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1.
Spinal Cord ; 49(2): 196-9, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20548320

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To describe the characteristics of patients with work-related traumatic spinal cord injuries (TSCI) in Chile. SETTING: Hospital del Trabajador in Santiago, Santiago, Chile. METHODS: Patients suffering from TSCI incurred at the workplace from 1986 to 2005 were identified through records of the Asociación Chilena de Seguridad (ACHS, Chilean Safety Association). RESULTS: The medical records of 173 patients, 172 men and 1 woman, were analyzed. The yearly average incidence was 7.8 per million workers. Age at TSCI onset was 38.2 ± 12.1 years. The principal external causes for TSCI incurred at the workplace were falls from a height in 86 cases (49.7%) and trauma blows to the vertebral spine in 61 cases (35.3 %). More falls occurred in the field construction, and other traumas occurred as a result of traumatic blows caused by tree trunks and stones in forestry and mining sectors. Mortality in this series was 8.7%, and the worst prognosis was for older patients with complete tetraplegia. The paraplegia:tetraplegia ratio was 3.2:1. CONCLUSIONS: The characteristics of workplace TSCI are specific to this population. It is important therefore to develop prevention programs for specific work-related TSCI.


Assuntos
Doenças Profissionais/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Ferimentos e Lesões/epidemiologia , Acidentes por Quedas/mortalidade , Adolescente , Adulto , Idoso , Chile/epidemiologia , Estudos de Coortes , Feminino , Agricultura Florestal , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mineração , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/epidemiologia , Adulto Jovem
2.
Spinal Cord ; 46(2): 135-9, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17607312

RESUMO

STUDY DESIGN: Descriptive case series study. OBJECTIVE: To describe the course of five spinal cord injury (SCI) patients who underwent proximal amputation of the inferior extremity, secondary to recurrent, complicated pressure ulcers (PU) and the clinical impact this intervention had in these patients. PLACE: Trabajador Hospital in Santiago, Chile. METHOD: Revision of five clinical cases of patients who underwent partial hemipelvectomy or hip disarticulation with amputation of the extremity as treatment for pelvic recurrent PU with chronic secondary osteomyelitis. The clinical impact was quantified as days of hospital stay, number of surgeries and previous and post surgery PU. RESULTS: After the proximal amputation of the extremity, patients significantly decreased number of days of hospital stay (P=0.035), number of surgeries (P=0.015) and PU (P=0.0065). CONCLUSION: Partial hemipelvectomy and hip disarticulation with proximal amputation of the inferior extremity are rescue procedures that can be last resource treatment for chronic recurrent pelvic PU secondary to chronic osteomyelitis.


Assuntos
Amputação Cirúrgica , Perna (Membro)/cirurgia , Osteomielite/cirurgia , Úlcera por Pressão/complicações , Traumatismos da Medula Espinal/complicações , Doença Crônica , Hemipelvectomia , Hospitalização , Humanos , Masculino , Osteomielite/etiologia , Resultado do Tratamento
3.
Spinal Cord ; 44(12): 734-9, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16534503

RESUMO

STUDY DESIGN: Case control study. OBJECTIVE: To determine the main risk factors for pressure ulcer (PU) in ambulatory spinal cord injury (SCI) patients. SETTING: Hospital del Trabajador, Santiago, (ACHS (Chilean Security Association), Chile. METHODS: We studied 41 patients for traumatic SCI, from Santiago, Chile, cared for in our hospital. The clinical histories were reviewed from first discharge to 1996. The patients were categorized into two groups: 18 cases with a previous history of PU, and 23 patients with no history of PU were considered as controls. Univariate analysis was performed, 18 variables per case, 10 of which were psychosocial factors. RESULTS: There were 37 men and four women. Average age was 41.7 years. Duration of SCI on average was 6.7 years. The distribution was complete paraplegia (CPP) 22 patients (54%), complete tetraplegia three patients (7%), incomplete paraplegia 11 patients (27%) and incomplete tetraplegia, five patients (12%). Four variables of the univariate analysis were significant: duration of cord injury (SCI time) >5 years, completeness of cord injury, paraplegia and not able to practice regular standing. There was a significant association in body morphology (endo or ectomorphic), being able to practice regular standing and personality disorder in CPP. CONCLUSIONS: The risk for developing PU was 4.3 times greater in CPP patients than is any other type of SCI. CPP patients who do not practice standing periodically, who have a personality disorder and have an ecto/endomorphic corporal morphology have a greater risk of suffering PU.


Assuntos
Úlcera por Pressão/etiologia , Traumatismos da Medula Espinal/complicações , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia , Úlcera por Pressão/prevenção & controle , Análise de Regressão , Medição de Risco , Fatores de Risco
4.
Spinal Cord ; 38(5): 301-8, 2000 May.
Artigo em Inglês | MEDLINE | ID: mdl-10822403

RESUMO

OBJECTIVES: To assess the state of the neurological bowel in spinal cord injured (SCI) patients, design and apply a program for the comprehensive management of neurogenic bowel and evaluate outcome. SETTING: Out-patient in a Rehabilitation Service. SUBJECTS: Thirty-eight SCI patients, 12 (32%) with complete lesions of more than 5 years duration. DESIGN: Observational, longitudinal and prospective. Pre and post intervention. METHOD: Pre and post SCI intestinal function was evaluated clinically prior to beginning program. The presence of GI symptoms were studied. Laboratory work-up included colonic transit time (CTT), anorectal manometry and recto-colonoscopy. An intestinal program was designed, in order to achieve an effective and efficient evacuation in a predictable and socially acceptable time, to avoid short and long term complications and eliminate inadequate intestinal evacuation habits. OUTCOME MEASURES: Pre and post SCI difficulty in intestinal evacuation (DIE) was increased (from 2.6% to 26.3%). The most frequent GI symptom was abdominal distention (53%). Colonic inertia was present in 49% of CTT, internal anal sphincter pressure was normal or increased in 77% and rectoanal inhibitory reflex was present in 88%. With the intestinal program, the incidence of DIE was reduced to 8.8%, manual extraction (ME) was reduced from 53% to 37%. Excellent and good results were obtained in 56% of the patients. CONCLUSION: The proposed intestinal program is effective in the rehabilitation of SCI patients with neurogenic bowel. It is essential to initiate these physiological and safe procedures as soon as possible after sustaining the injury; this will lead to better results and to the elimination of inadequate intestinal maneuvering in the future Spinal Cord (2000) 38, 301 - 308.


Assuntos
Enteropatias/diagnóstico , Enteropatias/etiologia , Traumatismos da Medula Espinal/complicações , Adulto , Cisaprida/uso terapêutico , Doenças do Colo/etiologia , Doenças do Colo/fisiopatologia , Fibras na Dieta/uso terapêutico , Ácido Dioctil Sulfossuccínico/uso terapêutico , Feminino , Fármacos Gastrointestinais/uso terapêutico , Trânsito Gastrointestinal , Glicerol/administração & dosagem , Glicerol/uso terapêutico , Humanos , Enteropatias/reabilitação , Enteropatias/terapia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Supositórios , Tensoativos/uso terapêutico , Resultado do Tratamento
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