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Type 1 fimbriae of Klebsiella pneumoniae mediate adherence to human uroepithelial cells
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ACADEMY ANNUAL ASSEMBLY ABSTRACTS
"Complications of Fluoroscopically-Guided Spinal Injections." Curtis W. Slipman, MD (Hospital of the University of Pennsylvania Medical Center, Philadelphia, PA); Jeffrey S. Meyers, MD; Larry H. Chou, BS; Elliot B. Sterenfeld, MD; Sheryl Abrams, RN, BSN.
"Utilization of a Vacuum Constriction Device for Erectile Dysfunction after Spinal Cord Injury: A Survey." John R. Baird, MD (Medical College of Virginia, Richmond, VA); William O. McKinley, MD; Gary Katz, MD.
There is little documentation on major complications associated with fluoroscopically guided spinal injections. A retrospective cohort study to document and ascertain frequency of medical complications resulting from fluoroscopically guided cervical and lumbar spinal injections was performed at our multidisciplinary spine center. Consecutive spinal injection procedures performed between July 1 and December 31, 1994 were reviewed by an independent observer. This involved reviewing procedure notes of caudal blocks, selective nerve root blocks, sacroiliac joint blocks, facet joint blocks, lumbar sympathetic blocks, and discograms. Of 888 total procedures, 8 (0.9%) significant complications occurred including 3 dural punctures, 1 vasovagal response leading to severe bradycardia, 1 allergic reaction to local anesthetic leading to unresponsiveness, 2 allergic reactions to contrast, and 1 case of posterior interosseus syndrome. None of the above complications resulted in permanent sequelae. All resolved without the need for hospitalization. This study demonstrates that fluoroscopically guided spinal injections performed by an experienced practitioner result in few major complications.
The effectiveness, degree of satisfaction, side effects, and technical difficulties encountered in a spinal cord injured population while using a vacuum constriction device for erectile dysfunction was examined. Thirty spinal cord injured individuals evaluated by a urologist for erectile dysfunction and treated with an Obson penile vacuum device were studied. A 40-question survey was conducted after the men had been prescribed the device for at least 6 months. Before receiving the vacuum device, 57% of the men rated their sexual drive as high and 43% could achieve an erection; however, only 7% could participate in sexual intercourse, secondary to inadequate penile tumescence, and only 21% could achieve orgasm. Sixty-seven percent used the device at least 4 times a month and were able to achieve an erection adequate for intercourse in a couple of minutes. Minor side effects occurred in 36% of individuals and consisted of mild bruising, cuts, and skin discoloration. More than 60% were satisfied with the device and reported that their partners were also satisfied. Sixty-eight percent of the men were able to achieve their pre-injury erectile size and an equal percentage felt the device improved their self-image, and was safe and effective. No change in the ability to achieve orgasm was reported.
Spinal Cord Injury "Natural Killer Cell Function in Tetraplegic Patients." Denise I. Campagnolo, MD (UMD-New Jersey Medical School, Newark, NJ); Seven E. Keller, PhD; Lisa Grimaldi, BS. Natural killer (NK) cells are large granular lymphocytes that provide nonspecific cytotoxicity of tumor ceils and virus infected cells. Catecholamines have been shown to reduce NK cell function in vitro. The betaadrenergic receptor is the likely modulator of the activity and is present on NK cell membranes. We hypothesized that NK cell function would be altered in complete tetraplegia because of the dysregulation of the sympathetic ann of the autonomic nervous system. This alteration would not be expected in complete paraplegic patients (T10 or below) and age/sex matched controls for each group. NK cell function was measured by a chromium release assay utilizing human K562 tumor line as target cells. Repeated measures analysis of variance revealed a statistically significant reduction in NK cell function in tetraplegic patients as compared to their neurologically intact controls at 3 different effectors target (E:T) cell ratios (DF = 60, F Ratio = 6.27, p = .01). There was no statistically significant difference found in the paraplegic patients as compared with their controls (DF = 24, F Ratio = 1.52, p = .23). This data supports our hypothesis of altered immune function following complete cervical spinal cord injury. "Type 1 Fimbriae of Klebsiella Pneumoniae Mediate Adherence to Human Uroepithelial Cells." Ki-Soo Kil, PhD (Baylor College of Medicine and Veterans Affairs Medical Center, Houston, TX); Rabih O. Darouiche, MD; David Mansouri, BS; Richard A. Hull, PhD; Daniel M. Musher, MD.
