The journal of spinal cord medicine
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Comparative Study
Daily vs twice daily enoxaparin in the prevention of venous thromboembolic disorders during rehabilitation following acute spinal cord injury.
Subcutaneous administration of low molecular weight heparin (eg, enoxaparin) has been shown to be safe and effective in the prevention of acute venous thromboembolic (TE) disease following acute spinal cord injury (SCI) in the rehabilitation setting. However, emerging evidence suggests that different dosing strategies may be equivalent. ⋯ Subcutaneous enoxaparin administered once or twice daily is equally effective for the prevention of venous TE disease. Both dosing strategies are associated with a low incidence of bleeding in patients with SCI who are undergoing rehabilitation.
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Case Reports Biography Historical Article
Fatal spinal cord injury of the 20th president of the United States: day-by-day review of his clinical course, with comments.
This article presents the medical history of the 20th president of the United States, James A. Garfield, with an emphasis on his spinal cord injury (SCI). Numerous references debate the care he received from the medical and surgical perspectives, but little has been written about the essential aspect of his gunshot wound-namely, the damage to his spinal cord. President Garfield was shot in the lumbar spine and was bedridden until he died 80 days following his injury. This article contrasts state-of-the-art care in 1881 to today's standards of care for SCI. ⋯ Deficiencies in general medical care and surgical technique at the time contributed to the president's demise. This case was marked by controversies that still are debated today-for example, whether the bullet should have been removed surgically. Examination of available evidence suggests that with today's advances in medical, surgical, and SCI medicine, a person with this type of injury would likely survive and be a candidate for rehabilitation.
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Although several reports characterize pain associated with adult-onset spinal cord injury (SCI), little is known about the incidence and etiology of pain associated with pediatric-onset SCI. The purpose of this study was to assess the incidence and type of chronic pain in the pediatric SCI population and to evaluate the resulting impact on activities of daily living (ADLs). ⋯ Based on these pilot data, pain associated with a pediatric-onset SCI is common. The incidence of pain in this study approached the reported incidence of chronic pain in adult-onset SCI. In the present population, nocioceptive pain was more common than was neuropathic pain. These data suggest that although common, chronic pain associated with childhood SCI has a significantly smaller impact on daily activities than that reported in the literature for adult-onset SCI.
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To delineate the prevalence, etiologies, clinical manifestations, complications, and management of autonomic dysreflexia in individuals who sustained spinal cord injury (SCI) as children. ⋯ Autonomic dysreflexia has a similar prevalence in pediatric-onset SCI compared with the adult SCI population. Dysreflexia is diagnosed less commonly in infants and preschool-aged children, and these 2 populations may present with more subtle signs and symptoms.
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Determine the unique effects of age across a variety of outcome domains following spinal cord injury (SCI). ⋯ There is a small but consistent decline with age in several outcome domains following SCI. Follow-up longitudinal studies should help tease a part possible cohort effects from the effects of age.