Rosemary Lindan

Incidence and clinical features of autonomic dysreflexia in patients with spinal cord injury

The histories of 444 patients admitted to this spinal cord injury service were reviewed for the incidence of autonomic dysreflexia (A.D.). Forty-eight per cent of 213 patients with complete cord lesions at T6 or above exhibited A.D. The time of onset post-injury, exciting causes, unusual manifestations of attacks, and the persistence of the condition were studied. These findings and the experience with attempts at prevention by education and by the use of an alpha-adrenergic blocker and a non-adrenergic vasodilating agent are reported.

The Application of Intracavernous Injection of Vasoactive Medications for Erection in Men with Spinal Cord Injury

Obtaining and sustaining an erection that is firm enough and adequate for vaginal penetration and satisfactory completion of intercourse are common problems for the male spinal cord injury patient. Intracavernous injection of vasoactive substances offers a new treatment option but it must be approached with caution in this population. During the last year we placed 20 spinal cord injury men (16 paraplegics and 4 quadriplegics) on self-injection of papaverine alone or with phentolamine. Of the patients 19 were able to obtain an erection adequate for penetration. The patient who did not obtain an adequate erection had anomalous penile venous drainage. Six episodes of priapism occurred in 3 patients: 1 had a surgical shunt placed elsewhere before he entered our program, and 2 were treated with aspiration of the corpora and injection of epinephrine. All 3 patients subsequently have been able to obtain satisfactory erections with use of lower doses of papaverine alone.

A comparison of the efficacy of an alpha-I-adrenergic blocker in the slow calcium channel blocker in the control of autonomic dysreflexia

Cystometry, using a portable CO2 cystometer, is a convenient method for detecting autonomic dysreflexia (A.D.) in response to bladder distention. Serial tracings on successive days were found to be consistent. This method was used to compare the effect of the anti hypertensive drugs, phenoxybenzamine and nifedipine, in modifying the blood pressure responses of 12 tetraplegic patients. Given as regular medication twice daily, neither drug was effective in preventing A.D. responses to bladder filling, and a significant number of patients developed troublesome hypotension. Nifedipine by mouth was found to be a valuable drug for the treatment of attacks which developed, and capable of preventing an anticipated attack if given shortly before the stimulus. The condition of ‘status dysreflexicus’ and its appropriate management is described.

A prospective study of the efficacy of low dose nitrofurantoin in preventing urinary tract infections in spinal cord injury patients, with comments on the role of pseudomonads

From the results we obtained it seems clear that, even in the presence of Foley catheters and a history of previous urinary infections, low dose antibacterial therapy is effective in preventing repeated invasion of the bladder urine by pathogenic organisms in spinal cord injured patients. It should be emphasised however that the quality of catheter care must also be of high standard and that antibacterials alone cannot compensate for poor care. Nitrofurantoin in the dose we use has proven to be non-toxic and free of side effects, and has not resulted in the emergence of drug resistant bacterial strains. Moreover it would seem that pseudomonas organisms may, in the absence of traumatic catheter techniques be safely left to browse undisturbed in the neuropathic bladder.

Experience with self intermittent catheterisation for women with neurological dysfunctions of the bladder

Twenty-four women with neurological dysfunctions of the bladder were trained in the technique of self intermittent catheterisation (SIC). Although all of them mastered the technique, four patients had to be discontinued from the programme for various reasons while still hospitalised and three others elected to return to Foley drainage, for reasons of convenience, after discharge home.The infection rate during SIC is low and most women welcome the advantage of freedom from drainage apparatus or diapers. However, patients must be both well motivated and independent in transfers to be able to continue indefinitely with such a programme.

The use of intermittent catheterization in a bladder training program: Preliminary report

Abstract The technique of intermittent urethral catheterization was used in 15 spinal cord injured patients (4 females, 11 males) in order to speed bladder training and reduce the problems of infection. All patients had been subjected to Foley catheter drainage for periods of 1–5 months and all had urinary tract infections on admission. The infections were cleared up by vigorous treatment before starting on the intermittent catheterization program. Relapse of the infection occurred in only 1 male patient following the establishment of reflex bladder function. One female patient became reinfected with a different bacterial species after discharge from the hospital. The program was successful in 14 of the 15 patients. One female patient had to be dropped from the program because of poor motivation and lack of cooperation. An intermittent catheterization program would seem to be a logical extension of good catheter care techniques.

Autonomic Dysreflexia: A Cause of Morbidity and Mortality in Orthopedic Patients with Spinal Cord Injury

Autonomic dysreflexia is a syndrome occurring in patients with spinal cord lesions at or above the sixth thoracic level, characterized by exaggerated autonomic responses to stimuli that are innocuous in unaffected persons. This syndrome, although originally observed by Bowley in 1890,3 remains unknown to most of the general medical and health professions. This article aims to draw attention to this syndrome. Accurate diagnosis and appropriate treatment are important, inasmuch as failure has resulted in serious neurologic deficit and death.l.5q9qI1.12,14.16,22 An increasing number of patients with spinal cord injuries are seeking care by orthopedists; hence, it is extremely important that this syndrome be recognized. Autonomic dysreflexia is found in patients with spinal cord lesions above the sympathetic splanchnic visceral outflow, especially in complete transverse lesions above the sixth thoracic segment. A variety of stimuli may initiate the reflex, including bladder and bowel distension, visceral inflammation, skin irritation, and pain. The initiating afferent stimuli travel to the spinal cord and trigger a gross sympathetic reflex in the caudal

Urological problems in the management of quadriplegic women

During the past 25 years enormous progress has been made in the management of the neuropathic bladder, largely as a result of the adoption of intermittent catheterisa-tion, together with improvements in catheter-related techniques, and the judicious use of antibacterial drugs and sphincter surgery.A few quadriplegic women can be trained to do self-intermittent catheterisation, using a special technique. For the majority of these women, however, there is no practical alternative at present to indwelling catheters. Bladder spasms resulting from the mechanical stimulation of the catheter and/or repeated infections may be difficult to control, and illustrative cases demonstrating some problems encountered are presented.There is an obvious need for an external collecting device for these women. The developments in the field of such devices are presented and evaluated.

The significance of antibody coated bacteria in neuropathic bladder urines

A total of 234 patients with neuropathic bladder dysfunction and bacteria in the urine have been studied for the presence of antibody coating on the bacteria. Approximately one third of the patients so studied were found to have antibody coated bacteria in the urine (ACB + ) by fluorescent microscopy. No correlation could be found between evidence of active tissue infection by the ACB test and the age, sex or catheter status of the patient, the radiological findings or the length of time since the neurological injury. There did, however, appear to be significant differences among the bacterial species isolated, in their ability to invade through urothelium. Testing for antibody coating is a useful epidemiological tool, but is not indicated for routine use as a guide to therapy. The choice of antibacterial drugs can, in most instances, be based on the identification of the bacterial isolate and its known potential for invasion of the upper urinary tract.

Effect of delayed intermittent catheterisation on kidney function in spinal cord injury patients—A long-term follow-up study

It is inequivocally demonstrated by these results that intermittent catheteri-sation for the removal of balloon catheters is beneficial over the long term in preventing repeated urinary infections and stone formation and in preserving renal function in spinal cord injury patients even when it is instituted weeks or months following the injury. The presence of bladder infections until this time do not necessarily indicate a poor prognosis. Intermittent catheterisation both can be, and should be, instituted as soon as possible after the spinal cord injury patient with an indwelling catheter arrives in the rehabilitation unit.