Early spermatogenesis changes in traumatic complete spinal cord-injured adult patients.

STUDY DESIGN: Prospective longitudinal study. OBJECTIVES: To assess the impact of spinal cord injury (SCI) on the spermatogenesis of patients studied in the early subacute stage and ensuing months. SETTING: National hospital for SCI patients. METHODS: A prospective follow-up study was conducted on 28 male patients with complete SCI who were evaluated in the early subacute phase (~1 month), and 3 and 6 months after the injury. At each time point, fine needle aspiration biopsy samples were taken from the testes for cytological assessment, and serum levels of relevant hormones were measured. At the end of the study period, ejaculation was attempted for standard semen analyses. RESULTS: Cytological patterns indicative of defective spermatogenesis were found in 61%, 52% and 20% of the patients at 1, 3 and 6 months after SCI, respectively, suggesting an improvement over time. Serum hormone analyses showed a steady elevation of estradiol levels above the reference range, and increasing levels of testosterone, inhibin B and prolactin throughout the study period. Prolactin levels were above the reference range at all time points. Only 2 out of the 10 patients who were able to ejaculate at 6 months post injury showed normal sperm parameters. CONCLUSION: A majority of the patients showed impaired spermatogenesis soon after the injury, which in most cases recovered over time. That was accompanied by parallel increases in serum levels of inhibin B, testosterone and prolactin, possibly driving or reflecting the spermatogenesis recovery. Further studies are needed to elucidate the biological mechanisms underlying these changes.

Guía de práctica clínica para el tratamiento de la espasticidad espinal con toxina botulínica / Clinical practice guideline for the treatment of spinal spasticity with botulinum toxin

Introducción. Hasta en un 70% de los pacientes con lesión medular aparece espasticidad; la necesidad de tratarla va aumentando progresivamente con el tiempo de evolución. La espasticidad espinal suele ser generalizada y la toxina botulínica puede ser útil como tratamiento adyuvante al farmacológico para resolver problemas concretos. Las guías de práctica clínica son instrumentos que facilitan la toma de decisiones y mejoran los resultados clínicos. Material y método. Presentamos el protocolo de valoración y tratamiento con toxina botulínica definido tomando como base las peculiaridades clínicas propias de la espasticidad asociada a la lesión medular. Resultados y conclusiones. El uso de esta guía en nuestro centro nos ha permitido estandarizar la selección del paciente con espasticidad espinal y establecer unos objetivos claros de tratamiento y un plan apropiado de seguimiento, facilitando la valoración objetiva de los resultados (AU)

Introduction. Spasticity occurs in approximately 70% of patients with a spinal cord injury. The need for treatment progressively increases from the time of injury. In spinal spasticity, which is usually generalized, botulinum toxin is useful as an adjuvant therapy in specific situations. Clinical practice guidelines are tools that enhance decision-making and improve clinical outcomes. Material and methods. We present a protocol for spinal spasticity assessment and treatment with botulinum toxin designed according to the specific features of spasticity associated with spinal cord injury. Results and conclusions. The use of this protocol at our center has allowed us to standardize the selection of patients with spinal spasticity, to define clear treatment aims and to develop an accurate follow up schedule, thus aiding objective assessment of results (AU)

Ectasia dural y dolor lumbar en el síndrome de Marfan / Dural ectasia and lumbar pain associated with Marfan syndrome

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