[Decubitus ulcer].
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Anti-Infective Agents, Local↗
Biomedical subjects
B Schurch
Publications and source records attributed to B Schurch.
Detrusor bladder neck dyssynergia revisited.
To our knowledge, direct measurement of active closure of the bladder neck during bladder contraction resulting in bladder neck dyssynergia and outflow obstruction has not yet been demonstrated. A total of 34 spinal cord injury patients underwent urodynamic investigation with 2 micro-transducer catheters in the urethrovesical and anorectal regions, respectively. Proper localization of the transducers was done with an image intensifier. The respective role of the striated and smooth muscles on bladder neck activity was evaluated after pudendal nerve blocks and phentolamine injections. Of the patients 25 had active bladder neck dyssynergia with concomitant detrusor-sphincter dyssynergia. Pressures were higher in the bladder neck than in the bladder. Pudendal blocks abolished detrusor-sphincter but not bladder neck dyssynergia, which was decreased by additional phentolamine but only in patients in whom bladder neck dyssynergia was associated with autonomic hyperreflexia. Evidence is presented that active bladder neck dyssynergia may exist in patients with a neurogenic bladder and that it is seemingly dependent on alpha 1-postsynaptic and alpha 2-presynaptic adrenoreceptors.
Female↗
Analyses of 94 consecutive spinal cord injury patients using ASIA definition and modified Frankel score classification.
Serial neurological examinations were analysed on 94 consecutive spinal cord injury (SCI) patients admitted for rehabilitation to the Swiss Paraplegic Center at the Clinic Balgrist Zurich, Switzerland between 1987 and 1992. Patients' data were examined adopting ASIA and modified Frankel definitions in order to compare the two classifications in terms of consistency and prognostic value. The modified Frankel definition was subdivided into five categories (A, B, C, D and E). On admission (discharge) 43 (37) patients were classified as Frankel A, 23 (11) patients in group B, 26 (42) patients in group C, 2 (2) patients as Frankel D and 0 (2) patients in group E. A qualitative analysis of the results on the base of a maximal score of 100 points (A = 0, B = 25, C = 50, D = 75 and E = 100 points) suggested a mean score improvement from 21.5 (+/- 22.5) to 29.0 (+/- 26.3) or 7.5 (+/- 7.1), regarding all 94 patients during follow up (admission/discharge). The median improvement was one modified Frankel grade (A/B to B/C). No detailed assessments were yielded concerning motor and sensory functions. Using ASIA definition, a continuous numerical score of motor and sensory function was observed. Recovery during follow up was determined by detailed motor and sensory function. For all 94 patients (quadriplegics and tetraplegics), the average motor recovery according to the ASIA definition was 9.4 (+/- 9.6). The mean ASIA motor score improved from 52.2 (+/- 17.3) on admission to 61.6 (+/- 17.9) on discharge.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Errors and limitations of the multimodality checking methods of defective spinal intrathecal pump systems. Case report.
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. Despite some benefit from increasing the daily dose of baclofen, it has not been possible to control the spastic symptoms. Surgery was therefore decided upon, and a small leak at the end of the catheter tip was discovered. Surgeons and physicians should be aware that checking methods of DAD cannot exclude failure of the system. Their errors and limitations are discussed.
Adult↗
[Rehabilitation of paraplegic patients].
Comprehensive management and care of spinal-cord-lesioned patients start at the site of injury or at the moment of the onset of paralysis, depend with its consequences on the treatment in the acute phase, pass to the reactivation and rehabilitation phase and continue throughout all life of such patients. Considering that even a complete transverse lesion is only an instable, temporarily balanced situation, every small complication can destroy this balance and may lead from total independence to total dependence. Orthopedic, neurological, neurosurgical, urological, physio- or ergotherapeutic, socio-professional or other aspects in the field of comprehensive care and rehabilitation can never be analyzed or managed singularly, but have to be seen always in the context of the whole final outcome. The coordinating role of the paraplegiologist and the importance of adequate spinal cord injury units is stressed. The changing pattern of aetiopathogenesis or epidemiology of spinal cord lesions (increase of medical causes such as vascular lesions, tumors, infection disease) and the definition for rehabilitability due to the higher amount of elderly people will bring a new challenge for all careers in the field of rehabilitation.
Aftercare↗
[Erectile dysfunction of male spinal cord injury patients].
Different problems regarding erectile dysfunction in men with spinal cord-injury are outlined. Neuroanatomical and neurophysiological aspects of erection and ejaculation are outlined and brought into relation with the different clinical pictures of such lesions. Different therapeutical possibilities are presented, particularly the new treatments like intracavernous papaverine (autoinjection), prostaglandin E1 and transcutaneous nitroglycerin; action, advantages and indications are discussed. The experience in ten para- or tetraplegic patients are discussed. It seems that even in spite of the higher price of PGE1 this treatment of the erectile dysfunction in spinal cord-injured men should be preferred, since it shows more advantages and less complications than other treatments.
Adult↗
[Effects of Botulinum A Toxin on the periurethral striated sphincter of the neurogenic bladder. Preliminary study].
The goal of this study was to try to determine the effects of the Botulinum A Toxin on the spasticity of the rhabdosphincter in 9 men with spinal cord injury and detrusor-sphincter dyssynergia. The cystometrography, before and after the endoscopic injection of 100 units of Botulinum A Toxin, consisted of recording the bladder, urethral and rectal pressures with microtip transducers the anatomical position of which was radiographically controlled. The subjective and objective results of that study allow us to conclude that the Botulinum A Toxin has a place in the treatment of spinal injuries with detrusor-sphincter dyssynergia. Due to his blocking effect on the release of acetylcholine in the motor nerve endings, the Botulinum A Toxin suppresses or decreases the spasticity of the rhabdosphincter and improves voiding. Although its relatively short living action (2-3 months) may require renewed injections, it has the advantage to hold off a surgical treatment such as a sphincterotomy and to give the patient another chance to reach a balanced bladder function secondary to the postinjection changes of reflexes which may have taken place between the bladder and the rhabdosphincter and vice versa.
Botulinum Toxins↗
[The value of retraining in female urinary incontinence].
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Exercise Therapy↗
[The treatment of arthroses using physical agents].
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Electric Stimulation Therapy↗
Fractures of the radial head and lesions of the lower radius and ulna in the adult: the importance of the prosthesis in resection.
Multi-fragmentary fracture of the head of radius is a common lesion of the elbow; and resection of the head is justified either in isolation or to be completed with prosthetic implant replacement. From a study of 25 hospital records of patients treated at the Orthopedic and Traumatology Center of CRAM of Strasbourg with an average post-operative follow-up of 8 years, it appears that the habitual complications secondary to simple resection of the radial head, in particular cubitus-valgus, ascension of radial shaft and dysfunction of the inferior radio-ulnar articulation, are not observed after prosthetic replacement. Furthermore, whenever an injury of the latter articulation exists concomitant with radial head trauma, no further secondary aggravation ensues following replacement. Arthroplasty seems to be, hence, at the present moment the operation of choice for serious fractures of the radial head in cases where osteosynthesis is not possible and which used to be indications for simple resection.
Adolescent↗