1/82. Special problems associated with abdominal aneurysmectomy in spinal cord injury patients.There were 8 patients with spinal cord injury in the last 100 consecutive patients with abdominal aortic aneurysm resected at the Long Beach veterans Administration Hospital. Emphasis is placed upon the problems in management not found in individuals without spinal cord injury. A successful outcome is dependent upon: (a) aggressive control of foci of infection, (b) early diagnosis and planned surgical intervention, (c) continuous intraoperative arterial and central venous pressure monitoring and (d) alertness to the prevention of postoperative complications, with emphasis upon careful tracheal toilet and anticipation of delayed wound healing.- - - - - - - - - - ranking = 1keywords = wound (Clic here for more details about this article) |
2/82. Catecholamine-induced hypertension in lumbosacral paraplegia: five case reports.hypertension in the patient with SCI is relatively rare and generally restricted to patients with high-level injuries where autonomic dysreflexia can occur. Resting blood pressure in individuals with SCI has been described as lower than that in the normal population. This report describes five previously normotensive teenagers with subsequent paraplegia as a result of gunshot wounds who presented with hypertension secondary to idiopathic elevation of plasma or urinary catecholamine levels. A clonidine suppression test was used as a neuroprobe to inhibit centrally mediated sympathetic outflow, excluding the probability of an extra-axial autonomous catecholamine-secreting tumor as the possible source of hypertension. Positive suppression was achieved in four patients (41%, 37.2%, 4.8%, and 37.2% decreases). One patient had values corresponding to orthostatic changes (an increase of 63%) because of poor compliance with the test. This patient was lost to follow-up; in the remaining four, hypertension resolved at 12, 8, 9, and 6 weeks postinjury. The increased circulating catecholamine level appears to be promoted by a centrally mediated response to the SCI. Elevated blood pressure probably results from an upgraded receptor regulation or an increased receptor sensitivity on the affected cells in the absence of restraining spinal reflexes. The pathophysiology of such hypertension seems to be secondary to autonomic dysfunction and, although it may be transient, it should be treated promptly and reevaluated periodically until stabilization is achieved.- - - - - - - - - - ranking = 16.112668147113keywords = gunshot, wound (Clic here for more details about this article) |
3/82. Delayed presentation of spinal stab wound: case report and review of the literature.Stab wounds to the spinal cord are relatively uncommon in north america, but even rarer is the presentation of such an injury in a delayed fashion. We report a case of a 31-year-old male who presented with neurologic deficit 4 weeks after a stab wound injury to the spine. Because of worsening neurologic deficit, the retained knife fragment was operatively removed, and the patient had an uneventful recovery. The management of such an injury is discussed, with a review of the literature.- - - - - - - - - - ranking = 6keywords = wound (Clic here for more details about this article) |
4/82. Gabapentin for chronic pain in spinal cord injury: a case report.A 30-year-old white woman with an L1 complete spinal cord injury (SCI) secondary to a gunshot wound in 1985, presented to a chronic pain service for evaluation. She had a 13-year history of chronic lower extremity pain. She described her discomfort as "throbbing, aching, and stabbing." She had tried many different medications, including opioids, Tegretol, and tricyclic antidepressants, without success. During the evaluation process, she admitted to being "angry, frustrated, and anxious." She was diagnosed with central pain after SCI. She was placed on gabapentin 300 mg 3 times daily; within 1 week, her visual analog pain scale fell from 95 mm to 27 mm, and her McGill Short Form pain score fell from 13 to 3. Her mood also vastly improved. This case report suggests that gabapentin should be studied as a therapeutic option for treating central pain post-SCI and should be considered as a viable, well-tolerated, low-toxicity tool.- - - - - - - - - - ranking = 16.112668147113keywords = gunshot, wound (Clic here for more details about this article) |
5/82. An unusual stab wound of the cervical spinal cord: a case report.STUDY DESIGN: A rare case of a laterally directed stab wound injury of the cervical spinal cord is reported. OBJECTIVE: To describe the unusual mechanism of injury of this case and its clinical features. The surgical indications for penetrating injuries of the spinal cord are discussed. SUMMARY OF BACKGROUND DATA: Spinal stab wound injuries are rare, and the literature on the subject is scant. There has been only one large clinical review from south africa, published in 1977. The clinical features and the injury mechanism of a laterally directed stab wound to the cervical spine have not been previously described. methods: An 18-year-old man was stabbed in the right side of the neck at C1-C2. The blade penetrated the spine laterally and went through the ligaments without affecting the bony structures. On admission the patient had tetraplegia and was in respiratory failure. Radiologic investigation showed the retained blade passing through the cord but showed no bony or vascular injuries. RESULTS: Before extraction, the knife was followed to its tip with careful dissection. Because no cerebrospinal fluid leak was noted in the area, the dura was not exposed. After surgery, magnetic resonance images showed a complete transection of the spinal cord at C1-C2. The patient was neurologically unchanged in follow-up examinations. CONCLUSION: Laterally directed horizontal stab wounds of the spine are particularly dangerous because the blade can pass between two vertebrae to transect the cord. The neurologic injury that results is irreversible. The more common stab wounds, inflicted from behind, usually produce incomplete cord damage.- - - - - - - - - - ranking = 9keywords = wound (Clic here for more details about this article) |
