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A retrospective study of 106 tetraplegic patients admitted consecutively to the Santa Clara Valley Medical Center (SCVMC) between August, 1981 and September, 1983 was conducted. The average age was 28; and 20 (19%) were female. The majority sustained their spinal cord injury in a motor vehicle accident (65%) or in a diving accident (19%). Forty-nine percent (52/106) of these patients had acute surgical intervention, and 63% (33/52) of these patients had this prior to admission to SCVMC. The majority (35/52) had posterior fusion alone. Twelve patients had an anterior fusion (11 at other hospitals) and four a laminectomy alone (three carried out at other hospitals). The length of rehabilitation stay was 133 days for those having surgery, and 119 days for non-surgical cases; statistically a non-significant difference. When acute medical/surgical hospitalisation and rehabilitation days were combined, those having surgery had a significantly longer stay (197 versus 153 days), but only when surgery was done other than at SCVMC. Complications occurred in 50/106 (47%) of the patients: 50% who had surgery and 44% who were treated conservatively. The most commonest complication was respiratory (43%), including 20% who had pneumonia. Complications were no greater in those patients who underwent posterior fusion than in those who had no spinal surgery. However, other types of surgery carried a higher risk of complications by approximately 20%. Anterior fusions and laminectomies, performed almost totally at other institutions (15/17), had a higher rate of complications.
Paraplegia 1986 Jun
PMID:Evaluation of the acute management of tetraplegia: conservative versus surgical treatment. 374 93

During a two-year period we admitted 13 respirator-dependent quadriplegic patients to the spinal cord injury service at Wood VAMC for weaning from a mechanical ventilator, and rehabilitation. The patients were sent to the Spinal Cord Injury Center because initial weaning attempts from the respirator at other medical centers were unsuccessful. We successfully weaned them from the respirator, and at the time of discharge, only two patients required an indwelling tracheostomy tube for suction. The time required for weaning off the respirator varied from two days to 14 months. Most of the patients were discharged and many of them could independently perform the activities of daily living. We conclude that are four main factors which influence the successful weaning of dependent quadriplegics from the mechanical ventilator: alleviation of patient's anxiety and depression; family support; close working relationship between staff; prevention of complications such as pneumonia and urinary tract infections.
J Am Paraplegia Soc 1985 Apr
PMID:Respirator-dependent quadriplegics: problems during the weaning period. 384 80

Report of a now 2 8/12-year-old girl, who presented at the age of 8 months with chronic progressive pneumonia, mucocutaneous candidiasis, diarrhea, failure to thrive and a non-progressive paraplegia. The child's mother presented AIDS with pneumocystis carinii pneumonia and progressive general paralysis one year after the beginning of the child's disease and died within a few months. Additional findings in the child include lymphopenia, hyperimmunoglobulinemia, cutaneous anergy and an abnormal T helper/T suppressor cell ratio. HTLV-III antibodies were positive (ELISA and Western blot virus strip RIA). Prophylactic treatment with Co-trimoxazole relieved pulmonary infections but failure to thrive remained unchanged in spite of a continuous nutritional support. A vertical mode of transmission of AIDS from mother to child seems very probable.
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PMID:[Acquired immunodeficiency syndrome in a child of Swiss origin whose mother died from AIDS]. 387 45

A 44-year-old male underwent a cadaveric renal transplantation at the university hospital of Tsukuba on March 3, 1979. On June 11, 1979, he was discharged this hospital. Immunosuppressive therapy with azathioprine and methylprednisolone was done. On November 1, 1979, he developed back pain associated with fever. On November 3, 1979, he was admitted to the university hospital of Tsukuba. Laboratory study revealed leucocytosis. CRP inserum was positive. But pneumonia, urinary tract infection and infectious skin lesion were ruled out by physical, radiological and laboratory examination. On November 16, 1979, he became paraparetic. On the next day, he consulted the neurosurgical unit. Neurological findings were as follows: paraplegia, and hypesthesia and hypalgesia below the level of T4, and bilateral hyperrefrexia of P.T.R. and A.T.R. Lumbar myelogram revealed a complete block at the level T7. On November 17, 1979, a laminectomy from T4 through T7 was performed. The epidural abscess containing yellow pus was found and totally removed. Gram-positive rods were isolated on bacteriologic culture. On the 7th postoperative day, the sensory level dropped to L4 bilaterally and the muscle strength in the lower extremity became fair. About 3 years after operation, he became to be able to walk without cane. Discussion was made about this case together with previously reported cases.
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PMID:[A case of spinal epidural abscess in a renal transplant recipient]. 637 92

