RESUMO
STUDY DESIGN: Prospective. OBJECTIVES: To test whether provocative stimulation of the testes identifies men with chronic spinal cord injury (SCI), a population in which serum testosterone concentrations are often depressed, possibly due to gonadal dysfunction. To accomplish this objective, conventional and lower than the conventional doses of human chorionic gonadotropin (hCG) were administered. METHODS: Thirty men with chronic SCI (duration of injury >1 year; 18 and 65 years old; 16 eugonadal (>12.1 nmol l-1) and 14 hypogonadal (⩽12.1 nmol l-1)) or able-bodied (AB) men (11 eugonadal and 27 hypogonadal) were recruited for the study. Stimulation tests were performed to quantify testicular responses to the intramuscular administration of hCG at three dose concentrations (ithat is, 400, 2000 and 4000 IU). The hCG was administered on two consecutive days, and blood was collected for serum testosterone in the early morning prior to each of the two injections; subjects returned on day 3 for a final blood sample collection. RESULTS: The average gonadal response in the SCI and AB groups to each dose of hCG was not significantly different in the hypogonadal or eugonadal subjects, with the mean serum testosterone concentrations in all groups demonstrating an adequate response. CONCLUSIONS: This work confirmed the absence of primary testicular dysfunction without additional benefit demonstrated of provocative stimulation of the testes with lower than conventional doses of hCG. Our findings support prior work that suggested a secondary testicular dysfunction that occurs in a majority of those with SCI and depressed serum testosterone concentrations.
Assuntos
Gonadotropina Coriônica/administração & dosagem , Hipogonadismo/diagnóstico , Traumatismos da Medula Espinal/complicações , Testículo/efeitos dos fármacos , Adolescente , Adulto , Idoso , Relação Dose-Resposta a Droga , Humanos , Hipogonadismo/etiologia , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Traumatismos da Medula Espinal/sangue , Testosterona/sangue , Adulto JovemRESUMO
Persons with spinal cord injury (SCI) undergo immediate unloading of the skeleton and, as a result, have severe bone loss below the level of lesion associated with increased risk of long-bone fractures. The pattern of bone loss in individuals with SCI differs from other forms of secondary osteoporosis because the skeleton above the level of lesion remains unaffected, while marked bone loss occurs in the regions of neurological impairment. Striking demineralization of the trabecular epiphyses of the distal femur (supracondylar) and proximal tibia occurs, with the knee region being highly vulnerable to fracture because many accidents occur while sitting in a wheelchair, making the knee region the first point of contact to any applied force. To quantify bone mineral density (BMD) at the knee, dual energy x-ray absorptiometry (DXA) and/or computed tomography (CT) bone densitometry are routinely employed in the clinical and research settings. A detailed review of imaging methods to acquire and quantify BMD at the distal femur and proximal tibia has not been performed to date but, if available, would serve as a reference for clinicians and researchers. This article will discuss the risk of fracture at the knee in persons with SCI, imaging methods to acquire and quantify BMD at the distal femur and proximal tibia, and treatment options available for prophylaxis against or reversal of osteoporosis in individuals with SCI.
Assuntos
Fêmur/fisiopatologia , Osteoporose/etiologia , Traumatismos da Medula Espinal/complicações , Tíbia/fisiopatologia , Absorciometria de Fóton/métodos , Densidade Óssea/fisiologia , Fêmur/diagnóstico por imagem , Humanos , Osteoporose/diagnóstico por imagem , Osteoporose/fisiopatologia , Medição de Risco/métodos , Traumatismos da Medula Espinal/fisiopatologia , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodosRESUMO
STUDY DESIGN: Prospective study. OBJECTIVE: To determine the integrity of the hypothalamic-pituitary-testicular axis in healthy men with spinal cord injury (SCI). METHODS: Thirty healthy men with chronic SCI (37±10 years) and thirty-eight able-bodied (AB) controls (36±10 years) participated. Gonadotropin-releasing hormone (GnRH; 100 µg IV) was administered to determine gonadotropin release, and human chorionic gonadotropin (hCG; 4000 IU IM) was administered to determine testosterone (T) secretion. Responses to stimulation were categorized as 'responder' or 'non-responder' by clinical criteria. Single factor ANOVA with repeated measures was performed to identify group differences. RESULTS: The proportion of responders to pituitary GnRH stimulation was similar in the SCI group (22 subjects (73%) for the follicular-stimulating hormone (FSH) and 23 subjects (76%) for the luteinizing hormone (LH) to that of the AB group. The SCI-responder group had an increased FSH response after stimulation compared with the AB-responder group (P<0.05). The SCI-responder group had a greater LH area under the curve to GnRH stimulation than the AB-responder group (P=0.06). The peak FSH response was at 60 min and the peak LH response at 30 min, regardless of group designation. All groups had similar increases in serum T concentration to hCG stimulation. CONCLUSIONS: The pituitary response to stimulation in healthy men with SCI revealed an augmented FSH response; LH response only trended higher. The testicular response to provocative stimulation was similar in hypogonadal and eugondal subjects and in GnRH responders and non-responders. These findings suggest a lack of hypothalamic drive of pituitary gonadotropin release in healthy people with chronic SCI.