Klebsiella pneumoniae has become the most common cause of urinary tract infection (UTI) in spinal cord injured (SCI) patients who undergo intermittent catheterization of the bladder. Nevertheless, it has not been clear how Kpneumoniae colonizes the human urinary tract. The purpose of this study was to find if the adhesion property of K pneumoniae contributes to its persistence in UTI. Eight urinary isolates of K pneumoniae from SCI patients, shown by polymerase chain reaction using primers derived from repetitive DNA sequence elements (REP-PCR) to be clonally unrelated strains, were examined for their in vitro adherence to HUC, human buccal cells and HEp-2 cells. Two bacterial isolates obtained from patients who had persistent UTI longer than 40 days despite appropriate antibiotic therapy showed much stronger adhesion activity to HUC, human buccal cells, and HEp-2 cells than did 6 bacterial isolates that caused only transient UTI. The persistent isolates adhered strongly (>50 bacteria per cell) to at least 95% of examined HUC, whereas the 6 nonpersistent isolates either did not adhere or adhered very weakly (<5 bacteria per cell) to at least 90% of HUC. Adherence was almost completly inhibited when bacteria were incubated with these epithelial cell lines in the presence of D-mannose, indicating that type 1 fimbriae are responsible. These results suggest that type 1 fimbriae mediate adherence of K pneumoniae to HUC and help to clarify the relationship between adherence of K pneumoniae to uroepithelial cells and bacterial persistence in urinary tract infection.
Arch Phys Med Rehabil Vol 76, November 1995
"Imaging of the Shoulder in Paraplegia." Linda R. Carroll, MD (University of Washington, Seattle, WA); Barry Goldstein, MD, PhD; Mark Hollister, MD; Eva M. Escobedo, MD; John C. Hunter, MD. Shoulder pain is common in individuals with paraplegia. Yet the etiology, diagnoses, and appropriate management of shoulder problems in this population is not clear. The purpose of this study was to describe plain film findings in symptomatic and asymptomatic individuals with paraplegia and age/sex-matched controls and to correlate these findings with magnetic resonance (MR) images. Eighty-two shoulder X-ray and MR films were reviewed. Three experienced, blinded musculoskeletal radiologists independently examined the MR images. Evaluation of plain films showed narrowing of the acromial-humeral space and a highriding humeral head in 65% of the symptomatic paraplegic shoulders. Degenerative changes of the glenoid occurred in only two of 33 shoulders (6%); however, degenerative changes of the acromioclavicular joint and inferior osteophytes were common (22 of 33 shoulders). Sclerosis of the greater tuberosity was noted in 13 of 33 symptomatic shoulders. Abnormal X-ray findings were noted in 9 of 16 asymptomatic shoulders. Twenty-two of 31 symptomatic paraplegic shoulders (71%) had rotator cuff tears with full-thickness tears of the supraspinatous found in 55%. Full-thickness tears of subscapularis or infraspinatous were seen in half of the shoulders with full-thickness supraspinatous tears. Only one of 22 asymptomatic shoulders demonstrated a rotator cuff tear (partial, supraspinatous). We conclude: (1) abnormal X-ray and MR findings are common in paraplegic individuals, (2) abnormal X-ray findings are common in both symptomatic and asymptomatic individuals; (3) MR findings of full-thickness rotator cuff tears are common in symptomatic but not asymptomatic individuals with paraplegia; and (4) clear recommendations for the diagnostic evaluation of the painful shoulder in this population is needed.
"Antibody Response to Influenza Vaccination in Spinal Cord Injured Patients." Rabih O. Daroniche, MD (Baylor College of Medicine/The Veterans Affairs Medical Center, Houston, TX); Amy HUlstrom, P.A.; Robert Atmar, MD; Jon Markowski, MD. Influenza vaccination is recommended for persons with increased risk for influenza infection and its complications. Many spinal cord injury patients may qualify for vaccination. The purpose of this study was to examine the antibody response of SCI subjects to the commercially available trivalent, 1994-1995, influenza vaccine. Antibody responses were determined using the standard hemagglutination-inhibition test in 40 SCI subjects and in a control group of 40 able-bodied subjects before and four weeks after vaccination. A fourfold or greater increase in serum hemagglntination inhibition antibody titer signified adequate antibody response to influenza vaccination. Adequate antibody response to the 3 influenza antigens among subjects younger than 55 years of age ranged from 61% to 74% in SCI patients versus 60% to 70% in able-bodied
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
"Complications of Fluoroscopically-Guided Spinal Injections." Curtis W. Slipman, MD (Hospital of the University of Pennsylvania Medical Center, Philadelphia, PA); Jeffrey S. Meyers, MD; Larry H. Chou, BS; Elliot B. Sterenfeld, MD; Sheryl Abrams, RN, BSN.
