No abstract available.
Autonomic Dysreflexia* ; Humans ; Manometry* ; Spinal Cord Injuries*

Hyperreflexic bladder is a disease manifested in patients with spinal cord lesions above the sacral segment. The treatments for hyperreflexic bladder are medical therapy, interruption of innervation, argumentation cystoplasty, etc. We treated four hyperreflexic bladder patients with 12% a phenol injection into the subarachnoid space for sacral nerve block. Before treatment the average bladder capacity was about 100 ml, and there was one case of autonomic dysreflexia. After the subarachnoid block the average bladder capacity increased above 300 ml and maximal intravesical pressure decreased below 30cmH2O, autonomic dysreflexia disappeared in one patient. The decreased bladder compliance after nerve block was managed by repetitive bladder overdistention. We suggest that subarachnoid block is easier and more effective than sacral nerve block individually, and is a treatment for hyperreflexic bladder refractory to medical therapy.
Autonomic Dysreflexia ; Compliance ; Humans ; Nerve Block ; Phenol ; Spinal Cord ; Subarachnoid Space ; Urinary Bladder*

PURPOSE: The purpose of this study was to investigate the effects on critical thinking, problem solving, communication, confidence in nursing performance and learning satisfaction after simulation with problem-based learning. METHODS: This study used a non-equivalent control group no-synchronized design. Forty junior baccalaureate nursing students were recruited conveniently and assigned to the experimental (n=20) or control (n=20) group using time difference. The experimental group participated in lecture and simulation with problem-based learning on care for patients with autonomic dysreflexia while the control group received lecture and traditional practices. RESULTS: The experimental group presented significant improvement in critical thinking (Z=−2.10, p=.036), problem solving (t=3.36, p=.002), communication (t=2.32, p=.026), confidence in nursing performance (Z=−2.20, p=.028) and learning satisfaction (Z=−3.42, p=.001) compared with the control group. CONCLUSION: The results of this study indicated that simulation with problem-based learning is effective in improving critical thinking, problem solving, communication, confidence in nursing performance and learning satisfaction for nursing students.
Autonomic Dysreflexia* ; Humans ; Learning ; Nursing ; Problem Solving ; Problem-Based Learning* ; Students, Nursing ; Thinking

Transverse myelitis is an acute inflammatory lesion of the spinal cord resulting in motor, sensory, and autonomic dysfunction. Pregnancy increases risk of complications depending on the level of the spinal cord lesion. Hence, a multidisciplinary approach is needed during prenatal period. This is a case of IB, a 32 year-old primigravid, a known case of Transverse Myelitis, initially seen at ten weeks age of gestation. Prenatal course was managed accordingly. She underwent primary cesarean section for arrest cervical dilatation at 39 weeks, with an unremarkable post-operative course. There is an increased risk of preventable complications such as recurrent urinary tract infections, anemia, development of decubitus ulcers, premature labor and delivery and autonomic dysreflexia. It is imperative that during the prenatal period, the patient be monitored closely and referred to specialists for further management of these simple to fatal complications.

Human ; Female ; Adult ; Pregnancy ; Myelitis, Transverse ; Autonomic Dysreflexia ; Patients ; Urinary Tract Infections ; Anemia ; Pressure Ulcer ; Ulcer

Adult ; Autonomic Dysreflexia ; therapy ; Cesarean Section ; Female ; Humans ; Pregnancy ; Pregnancy Complications ; therapy ; Spinal Cord Injuries ; complications

Effective rehabilitation and assisted reproductive technology may increase the number of women considering pregnancy who have spinal cord injuries. It is important that obstetricians caring for these patients are aware of the specific problems related to spinal cord injuries. Autonomic dysreflexia is the most significant medical complication found in women with spinal cord injuries, and precautions should be taken to avoid stimuli that can lead to this potentially fatal complication. Women with spinal cord injuries may give birth vaginally, but when cesarean delivery is indicated, adequate anesthesia is needed. We report three cases of delivery in patients with spinal cord injury.
Anesthesia ; Autonomic Dysreflexia ; Female ; Humans ; Parturition ; Pregnancy ; Pregnant Women ; Reproductive Techniques, Assisted ; Spinal Cord ; Spinal Cord Injuries

