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2-52-11 The influence of physical therapy in lung function on patients suffering from cervical spinal cord injury
Spinal Cord Injuries
s134
pmol.100 g-’ min-‘. SCGU in grey matter (anterior and posterior horns) was similar in the cervical (60 f 6 ~mol.100 g-’ min-‘) and the lumbar (59 f 5 /~mol.lOO g-’ min-‘) regions, but lower (17%; p < 0.05) in the thoracfc region (49 f 4 ~mol.100 g-’ mini) SCGU in white matter was lower than grey matter regions in the cervical (46%; p < 0.01) thoracic (46%; p 4 0.005) and lumbar (42%; p i 0.01) regions. During exercise at -65% of maximal 02 uptake, average SCGU increased 112% (p < 0.001) to 76 f 4 ~mol.100 g-’ min-’ for the total spinal cord SCGU increased during exercise by 62% (p -Z 0.001) in the cervical, 90% (p < 0.005) in the thoracic and 97% (p < 0.001) in the lumbar grey matter, and by 104% (p < 0.005) in the cervical, 151% (p < 0.005) in the thoracic and 111% (p < 0.01) in the lumbar white matter. The highest increase by 170% (p -= 0.005) was measured in the thoracic segment of the lateral part of the Spinothalamic tract. During exercise SCGU in grey matter (anterior and posterior horns) was similar in the cervical (110 f 3 pmol.100 g-’ min-I) and the lumbar (111 f 9 ~mol.100 g-’ min-‘) regions, but lower (17%; p < 0.01) in the thoracic region (93 f 5 ~mol.100 g-’ min-I), and SCGU in white matter was lower than grey matter regions in the cervical (40%; p -Z O.OOl), thoracic (32%; p < 0.005) and lumbar (35%; p < 0.01) regions. This study shows exercise-induced increases in SCGU in all measured areas of the spinal cord and provide clues to the spinal areas that participate in the motor, sensory and autonomic adaptation occurring in exercise.
12-52-l 0 / Sildenafil (viagra”): A double-blind, placebo-controlled, single-dose, two-way crossover study in men with erectile dysfunction caused by traumatic spinal cord injury F. Deny ’ , C. Glass 2, W.W. Dinsmore 3, M. Fraser 2, BP. Gardner ‘, G. Muirhead 4, M. Maytom 4, M. Orr 4, I.H. Ostedoh 4, M.D. Smith 4. ’ National Spinal Injuries Centre, Stoke Mandeville, UK, 2 Northwest Regional Spinal Injuries Centre, Southport, UK, 3 Department of GU Medicine, Royal Victoria Hospital, BeHast, UK, 4Pfizer Central Research, Sandwich, UK
Penile erection is mediated by nitric oxide via cyclic guanosine monophosphate (cGMP). Sildenafil is a selective inhibitor of type 5 phosphodiesterase, the predominant isozyme causing the inactivation of cGMP in the human corpus cavemosum. Through this increase in cGMP, sildenafil produces a pro-erectile effect. This study was designed to determine the efficacy, safety, and toleration of single oral doses of sildenafil in spinal cord injury (SCI) patients with erectile dysfunction (ED). Additionally, the relationship between plasma concentrations of sildenafil and the erectile response achieved in these patients was investigated. The study had a double-blind, randomised, placebo-controlled, single-dose, two-way crossover design. Patients with ED solely attributable to SCI were screened; only those with at least a grade 2 reflexogenic erectile response to a vibrator were included. Fasted patients were randomised to receive a single oral dose of 50 mg of sildenafil or placebo, administered in double-blind fashion in a private room. A washout period of at least 3 days occurred between the crossover periods. Reflexogenic erections were stimulated by applying a vibrator to the shaft and glans of the penis at: T = 0 (pre-dose), and T = 0.5 hour, T = 1 hour, and T = 1.5 hours post-dose. Efficacy was evaluated by RigiScane recordings. Plasma samples for assessing drug concentrations were collected after the final RigiScanc recording (T = 1.5 hours). Twenty-seven male patients (mean age 32.9 years, range 2149 years) with ED solely attributable to SCI (cord level range T6-L4/5) were studied; one patient did not complete the study. No patients discontinued treatment due to adverse events. total of 17 of 26 (65%) patients on sildenafil had penile base rigidity >60% [median duration (range) = 10 minutes (0.5-72.5 min)], whereas only 2 of 26 (6%) patients on placebo had penile base rigidity 260% (duration 2 and 4 minutes); this difference was statistically significant (p < 0.01). Of 20 patients with plasma sildenafil concentrations ,100 rig/ml, 16 (60%) exhibited a response of r60% penile base rigidity versus only 1 of 6 (17%) patients with plasma concentrations < 100 @ml. The results indicate that sildenafil is a promising oral treatment of ED in SCI patients with reflexogenic erectile capacity.
