Paraplegia
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In the present study we report the renal pathological findings from autopsy material along with relevant clinical data on 21 spinal cord injury patients with end-stage renal disease (SCI-ESRD) treated with maintenance haemodialysis. These data are compared with the relevant clinical and post-mortem findings on 43 ambulatory dialysis patients who expired during the same time period. The SCI-ESRD patients exhibited markedly different clinical and renal histopathological data when compared to the ambulatory--ESRD group. ⋯ Infection with gram negative sepsis was the predominant cause of death in the SCI-ESRD patients, while death secondary to cardiovascular disease predominated in the ambulatory-ESRD group. Furthermore, the urinary tract and infected decubitus ulcers were determined to be the major source for sepsis in the SCI patients. From these findings it would follow that more effective prevention and control of these infections would result in not only a lower incidence of renal failure but also a substantially reduced morbidity and mortality in chronic SCI.
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Urological problems in M. S. patients are very frequent and are usually very disabling. Complaints will often be misleading. ⋯ S. is unpredictable. Treatment has to be conservative, flexible and reversible if possible. The goal of the treatment is to get a balanced bladder and complications due to urological manipulations must be avoided.
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The authors reviewed 162 clinical cases selected from several cases and referring to paraplegic patients, who have been treated in a polyvalent rehabilitation centre during approximately 20 years. The cases studied focused on those of vertebromedullar traumatisms due to water sports, work and road accidents, since in the authors' opinion the inclusion of the latter is of particular interest to the global comparative analysis.
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The concept of a wheelchair cushion fitting clinic for the prevention of pressure sores is reviewed in the light of recent estimates of the cost of pressure sores in the U. K. A method for measuring the pressure beneath the ischial tuberosities is discussed and techniques for measuring a patient's habitual exercise frequency and seated posture are described. Results from the records of 600 spinal injury patients including Rancho Los Amigos Hospital are reported and used to demonstrate the importance of low pressure beneath the ischial tuberosities as an indicator of wheelchair cushion suitability.
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Case Reports
Paraplegia following surgery in Foix and Alajouanine syndrome. (Arteriovenous malformation of the spinal cord).
Two patients with spinal cord arteriovenous malformation became paraplegic after removal of the abnormal vessels from the dorsal surface of the thoracolumbar spinal cord. Surgical exposure of a spinal cord arteriovenous malformation without an attempt at removal accelerated the pace of progressive paraparesis in two other patients. ⋯ We propose that the intramedullary vascular changes in this condition are an integral component of the arteriovenous malformation. Additionally, the phenomenon of nocturnal seminal ejaculation in spite of progressing impotence may be a clinical feature unique to spinal cord arteriovenous malformations.