ABSTRACT
OBJECTIVE: To prospectively evaluate the effect of pump-infused intrathecal baclofen infusion (ITB) in therapeutic doses on sleep quality and on daytime and nighttime respiratory function in patients with severe spasticity. METHODS: We prospectively evaluated 20 consecutive patients (mean +/- SD age 45 +/- 13 years). We assessed spasticity and obtained polysomnography, pulmonary function tests, and resting energy expenditure measurements 1 week before and at least 8 days after pump implantation. Patients stopped oral baclofen upon pump implantation but continued other medications unchanged. We report descriptive statistics as means +/- SD. RESULTS: Most of the patients had multiple sclerosis (n = 9) or spinal cord injury (n = 8); there was one case each of cerebral palsy, hereditary spastic paraplegia, and Friedreich ataxia. Before and after ITB initiation, mean Ashworth scores were 2.75 +/- 0.85 and 1.15 +/- 0.36, and mean spasm scores were 3.75 +/- 0.55 and 1.00 +/- 0.56. ITB improved total sleep time (p = 0.05) and sleep efficiency (p = 0.01) and reduced periodic leg movements (p = 0.02). ITB did not modify sleep-related respiratory events, lung function tests, CO2 rebreathing response, or resting energy expenditure. CONCLUSION: Compared with oral baclofen, intrathecal baclofen infusion did not affect respiratory function and improved sleep continuity. Intrathecal baclofen infusion in therapeutic doses may act at the spinal level rather than at the supraspinal level.
Subject(s)
Baclofen/administration & dosage , Muscle Relaxants, Central/administration & dosage , Muscle Spasticity/drug therapy , Muscle Spasticity/physiopathology , Respiration/drug effects , Sleep/drug effects , Adult , Baclofen/therapeutic use , Circadian Rhythm , Female , Humans , Injections, Spinal , Middle Aged , Multiple Sclerosis/complications , Muscle Relaxants, Central/therapeutic use , Muscle Spasticity/etiology , Oxygen Consumption , Prospective Studies , Respiratory Function Tests , Rest , Severity of Illness Index , Spinal Cord Injuries/complicationsABSTRACT
The authors report the case of uterine rupture occurring after 28 weeks of amenorrhea and related to placenta accreta and treated by means of hysterectomy. They stress the diagnostic problems and discuss possible conservative treatment.
Subject(s)
Placenta Accreta/complications , Uterine Rupture/etiology , Adult , Female , Humans , Incidence , Placenta Accreta/diagnosis , Placenta Accreta/epidemiology , Pregnancy , Pregnancy Trimester, Second , Uterine Rupture/diagnosis , Uterine Rupture/surgeryABSTRACT
We report 13 cases of iatrogenic injuries to the ureter assembled in the department of urology of Averroes hospital. All the cases resulted from gynecological and obstetric mishaps. The patients ranged in ages from 18 to 45 years. Clinical features consisted of permanent urinary incontinence through the vagina with persistence of normal micturition in the majority of our patients. Ureterohydronephrosis and uretero-vaginal fistulae were noted in the majority of our cases. All the uretero-vaginal fistulae were repaired, by different techniques with good results.