12-52-l 1 1 The influence of physical therapy in lung function on patients suffering from cervical spinal cord injury P. Despaigne,
R. Padilla, F. Zamora,
Cord Injuries Service, Havana, Cuba
International
A. Femandez, Center
F. Araujo, A. Cod. Spinal
for Neurological
Restoration,
The injury of the cervical spinal cord has as consequence disorders in the respiratory function due to paralysis that is produced from the muscle that participate in breathing. The objective of our work is to demonstrate the improvement of the lung function on quadriplegic patients by using a physical therapy program and the measuring of the vital capacity though espirometrfc tests.
This study was performed in 10 chronic quadriplegic patients of a traumatic origin, who were hospitalized at the International Center for Neurologic Restoration (CIREN) for an approximate period of two months and a half. As a result from such study, we obtained an augment in the muscular force of the muscle that participate in breathing, as well as a improvement of the vital capacity which contributes to diminish the sicknesses and mortality of these patients.
2-52-l 2 Guillermo
Spinal cord injuries. New optimism developing treatments
B. Figallo, Ricardo
E. Saisi. Neurological
Center.
blooms for Rosario-Santa
Fe,
Argentina
The injuries of the spinal cord are the most common causes of severe incapacity or death after a traumatic disorder or other pathology. In the past the first physicians describe that the medullar lesions was a pathology musn’t be treat; but in the last thirty years the advances of orthopaedic, neurosurgeon, neurophysiology, biomechanics, genetic and bioengineering has contributed to recovery those patients. We show our work in the treatment of several spinal injuries in 416 patients in the last ten years. All of them were treated by surgery by anterior or posterior approach to the spinal cord, support with some drugs like metil/prednisolona, TRH analog (nerve growth factor) and tiroid hormone. The result of this way of treatment shows that the 60% of the patients with medullars injuries lose the wheel-chair and begin to walk with orthesis and walkin stick after a period of rehabilitation. In many centers of the world are developing new treatments like: fetal transplantion, gene therapy, genetic engineering, nerve growth factors, nerve regeneration, schwann cells, medullar suture or stimulation with chips or current. We hope that in the near years this treatment cure our patients and return they to a normal life with little sequel.
