RESUMEN

BACKGROUND: The Swedish health-care system is well suited for surveys of incidence of surgical procedures including those for morbid obesity, since almost all hospital care is provided by public hospitals funded by a public health-care insurance system. The National Board of Health and Welfare keeps a nation-wide registry of all in-patient hospital care. In order to describe the practice of obesity surgery, we extracted data for all patients who had undergone obesity surgery between 1987 and 1996. MATERIAL: 6,339 patients had at least one obesity surgery procedure between Jan. 1987 and Dec. 1996. A total of 7,176 procedures were identified. 77.2% were women, and the mean age was 39 years. Hospital stay averaged 8 days. RESULTS: There was a 3-fold increase in the annual incidence from 312 procedures/year in 1987 to 952 in 1996. 14% of the patients operated in1996 had previously undergone obesity surgery during the study period. The hospital mortality was 0.4%. Simple gastric restrictive procedures dominated (76%), and gastric bypass and jejuno-ileal bypass were performed in 7.5% and 5%, respectively. There was a trend that gastric bypass was performed more frequently towards the end of the study period. An increased number of procedures were performed in smaller hospitals during 1994-96, and there were obvious geographical variations. CONCLUSION: There has been 3-fold increase in obesity surgery in Sweden between 1987 and 1996, accounted for by increased performance of simple gastric restrictive procedures. The operative mortality is low, but the incidence of a second obesity surgery procedure is high.

Asunto(s)

RESUMEN

BACKGROUND: Acute follicular conjunctivitis is a clinical diagnosis common to multiple etiologies, of which chlamydial infection requires specific antibiotic treatment. PURPOSE: This prospective study was designed to evaluate Chlamydia trachomatis as the cause of acute follicular conjunctivitis by two sensitive tests: direct enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). METHODS: Conjunctival scrapings from patients presented with untreated acute follicular conjunctivitis were examined by ELISA and PCR, and patients were followed up for prolongation of the disease course. RESULTS: All 36 consecutive patients presented with acute follicular conjunctivitis were negative for Chlamydia trachomatis by ELISA and PCR. None of the patients had a prolonged course of more than 4 weeks or required treatment with systemic antibiotics as would be expected from chlamydial infection. CONCLUSIONS: Chlamydia trachomatis was probably not responsible for the acute follicular conjunctivitis in this series, and ELISA and PCR may not be cost effective for evaluation of acute follicular conjunctivitis due to chlamydial infection. Further evaluation of the cost effectiveness of these tests is required in chronic follicular conjunctivitis.

Asunto(s)

RESUMEN

The purpose of this descriptive study is to describe the profile of individuals with spinal cord injuries (SCI) who frequently use health care services in an unplanned manner so that nursing interventions could be designed to decrease utilization. The medical records of 78 subjects with SCI were reviewed for demographic and injury-related variables, comorbid health conditions, discharge disposition, and health care utilization for five years. Based on the rate of unplanned utilization of health care services, three groups of users were identified: non-user, low-user, and high-user groups. Results indicated that high users, compared to non-users and low users, had a higher substance-use rate, a higher unemployment rate at the time of the most recent health care visit, and more violent causes of their SCI. Findings suggest four clinically meaningful trends that have practical implications for nurses related to marital status, substance use, employment status, and etiology of injury. Results of this study laid the foundation for future research aimed at devising a more in-depth risk profile of high users of health care services in the SCI population.

Asunto(s)

RESUMEN

The impairment in defecation function that comes as a result of spinal cord injury may have a significant negative impact upon quality of life. Electrical stimulation (ES) of the somatic nervous system has been used to elicit autonomic reflexes in animals, before and after spinal cord transection. To determine whether ES might be used to promote bowel emptying, seven persons with recent spinal cord injury (SCI) and seven control subjects were studied. Electrical stimulation of the second sacral dermatome was applied during rectal manometry in both groups, and ES was added to the bowel programs of SCI patients. A significant rise in the number of rectal pressure spikes was noted in both groups after application of ES (p < .002, f = 6.34). There was no significant differences between the SCI and control groups when measuring the amplitude of spike waves in the colon. No significant change was noted in the time required for SCI patients to initiate a bowel movement, or in the time required to complete bowel emptying. Electrical stimulation of the sacral dermatomes can result in a change in the bowel activity of the recto-sigmoid colon. To date, no clinical effect on bowel emptying has been demonstrated.

Asunto(s)

RESUMEN

The Highland View Hospital Urinary Catheter Care Team was organised in 1962, primarily in response to the problems of increasingly drug resistant urinary infections and their complications in a chronic disease population which included patients with strokes, renal and liver failure and heart disease as well as those with spinal cord injury (SCI). When the spinal cord injury centre was formed in 1970 the team became an integral part of the service. The early problems in organising the team, its evolution into a valuable, economically viable, patient care service and its role in urological clinical research, are discussed.

