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The medical records of 32 spinal cord injury patients with 43 vesicoureteral refluxes admitted to our hospital from 1970 to 1982 were retrospectively reviewed. These patients were followed yearly with pyelograms together with cystograms or cystourethrograms. Many of these individuals were on an indwelling Foley catheter at the time reflux was detected, indicating that free urinary drainage such as a Foley catheter did not prevent reflux formation. Further, the majority of refluxes developed 1-2 years post-injury, and some disappeared spontaneously without causing any damage to the urinary tract. However, the indwelling Foley catheter was ineffective for reflux treatment because in the long run it did not prevent progression of vesicoureteral reflux and did not protect the refluxing kidney from damage. We also noticed that the incidence of reflux was statistically higher in patients with complete spinal lesion than in those with incomplete neurological dysfunction. This incidence was also higher in individuals with an upper motor neuron lesion.

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To determine factors that may influence kidney stone formation in spinal cord injury patients, the medical records of 893 patients who had been followed up by the Milwaukee Veterans Administration Medical Center from 1970 to 1984 were extensively reviewed. Urography showed that 12 patients had kidney stones. Twenty-four non-kidney stone patients with a similar age range, sex and duration of time since injury were selected as controls. Variables, such as level of spinal lesion, completeness of neurological dysfunction, presence of ureteric reflux etc, were compared and analysed statistically. The results showed that there was no difference between patients with and those without renal stone as far as the level of spinal injury and completeness of spinal cord lesion were concerned. There was no relationship between kidney stone formation and methods of urinary drainage or the presence of ureteric reflux. However, patients with good bladder control had no renal calculi. Serum creatinine, phosphorus, uric acid and calcium levels were similar in both groups of patients. There was a relationship between sepsis, positive urine culture and kidney stone formation. The absence of physical activity was not a risk factor for renal calculi and patients on a high fibre diet had the same incidence of stones as those on a regular diet.

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Traditional methods of evaluating sexual function in disabled individuals using neurological examinations, interviews, and psychological screening has been well established. A patient's ability to have erections and ejaculations are recorded through interviews with the patient and his partner. Therefore, to obtain a more objective view of the patient's sexual function, we used a nocturnal penile tumescence monitor in 12 tetraplegics and 12 paraplegics. Patients were interviewed for sexual histories before and after the injury. Their penile size was monitored during sleeping time using two strain gauges attached to each end of the penile shaft. The bridge output from these strain gauges was amplified to a single channel recorder. The spontaneous increase of penile circumference and its duration was recorded. The result showed that: tetraplegics had a greater increase of penile size and longer duration of erection than paraplegics, there is no correlation between incompleteness of spinal lesion and erection, there is no correlation between the presence of bulbocavernosus reflex and erection, and there is no correlation between sex dreams and erections.

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Chronic pain is a common clinical finding in spinal cord injury (SCI), with a reported incidence of between 45% and 90%. This figure was obtained by using nonstandardized pain evaluation and for mostly inpatient populations. Because of the shortcomings of previous investigations and the wide range of reported incidence, a study was conducted using self-rating pain measurement, an activity check list, and a drug-use rating scale. Pain in 40 hospitalized SCI patients (19 quadriplegics and 21 paraplegics) was evaluated according to the self-rating pain scale and for physical activities. The medical record of each of these patients was then reviewed to evaluate use of pain medications. Using the same method, 24 outpatients (12 with quadriplegia and 12 with paraplegia) in the Hospital Based Home Care Program were studied. Statistical analysis showed an incidence of chronic pain and decreased activity of 60% among inpatients and of 16.6% in outpatients. The drug-use rating scale was also significantly higher among inpatients while outpatients had a higher level of physical activity than inpatients. Whether these differences are causally related to the patient's hospitalization is difficult to determine.

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During a two-year period we admitted 13 respirator-dependent quadriplegic patients to the spinal cord injury service at Wood VAMC for weaning from a mechanical ventilator, and rehabilitation. The patients were sent to the Spinal Cord Injury Center because initial weaning attempts from the respirator at other medical centers were unsuccessful. We successfully weaned them from the respirator, and at the time of discharge, only two patients required an indwelling tracheostomy tube for suction. The time required for weaning off the respirator varied from two days to 14 months. Most of the patients were discharged and many of them could independently perform the activities of daily living. We conclude that are four main factors which influence the successful weaning of dependent quadriplegics from the mechanical ventilator: alleviation of patient's anxiety and depression; family support; close working relationship between staff; prevention of complications such as pneumonia and urinary tract infections.