Survival, mortality rates, and causes of death were determined for 132 myelopathy patients during the 9-year period between April 1973 and March 1982. The average age was 54; 81% were paralyzed by trauma. Average survival was 15 years. Myelopathy mortality was eight times that of the general population for the third decade of life but comparable by the seventh decade. The major causes of death were pulmonary (41 patients- 71% with pneumonia or bronchitis), vascular (37 patients - 54% with ischemic heart disease), gastrointestinal (19 patients - 42% with carcinoma, 32% with peritonitis), and urinary (16 patients - 50% with renal failure and 44% with carcinoma). As survival of myelopathy patients has improved, deaths due to pneumonia, ischemic heart disease, carcinoma, and renal failure have become the major causes of death.
J Am Paraplegia Soc 1983 Jul
PMID:Increasing survival and changing causes of death in myelopathy patients. 661 34

A term male infant with pneumonia was receiving fluid and antibiotics through an intravenous line in the scalp. Air was accidentally infused in this line. Subsequently, discoloration of the skin, a flaccid paraplegia, hematuria, and gastrointestinal bleeding occurred as the presumed effect of venous air entering the systemic arteries. The umbilical vessels were never catheterized. Absence of any apparent cerebral air embolism is interpreted as being due to the infant's position (head down) at the time of air infusion. The pathogenesis and prevention of this tragic complication are discussed.
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PMID:Paraplegia due to peripheral venous air embolus in a neonate: a case report. 697 28

Our investigation of cefsulodin in pediatric Pseudomonas infect ion produced the following results. 1. Cefsulodin (CFS) was administered intravenously by one shot or drip infusion in 3 patients with Pseudomonas infections. These diseases consisted of pneumonia with IgA deficiency, ALL with opportunistic infection, UTI with paraplegia due to spina bifida. CFS was effective in all cases. 2. Transient eosinophilia was observed in 1 case. But other side effect was not noted in any cases.
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PMID:[Clinical application of cefsulodin in gravely ill children with Pseudomonas infection]. 716 67

Of the 215 cervical spinal cord injury (CSCI) patients treated in Tokai University Hospital over the last 17 years, 42 who were hospitalised for more than 90 days were selected as the subjects for this survey. They were divided into two groups: group A: patients hospitalised for 180 days or more; and group B: patients hospitalised for more than 90 but less than 180 days. The aspects surveyed were: the number of days of hospitalisation, type of injury, level of spinal cord injury, extent of spinal cord paralysis, assessment based on Frankel's classifications, whether a tracheotomy was performed or not, surgical treatment, complications, and the clinical course after discharge. The most common injury for the 13 patients in group A (average stay 281 days) was a fracture-dislocation, followed next by those with a burst fracture. The majority of the 28 patients in group B (average stay was 117 days) had a central type of spinal cord injury. Characteristics observed in group A in particular were: higher segment injuries to the cervical spinal cord, complete paralysis, respiratory complications such as pneumonia, tracheotomy, or a waiting time of at least 6 months before discharge, in cases where a transfer to a rehabilitation hospital was possible. The major problems of treating CSCI patients in university hospitals are that severe cases, which are concentrated in university hospitals, are forced to occupy private rooms for long term treatment, and there is a difficulty in transferring these patients to rehabilitation hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)
Paraplegia 1994 Jan
PMID:Problems of long-term hospitalised cervical spinal cord injury patients in university hospitals. 801 31

