips sometimes with a normal bone scan and normal X-ray of the hips. This appeared to represent the pre cursor phase of HO formation since, on repeat scans, the bone scan showed accumulation of the bone-seeking radionuclide usually in 2 to 4 weeks and the X -ray revealed ossification.Fifty-two patients treated with Didronel between October 1978 and December 1979 were reviewed to determine the value of Didronel treatment.There were 23 patients in the series who either showed HO by X-ray on admission or developed HO on follow-up X-rays before beginning Didronel therapy. A three phase bone scan revealed increased vascularity and accumulation of radioactivity on the bone scan in all areas of ossification on the X-ray and in some areas that did not appear to be involved. The other 29 patients had serial three-phase bone scans, X-ray study, and an alkaline phosphatase determination at approximately 2-week intervals. Didronel treatment was started as soon as the precursor phase of HO was demon strated on the three-phase bone scan in most of these patients. Nine have not developed ossification that could be seen in X-rays during 3 months of continuing study.Six patients seen at follow-up during the past year had known HO of 4 to 7 years' duration. The three-phase bone scan was used to predict the maturity of HO in these patients.Our study indicates that increased vascularity precedes rather than being secondary to HO formation as is suggested in the literature. Didronel treatment appears to be most effective if initiated during this precursor phase.
Outcomes of bowel management were evaluated in 1993 among 221 British long-term spinal cord injury survivors who were followed-up as part of a longitudinal study of aging with spinal cord injury. Representing a population-based sample followed up by two regional spinal cord injury treatment centres ± Stoke Mandeville Hospital in Aylesbury and the District General Hospital in Southport, England ± all had been injured at least 20 years when the study was begun in 1990; all underwent comprehensive assessments and extensive interviewing at their centres in 1990 and 1993. When assessed in 1993, 42% of the entire sample reported constipation, 35% reported gastrointestinal pain, and 27% complained of bowel accidents. Physician examiners diagnosed signi®cantly more hemorrhoids among those using primarily suppositories and enemas to manage their bowels (P50.05) and more constipation among persons with paraplegia (P50.05) and those using digital stimulation, manual evacuation, or increased abdominal pressure in their bowel programs. Fecal incontinence and diarrhea was diagnosed three times more often in participants with tetraplegia as in other neurological groupings. These and other ®ndings suggest future research needs and directions relative to long-term bowel management for spinal cord injury survivors.
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