[Endocrinological and metabolic aspects in spinal patients].
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Biomedical subjects
Publications and source records attributed to R Rozin.
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A case of osteomylitis of the foot and ankle bones with subsequent complications is presented. Antibiotic therapy was unsuccessful and a below-knee amputation was performed. A comparison of the various Mycobacteria species and their role as etiologic agents in osteomyelitis follows.
In the study of sexual functions and marital relations in 16 couples involving a normal female and a paraplegic male, married following the injury, it was found that a major source of dissatisfaction on the part of the wives was their inability to become pregnant and bear children. Sexual relations were surprisingly of secondary importance. Common in all 16 couples was the almost total lack of knowledge on the part of the woman about the man's sexual capabilities and the effect of his injury on fertility. Premarital counselling seems to be of primary importance in assuring the survival of such marriages. It may be useful to suggest they have premarital experience. Later, counselling should include the importance and advantages of artificial insemination donor treatment as a solution to infertility.
In a study of 16 married paraplegic patients, it was found that without electrostimulations, erections occurred in eight patients and ejaculation in three of them. Rectal electroejaculation performed in all the patients for the purpose of collecting sperm showed poor results. Sperm analysis revealed severe distubrances in spermatogenesis and spermiogenesis, the etiology of which was not clear since hormonal and sperm metabolic substrates were found to be in the normal range.
Twenty patients with spinal cord injury underwent serial electromyographic examinations. Fibrillation potentials and positive waves were noted in six patients in the spinal shock phase. In another subject, these potentials were found 27 months after injury. Our finding of significant slowing in the NCV of both nerves, indicates that lower motor neurons are indeed affected by upper motor neuron lesions. The H-reflex studies showed an increase in the mean H/M ratio. This may indicate an increase of reflex motor neuron excitability. No clear correlation was found between this increase and the degree of clinical spasticity. With repeat investigations, after a period of physical activity, a trend to reduction of the H/M ratio was noted with no clinical confirmation of reduction in spasticity. These findings emphasise the need for not assigning diagnostic terms to EMC abnormalities, but rather identifying them as neurophysiological changes which must be interpreted in the light of the clinical picture.
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Since 1973 intermittent catheterisation was introduced in our centre and this practically eliminated pathology of the urethra. More than half of the patients had a high and complete lesion. It is our impression that 5 years following injury more than half of the patients preserved a normal upper urinary tract; however, only 39 of the 92 patients had a follow-up of over 5 years. Nephrolithiasis was rare in comparison to other reports in spite of belonging to the stone belt area. Complications of the lower urinary tract including a 10 per cent incidence of vesico-ureteric reflux were compatible with other series. Narrowing of the external sphincter on voiding cystogram should be substantiated by a profile pressure record. One female patient is a candidate for ileal conduit. Most of the patients have some form of erection but the data on ejaculation should be accepted with reserve. Two patients in this series died more than 10 years after injury, one due to a myocardial infarction and the other due to chronic renal failure following secondary amyloidosis.
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In a research study, the vocational status of 172 patients with multiple sclerosis who were from 20 to 50 years of age was evaluated. These patients constituted 35% of the total population having multiple sclerosis in Israel. Ninety-four are working and 78 are unemployed. In the unemployed group, 41 are severely disabled but 37 have working potential. No rational explanation could be found in the demographic, vocational or educational backgrounds for the unemployment of the 37 patients. It is suggested that a vocational rehabilitation program at the onset of the patient's disability may prevent eventual unemployment.
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