6/82. Stab injury of the spinal cord surgically treated.The authors report a case of thoracic spinal cord stab injury with neurologic impairment that was treated surgically after injury. A literature review and case analysis indicate that surgical extraction of foreign bodies retained within the spinal canal is indicated to avoid infection, delayed myelopathy, and neurologic loss. The amount of motor and functional recovery for incomplete injuries after spinal cord stab wound can be strikingly good despite pathologic changes to severely damaged areas, and removal of retained intraspinal metallic fragment can improve this neurologic outcome. Open removal of the knife seems preferable to avoid bleeding and infection.- - - - - - - - - - ranking = 1keywords = wound (Clic here for more details about this article) |
7/82. The role of plasma transglutaminase (F XIII) in wound healing of complicated pressure sores after spinal cord injury.STUDY DESIGN: A case report. OBJECTIVES: To demonstrate stimulating action of F XIII in wound healing of complicated pressure sores. SETTING: A spinal cord Injury Center in germany. methods: Clinical exam, clinical and photographic wound control, biochemical serum monitoring. RESULTS: Recurrent pressure sores in plegic patients are common complications requiring long-standing conservative or operative therapy. Additional risk factors such as diabetes increase the complication rate for surgery. Surgery itself may be difficult in recurrent pressure sores due to limited remaining soft tissues. We report the case and treatment of a 47-year-old patient with long-standing and recurrent ulcers and complications after flap surgery. As a final option we added plasma transglutaminase (factor xiii) to our treatment scheme which changed the course of the disease dramatically and we achieved complete and rapid healing. CONCLUSION: Our experience suggests that F XIII has a positive role in treating pressure sores as shown already in several other surgical fields. Its use is giving the surgeon an additional tool in complicated cases.- - - - - - - - - - ranking = 6keywords = wound (Clic here for more details about this article) |
8/82. carcinoid tumor mistaken for persistent neurogenic bowel symptoms in a patient with paraplegia: a case report.neurogenic bowel in spinal cord injury (SCI) can present with constipation and diarrhea as ongoing problems. Usually, these manifestations are adequately controlled with modification in the bowel program. When these symptoms persist, other causes should be considered. This case report describes a jejunal carcinoid tumor with colonic extension that was diagnosed in a paraplegic patient with persistent constipation and diarrhea. A 39-year-old man sustained a T1 paraplegia with neurogenic bowel and bladder dysfunction from a gunshot wound. His bowels were initially managed adequately with digital disimpaction. Over the next 8 years, he had intermittent constipation that was managed with the addition of various suppositories. He then developed progressively worsening constipation, and other gastrointestinal (GI) symptoms. Although his symptoms initially resolved with medical management, the constipation worsened. Upper endoscopy revealed a submucosal bulge in the duodenal bulb. A month later, gallstones were found on renal ultrasound performed to evaluate recurrent urinary tract infections. He underwent cholecystectomy, but his GI symptoms persisted over the next several months. Repeat upper endoscopy subsequently revealed an ulcerated tumor at the duodenojejunal flexure. An upper-GI scan with small bowel follow through showed a proximal jejunal mass. The patient underwent laparotomy with resection of the mass. Final pathologic diagnosis was malignant carcinoid tumor. This case shows the importance of entertaining other clinical entities in patients with SCI when constipation and diarrhea persist despite adequate management.- - - - - - - - - - ranking = 16.112668147113keywords = gunshot, wound (Clic here for more details about this article) |
9/82. Traumatic Brown-Sequard-plus syndrome.BACKGROUND: In the 1840s Brown-Sequard described the motor and sensory effects of sectioning half of the spinal cord. Penetrating injuries can cause Brown-Sequard or, more frequently, Brown-Sequard-plus syndromes. OBJECTIVE: To report the case of a 25-year-old man who developed left-sided brown-sequard syndrome at the C8 level and left-sided horner syndrome plus urinary retention and bilateral extensor responses following a stab wound in the right side of the neck. RESULTS: magnetic resonance imaging demonstrated a low cervical lesion and somatosensory evoked potentials confirmed the clinical finding of left-side dorsal column disturbance. At follow-up, the patient's mobility and bladder function had returned to normal. CONCLUSION: This patient recovered well after a penetrating neck injury that disturbed function in more than half the lower cervical spinal cord (Brown-Sequard-plus syndrome).- - - - - - - - - - ranking = 1keywords = wound (Clic here for more details about this article) |
10/82. spinal cord injury caused by gunshot wound during pregnancy.We report a case of a pregnant woman with acute spinal cord injury (C5) caused by gunshot wound and discuss the respective maternal and fetal considerations. Neither decompressive surgery nor corticosteroid protocols were used. At 37 weeks, the patient delivered a normal female infant after induction of labor and epidural anesthesia, with no medical or obstetrical complications. With conservative management and rehabilitation, this patient had significant recovery of function.- - - - - - - - - - ranking = 80.563340735567keywords = gunshot, wound (Clic here for more details about this article) |
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