2-52-l 3
Treatment of neurogenic bladder in spinal cord iniurv (SCI) oatients bv means of clean intermittent c&h&riz&bn (CIC): Prevention of renal disease
A. Giannantoni I, G. Scivoletto’, A. Silecchia’B2, E. Finaui-Agro Stasi’, V.U. Vona I, L. lpektchi 1,2, L. Di Lucente I, V. Castellano Rehabilitation Hospital “S. Lucia”, Vefgata Universiw Rome, /ta/y
Rome,
/tab 2 Department
‘v2, S.M. Di I. ‘IRCCS
of Urolog)
Tar
Upper urinary tract complications have been reported in about 20-30% of SCI patients. Their pathogenesis is linked to the presence of high-pressure unhinibited detrusor contractions, high leak point pressure and low bladder compliance. Aim of this study was to evaluate the incidence of upper urinary tract complications in 72 SCI patients (57 M and 21 F, mean age 35.1 f 13.2 years, mean disease duration 69 f 106 months) divided in 2 homogeneous groups with different bladder emptying modalities (CIC vs. tapping, abdominal starining, Crede’s manoeuvre) and the relationship with clinic and urodynamic features. Including criteria were: disease duration longer than 12 months after spinal shock, no previous medications, no urinary tract infection at the time of urological evaluation, no previous history of bladder and renal disease. Urodynamic evaluation consisted of cystometry and pelvic floor needle electromyography. Lower and upper urinary tract were evaluated by ultrasound, intravenous excretory pielogram and/or voiding cystourethrography. Upper urinary tract involvement was defined as the presence of pyelonephritis, hydronephross, renal stone formation or vesicoureteral reflux. A total of 17 patients (22%) suffered upper urinary tract complications. The incidence of both urinary tract dilation and vesicoureteral reflux was significantly lower in patients under intermittent catheterization (p = 0.03 and 0.04 respectively). This difference does not depend upon different clinical features or different bladder and sphincter behaviours: in the two groups, in fact, the incidences of the various urodynamic abnormalities was exactly the same. CIC seems thus effective in preventing upper urinary tract disease probably because: 1) it allows regular and rithmic bladder emptying with low bladder pressure, while the other modalities act by increasing bladder pressure until it overcomes urethral pressure: 2) if correctly effectuated it helps to prevent urinary tract infections: in fact high residual volumes and bladder overdistension produce bladder wall ischemia and reduce host resistance to infections; 3) it allows complete bladder emptying: avoiding residual urine means to reduce the possibility to reach uninhibited contractions threshold and finally reduce exposure of bladder and upper urinary tract to high pressures. The finding of upper urinary tract complications also in patients under CIC showing high intravesical pressures stresses the need of adding anticholinergic medications to the rehabilitation regimen of these patients.
s134
pmol.100 g-’ min-‘. SCGU in grey matter (anterior and posterior horns) was similar in the cervical (60 f 6 ~mol.100 g-’ min-‘) and the lumbar (59 f 5 /~mol.lOO g-’ min-‘) regions, but lower (17%; p < 0.05) in the thoracfc region (49 f 4 ~mol.100 g-’ mini) SCGU in white matter was lower than grey matter regions in the cervical (46%; p < 0.01) thoracic (46%; p 4 0.005) and lumbar (42%; p i 0.01) regions. During exercise at -65% of maximal 02 uptake, average SCGU increased 112% (p < 0.001) to 76 f 4 ~mol.100 g-’ min-’ for the total spinal cord SCGU increased during exercise by 62% (p -Z 0.001) in the cervical, 90% (p < 0.005) in the thoracic and 97% (p < 0.001) in the lumbar grey matter, and by 104% (p < 0.005) in the cervical, 151% (p < 0.005) in the thoracic and 111% (p < 0.01) in the lumbar white matter. The highest increase by 170% (p -= 0.005) was measured in the thoracic segment of the lateral part of the Spinothalamic tract. During exercise SCGU in grey matter (anterior and posterior horns) was similar in the cervical (110 f 3 pmol.100 g-’ min-I) and the lumbar (111 f 9 ~mol.100 g-’ min-‘) regions, but lower (17%; p < 0.01) in the thoracic region (93 f 5 ~mol.100 g-’ min-I), and SCGU in white matter was lower than grey matter regions in the cervical (40%; p -Z O.OOl), thoracic (32%; p < 0.005) and lumbar (35%; p < 0.01) regions. This study shows exercise-induced increases in SCGU in all measured areas of the spinal cord and provide clues to the spinal areas that participate in the motor, sensory and autonomic adaptation occurring in exercise.