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We have investigated the effectiveness of a low calcium diet, low sodium diet, and hydrochlorthiazide to reduce urinary calcium excretion in ten spinal cord injured patients during the early phase of their rehabilitation. Five patients were given the regular hospital diet and low calcium diet (300 mg calcium/day diet) on a randomized cross-over design. The other five patients were given four treatment modalities: a. regular diet, b. low calcium diet, c. low sodium diet (2 gm sodium/day diet), d. low calcium diet plus hydrochlorthiazide 25 mg twice a day according to a cross-over randomized block design. Each treatment regimen lasted two weeks and 24-hour urinary calcium concentrations were determined weekly. The result indicated that low calcium diet, low sodium diet or low calcium diet plus hydrochlorthiazide reduced hypercalciuria significantly (P less than 0.01). Low calcium diet combined with hydrochlorthiazide was the most effective treatment for hypercalciuria. In retrospective studies, we found that recently injured patients developed hypercalciuria, however, there was no significant difference in the incidence of bladder stone formation in patients with hypercalciuria compared with those with normal urinary calcium excretion.

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Only nine cases of adrenomyeloneuropathy have been reported in the literature. It manifested as adrenal insufficiency, spastic paraparesis, loss of bowel, bladder and sexual functions, and peripheral neuropathy. Our paper describes a patient with the diagnosis of adrenomyeloneuropathy who was admitted to our hospital for rehabilitation. Family and neurological history, physical examination and special laboratory studies such as ACTH stimulation test, electrodiagnostic findings, cystometrogram and sexual function evaluation were essential to establish the diagnosis of this disease. His rehabilitation consisted of bowel and bladder training, ambulation with long-leg braces and crutches, wheelchair mobilization and transfers, and independence of all activities of daily living.

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The most important factors for the formation of pressure sores are sufficient pressure for an adequate period of time. Many investigators have shown that psycho-social factors are also associated with pressure sores. We investigated other factors that may relate to higher incidence and more extensive pressure sores. Seventeen paraplegics and 21 quadriplegics were clinically examined regarding the degree of spasticity and the size of their pressure sores were measured. They were interviewed for cigarette smoking habit, the presence of help in skin care and their employment or educational activities. Body weight was obtained and the types of wheelchair cushion used were inspected. The result shows that patients with more pack-years of smoking habit had higher incidence and more extensive pressure sores. Other variables such as level of spinal cord injury, completeness of neurological lesion, the availability of help in skin care, the presence of employment or educational activities, spasticity, and body weight were not associated with pressure sores. The types of wheelchair cushion used by our patients did not correlate to the incidence of pressure sores. In addition, cigarette smoking did not decrease spasticity in our patients.

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Few reports on nutritional management of patients with both brain damage and spinal-cord-injury appear in the literature. We present a case of a 20-year-old male quadriplegic, C4 complete, who also sustained brain damage secondary to cerebral anoxia. When the patient was transferred to our rehabilitation unit, deterioration in nutritional status was noted, as evidenced by weight loss and depressed serum albumin and hemoglobin. Nutritional rehabilitation consisted of weaning from nasogastric tube feedings to an oral diet providing snacks and commercial supplements. This resulted in a positive nitrogen balance. Other factors, such as mobilization, exercises, and closure of a pressure sore, contributed favorably to improvement of nutritional status.

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Traumatic fracture of the long bones of the lower extremities may frequently occur in spinal cord injured patients. In the past, conservative treatment with pillow or sand bag splinting was advocated by many clinicans. This paper presents two cases in which posterior splinting was used on the affected leg for stabilization of the fracture with good result and well accepted by patients. Also, the use of Mud bed for prevention of pressure sores was illustrated.

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Three normotensive volunteers were given oral doses of alpha-tocopherylquinone. Blood pressure and its plasma concentrations were measured before and within 6 hours after taking this drug. Two dogs were given alpha-tocopherylquinone orally and after 3 days intravenously. Plasma concentrations were measured after each administration. Our result showed that this drug did not affect the blood pressure of normotensive individuals, and only small concentrations of alpha-tocopherylquinone were detected in plasma. In dogs, oral doses gave higher plasma levels than intravenous administration.

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A crossover clinical trial of benapryzine and trihexyphenidyl in ten parkinsonian patients during a four-month study is described. The improvement from initial disability ranged from 29.5 to 64.4 per cent for benapryzine and from 27.2 to 64.9 per cent for trihexyphenidyl. The effect of benapryzine and trihexyphenidyl on most parkinsonian symptoms did not differ significantly. Patients taking benapryzine had significantly fewer of the common side effects of trihexyphenidyl but more sialorrhea. It is uncertain whether benapryzine is superior to trihexylphenidyl in the treatment of Parkinson's disease.

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