Assuntos
Gonadotropina Coriônica/administração & dosagem , Hormônio Foliculoestimulante/sangue , Hormônio Liberador de Gonadotropina/administração & dosagem , Hormônio Luteinizante/sangue , Traumatismos da Medula Espinal/sangue , Testosterona/sangue , Administração Intravenosa , Adulto , Análise de Variância , Relação Dose-Resposta a Droga , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Traumatismos da Medula Espinal/fisiopatologia , Fatores de TempoRESUMO
The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) is routinely used to determine levels of injury and to classify the severity of the injury. Questions are often posed to the International Standards Committee of the American Spinal Injury Association (ASIA) regarding the classification. The committee felt that disseminating some of the challenging questions posed, as well as the responses, would be of benefit for professionals utilizing the ISNCSCI. Case scenarios that were submitted to the committee are presented with the responses as well as the thought processes considered by the committee members. The importance of this documentation is to clarify some points as well as update the SCI community regarding possible revisions that will be needed in the future based upon some rules that require clarification.
RESUMO
The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) is routinely used to determine the levels of injury and to classify the severity of the injury. Questions are often posed to the International Standards Committee of the American Spinal Injury Association regarding the classification. The committee felt that disseminating some of the challenging questions posed, as well as the responses, would be of benefit for professionals utilizing the ISNCSCI. Case scenarios that were submitted to the committee are presented with the responses as well as the thought processes considered by the committee members. The importance of this documentation is to clarify some points as well as update the SCI community regarding possible revisions that will be needed in the future based upon some rules that require clarification.
Assuntos
Traumatismos da Medula Espinal/classificação , Humanos , Exame Neurológico , Padrões de Referência , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/fisiopatologia , Vocabulário ControladoRESUMO
STUDY DESIGN: Randomized controlled trial with single-blinded primary outcome assessment. OBJECTIVES: To determine the efficacy and safety of autologous incubated macrophage treatment for improving neurological outcome in patients with acute, complete spinal cord injury (SCI). SETTING: Six SCI treatment centers in the United States and Israel. METHODS: Participants with traumatic complete SCI between C5 motor and T11 neurological levels who could receive macrophage therapy within 14 days of injury were randomly assigned in a 2:1 ratio to the treatment (autologous incubated macrophages) or control (standard of care) groups. Treatment group participants underwent macrophage injection into the caudal boundary of the SCI. The primary outcome measure was American Spinal Injury Association (ASIA) Impairment Scale (AIS) A-B or better at ≥6 months. Safety was assessed by analysis of adverse events (AEs). RESULTS: Of 43 participants (26 treatment, 17 control) having sufficient data for efficacy analysis, AIS A to B or better conversion was experienced by 7 treatment and 10 control participants; AIS A to C conversion was experienced by 2 treatment and 2 control participants. The primary outcome analysis for subjects with at least 6 months follow-up showed a trend favoring the control group that did not achieve statistical significance (P=0.053). The mean number of AEs reported per participant was not significantly different between the groups (P=0.942). CONCLUSION: The analysis failed to show a significant difference in primary outcome between the two groups. The study results do not support treatment of acute complete SCI with autologous incubated macrophage therapy as specified in this protocol.
