Cases reported "Spinal Cord Injuries"

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11/879. Cervical spinal cord injury in sapho syndrome.

    Cervical spinal fracture and pseudarthrosis are previously described causes of spinal cord injury (SCI) in patients with spondylarthropathy. SAPHO (synovitis Acne Pustulosis hyperostosis osteitis) syndrome is a recently recognized rheumatic condition characterized by hyperostosis and arthro-osteitis of the upper anterior chest wall, spinal involvement similar to spondylarthropathies and skin manifestations including palmoplantar pustulosis and pustular psoriasis. We report the first case of SAPHO syndrome disclosed by SCI related to cervical spine ankylosis.
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12/879. Double spinal cord injury in a patient with ankylosing spondylitis.

    Ankylosing spondylitis patients are more prone to spinal fractures and these fractures commonly result in mobile nonunion. We report a patient with a 30-year history of ankylosing spondylitis who sustained double spinal cord injuries following minor trauma. The first injury occurred at the lumbar level due to pseudoarthrosis of an old fracture, and the second at the thoracic level following cardiopulmonary arrest and an episode of hypotension. The possible mechanisms of the injuries are discussed and maintaining normal blood pressure in these patients is emphasized.
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13/879. Refusal of treatment: an ethical dilemma.

    When a patient with a new spinal cord injury (SCI) refuses all care, the treatment team struggles with an ethical dilemma. The issues of patients' rights and autonomy are in conflict with the concepts of beneficence and nonmaleficence. Thomasma (1978) recommended a model useful in addressing situations in which values are in conflict. This model for an ethical workup is applied retrospectively to review a specific clinical case. The need to recognize and respect as many ethical principles as possible is identified as useful in reaching some acceptable resolution of an ethical dilemma.
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keywords = injury
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14/879. Virtual reality in paraplegia: a VR-enhanced orthopaedic appliance for walking and rehabilitation.

    spinal cord injuries (SCIs) have a profound physical, social and emotional cost to patients and their families. Obviously SCIs severely disrupt normal patterns of interaction with the environment. Firstly, the opportunities for active interaction are inevitably diminished due to motor or sensory impairment. Moreover, such problems may increase as the time since injury lengthens and the patient becomes more withdrawn and isolated in all spheres of activity. However, advances in Information technology are providing new opportunities for rehabilitation technology. These advances are helping people to overcome the physical limitations affecting their mobility or their ability to hear, see or speak. In this chapter an overview is given of the design issues of a VR-enhanced orthopaedic appliance to be used in SCI rehabilitation. The basis for this approach is that physical therapy and motivation are crucial for maintaining flexibility and muscle strength and for reorganizing the nervous system after SCIs. First some design considerations are described and an outline of aims which the tool should pursue given. Finally, the design issues are described focusing both on the development of a test-bed rehabilitation device and on the description of a preliminary study detailing the use of the device with a long-term SCI patient.
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15/879. Prevention of human diaphragm atrophy with short periods of electrical stimulation.

    We determined whether prolonged complete inactivation of the human diaphragm results in atrophy and whether this could be prevented by brief periods of electrical phrenic nerve stimulation. We studied a subject with high spinal cord injury who required removal of his left phrenic nerve pacemaker (PNP) and the reinstitution of positive-pressure ventilation for 8 mo. During this time, the right phrenic nerve was stimulated 30 min per day. Thickness of each diaphragm (tdi) was determined by ultrasonography. Maximal tidal volume (VT) was measured during stimulation of each diaphragm separately. After left PNP reimplantation, VT and tdi were measured just before the resumption of electrical stimulation and serially for 33 wk. On the previously nonfunctioning side, there were substantial changes in VT (from 220 to 600 ml) and tdi (from 0.18 to 0.34 cm). On the side that had been stimulated, neither VT nor tdi changed appreciably (VT from 770 to 900 ml; tdi from 0.25 to 0.28 cm). We conclude that prolonged inactivation of the diaphragm causes atrophy which may be prevented by brief periods of daily phrenic nerve stimulation.
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ranking = 0.20060756087141
keywords = injury, nerve
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16/879. Surgical challenge of massive bilateral staghorn renal calculi in a spinal cord injury patient.

    We report a rare case of massive bilateral staghorn calculi in a spinal cord injury patient with significant renal compromise. The patient was successfully treated with percutaneous nephrolithotomy to achieve a stone-free status. The various options of treatment are discussed with special attention to the technical aspects necessary to achieve complete eradication of the stone burden during percutaneous nephrolithotomy. Furthermore, the importance of treating bladder dysfunction and urinary metabolic abnormalities is emphasized.
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keywords = injury
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17/879. Squamous cell carcinoma of suprapubic cystostomy tract without bladder involvement.