"Utilization of a Vacuum Constriction Device for Erectile Dysfunction after Spinal Cord Injury: A Survey." John R. Baird, MD (Medical College of Virginia, Richmond, VA); William O. McKinley, MD; Gary Katz, MD.
There is little documentation on major complications associated with fluoroscopically guided spinal injections. A retrospective cohort study to document and ascertain frequency of medical complications resulting from fluoroscopically guided cervical and lumbar spinal injections was performed at our multidisciplinary spine center. Consecutive spinal injection procedures performed between July 1 and December 31, 1994 were reviewed by an independent observer. This involved reviewing procedure notes of caudal blocks, selective nerve root blocks, sacroiliac joint blocks, facet joint blocks, lumbar sympathetic blocks, and discograms. Of 888 total procedures, 8 (0.9%) significant complications occurred including 3 dural punctures, 1 vasovagal response leading to severe bradycardia, 1 allergic reaction to local anesthetic leading to unresponsiveness, 2 allergic reactions to contrast, and 1 case of posterior interosseus syndrome. None of the above complications resulted in permanent sequelae. All resolved without the need for hospitalization. This study demonstrates that fluoroscopically guided spinal injections performed by an experienced practitioner result in few major complications.
The effectiveness, degree of satisfaction, side effects, and technical difficulties encountered in a spinal cord injured population while using a vacuum constriction device for erectile dysfunction was examined. Thirty spinal cord injured individuals evaluated by a urologist for erectile dysfunction and treated with an Obson penile vacuum device were studied. A 40-question survey was conducted after the men had been prescribed the device for at least 6 months. Before receiving the vacuum device, 57% of the men rated their sexual drive as high and 43% could achieve an erection; however, only 7% could participate in sexual intercourse, secondary to inadequate penile tumescence, and only 21% could achieve orgasm. Sixty-seven percent used the device at least 4 times a month and were able to achieve an erection adequate for intercourse in a couple of minutes. Minor side effects occurred in 36% of individuals and consisted of mild bruising, cuts, and skin discoloration. More than 60% were satisfied with the device and reported that their partners were also satisfied. Sixty-eight percent of the men were able to achieve their pre-injury erectile size and an equal percentage felt the device improved their self-image, and was safe and effective. No change in the ability to achieve orgasm was reported.
Spinal Cord Injury "Natural Killer Cell Function in Tetraplegic Patients." Denise I. Campagnolo, MD (UMD-New Jersey Medical School, Newark, NJ); Seven E. Keller, PhD; Lisa Grimaldi, BS. Natural killer (NK) cells are large granular lymphocytes that provide nonspecific cytotoxicity of tumor ceils and virus infected cells. Catecholamines have been shown to reduce NK cell function in vitro. The betaadrenergic receptor is the likely modulator of the activity and is present on NK cell membranes. We hypothesized that NK cell function would be altered in complete tetraplegia because of the dysregulation of the sympathetic ann of the autonomic nervous system. This alteration would not be expected in complete paraplegic patients (T10 or below) and age/sex matched controls for each group. NK cell function was measured by a chromium release assay utilizing human K562 tumor line as target cells. Repeated measures analysis of variance revealed a statistically significant reduction in NK cell function in tetraplegic patients as compared to their neurologically intact controls at 3 different effectors target (E:T) cell ratios (DF = 60, F Ratio = 6.27, p = .01). There was no statistically significant difference found in the paraplegic patients as compared with their controls (DF = 24, F Ratio = 1.52, p = .23). This data supports our hypothesis of altered immune function following complete cervical spinal cord injury. "Type 1 Fimbriae of Klebsiella Pneumoniae Mediate Adherence to Human Uroepithelial Cells." Ki-Soo Kil, PhD (Baylor College of Medicine and Veterans Affairs Medical Center, Houston, TX); Rabih O. Darouiche, MD; David Mansouri, BS; Richard A. Hull, PhD; Daniel M. Musher, MD.