12-52-l 0 / Sildenafil (viagra”): A double-blind, placebo-controlled, single-dose, two-way crossover study in men with erectile dysfunction caused by traumatic spinal cord injury F. Deny ’ , C. Glass 2, W.W. Dinsmore 3, M. Fraser 2, BP. Gardner ‘, G. Muirhead 4, M. Maytom 4, M. Orr 4, I.H. Ostedoh 4, M.D. Smith 4. ’ National Spinal Injuries Centre, Stoke Mandeville, UK, 2 Northwest Regional Spinal Injuries Centre, Southport, UK, 3 Department of GU Medicine, Royal Victoria Hospital, BeHast, UK, 4Pfizer Central Research, Sandwich, UK
Penile erection is mediated by nitric oxide via cyclic guanosine monophosphate (cGMP). Sildenafil is a selective inhibitor of type 5 phosphodiesterase, the predominant isozyme causing the inactivation of cGMP in the human corpus cavemosum. Through this increase in cGMP, sildenafil produces a pro-erectile effect. This study was designed to determine the efficacy, safety, and toleration of single oral doses of sildenafil in spinal cord injury (SCI) patients with erectile dysfunction (ED). Additionally, the relationship between plasma concentrations of sildenafil and the erectile response achieved in these patients was investigated. The study had a double-blind, randomised, placebo-controlled, single-dose, two-way crossover design. Patients with ED solely attributable to SCI were screened; only those with at least a grade 2 reflexogenic erectile response to a vibrator were included. Fasted patients were randomised to receive a single oral dose of 50 mg of sildenafil or placebo, administered in double-blind fashion in a private room. A washout period of at least 3 days occurred between the crossover periods. Reflexogenic erections were stimulated by applying a vibrator to the shaft and glans of the penis at: T = 0 (pre-dose), and T = 0.5 hour, T = 1 hour, and T = 1.5 hours post-dose. Efficacy was evaluated by RigiScane recordings. Plasma samples for assessing drug concentrations were collected after the final RigiScanc recording (T = 1.5 hours). Twenty-seven male patients (mean age 32.9 years, range 2149 years) with ED solely attributable to SCI (cord level range T6-L4/5) were studied; one patient did not complete the study. No patients discontinued treatment due to adverse events. total of 17 of 26 (65%) patients on sildenafil had penile base rigidity >60% [median duration (range) = 10 minutes (0.5-72.5 min)], whereas only 2 of 26 (6%) patients on placebo had penile base rigidity 260% (duration 2 and 4 minutes); this difference was statistically significant (p < 0.01). Of 20 patients with plasma sildenafil concentrations ,100 rig/ml, 16 (60%) exhibited a response of r60% penile base rigidity versus only 1 of 6 (17%) patients with plasma concentrations < 100 @ml. The results indicate that sildenafil is a promising oral treatment of ED in SCI patients with reflexogenic erectile capacity.
12-52-l 1 1 The influence of physical therapy in lung function on patients suffering from cervical spinal cord injury P. Despaigne,
R. Padilla, F. Zamora,
Cord Injuries Service, Havana, Cuba
International
A. Femandez, Center
F. Araujo, A. Cod. Spinal
for Neurological
Restoration,
The injury of the cervical spinal cord has as consequence disorders in the respiratory function due to paralysis that is produced from the muscle that participate in breathing. The objective of our work is to demonstrate the improvement of the lung function on quadriplegic patients by using a physical therapy program and the measuring of the vital capacity though espirometrfc tests.
This study was performed in 10 chronic quadriplegic patients of a traumatic origin, who were hospitalized at the International Center for Neurologic Restoration (CIREN) for an approximate period of two months and a half. As a result from such study, we obtained an augment in the muscular force of the muscle that participate in breathing, as well as a improvement of the vital capacity which contributes to diminish the sicknesses and mortality of these patients.