    This report describes a third case of squamous cell carcinoma of the suprapubic cystostomy tract. The first case reported in 1993 concerned a squamous cell carcinoma arising adjacent to the suprapubic cystostomy site and extending anteriorly to the abdominal wall in a 80-year-old man, 5 years after suprapubic urinary diversion for urethral stricture. A second case published in 1995 described a 50-year-old paraplegic man (T11-T12 spinal cord injury) in whom a suprapubic cystostomy tract squamous cell carcinoma developed after 25 years of urinary diversion. The tumour involved the cystostomy tract primarily with extension into the bladder but did not penetrate the bladder wall muscle. Our patient is in fact the second one to have a suprapubic cystostomy tract squamous carcinoma not involving the bladder.
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ranking = 0.2
keywords = injury
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18/879. Diagnosis and treatment of acute central cervical cord injury.

    OBJECTIVE: To clarify the diagnosis and management of acute central cervical cord injury. methods: Eighty-nine patients with acute cervical central cord injury were retrospectively reviewed. Sixty-three patients were treated conservatively and 26 were treated surgically. There were two acute deaths. Eighty-seven patients were followed up for 3 months to 15 years. RESULTS: Their average neurological score (asia) was increased from 41.7 at admission to 83.1 at follow-up. CONCLUSIONS: Acute central cervical cord injury should be differentiated from complete spinal cord injury, cervical myelopathy, cruciate paralysis and C8 nerve root injury. When compression of nerve tissue or cervical instability is identified, operative intervention should be indicated. The prognosis is less optimistic in the patients with severe primary injury and at old age.
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ranking = 2.0003037804357
keywords = injury, nerve
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19/879. Spinal cord injury after electrical trauma treated in a burn unit.

    OBJECTIVE: To analyse the incidence, diagnosis and outcome of spinal cord injury in patients with electrical injuries. patients AND methods: Retrospective analysis of patients with electrical injuries admitted to our intensive care Burn Unit over a 5 year period. Among 435 admissions, 57 (13.1% of all admissions) were electrical injuries, due to either electrical flash (n = 34) or high voltage (n = 23). Two cases (8.6% of high voltage injuries) presented signs of spinal cord injury. Both cases presented an acute transverse myelopathy, involving the pyramidal tract, the posterior cords and the spinothalamic tract, causing a pyramidal syndrome with abnormal sensation and involvement of posterior cords, one with paraplegia and the other one with quadriplegia. Diagnoses were made 1 and 2 weeks after admission, respectively, when sedation was discontinued and neurological signs could be appreciated. Computerised axial tomography and nuclear magnetic resonance were normal in both cases at the moment of diagnosis. Both patients experienced a slow but progressive improvement of their neurological condition, and remain presently in a rehabilitation program 15 and 18 months after trauma. DISCUSSION: Our cases illustrate (i) that damage to the spine is not infrequent after electrical injury, (ii) the difficulty in making the diagnosis of spinal cord injury after electrical trauma, and (iii) the importance of early diagnosis to define neurological prognosis and start available therapies as soon as possible.
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ranking = 1.6
keywords = injury
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20/879. electrodiagnosis in spinal cord injured persons with new weakness or sensory loss: central and peripheral etiologies.

    OBJECTIVE: To assess the prevalence and causes of late neurologic decline of persons with spinal cord injury (SCI). DESIGN: Retrospective review of persons with SCI over a 9-year period. Those with complaints of new weakness or sensory loss were grouped into three categories based on clinical examination, electrodiagnosis, and imaging: (1) central pathology (ie, brain, spinal cord, or nerve root); (2) peripheral pathology (plexus or peripheral nerve); or (3) no identifiable etiology. The specific diagnoses of late neurologic decline were identified. SETTING: Regional veterans Affairs Spinal Cord Injury Service. patients: Five hundred two inpatient and outpatient adults with SCI. RESULTS: Nineteen percent of the study population complained of new weakness and/or sensory loss. Neurologic abnormalities were noted in 13.5%, 7.2% with central and 6.4% with peripheral causes. The most common pathologies were posttraumatic syringomyelia (2.4%) and cervical (1.6%) and lumbosacral (1.2%) myelopathy/radiculopathy. A specific etiology was not determined in 6 cases (1.6%). Peripheral involvement was mostly from ulnar nerve entrapment (3.4%) and carpal tunnel syndrome (3.0%). CONCLUSIONS: Late-onset neurologic decline is common after SCI and can result from central or peripheral pathology. Regular neurologic monitoring of SCI patients is recommended, since many with neurologic decline respond favorably if diagnosed and treated early.
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ranking = 0.20045567065356
keywords = injury, nerve
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