We report a 24-year-old man who presented unilateral multiple cranial nerve involvements followed by progressive paraplegia. The patient expired after developing DIC and pneumonia. Post-mortem examination revealed Ewing's sarcoma originated in the pubic bone with extensive metastases including the clivus which was responsible for his cranial nerve lesions. The patient was well until 24 years of age when he noted an onset of pain and a mass in the pubic region. The histology of the biopsy specimen of the tumor suggested Ewing's sarcoma. He was treated with chemotherapy and local radiation. A year after, he noted an onset of nuchal pain, difficulty in tongue movement, dysarthria, deafness in the left ear, and diplopia. On admission to our hospital in July 1990, neurological examination revealed an alert and intelligent Japanese male in no acute distress. The olfactory to the trigeminal nerves appeared intact. He showed complete abducens nerve palsy, facial weakness, mild deafness, and weakness of the soft palate, the sternocleidomastoid muscle and the tongue, all on the left side. The remainder of the neurological examination was unremarkable except for dysesthesia along the left C8 and Th1 dermatoms. Radiological examination revealed a 10 x 10 cm sclerotic mass in the public bone and a high signal mass lesion between the clivus and the pons in the T2-weighted MRI. His clinical course was complicated by acute paraplegia with anesthesia below the Th4 dermatom, DIC, and respiratory distress due to plural effusion. Post-mortem examination revealed a necrotic and hemorrhagic tumor in the pubic bone. The histology was consistent with Ewing's sarcoma.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A 24-year-old man presenting Garcin syndrome and paraplegia]. 847 71

The results of omental transposition in chronic spinal cord injury have been reported in 160 patients operated upon in the United States, Great Britain, China, Japan, India and Mexico, with detailed outcomes reported in few studies. Recovery of function to a greater degree than expected by natural history has been reported. In this series, 15 patients with chronic traumatic spinal cord injury (> 1.5 years from injury) underwent transposition of pedicled omentum to the area of the spinal cord injury. Of the first series of four patients who were operated upon in 1988, one died, one was lost to follow-up and two were followed with sequential neurological examinations and Magnetic Resonance Imaging (MRI) scans preoperatively, at 1 year post injury and 4 1/2 years post injury. Another 11 patients were operated in 1992 and underwent detailed neurological and neurophysiological examinations and had MRI scans preoperatively and every 4 months for at least 1 year after surgery. All patients completed a detailed self-report form. Of the total of 13 operated patients in both series followed for 1-4 1/2 years, six reported some enhanced function at 1 year and five of these felt the changes justified surgery primarily because of improved truncal control and decreased spasticity. MRI scans showed enlargement of the spinal cord as compared to preoperative scans in seven patients. Increased T2 signal intensity of the spinal cord was found by 1 year after surgery in eight of 13 operated patients. Neurophysiological examinations of 11 patients in the second series agreed with self-reports of increases or decreases in spasticity (r = 0.65, P < 0.03). Somatosensory evoked potentials and motor evoked potentials at 4 month intervals up to 1 year in these patients showed no change after surgery. Neurological testing, using the American Spinal Injury Association (ASIA) and International Medical Society of Paraplegia (IMSOP) international scoring standards, failed to show any significant changes when the 1-year post operative examination was compared to the first preoperative examination except for decreased sensory function after surgery which approached statistical significance. When the 11 patients in the second series were compared to eight non-operated matched patients, followed for a similar length of time, no significant differences were found. Complications encountered in the operated patients from both series included one postoperative death from a pulmonary embolus, one postoperative pneumonia, three chronic subcutaneous cerebrospinal fluid (CSF) fistulae requiring wound revision, and one patient who developed biceps and wrist extensor weakness bilaterally requiring graft removal. We conclude that the omental graft remains viable over time and this operation can induce anatomical changes in the spinal cord as judged by MRI. Some patients reported subjective improvement but this was not supported by objective testing. We, therefore, find no justification for further clinical trials of this procedure in patients who have complete or sensory incomplete lesions. Further testing in motor incomplete patients would seem appropriate only with compelling supportive data.
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PMID:Omental transposition in chronic spinal cord injury. 907 74


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