2-52-l 2 Guillermo
Spinal cord injuries. New optimism developing treatments
B. Figallo, Ricardo
E. Saisi. Neurological
Center.
blooms for Rosario-Santa
Fe,
Argentina
The injuries of the spinal cord are the most common causes of severe incapacity or death after a traumatic disorder or other pathology. In the past the first physicians describe that the medullar lesions was a pathology musn’t be treat; but in the last thirty years the advances of orthopaedic, neurosurgeon, neurophysiology, biomechanics, genetic and bioengineering has contributed to recovery those patients. We show our work in the treatment of several spinal injuries in 416 patients in the last ten years. All of them were treated by surgery by anterior or posterior approach to the spinal cord, support with some drugs like metil/prednisolona, TRH analog (nerve growth factor) and tiroid hormone. The result of this way of treatment shows that the 60% of the patients with medullars injuries lose the wheel-chair and begin to walk with orthesis and walkin stick after a period of rehabilitation. In many centers of the world are developing new treatments like: fetal transplantion, gene therapy, genetic engineering, nerve growth factors, nerve regeneration, schwann cells, medullar suture or stimulation with chips or current. We hope that in the near years this treatment cure our patients and return they to a normal life with little sequel.
2-52-l 3
Treatment of neurogenic bladder in spinal cord iniurv (SCI) oatients bv means of clean intermittent c&h&riz&bn (CIC): Prevention of renal disease
A. Giannantoni I, G. Scivoletto’, A. Silecchia’B2, E. Finaui-Agro Stasi’, V.U. Vona I, L. lpektchi 1,2, L. Di Lucente I, V. Castellano Rehabilitation Hospital “S. Lucia”, Vefgata Universiw Rome, /ta/y
Rome,
/tab 2 Department
‘v2, S.M. Di I. ‘IRCCS
of Urolog)
Tar
Upper urinary tract complications have been reported in about 20-30% of SCI patients. Their pathogenesis is linked to the presence of high-pressure unhinibited detrusor contractions, high leak point pressure and low bladder compliance. Aim of this study was to evaluate the incidence of upper urinary tract complications in 72 SCI patients (57 M and 21 F, mean age 35.1 f 13.2 years, mean disease duration 69 f 106 months) divided in 2 homogeneous groups with different bladder emptying modalities (CIC vs. tapping, abdominal starining, Crede’s manoeuvre) and the relationship with clinic and urodynamic features. Including criteria were: disease duration longer than 12 months after spinal shock, no previous medications, no urinary tract infection at the time of urological evaluation, no previous history of bladder and renal disease. Urodynamic evaluation consisted of cystometry and pelvic floor needle electromyography. Lower and upper urinary tract were evaluated by ultrasound, intravenous excretory pielogram and/or voiding cystourethrography. Upper urinary tract involvement was defined as the presence of pyelonephritis, hydronephross, renal stone formation or vesicoureteral reflux. A total of 17 patients (22%) suffered upper urinary tract complications. The incidence of both urinary tract dilation and vesicoureteral reflux was significantly lower in patients under intermittent catheterization (p = 0.03 and 0.04 respectively). This difference does not depend upon different clinical features or different bladder and sphincter behaviours: in the two groups, in fact, the incidences of the various urodynamic abnormalities was exactly the same. CIC seems thus effective in preventing upper urinary tract disease probably because: 1) it allows regular and rithmic bladder emptying with low bladder pressure, while the other modalities act by increasing bladder pressure until it overcomes urethral pressure: 2) if correctly effectuated it helps to prevent urinary tract infections: in fact high residual volumes and bladder overdistension produce bladder wall ischemia and reduce host resistance to infections; 3) it allows complete bladder emptying: avoiding residual urine means to reduce the possibility to reach uninhibited contractions threshold and finally reduce exposure of bladder and upper urinary tract to high pressures. The finding of upper urinary tract complications also in patients under CIC showing high intravesical pressures stresses the need of adding anticholinergic medications to the rehabilitation regimen of these patients.