Klebsiella pneumoniae has become the most common cause of urinary tract infection (UTI) in spinal cord injured (SCI) patients who undergo intermittent catheterization of the bladder. Nevertheless, it has not been clear how Kpneumoniae colonizes the human urinary tract. The purpose of this study was to find if the adhesion property of K pneumoniae contributes to its persistence in UTI. Eight urinary isolates of K pneumoniae from SCI patients, shown by polymerase chain reaction using primers derived from repetitive DNA sequence elements (REP-PCR) to be clonally unrelated strains, were examined for their in vitro adherence to HUC, human buccal cells and HEp-2 cells. Two bacterial isolates obtained from patients who had persistent UTI longer than 40 days despite appropriate antibiotic therapy showed much stronger adhesion activity to HUC, human buccal cells, and HEp-2 cells than did 6 bacterial isolates that caused only transient UTI. The persistent isolates adhered strongly (>50 bacteria per cell) to at least 95% of examined HUC, whereas the 6 nonpersistent isolates either did not adhere or adhered very weakly (<5 bacteria per cell) to at least 90% of HUC. Adherence was almost completly inhibited when bacteria were incubated with these epithelial cell lines in the presence of D-mannose, indicating that type 1 fimbriae are responsible. These results suggest that type 1 fimbriae mediate adherence of K pneumoniae to HUC and help to clarify the relationship between adherence of K pneumoniae to uroepithelial cells and bacterial persistence in urinary tract infection.
Arch Phys Med Rehabil Vol 76, November 1995
"Imaging of the Shoulder in Paraplegia." Linda R. Carroll, MD (University of Washington, Seattle, WA); Barry Goldstein, MD, PhD; Mark Hollister, MD; Eva M. Escobedo, MD; John C. Hunter, MD. Shoulder pain is common in individuals with paraplegia. Yet the etiology, diagnoses, and appropriate management of shoulder problems in this population is not clear. The purpose of this study was to describe plain film findings in symptomatic and asymptomatic individuals with paraplegia and age/sex-matched controls and to correlate these findings with magnetic resonance (MR) images. Eighty-two shoulder X-ray and MR films were reviewed. Three experienced, blinded musculoskeletal radiologists independently examined the MR images. Evaluation of plain films showed narrowing of the acromial-humeral space and a highriding humeral head in 65% of the symptomatic paraplegic shoulders. Degenerative changes of the glenoid occurred in only two of 33 shoulders (6%); however, degenerative changes of the acromioclavicular joint and inferior osteophytes were common (22 of 33 shoulders). Sclerosis of the greater tuberosity was noted in 13 of 33 symptomatic shoulders. Abnormal X-ray findings were noted in 9 of 16 asymptomatic shoulders. Twenty-two of 31 symptomatic paraplegic shoulders (71%) had rotator cuff tears with full-thickness tears of the supraspinatous found in 55%. Full-thickness tears of subscapularis or infraspinatous were seen in half of the shoulders with full-thickness supraspinatous tears. Only one of 22 asymptomatic shoulders demonstrated a rotator cuff tear (partial, supraspinatous). We conclude: (1) abnormal X-ray and MR findings are common in paraplegic individuals, (2) abnormal X-ray findings are common in both symptomatic and asymptomatic individuals; (3) MR findings of full-thickness rotator cuff tears are common in symptomatic but not asymptomatic individuals with paraplegia; and (4) clear recommendations for the diagnostic evaluation of the painful shoulder in this population is needed.
"Antibody Response to Influenza Vaccination in Spinal Cord Injured Patients." Rabih O. Daroniche, MD (Baylor College of Medicine/The Veterans Affairs Medical Center, Houston, TX); Amy HUlstrom, P.A.; Robert Atmar, MD; Jon Markowski, MD. Influenza vaccination is recommended for persons with increased risk for influenza infection and its complications. Many spinal cord injury patients may qualify for vaccination. The purpose of this study was to examine the antibody response of SCI subjects to the commercially available trivalent, 1994-1995, influenza vaccine. Antibody responses were determined using the standard hemagglutination-inhibition test in 40 SCI subjects and in a control group of 40 able-bodied subjects before and four weeks after vaccination. A fourfold or greater increase in serum hemagglntination inhibition antibody titer signified adequate antibody response to influenza vaccination. Adequate antibody response to the 3 influenza antigens among subjects younger than 55 years of age ranged from 61% to 74% in SCI patients versus 60% to 70% in able-bodied