Raphael Rozin

Sexual function, pregnancy and delivery in spinal cord injured women.

Complete spinal cord injury results in abolition of motor, sensory and autonomic functions. Among the autonomic functions, the sexual system is seriously disturbed. The spinal cord injury with its many complications offers a challenge to the rehabilitation team, and the sexual problem is one of its most important aspects. For the female paraplegic, rehabilitation of sexual functions is an essential part in the building of a positive new self-image. In this review, we try to summarize the gynecological and obstetrical aspects of spinal cord injured women. Although the innervation of the reproductive system is damaged, this system continues to function and the menstrual cycle resumes its normal course after a while. Ovulation takes place regularly and pregnancy is possible. Today the general opinion is that the pregnant paralyzed woman can deliver vaginally and not by cesarean section as was believed before. We emphasize the importance of special medical care before, during and after delivery. The cooperation between physiatrist and gynecologist is mandatory.

Spinal cord injuries: male infertility aspects.

Among I6 married male paraplegic patients, eight had spontaneous erections and three ejaculations. Rectal electroejaculation gave poor results. Although hormonal and sperm metabolic values were normal, sperm analysis showed severe disturbances.

Shoulder complications as a cause of delay in rehabilitation of spinal cord injured patients. (Case reports and review of the literature).

We describe ten patients with spinal cord disease or injury who developed upper extremity and shoulder complications during rehabilitation. These shoulder complications caused delay in rehabilitation. We discuss the aetiology, treatment and management of shoulder complications in spinal patients and in patients with other neurological diseases.

Are chronic spinal cord injured patients (SCIP) prone to premature aging

Our hypothesis, based upon clinical observation and on the literature, is that chronic spinal cord injured patients are prone to premature aging. Physical and mental disabilities and prolonged immobilization change the entire homeostatic mechanisms into a new state. Thus, we feel that this lead to accelerated aging among these chronic handicapped persons.

Survival in marriage in the paraplegic couple: psychological study

In a study of sexual functions and marital relations in 16 couples involving a normal female and a paraplegic male, married following the injury, it was found that a major source of dissatisfaction on the part of the wives was their inability to become pregnant and bear children. Sexual relations were surprisingly of secondary importance. Common in all 16 couples was the almost total lack of knowledge on the part of the woman about the mans sexual capabilities and the effect of his injury on fertility. Premarital counselling seems to be of primary importance in assuring the survival of such marriages. It may be useful to suggest they have premarital experience. Later, counselling should include the importance and advantages of artificial insemination donor treatment as a solution to infertility

Peculiar septic responses in traumatic tetraplegic patients.

Patients with a high level tetraplegia from a spinal injury have only been able to survive the critical initial period since the development of modern resuscitation techniques including artificial respiration. However, their lives are still threatened by many complications, such as decubitis ulcers, infections and respiratory failure. We describe four young tetraplegic patients who developed an unusual sepsis pattern several years after the injury. The sepsis was accompanied by hypothermia, leukopenia and mental deterioration. This peculiar ‘silent’ sepsis may also occur in elderly people who are not paralysed. The question arises, therefore, if the chronic spinal cord injured patient may become ‘prematurely aged’.

Is the polio virus responsible for late central nervous system tumors

A hypothesis is advanced concerning the relationship of poliomyelitis viruses and late developing neoplasia in the central nervous system. The literature is surveyed, and several experimental approaches based upon known evidence of viral and neoplastic behaviour are advanced. The present status of world polio incidence is discussed as it applies to this possible relationship.

The status of the urinary tract in a survey of 92 cases with neurogenic bladder.

Since 1973 intermittent catheterisation was introduced in our centre and this practically eliminated pathology of the urethra. More than half of the patients had a high and complete lesion. It is our impression that 5 years following injury more than half of the patients preserved a normal upper urinary tract; however, only 39 of the 92 patients had a follow-up of over 5 years. Nephrolithiasis was rare in comparison to other reports in spite of belonging to the stone belt area. Complications of the lower urinary tract including a 10 per cent incidence of vesico-ureteric reflux were compatible with other series. Narrowing of the external sphincter on voiding cystogram should be substantiated by a profile pressure record. One female patient is a candidate for ileal conduit. Most of the patients have some form of erection but the data on ejaculation should be accepted with reserve. Two patients in this series died more than 10 years after injury, one due to a myocardial infarction and the other due to chronic renal failure following secondary amyloidosis.

Misdiagnosis of spinal cord injuries--the physiatrist's point of view.

Thirteen different patients involving spinal cord pathology with delayed or false diagnosis are presented and these diagnostic pitfalls are discussed. Many seemingly simple explanations for para or quadriplegia are suddenly quite complex upon scrutiny. The problem of proper diagnosis is capital in instituting proper therapy, advising the patient and his family, and unfortunately in todays medical climate, for medical legal reasons.

The social aspects of the treatment of spinal cord injured patients in Israel

The great importance of the social workers special role in the treatment of spinal cord injury patients is stressed, and this is brought out in this paper with reference to the particular social structure in Israel relating to the rehabilitation of the disabled