BACKGROUND: We determined the effect of spinal cord injury (SCI) on sevoflurane requirements and stress hormone responses, and sevoflurane concentration to block autonomic hyperreflexia (AHR) in SCI patients. METHODS: In the first series, sevoflurane concentrations to maintain bispectral index score (BIS) at 40-50 and stress hormone response were examined in 27 SCI patients undergoing surgery below the level of injury.Fifteen patients without SCI served as control.Measurements included end-tidal sevoflurane concentrations (ET(SEVO)), systolic blood pressure (SBP), heart rate (HR), catecholamines, vasopressin, and cortisol concentrations.In the second series, sevoflurane concentration to block AHR was examined in 31 SCI patients undergoing transurethral litholapaxy.When a patient developed an episode of AHR, the target sevoflurane concentration was maintained for 10 min, and then the procedure was repeated.Each target concentration was determined by up-down method based on SBP. RESULTS: During surgery, SBP, HR, and BIS were comparable between SCI and control.However, ETSEVO was significantly smaller in the SCI than the control.Plasma concentrations of norepinephrine, epinephrine and cortisol were significantly lower in the SCI than the control.SBP rose by 67 +/- 31 mmHg, whereas HR fell by 13 +/- 8 bpm during the 1st trial in the SCI (P < 0.01).Hypertensive events were associated with increases of norepinephrine concentrations.ETSEVO required to prevent AHR were 3.12% in 50% of patients, 3.83% in 95% of patients. CONCLUSIONS: SCI reduces the anesthetic requirement by 39%, and decreases stress hormone responses during surgery below the level of injury.To prevent AHR in 95% of SCI patients undergoing litholapaxy, ETSEVO 3.83% may be required.
Autonomic Dysreflexia ; Blood Pressure ; Catecholamines ; Epinephrine ; Heart Rate ; Humans ; Hydrocortisone ; Lithotripsy ; Methyl Ethers ; Mustard Compounds ; Norepinephrine ; Spinal Cord Injuries ; Vasopressins

Autonomic dysreflexia is a clinical emergency syndrome of uncontrolled sympathetic output that can occur in patients who have a history of spinal cord injury. Despite its frequency in spinal cord injury patients, central nervous system complications are very rare. We report a man with traumatic high level incomplete spinal cord injury who suffered hypertensive right thalamic hemorrhage secondary to an episode of autonomic dysreflexia. Prompt recognition and removal of the triggering factor, the suprapubic catheter obstruction which led to hypertensive attack, the patient had a favorable functional outcome after the resorption of the hematoma and effective rehabilitation programme.
Autonomic Dysreflexia* ; Catheter Obstruction ; Central Nervous System ; Cerebral Hemorrhage* ; Emergencies ; Hematoma ; Hemorrhage ; Humans ; Rehabilitation ; Spinal Cord Injuries

PURPOSE: Autonomic dysreflexia represents one of the most serious medical emergencies in the care and rehabilitation of patients with spinal cord injury. We evaluated the effect of terazosin for the prevention of symptoms due to autonomic dysreflexia in patients with spinal cord injury. MATERIALS AND METHODS: The effect of terazosin was evaluated in 20 spinal cord injury patients with autonomic dysreflexia. All patients received terazosin as the only medication for the autonomic dysreflexia. Baseline measurements of blood pressure, the autonomic dysreflexia severity score and autonomic dysreflexia frequency score were recorded before terazoxin medication. Follow-up measurements were taken at 1 week, 1 month and 3 month after medication. All the data were statistically evaluated and the following results were obtained. RESULTS: The majority of patients(95%) had manifested headache and sweating. The autonomic dysreflexia severity score after terazosin medication decreased from an average of 9.0+/-0.6 at baseline to 6.8+/-0.7, 5.2+/-0.7 and 4.9+/-0.6 at 1 week, 1 month and 3 months repectively(p=0.001). And the autonomic dysreflexia frequency score after terazosin medication decreased from an average of 2.4+/-0.5 to 1.2+/-0.4 at 3 months. CONCLUSION: Tetazosin appears to be effective in preventing symptoms due to autonomic dysreflexia.
Autonomic Dysreflexia ; Blood Pressure ; Emergencies ; Follow-Up Studies ; Headache ; Humans ; Rehabilitation ; Spinal Cord Injuries* ; Spinal Cord* ; Sweat ; Sweating

We tried subcutaneous physostigmine 31 times in 24 spinal cord injured patients who had lost ejaculatory capacity. Normal semens were obtained in 4 patients(6.7 %), subnormal semen in 1 patient(4.2 %), a few sperms in 5 patients(20.8 %), and no sperm in 14 patients(58.3%). Sperm appearance rate was 41.7%. Patients with injuries in cervical and upper thoracic levels ejaculated successfully mere frequently than those with injuries in lower thoracic and lumbar levels. The results or T, L1, L2 injured patients were not successful. Side effects included nausea and vomiting (91.7%), dizziness(45.8%) and headache(25.0%), but all patients could tolerate them. Significant adverse effects, particularly autonomic dysreflexia, were not found. Artificial uterine inseminations with sperms induced by subcutaneous physostigmine were performed in 3 cases, and all of these attempts were successful. We have 3 live births. In conclusion, subcutaneous physostigmine for provoking ejaculation in anejaculatory spinal cord injury is cheap, easy to be performed and has no significant side effect.
Autonomic Dysreflexia ; Ejaculation* ; Humans ; Insemination ; Live Birth ; Male ; Nausea ; Physostigmine* ; Semen ; Spermatozoa ; Spinal Cord Injuries* ; Spinal Cord* ; Vomiting