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Biomedical subjects

J R Silver

Publications and source records attributed to J R Silver.

At least 73 records · Page 4Linked to original sources
PubMed1986

Gastrointestinal bleeding in patients with acute spinal injuries.

439 acute, male, spinal injury patients were admitted over an 11-year period at the National Spinal Injuries Centre: 206 cervical, 182 dorsal, and 51 lumbar cord injuries. 27 patients had gastrointestinal bleeds; 20 bled on one occasion, 7 had more than one episode; 22 bled within 4 weeks of injury. The mean was 22.5 days. The presentation was mostly malaena. A diagnosis was made in 19 cases; 12 had duodenal ulcers, 4 gastric ulcers, 1 had gastritis, 1 had a gastric carcinoma, 1 had oesophagitis with a possible Mallory-Weiss tear; 4 died. The incidence was higher in cervical patients. Causation was thought to be due to patients being sick from severe intercurrent illnesses and injuries. Implications for further research are discussed.

Acute Disease↗
PubMed1985

Contribution of the rib cage to breathing in tetraplegia.

In tetraplegia there is often paradoxical inward motion of the rib cage during inspiration. The volume of this negative contribution is difficult to estimate but can be obtained by optical mapping. The partitioning of ventilation between the rib cage and abdomen in six normal subjects, 10 stable tetraplegic patients, and one tetraplegic patient at intervals during rehabilitation has been studied by this technique. In normal subjects the tidal volume and the vital capacity were the sum of positive contributions from the rib cage and abdomen. In stable tetraplegic subjects with similar neurological levels, the rib cage contribution varied widely but the total chest wall displacement could not be predicted from the vital capacity. In the patient studied sequentially rib cage paradox reversed with time after injury, and this was associated with an absolute increase in vital capacity and an improvement in the action of the diaphragm.

Adolescent↗
PubMed1984

Aetiology of pressure sores in patients with spinal cord injury.

One hundred consecutive patients admitted to the National Spinal Injuries Centre, Stoke Mandeville Hospital, with pressure sores were studied to assess the relative importance of factors known to predispose to the development of scores. Loss of feeling was critical, because patients were unable to appreciate pain when the sore was developing. Risk of developing a sore increased with age, but duration of the paralysis was of equal importance. After discharge from hospital the presence of a caring relative or friend was essential for survival. Many patients developed sores because of poor facilities at home or inappropriate advice from those who looked after them. An even more distressing factor was the number of patients who developed sores in hospital owing to inadequate nursing care. There are relatively few paralysed patients in the community, but the lessons learnt in this study may be applied to all patients with orthopaedic injuries and to geriatric patients with limited mobility. Nursing and medical staff must turn patients regularly and ensure that there is proper equipment to relieve pressure on the skin. Patients should not be allowed to sit in a chair if they develop a sacral or trochanteric sore. More effort should be directed towards the appropriate education of patients, their relatives, and all those who are concerned with their welfare.

Acute Disease↗
PubMed1984

Injuries of the spine sustained in rugby.

Between 1952 and 1982, 67 rugby players (63 rugby union, two rugby league, and two American football) sustained serious injuries of their spine. The injuries fell predominantly on the lower cervical spine. Forty eight of the players sustained serious injuries of the spinal cord, leading to paralysis and total incapacity. The incidence of such injuries appears to have increased in recent years, particularly those incurred in tackles and mauls and rucks, and particularly among schoolboys. Changes in the laws of the game and in the attitudes of the players over the past few years should improve play and lead to a lower incidence of injuries.

Adolescent↗
PubMed1984

Traumatic cerebral flaccid paraplegia.

Two cases of paraplegia caused by head injuries sustained in recent military conflicts are presented. The underlying pathological disturbances could be related to the CT scan appearances and are discussed in the light of previously reported series. Both cases were remarkable for an early and prolonged paraplegia which was flaccid, rather than spastic, and for the sensory impairment produced.

Adult↗
PubMed1984

Atropine toxicity in acute cervical spinal injury.

A patient with a C.3/C.4 fracture dislocation resulting in an incomplete tetraplegia was treated with Cimetidine 400 mg bd to prevent gastrointestinal bleeding and 0.6 mg of atropine 6 hourly. He developed symptoms of atropine poisoning in the form of hallucinations, confusion and dilated pupils when the total dosage of atropine was 2.8 mg. This is far below the toxic levels normally considered necessary to produce atropine poisoning. The patient recovered. In view of the fact that this combination of drugs may be used in spinal units to prevent gastrointestinal bleeding and bradycardia, this experience is reported.

Adult↗
PubMed1984

Major amputation in paraplegic and tetraplegic patients.

In the 1940s major amputation in paraplegic and tetraplegic patients was performed mainly for the complications of pressure sores. With the increased understanding of paraplegia, life expectancy has greatly improved, with the consequence that the chief indication for amputation is now gangrene due to atherosclerosis. The special problems of the spinal-cord-paralysed amputee are reviewed.

Adult↗
PubMed1983

Combined brachial plexus and spinal cord trauma.

The clinical features of combined injuries of the brachial plexus and spinal cord in 31 patients are described. Diagnosis of the brachial plexus lesion was delayed in 17 instances, and the reasons for this are discussed. Early diagnosis is important so that definitive treatment and long-term plans can be instituted without delay. This dual lesion constitutes a very severe disability; as a direct result of their brachial plexus paralysis, 9 paraplegics did not achieve their predicted level of independence. Possible mechanisms of injury are suggested. Motorcycle accidents are particularly likely to cause these injuries, and a plea is made for further legislation to reduce the risks of injuries to young motorcyclists.