Assuntos
Macrófagos/transplante , Traumatismos da Medula Espinal/cirurgia , Doença Aguda , Adolescente , Adulto , Terapia Baseada em Transplante de Células e Tecidos/efeitos adversos , Terapia Baseada em Transplante de Células e Tecidos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/patologia , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Transplante Autólogo/patologia , Falha de Tratamento , Adulto JovemRESUMO
Men with spinal cord injury are at an increased risk for secondary medical conditions, including metabolic disorders, accelerated musculoskeletal atrophy, and, for some, hypogonadism, a deficiency, which may further adversely affect metabolism and body composition. A prospective, open label, controlled drug intervention trial was performed to determine whether 12 months of testosterone replacement therapy increases lean tissue mass and resting energy expenditure in hypogonadal males with spinal cord injury. Healthy eugonadal (n = 11) and hypogonadal (n = 11) outpatients with chronic spinal cord injury were enrolled. Hypogonadal subjects received transdermal testosterone (5 or 10 mg) daily for 12 months. Measurements of body composition and resting energy expenditure were obtained at baseline and 12 months. The testosterone replacement therapy group increased lean tissue mass for total body (49.6 ± 7.6 vs. 53.1 ± 6.9 kg; p < 0.0005), trunk (24.1 ± 4.1 vs. 25.8 ± 3.8 kg; p < 0.005), leg (14.5 ± 2.7 vs. 15.8 ±2.6 kg; p = 0.005), and arm (7.6 ± 2.3 vs. 8.0 ± 2.2 kg; p < 0.005) from baseline to month 12. After testosterone replacement therapy, resting energy expenditure (1328 ± 262 vs. 1440 ± 262 kcal/d; p < 0.01) and percent predicted basal energy expenditure (73 ± 9 vs. 79 ± 10%; p < 0.05) were significantly increased. In conclusion, testosterone replacement therapy significantly improved lean tissue mass and energy expenditure in hypogonadal men with spinal cord injury, findings that would be expected to influence the practice of clinical care, if confirmed. Larger, randomized, controlled clinical trials should be performed to confirm and extend our preliminary findings.
Assuntos
Terapia de Reposição Hormonal/efeitos adversos , Hipogonadismo/complicações , Hipogonadismo/tratamento farmacológico , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/tratamento farmacológico , Testosterona/efeitos adversos , Testosterona/uso terapêutico , Adolescente , Adulto , Idoso , Composição Corporal , Exame Retal Digital , Metabolismo Energético , Humanos , Hipogonadismo/patologia , Hipogonadismo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Traumatismos da Medula Espinal/patologia , Traumatismos da Medula Espinal/fisiopatologia , Resultado do Tratamento , Adulto JovemRESUMO
STUDY DESIGN: Post hoc analysis from a randomized controlled cellular therapy trial in acute, complete spinal cord injury (SCI). OBJECTIVES: Description and quantitative review of study logistics, referral patterns, current practice patterns and subject demographics. SETTING: Subjects were recruited to one of six international study centers. METHODS: Data are presented from 1816 patients pre-screened, 75 participants screened and 50 randomized. RESULTS: Of the 1816 patients pre-screened, 53.7% did not meet initial study criteria, primarily due to an injury outside the time window (14 days) or failure to meet neurological criteria (complete SCI between C5 motor/C4 sensory and T11). MRIs were obtained on 339 patients; 51.0% were ineligible based on imaging criteria. Of the 75 participants enrolled, 25 failed screening (SF), leaving 50 randomized. The primary reason for SF was based on the neurological exam (51.9%), followed by failure to meet MRI criteria (22.2%). Of the 50 randomized subjects, there were no significant differences in demographics in the active versus control arms. In those participants for whom data was available, 93.8% (45 of 48) of randomized participants received steroids before study entry, whereas 94.0% (47 of 50) had spine surgery before study enrollment. CONCLUSION: The 'funnel effect' (large numbers of potentially eligible participants with a small number enrolled) impacts all trials, but was particularly challenging in this trial due to eligibility criteria and logistics. Data collected may provide information on current practice patterns and the issues encountered and addressed may facilitate design of future trials.
