Gut hormone release in patients after spinal cord injury.

Gastrointestinal disorders including abdominal pain, abdominal distention, ileus, and constipation are common after spinal cord injury. In physiologic studies of patients with spinal cord injury, slow gastric emptying, ileal dilation, and abnormal rectosigmoid motility have been found. However, it is not yet known whether abnormal gut hormone release is important in the development of these abnormalities. In healthy volunteers, there are postprandial increases in plasma peptide YY and motilin levels, which appear related to neural mechanisms. We hypothesized that abdominal sympathetic pathways provide tonic inhibition of peptide YY and motilin release and that postprandial increases in these gut hormones are mediated through spinal pathways. Fasting serum was obtained from normal volunteers, paraplegic patients, and tetraplegic patients. In studies in which patients were fed, serum was obtained from normal volunteers, paraplegic patients, and tetraplegic patients before and at 30-min intervals after a 280 kcal meal. Serum motilin and peptide YY levels were measured by radioimmunoassays. In fasting studies, there was a trend (P = 0.23) toward increased fasting serum motilin in paraplegic patients, and this result did not support tonic inhibition of motilin release. Fasting peptide YY levels were not increased in spinal cord injury patients, which did not support tonic inhibition of peptide YY release. In fed studies, there were strong trends toward postprandial increases in serum peptide YY in volunteers and paraplegic patients and a significant postprandial rise in serum peptide YY in tetraplegic patients (P = 0.04). This was evidence against involvement of spinal pathways in postprandial release of peptide YY.(ABSTRACT TRUNCATED AT 250 WORDS)

Osteoporosis in spinal cord injury: using an index of mobility and its relationship to bone density.

This study was undertaken to improve quantification of the extent of osteoporosis that accompanies spinal cord injuries (SCI) of various types, using single photon densitometry. In this study, we evaluated subjects with complete and incomplete SCI to determine whether there is a correlation between mobility and bone density. We created an index to rank the various levels of mobility among SCI subjects. Mobility index parameters ranged from 1, for complete immobility, to 9, for the full mobility of the uninjured control population. Incomplete SCI subjects (motor and/or sensory) ranked from 2 to 8 on the mobility scale. We also attempted to define clearly the mechanism of osteoporosis in those with predominantly unilateral SCI (Brown-Sequard syndrome). Using single photon absorptiometry (SPA), we found a strong correlation between our mobility index and observed bone density. These observations clearly show that osteoporosis is affected by the subject's level of physical activity. These observations also support the hypothesis that SCI individuals benefit from efforts to maintain a standing posture with some regularity. This effort to improve bone density slows the development of osteoporosis, a process that results in physical impairments in the SCI population.

Seasonal affective disorder in a spinal cord injury population.

Seasonal Affective Disorder (SAD) has received formal research attention only within the last eight years. Diagnostic criteria for SAD include many characteristics typical of depression: sadness, low self-esteem, lack of energy, social withdrawal, and suicide ideation, and features of atypical depression: carbohydrate craving, overeating, weight gain, and hypersomnia. Differential diagnosis of the disorder depends on an onset in fall/winter and remission in spring/summer. It was hypothesized that spinal cord injury (SCI) patients would have a higher incidence of the disorder in the northern latitudes because of decreased outdoor activities in winter and because of such light-depriving winter survival tactics as installing opaque plastic for storm windows. SCI patient responded to a postal survey which included Rosenthal's Seasonal Pattern Assessment Questionnaire (SPAQ) and the Beck Depression Inventory (BDI). Results showed a substantially higher rate of SAD among SCI patients than in the normative sample.

The efficacy of colostomy as a bowel management alternative in selected spinal cord injury patients.

Although colostomy has been used to divert the fecal stream from pressure sore sites and to deal with fecal incontinence in patients with conus/cauda level injuries, its use on an elective basis to shorten and simplify the bowel routines of SCI patients to improve their quality of life has not normally been advocated. A questionnaire and two case histories were used to gather data relating to self-care and management of elimination in order to delineate criteria for consideration of elective colostomy. The study concludes that elective colostomy may be an appropriate alternative for some SCI patients, particularly those who have failed in self-care or for whom their vocation or avocation is impaired by prolonged bowel routines.

Ultrasound sector scanning used to define changes in muscle configuration.

Dynamic configurational changes in the rectus femoris muscle were examined using a real time ultrasound sector scanner in ten normal subjects. The angle of passive knee flexion was varied as transverse ultrasound scanning was performed at the mid-transverse thigh. Configurational changes in the rectus femoris were computed from a traced outline of the muscle and the geometric center of the mass was calculated at all degrees of knee flexion. The geometric center of the mass varied with knee position. The anterioposterior dimensions and cross sectional areas of the rectus femoris and vastus intermedius remained constant, however, despite changes in knee position. The pattern of change observed was reproducible and reflects consistent changes in muscle configuration. The technique and instrumentation should have value for non-invasive dynamic and static observation of individual muscles.

Anorectal injuries incident to enema administration. A recurring avoidable problem.

Injuries to the anorectum have been described as having resulted from therapeutic enema use. We report three cases occurring in patients with premorbid perianal pathology. All extended hospitalization although each was managed nonoperatively. These accidents can be prevented by pre-enema rectal examination and attention to perianal anatomy and patient complaints of discomfort during the procedure.

Abdominal distention as an indication of post-polio ventilatory insufficiency. Clinical note.

Post-polio patients may experience episodes of recurrent respiratory insufficiency even after years of relatively stable pulmonary function. This patient's case was clearly documented with pulse oxymetry at night. Her major complaint, that of abdominal distension, was successfully addressed with the use of negative pressure ventilation. The likely cause of the abdominal distension was the excessive swallowing of air during episodes of ventilatory insufficiency. The goal of care for this patient was a safer, less stressful, more comfortable and restful nighttime routine with less daytime fatigue. The symptom of abdominal distention served as an indicator of a significant threat to her well being. Psychological support was a key element in her acceptance of the use of the ventilatory support equipment.