Rehabilitation in spinal cord disorders. 3. Comprehensive management of spinal cord injury.

This self-directed learning module highlights advances in the management of the person with a spinal cord deficit. Traumatic spinal cord injury is being used as the model, but the principles apply to all patients with spinal cord deficits. This article is part of the chapter on rehabilitation of spinal cord disorders for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. Specifically, this section contains information regarding prehospital care, acute assessment and management, primary rehabilitation by systems, sexuality and psychosocial issues, management of pain and spasticity, functional goals, the role of functional electrical stimulation, and long-term follow-up.

Experimental evaluation of nonspecific immunostimulation and chemotherapy in the intracranial tumor-bearing Fisher rat.

One hundred sixty rats bearing intracranial tumors were divided into groups of 10 to evaluate C-I interval +, effect of chemotherapy alone (BCNU), chemotherapy and C. parvum, and C. parvum alone in the rat tumor model. All therapy was administered intraperitoneally: BCNU -5.2 mg/kg (40% of LD10) on the 9th and 16th post tumor implant day, and C. parvum-1.4 mg regardless of the body weight and the 6th or 23rd day and 6th and 23rd post tumor implant day. An additional group received BCNU on the 9th and 16th day and C. parvum every 3rd day beginning with the 11th post implant day. It is concluded that C. parvum given before BCNU yields the greatest increase in survival in this animal system. Two or more injections were detrimental and injections after BCNU were of less value. C. parvum alone was minimally effective. If nonspecific immunostimulation is contemplated in this animal tumor system, it would appear to be best given before chemotherapy. This may relate to the brain as a "privileged immune site", or a peculiarity of the blood brain barrier in an intracranial lesion as it related to combined therapy.