Assuntos
Transplante de Células/métodos , Traumatismos da Medula Espinal/cirurgia , Transplante Autólogo/métodos , Doença Aguda , Adolescente , Adulto , Técnicas de Cultura de Células , Técnicas de Cocultura , Feminino , Humanos , Israel , Macrófagos/patologia , Macrófagos/fisiologia , Macrófagos/transplante , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Traumatismos da Medula Espinal/patologia , Adulto JovemRESUMO
OBJECTIVE: To determine the effectiveness of acupuncture and Trager Psychophysical Integration (a form of manual therapy) in decreasing chronic shoulder pain in wheelchair users with spinal cord injury (SCI). DESIGN: A prospective clinical trial, with subjects randomized to acupuncture or Trager treatment condition. Subjects served as their own controls by including a 5-week pretreatment baseline period and a 5-week posttreatment follow-up period. SETTING: Rehabilitation hospital research department. PARTICIPANTS: Eighteen subjects with chronic SCI and chronic shoulder pain who used manual wheelchairs as their primary means of mobility. INTERVENTION: Ten acupuncture or 10 Trager treatments over a 5-week period. MAIN OUTCOME MEASURES: Changes in performance-corrected Wheelchair User's Shoulder Pain Index (PC-WUSPI) scores during baseline, treatment, and follow-up periods were assessed by using analysis of variance. RESULTS: The mean PC-WUSPI score +/- standard deviation of the 18 subjects at entry was 48.9 +/- 24.6 (range, 8.0-94). No significant change in mean PC-WUSPI scores occurred during the pretreatment baseline period. Mean PC-WUSPI scores decreased significantly during the treatment period in both the acupuncture (53.4%; 23.3 points) and Trager (53.8%; 21.7 points) treatment groups. The reduced PC-WUSPI scores were maintained in both groups throughout the 5-week posttreatment follow-up period. CONCLUSION: Acupuncture and Trager are both effective treatments for reducing chronic shoulder pain associated with functional activities in persons with SCI.
Assuntos
Terapia por Acupuntura/métodos , Psicofisiologia/métodos , Dor de Ombro/etiologia , Dor de Ombro/reabilitação , Traumatismos da Medula Espinal/reabilitação , Cadeiras de Rodas , Adulto , Idoso , Análise de Variância , Anti-Inflamatórios não Esteroides/uso terapêutico , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Centros de Reabilitação , Inquéritos e Questionários , Resultado do TratamentoRESUMO
An important aspect of respiratory management in patients with acute spinal cord injury (SCI) is the elimination of secretions. Methods utilized for secretion management in patients with SCI includes endotracheal suctioning and mechanical in-exsufflation (MI-E). Surveyed here is a group of patients with SCI who have had experience with both endotracheal suctioning and MI-E via tracheostomy, to determine patient opinions and experiences regarding the 2 techniques. The survey was administered to 18 patients with traumatic SCI, with an average age of 34. 72% were ASIA A, 22% percent were ASIA B, and 6% were ASIA C, with neurological level of injury ranging from C-1-T-3. Results indicate that patients found MI-E significantly less irritating (p < 0.001), less painful (p < 0.001), less tiring (p = 0.01), and less uncomfortable (p < 0.001) than endotracheal suctioning. In a direct comparison, 89% of patients preferred mechanical in-exsufflation to suctioning. In addition, 89% of patients found MI-E faster, 78% found MI-E more convenient, and 72% found MI-E more effective than suctioning. This study demonstrates that all measured aspects of patient experience are more positive for MI-E than for endotracheal suctioning.
Assuntos
Terapia Respiratória , Traumatismos da Medula Espinal/reabilitação , Sucção , Traqueostomia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Respiratória/psicologia , Traumatismos da Medula Espinal/psicologia , Sucção/psicologia , Traqueostomia/psicologiaRESUMO
A comprehensive physical examination of the patient with acute spinal cord injury is essential in determining the initial level of injury and is the most accurate method of prognosticating neurologic recovery. Understanding neurologic recovery helps predict ultimate functional capability and needs, and helps evaluate the effectiveness of pharmacologic and therapeutic interventions.
