Paraplegia
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Case Reports
Total en bloc spondylectomy and circumspinal decompression for solitary spinal metastasis.
We have developed a new surgical technique, 'total en bloc spondylectomy' (TES), to treat a solitary metastasis in the thoracic or lumbar vertebra. This operation is designed as a local cure for the metastatic site and involves the radical resection of the affected vertebra with a wide margin. The spondylectomy consists of two steps: en bloc laminectomy with posterior spinal instruments for stabilisation (first step) and en bloc corporectomy and replacement using a vertebral prosthesis (second step). ⋯ There has been no recurrence of the local tumour after surgery. After a median follow up period of 14.1 months, 12 patients have survived. These data suggest that TES may have a significant clinical value in the treatment of spinal metastasis.
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To survey the situation of traumatic spinal cord injuries (SCI) in Japan, the SCI Prevention Committee of the Japanese Medical Society of Paraplegia sent out by mail study charts in the form of questionnaires to institutions nationwide. Using the statistical method of the nationwide epidemiological survey described by Hashimoto et al,1 the annual estimated incidence was obtained from the number of patients registered, and from the questionnaire reply rate at each prefecture. The number of registered patients in 1990 was 3465 and the mean reply rate was 56.6%. ⋯ The mean age at the time of injury was 48.5 years. The cause most frequently seen was traffic accidents, the second most frequent being falls from a height. Besides those two, sports injuries and falls on level ground were the third most frequent causes of SCI in the young generation and in elderly people respectively.
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Case Reports
Problems of long-term hospitalised cervical spinal cord injury patients in university hospitals.
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 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)
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This study examined the complications and costs of management of patients with acute spinal cord injury (ASCI) in a regional, multidisciplinary acute spinal cord injury unit (ASCIU). Data were available to compute length of stay (LOS) on 191 of the first 220 consecutive patients managed in this unit from 1974 to 1981. Specific formulae for assessing hospital and medical costs were developed based on a systems analysis approach. ⋯ The annual mean CPS decreased dramatically during the period of the study from 1974-81 due mainly to a decrease in LOS. Multiple regression analysis showed that severity and level of the spinal column and spinal cord injury, and the presence of complications had the most significant effects on duration and cost of care. The study also suggests that a specialized, multidisciplinary regional unit for ASCI patients is associated with a reduction in LOS and cost of care.
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The loss of benefit from intrathecal baclofen, with increased spasticity and a discrepancy between the residual and the calculated volume content (underinfusion), made us suspect dysfunction of the intrathecal baclofen infusion in a paraplegic patient. Although all possible usual checking methods were used, no failure in the drug administration device (DAD) could be found. ⋯ Surgeons and physicians should be aware that checking methods of DAD cannot exclude failure of the system. Their errors and limitations are discussed.