Medical conditions and outcomes at 1 year after acute traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study.

STUDY DESIGN: Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS). OBJECTIVES: To evaluate and compare outcomes, length of stay (LOS), associated conditions and medical complications at 1-year post-trauma. SETTINGS: The Greater Thessaloniki region, Greece, and the Greater Stockholm region, Sweden. While Stockholm follows a SCI system of care, Thessaloniki follows a fragmented 'non-system' approach. SUBJECTS: Out of the 87 cases in Thessaloniki and the 49 cases in Stockholm who comprised the study population of STATSCIS, 75 and 42 cases respectively were successfully followed-up during the first year post-trauma. RESULTS: Significantly superior outcomes (that is, survival with neurological recovery, functional ability and discharge to home) and shorter LOS for initially motor complete cases occurred in Stockholm. Management routines known to increase long-term morbidity, for example, long-term tracheostomy and indwelling urethral catheters were significantly more common in Thessaloniki. Major medical complications, that is, multiple pressure ulcers, heterotopic ossification and bacteremia/sepsis were more frequent in Thessaloniki. CONCLUSIONS: Our findings show how two rather similar cohorts of TSCI manifest large discrepancies in terms of 1-year outcomes and complications, depending on the type of management they receive. As the major difference between regions was the presence or absence of a SCI system of care, rather than differences in availability of modern medicine, the mere presence of the latter does not seem to be sufficient to guarantee adequate outcomes. This study provides strong evidence as to the urgent need of implementing a SCI system of care in Greece.

A clinical and immunological study of a myasthenia gravis patient treated with infliximab.

OBJECTIVES: To measure clinical and immunological parameters in a patient with myasthenia gravis (MG) treated with antibodies against tumour necrosis factor-alpha (infliximab, Remicade). PATIENT AND METHODS: A patient with severe MG received repeated injections of infliximab. His muscle function score was monitored and the immunological parameters were followed using enzyme-linked immunosorbent assay, flow cytometry and radioimmunoassay. RESULTS: The patient improved in muscle fatigability tests and the levels of antibodies against the acetylcholine receptor decreased during treatment. The activation marker human leucocyte antigen-DR on CD4(+) T cells also decreased. CONCLUSION: Treatment with infliximab might be beneficial for patients with severe MG but demands careful monitoring of possible serious side-effects.

Acute effects of intravenous injection of beta-adrenoreceptor- and calcium channel at antagonists and agonists in myasthenia gravis.

The effect of intravenous injection of propranolol, verapamil, terbutaline, calcium, and edrophonium on neuromuscular transmission has been studied with repetitive nerve stimulation and clinical tests in 10 patients with myasthenia gravis (MG). The drugs were given intravenously in doses commonly used in clinical practice. Only minor clinical effects were noted except for edrophonium. The mean decrement of the deltoid muscle was not significantly changed after injection of propranolol (before 31%, 15 min after injection 27%) and verapamil (before 29%, 15 min after injection 26%). Terbutaline applied after propranolol and calcium applied after verapamil improved the decrement substantially. Edrophonium applied after propranolol or verapamil also greatly improved the decrement. We conclude that there is no rapid deterioration of neuromuscular transmission in patients with moderately severe MG after injections with therapeutic doses of propranolol and verapamil. However, we do not know if the most severely disabled MG patient could have reacted otherwise. We consider that, in cardiovascular emergencies, propranolol and verapamil may be used even in severe MG but with resuscitation equipment as well as specific antidotes available.