Assuntos
Traumatismos da Medula Espinal/reabilitação , Humanos , Paraplegia/reabilitação , Prognóstico , Quadriplegia/reabilitação , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/terapiaRESUMO
BACKGROUND: Recent case reports implicate peripheral vascular disease (PVD) as an etiology for pressure ulcers (PU), failed myocutaneous flap surgeries, and amputation in spinal cord injury (SCI). Early detection of PVD is complicated by motor and sensory deficits in this population. The ankle-brachial index (ABI) is used to quantify PVD in the able-bodied population. We hypothesized that the ABI would be a useful screening tool for detecting PVD in patients with SCI. Differences in baseline blood pressure, as well as motor and sympathetic function, could potentially alter ABI, so values were studied in a sample of patients with SCI without risk factors or signs of PVD, and compared to those in able-bodied controls without PVD. METHODS: ABI values were measured in 15 healthy individuals with chronic complete SCI above the T6 level, who had no evidence for risk factors or physical findings of PVD, and compared with the values for a group of 10 able-bodied controls. RESULTS: No statistically significant difference in ABI was found between patients with SCI and the able-bodied comparison group. There was no statistically significant correlation between ABI and post-injury duration or incidence of PU. CONCLUSION: ABI may prove to be a useful screening device in individuals with SCI. Follow-up studies are needed to confirm these findings and to ascertain that the ABI correlates with presence and severity of PVD in patients with SCI who have risk factors and signs of PVD.
Assuntos
Tornozelo/irrigação sanguínea , Pressão Sanguínea/fisiologia , Artéria Braquial/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Reprodutibilidade dos Testes , Vértebras TorácicasRESUMO
Enoxaparin, a low molecular weight heparin, has been demonstrated to be effective in the prophylaxis and treatment of deep vein thrombosis (DVT) in the general population. This study presents an analysis of the costs of subcutaneous (SQ) enoxaparin compared with intravenous (IV) heparin. Data were gathered on six spinal cord injured (SCI) patients in an acute freestanding rehabilitation center who were initially treated with SQ enoxaparin (n=3) or IV heparin (n=3) for a proximal DVT. No patients in either group developed further clinical complications. Comparison of the total costs of each treatment was performed, including the direct cost of the drug, as well as some of the costs of administration. Although the cost of enoxaparin per unit dose is higher, the total costs of enoxaparin are slightly lower, because its labor and administration costs are less. Subcutaneous enoxaparin is a safe, cost-effective, and less labor-intensive treatment, and can be of substantial benefit in the treatment of DVT in SCI patients in the rehabilitation setting.
Assuntos
Anticoagulantes/economia , Enoxaparina/economia , Traumatismos da Medula Espinal/economia , Tromboflebite/economia , Adulto , Anticoagulantes/administração & dosagem , Análise Custo-Benefício , Custos e Análise de Custo , Enoxaparina/administração & dosagem , Feminino , Heparina/administração & dosagem , Heparina/economia , Humanos , Infusões Intravenosas , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Centros de Reabilitação/economia , Estudos Retrospectivos , Traumatismos da Medula Espinal/complicações , Tromboflebite/tratamento farmacológicoRESUMO
OBJECTIVE: Traumatic spinal cord injury (SCI) affects 8,000 to 10,000 individuals per year in the United States. One of the most difficult tasks confronting the clinician is the discussion of neurologic recovery and prognosis with the patient and/or family. Our objective is to provide a guide for practitioners to accurately predict neurologic outcome in acute traumatic cervical SCI (tetraplegia). DATA SOURCE: Published reports obtained through MEDLINE search, texts, and studies presented at national conferences. STUDY SELECTION: Peer reviewed studies, in English language, that discussed prognosis after traumatic SCI. CONCLUSION: A comprehensive physical examination of the acute SCI patient is essential in determining the initial level and classification of the injury and is the most accurate method to predict neurologic recovery. Other diagnostic tests, including somatosensory evoked potentials, magnetic resonance imaging, and transcranial magnetic stimulation, may be helpful in further determining outcome when used in association with the clinical examination. The understanding of neurologic recovery should help predict ultimate functional capability and potential needs.