Asunto(s)

RESUMEN

Verapamil, a calcium channel blocker, was tested alone and in combination with oxybutynin chloride for its clinical effectiveness in the treatment of detrusor hyperreflexia in a spinal cord injured population. Fourteen patients with detrusor hyperreflexia were included. All patients were treated with oxybutynin chloride alone and with the combination of oxybutynin chloride and verapamil. Six of the patients were also studied on no medication and verapamil alone. Cystometric and clinical comparisons were made with each change in drug dosage. Verapamil 240SL, when used alone, produced a delay in the first detrusor contraction as compared to no medication in 5 of the 6 patients but clinical improvement was insignificant. Clinical improvement with tolerable side effects was noted in 13 of the 14 patients treated with the combination of oxybutynin chloride and verapamil over oxybutynin alone. Our early experience with verapamil suggests that it may be a valuable adjunct in the treatment of detrusor hyperreflexia.

Asunto(s)

Asunto(s)

RESUMEN

During the past 25 years enormous progress has been made in the management of the neuropathic bladder, largely as a result of the adoption of intermittent catheterisation, together with improvements in catheter-related techniques, and the judicious use of antibacterial drugs and sphincter surgery. A few quadriplegic women can be trained to do self-intermittent catheterisation, using a special technique. For the majority of these women, however, there is no practical alternative at present to indwelling catheters. Bladder spasms resulting from the mechanical stimulation of the catheter and/or repeated infections may be difficult to control, and illustrative cases demonstrating some problems encountered are presented. There is an obvious need for an external collecting device for these women. The development in the field of such devices are presented and evaluated.

Asunto(s)

RESUMEN

Obtaining and sustaining an erection that is firm enough and adequate for vaginal penetration and satisfactory completion of intercourse are common problems for the male spinal cord injury patient. Intracavernous injection of vasoactive substances offers a new treatment option but it must be approached with caution in this population. During the last year we placed 20 spinal cord injury men (16 paraplegics and 4 quadriplegics) on self-injection of papaverine alone or with phentolamine. Of the patients 19 were able to obtain an erection adequate for penetration. The patient who did not obtain an adequate erection had anomalous penile venous drainage. Six episodes of priapism occurred in 3 patients: 1 had a surgical shunt placed elsewhere before he entered our program, and 2 were treated with aspiration of the corpora and injection of epinephrine. All 3 patients subsequently have been able to obtain satisfactory erections with use of lower doses of papaverine alone.

Asunto(s)

RESUMEN

Cystometry, using a portable CO2 cystometer, is a convenient method for detecting autonomic dysreflexia (A.D.) in response to bladder distention. Serial tracings on successive days were found to be consistent. This method was used to compare the effect of the antihypertensive drugs, phenoxybenzamine and nifedipine, in modifying the blood pressure responses of 12 tetraplegic patients. Given as regular medication twice daily, neither drug was effective in preventing A.D. responses to bladder filling, and a significant number of patients developed troublesome hypotension. Nifedipine by mouth was found to be a valuable drug for the treatment of attacks which developed, and capable of preventing an anticipated attack if given shortly before the stimulus. The condition of 'status dysreflexicus' and its appropriate management is described.

Asunto(s)

RESUMEN

Chlamydomonas exhibits force transduction in association with its flagellar surface; this can be visualized by the saltatory movements of attached polystyrene microspheres. This flagellar surface motility has been quantitated by determining the percentage of attached microspheres in motion at the time of observation (60% in the case of control cells at 25 degrees C). A number of experimental treatments reversibly inhibit flagellar surface motility. These include an increase in sodium or potassium chloride concentration, a decrease in temperature, or a decrease in the free calcium concentration in the medium. Many of the conditions that result in inhibition of flagellar surface motility also result in an induction of flagellar resorption. Although both flagellar stability and flagellar surface motility are dependent on the availability of calcium, the two processes are separable; under appropriate conditions, flagellar surface motility can occur at normal levels on flagella that are resorbing. Inhibition of protein synthesis results in a gradual loss of both the binding of microspheres to the flagellum and the flagellar surface motility. After resumption of protein synthesis, both binding and movement return to control levels. The effect of the inhibition of protein synthesis is interpreted in terms of selective turnover of certain components within the intact flagellum, one or more of these components being necessary for the binding of the microspheres and their subsequent movement. If this turnover is inhibited by keeping the cells below 5 degrees C, the absence of protein synthesis no longer has an effect on microsphere attachment and motility, when measured immediately after warming the cells to 25 degrees C.

Asunto(s)