Intracavernous injection of prostaglandin E1 for the treatment of erectile dysfunction in spinal cord injured patients: experience with 30 patients

To evaluate the efficacy of intracavernous injections of alprostadyl [Caverject] in the treatment of erectile dysfunction in patients with spinal cord injury [SCI] and to determine the mean necessary dose to obtain functional erection. Material and Thirty patients aged between 20 to 44 years, duration of lesion from one to 13 years and level of SCI from C5 incomplete to L3 complete, were included in the study. The treatment started with a minimal dose of 1.125 micrograms and the dosage was titrated to achieve rigid erection. Following the establishment of the effective dose, the patients were trained in the technique of self-injection. They returned periodically for follow up. Twenty seven patients achieved functional erection [Schramek grade 4 or 5] with a dose equal or less than 20 micrograms [mcg] of Caverject. The average effective dose was 11.75 +/- 4.6 mcg. Average duration of erection was 48.3 minutes. No side effects from the t reatment were observed except discomfort in two patients and mild penile pain in one patient. 76% of the patients were satisfied and very satisfied with the treatment. Intracavernous injections of Caverject are e ffective and safe therapy for erectile dysfunction provided that individual dose is established by titration, the patients are trained in the technique of self-injection

Our experience with interamuscular injections of botulinum toxin A for the treatment of upper limb flexors spasticity after stroke

Focal spasticity can be a major drawback in the rehabilitation of stroke patients. Previous studies suggest a beneficial effect of Botulinum toxin A[Botox A] for relief of spasticity. To evaluate the therapeutic effects of intramuscular injections of Botox A [Btx A] on spasticity of the upper limb. D e s i g n: An open-label non-controlled trial for a duration of 16 weeks was design to determine the e fficacy and safety of intramuscular Btx A injections in the treatment of 56 patients with spastic hemiparesis after stroke. The patients were assessed at baseline, 2, 4, 12 and 16 weeks after treatment by several outcome measures - modified Ashworth scale, motricity index arm score, limb position at rest, semi-quantitative o rdinal scale for severity of pain, patient's global response to Btx A t reatment, Barthel index of activities of daily living, difficulties encountered during thre e upper limb motor tasks. Significant reduction of muscle tone, spasticity related pain and improvement in the three selected functional tasks [cleaning the palm of the affected hand, cutting the fingernails of the affected hand, putting the affected arm into the sleeve] were observed one week after Btx A injections and were sustained throughout the 16 weeks follow-up period. Botox A is effective and safe adjunctive treatment to on-going rehabilitation for patients with post - stroke localized moderate-to-severe spasticity refractory to physical and medical treatments

Neck pain, neck mobility and alignment of cervical spine in 30 patients with cervical strain

Neck pain due to acute and repetitive neck injuries is a common complaint in the general population. Functional assessment of cervical spine by measurement of cervical range of movements [CROM] is informative and beneficial for planning proper treatment of patients with cervical strain. Muscle spasm is the widely used explanation for straightening and reversal of cervical lordosis commonly seen after trauma, but more specific interpretation is not supported in the literature. To evaluate the intensity of neck pain, the mobility of cervical spine and the cervical curve in patients with chronic cervical strain. Semiquantitative ordinal scale was used for evaluation of the severity of neck pain. Assessment of cervical movements was performed using cervical gonimeter with three separate inclinometers, measuring the movements in frontal, sagittal and horizontal planes. Two line Cobb method was used to determine the angle of cervical curve on lateral cervical radiographs. Significant reduction of total active CROM was found in patients with cervical strain with predominantly restricted neck extension followed by neck flexion, lateral flexion and to a lesser extent rotation. No significant difference was found in the prevalence of lordotic, straight and kyphotic curves in the group of patients with cervical strain compared to those in the control group. In our study, the existence of CROM limitation in cervical strain patients did not show a different than normal distribution of lordotic, straight and kyphotic cervical spine on radiographic images established by Cobb method

Incontinence and its risk factors in 123 patients with stroke in a rehabilitation setting in Kuwait

Incontinence of urine and feces is a common sequela of stroke and has significant importance both prognostically and socially for patients and their caregivers. The aim of this study was to evaluate the prevalence and risk factors of incontinence in patients with stroke. Material and We retrospectively studied 123 patients with recent hemispheric strokes [infarction, hemorrhage], representing consecutive admissions to the Physical Medicine and Rehabilitation Hospital in Kuwait during 1998-1999. The following pre-selected risk factors were evaluated by means of univariate analysis: age, sex, history of former stroke, diabetes mellitus, hypertension, other disabling diseases, severity of motor deficit in the paralyzed limbs, aphasia, type, side and size of brain lesion, presence of urinary tract infection. T h e re was a 53% prevalence of urinary incontinence [UI] on admission and 37% at discharge, which is comparable to other studies. Patients with initial UI were significantly older, had significantly more often communication deficit and severe motor deficit in the affected limbs; the brain lesions were more often large in size and more often multiple infarctions were detected on CT scan. Urinary tract infection showed a significantly higher rate in the incontinent group of patients. Fecal incontinence [FI] showed a 20% prevalence on admission and 4% at discharge and was significantly associated with age, aphasia, severe motor deficit, large and multiple infarctions, and comorbidity with other disabling diseases. Age, aphasia, severity of stroke [severe motor deficit and large size and multiple brain lesions] are common significant risk factors for both urinary and fecal incontinence. Early recognition of the risk factors may assist rehabilitation management of stroke patients, particularly for appropriate treatment setting and improvement of their long-term outcome