Assuntos
Traumatismos da Medula Espinal/reabilitação , Humanos , Imageamento por Ressonância Magnética , Prognóstico , Quadriplegia/fisiopatologia , Quadriplegia/reabilitação , Sensação , Traumatismos da Medula Espinal/fisiopatologia , Síndrome , Resultado do TratamentoRESUMO
OBJECTIVE: To study the effect of a 2-week clerkship on the perceptions and knowledge of physical medicine and rehabilitation (PM&R) among fourth-year medical students. DESIGN: Survey of fourth-year medical students before and after completion of a mandatory clerkship. RESULTS: Knowledge of PM&R by fourth-year medical students is marginal, but a clerkship increases the awareness of the practice of physiatry. CONCLUSIONS: Mandatory clerkships can help expose future physicians to the benefits of physiatric services and should be pursued by academic PM&R departments.
Assuntos
Estágio Clínico/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Medicina Física e Reabilitação/educação , Medicina Física e Reabilitação/organização & administração , Estudantes de Medicina , Escolha da Profissão , Avaliação Educacional , Humanos , Avaliação de Programas e Projetos de Saúde , Estudantes de Medicina/psicologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To determine current characteristics of bowel care practices of chronic spinal cord injury (SCI) patients. DESIGN: Prospective interview and examination of 100 SCI patients injured for more than 1 year. SETTING: Freestanding rehabilitation outpatient SCI center. PARTICIPANTS: One hundred chronic SCI patients. RESULTS: The following bowel program characteristics were found: alternate-day programs were most common; most subjects performed their programs in the morning; and tetraplegic subjects performed their programs less often, used suppositories more often, required greater assistance, and took longer to complete their programs. CONCLUSIONS: Bowel dysfunction in chronic SCI need not be associated with complications in the majority of cases.
Assuntos
Incontinência Fecal/reabilitação , Autocuidado/métodos , Traumatismos da Medula Espinal/complicações , Atividades Cotidianas , Adolescente , Adulto , Idoso , Catárticos/uso terapêutico , Doença Crônica , Constipação Intestinal/etiologia , Diarreia/etiologia , Incontinência Fecal/etiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Fatores de TempoRESUMO
A prospective, blinded study of 40 hospitalized spinal cord injured (SCI) patients was conducted to evaluate the effects of refrigeration on urinalysis and culture results. Urine samples were divided, with one aliquot examined within 4 hours and the other after 24 hours of refrigeration. Comparisons using Wilcoxon Signed Rank analysis showed no significant difference between fresh and refrigerated samples in white blood cell (WBC) count (z = -0.353, p = 0.724), number of bacteria (z = -0.772, p = 0.440), leukocytes (z = -0.277, p = 0.782), or colony counts of E. fecalis, E. coli, Citrobacter, Pseudomonas, Streptococcus, Yeast, or Acinetobacter (z = -1.00, p = 0.317; z = 0.00, p = 1.0; z = 0.00, p = 1.0; z = 0.00, p = 1.0; z = -1.00, p = 0.317; z = 0.00, p = 1.0; z = 0.00, p = 1.0, respectively). A statistically significant difference between fresh and refrigerated samples was found with "mixed" organisms (z = -2.565, p = 0.010) and a difference approaching significance was found with Staph aureus (z = -1.841, p = 0.066), both with colony counts of less than 50 k. No changes in cultures or colony counts occurred following refrigeration that would have resulted in altered treatment regimens. This study indicates that refrigeration of urine samples for up to 24 hours in the hospital setting rarely causes changes in identified organism type and causes no clinically significant changes in urinalysis or urine culture results in SCI patients.
Assuntos
Contagem de Colônia Microbiana , Hospitalização , Refrigeração , Traumatismos da Medula Espinal/urina , Bexiga Urinaria Neurogênica/microbiologia , Infecções Urinárias/diagnóstico , Método Duplo-Cego , Humanos , Estudos Prospectivos , Infecções Urinárias/microbiologia , Infecções Urinárias/urinaRESUMO
This study was conducted to further investigate the natural history of the anemia, hypoproteinemia and hypoalbuminemia commonly observed in patients with traumatic spinal cord injury (SCI). Blood samples were taken from 46 traumatic SCI patients at the time of initial admission to an acute rehabilitation hospital and again approximately one year later during a routine follow-up appointment. At initial admission, 65 percent of patients were anemic (hemoglobin < 13.0 g/dl), 86.7 percent were hypoalbuminemic (albumin < 3.2 g/dl) and 48.9 percent were hypoproteinemic (total protein < 6.5 g/dl). Deficiencies were most commonly observed in tetraplegics and in patients with complete injuries. At the time of follow-up, 6.8 percent of patients were anemic, 2.2 percent demonstrated abnormally low serum protein concentrations and a significant (p = 0.01) decrease in the incidence of each deficiency was observed. Our findings suggest that anemia and decreased serum protein concentrations, while commonly observed in the acute SCI population, are much less frequently encountered in the more chronically injured. If noted in the chronic SCI patient, these deficiencies should alert clinicians to the likelihood of a concurrent process.