Accidents, Traffic↗
PubMed1983

A comparison of fine-bore suprapubic and an intermittent urethral catheterisation regime after spinal cord injury.

A prospective trial, comparing fine-bore suprapubic catheterisation and intermittent urethral catheterisation as methods of bladder drainage in the acute stage following spinal cord injury, was conducted. The results showed no important difference in either method of bladder management. Fine-bore suprapubic catheterisation is particularly suitable for young female patients, who find repeated urethral catheterisation distasteful; in other patients it is an acceptable alternative to intermittent urethral catheterisation, particularly where economic considerations are paramount.

Adolescent↗
PubMed1983

Amputation for peripheral vascular disease in the paraplegic and tetraplegic.

The occurrence of lower limb gangrene due to atherosclerosis is reported in 14 spinal cord paralysed patients. A further three patients became paraplegic and developed lower limb gangrene following aortic surgery for atherosclerotic complications. The clinical features are described and the difficulty in diagnosing ischaemia in the paralysed limb is emphasised. The incidence and prognosis following amputation are similar to those in the general population and there is no evidence from this series that paraplegia and tetraplegia predispose to atherosclerosis.

Adult↗
PubMed1983

Post-traumatic syringomyelia: the results of surgery.

Between 1973 and 1982 twenty-seven patients with post-traumatic syringomyelia had operations performed to drain the cyst. Three types of operation were performed, cord transection, tube syringostomy to the sub-arachnoid space and tube syringostomy to the peritoneal cavity. Five patients developed proven blockage of their catheters. The results are presented. Pain was dramatically and gratifyingly improved in 14 patients. Motor power showed the most consistent improvement in 14 patients. Only eight patients showed the most consistent improvement in 14 patients. Only eight patients showed sensory improvement; this was the least likely to improve. The progress of the condition could be arrested in the majority of cases, but a small number continued to deteriorate and required further operations.

Adult↗
PubMed1983

Role of outflow surgery in the rehabilitation of male paraplegic patients.

The role of bladder neck resection and division of the external sphincter in the establishing of micturition in patients with traumatic paraplegia is evaluated, based on a series of male admissions seen at Liverpool and at Stoke Mandeville. Operation was performed in about 30% of patients. It was extremely successful in eliminating the residual urine and infection and in establishing a satisfactory pattern of micturition. Impotence developed in only about 30% of cases.

Erectile Dysfunction↗
PubMed1982

Missed injuries of the spinal cord.

Damage to the spinal cord had not been recognised initially in 15 patients out of a consecutive series of 353 admitted over a decade to the National Spinal Injuries Centre with paralysis due to trauma to the cord. In some patients the missed diagnosis led to mismanagement and a greater neurological deficit. Missed injuries of the spinal cord are seen in patients with multiple injuries and head injuries and in those without any paralysis. Various radiological errors contribute to the failure to recognise the vertebral injury. In addition to causing severe disability to the victim these missed and mismanaged injuries of the spinal cord cost the National Health Service large sums in compensation. A careful evaluation of the history of each accident, with greater awareness of the potential of certain types of accidents to cause spinal cord injury, should reduce the incidence of missed injuries of the spinal cord.

Accidents↗
PubMed1982

Gastrointestinal bleeding in patients with acute spinal injuries.

Twenty out of 365 patients (5.5 per cent) with acute spinal cord injuries referred to a spinal ward over a 91/2-year period bled from the gastrointestinal tract. A cause of the haemorrhage was found in 15 patients. Six patients were endoscoped. Most patients had gastroduodenal ulceration but we could not be certain whether this was due to stress or peptic ulceration. We did not confirm that cervical cord lesions were associated with a higher incidence of gastrointestinal bleeding. The 4 patients who died probably represent an "inevitable' mortality in severely ill patients. The role of endoscopy is outlined, the pathogenesis of gastrointestinal ulceration discussed and future management of these patients is suggested.

Gastrointestinal Hemorrhage↗
PubMed1982

The occurrence of acute renal failure in patients with neuropathic bladders.

A group of patients with neuropathic bladders, who developed acute renal failure, is described. In each instance, sepsis from the urinary tract, its consequences or its treatment was implicated in the aetiology of the renal failure. Aggressive management of acute renal failure in the patients in our study showed their survival and functional renal recovery to be no worse than for similar patients without paraplegia. This illustrates that these patients presenting with a rare and serious complication of paraplegia should not be abandoned, since aggressive treatment along conventional lines in consultation with renal physicians and urologists was successful in four out of five of our patients.

Acute Kidney Injury↗
PubMed1982

Survival following traumatic tetraplegia.

In a review of 166 male tetraplegic patients admitted over an eleven year period, there were four acute deaths. Three of the four were over the age of 60 at the time of injury. Of the remaining 162 patients, the whereabouts of 143 patients could be ascertained. Twenty-three were lost to follow up. Sixteen patients died during the period of follow up. There were no deaths among those tetraplegics who survived for at least 5 years after the injury. Respiratory infections were the commonest cause of death among tetraplegic patients. With improved primary care of the tetraplegic patient acute mortality can be reduced.

Adult↗