Assuntos
Anemia/etiologia , Proteínas Sanguíneas/deficiência , Traumatismos da Medula Espinal/complicações , Adulto , Feminino , Seguimentos , Humanos , Masculino , Paraplegia/sangue , Paraplegia/etiologia , Quadriplegia/sangue , Quadriplegia/etiologia , Albumina Sérica/deficiência , Traumatismos da Medula Espinal/reabilitaçãoRESUMO
Spinal cord injury (SCI) impacts metabolic function and deranges various hormonal axes. Previous studies characterizing thyroid hormones in SCI reported depressed triiodothyronine (T3) and thyroxin (T4), primarily in acute tetraplegics. These studies cited an 11-13 percent incidence of low T3 syndrome (LT3S) in SCI patients, with an increased incidence in tetraplegics (20-36 percent). The purpose of this study was to evaluate thyroid function and determine the incidence and clinical relevance of LT3S in the chronic SCI population. Thyroid function tests were performed on 30 chronic SCI patients (14 tetraplegics and 16 paraplegics) and 30 age- and gender-matched controls. Mean T3 and T4 levels were significantly depressed in SCI patients relative to controls, while T3 resin uptake (T3RU) values were significantly elevated. LT3S only occurred in the SCI population with an incidence of 23.3 percent. SCI patients with LT3S did not differ significantly from those without in the level or completeness of injury, age or the interval since injury. They did, however, have co-existent pathology: decubiti, urinary tract infections, etc. When SCI patients with normal T3 were compared with controls, they still had depressed mean T3 levels. We conclude that LT3S occurs frequently in the chronic SCI population and suggest that depressed serum T3 levels may predispose SCI patients to sick euthyroidism in the face of minor pathologic insult.
Assuntos
Síndromes do Eutireóideo Doente/fisiopatologia , Quadriplegia/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Hormônios Tireóideos/sangue , Atividades Cotidianas/classificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Metabolismo Energético/fisiologia , Síndromes do Eutireóideo Doente/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/fisiopatologia , Testes de Função Tireóidea , Tiroxina/sangue , Tri-Iodotironina/sangueRESUMO
To understand better how career choices are made by physiatrists, a 16-item, 7-page questionnaire was sent to all 1994 graduating physical medicine and rehabilitation (PM&R) resident physicians in the United States. Of the 343 senior residents, 202 completed the questionnaire for a response rate of 59%. The questionnaire focused on the following areas: timing of the decision to enter PM&R; and how the medical school curriculum, certain groups of people, and certain specific factors influenced their choices. There were 130 factors modeled after the American Association of Medical Colleges (AAMC) annual medical student questionnaire that the recipients were asked to grade on a numerical scale: 1 = unimportant to 5 = very important. Of the graduating residents, 60.1% (119/198) made the decision to enter PM&R in their 3rd or 4th yr of medical school, 13.1% (26/198) in the first 2 yr, and 11.1% (22/198) after starting another residency. The five factors ranked most important in the decision were (mean rank score): sufficient time/flexibility for family obligations (4.60); opportunity to make a difference in peoples lives (4.57); interest in helping people (4.55); types of patient problems encountered (4.50); and consistency with personality (4.49). We also obtained the AAMC's 1993 annual data on medical students choosing PM&R. Their top five factors were the same as those listed by the graduating residents, but in a slightly different rank order. Profiles have also been derived on those graduating PM&R residents who chose an academic career (n = 68) v nonacademic (n = 133) and fellowship (n = 34) v nonfellowship (n = 163).