Poster Presentations #P1–#P39

Abstract

Background: Vaccination rates among individuals with spinal cord injury (SCI) could be improved if it can be shown that vaccination performed on insensate areas is effective. This would eliminate the the risk of discomfort and soreness at the injection site.

Objective: To determine whether immune responsiveness varies between areas with intact and impaired innervation in patients with stroke-related paresis.

Design: Prospective trial in which each subject served as his or her own control.

Setting: Rehabilitation wards and long-term care units at a Veterans Affairs Medical Center.

Patients: Individuals with a history of cerebrovascular accident (CVA) affecting 1 side of the body.

Methods: The Multitest cell-mediated immunity (CMI) and purified protein derivative (PPD) of tuberculin were administered intradermally to each arm of each subject.

Main Outcome Measures: Total millimeters of induration in response to either test and positive vs negative responses to either test were compared between the 2 arms of each subject.

Results: Response to delayed hypersensitivity testing did not differ between the arms affected and unaffected by CVA in each subject, and the time since CVA also did not affect the magnitude of the skin response.

Conclusions: Skin testing for delayed hypersensitivity can be effectively administered in the paretic arms of persons who have experienced CVA. Although this study was performed in patients with stroke-related impairment, it has implications for vaccine administration in individuals with SCI-related neurologic deficits.     

Poster abstracts: Academy of Spinal Cord Injury ProfessionalsEducational Conference 2013Bally's Hotel,Las Vegas,NevadaSeptember 2–4, 2013Poster abstracts #P1–#P64

Background

We have demonstrated comparable increases in blood pressure (BP) after administration of midodrine and L-NAME during laboratory assessments in individuals with spinal cord injury (SCI). However, effects of these anti-hypotensive agents on 24-hour hemodynamics in those with SCI compared to intact able-bodied (AB) controls have not been reported.

Objective

To determine average (avg), minimum (min), and maximum (max) 24-hour systolic BP (SBP) diastolic BP (DBP) and heart rate (HR) responses in individuals with SCI and controls following administration of (1) midodrine hydrochloride (10 mg), (2) a nitric oxide synthase inhibitor (L-NAME (1.0 mg/kg)), and (3) no drug.

Design

Open-label randomized prospective trial.

Participants/Methods

These anti-hypotensive agents were administered in random order over three visits in 13 individuals with SCI (T: C3-T4) and six AB controls. Twenty-four-hour hemodynamic data were collected using a portable BP monitor that recorded BP and HR every 20 minutes during the daytime and every 30 minutes during the nighttime. Data were analyzed with a 3 (condition: no drug, midodrine, L-NAME) by 2 (group: SCI, AB) repeated measures analysis of variance.

Results

There were no significant main or interaction effects for 24-hour SBPavg, DBPavg, HRavg, SBPmin, DBPmin, or HRmin. However, in subjects with SCI, 24-hour SBPmax and DBPmax were significantly increased with midodrine (135 ± 17/90 ± 13) and L-NAME (128 ± 10/84 ± 8) compared to no drug (92 ± 8/53 ± 7; P < 0.0001). In addition, HRmax, was significantly increased after administration of midodrine (88 ± 13 bpm) and L-NAME (97 ± 20 bpm) compared to no drug (55 ± 7 bpm; P < 0.0001) in those with SCI. Three subjects with SCI had hypertensive responses (SBP_max ≥ 140 or DBP_max ≥ 90 mmHg) to both L-NAME and midodrine; an additional four subjects had hypertensive responses to midodrine only, and one subject had a DBP_max in the hypertensive range after L-NAME administration.

Conclusion

Although average 24-hour hemodynamics were not significantly changed after administration of these anti-hypotensive agents, maximum BP was increased. Qualitatively, there was an increased proportion of hypertensive responses after midodrine than after L-NAME administration. Before these anti-hypotensive medications can be considered safe for long-term use in the SCI population, these hemodynamic responses should be studied in greater detail for extended periods.

• J Spinal Cord Med. 2013 Sep; 36(5): 524–567.
»
• P2. THE HYPERTENSIVE EFFECTS OF DROXIDOPA ON RESTING CARDIAC VAGAL TONE

J Spinal Cord Med. 2013 Sep; 36(5): 524–567. doi: 10.1179/1079026813Z.000000000207

P2. THE HYPERTENSIVE EFFECTS OF DROXIDOPA ON RESTING CARDIAC VAGAL TONE

Adrian M. Ivan, MS,¹ Miroslav Radulovic, MD,² Dwindally Rosado-Rivera, EdD,¹ Christina Yen, BS,¹ William A. Bauman, MD,³ and Jill M. Wecht, EdD³

Adrian M. Ivan

¹The Center of Excellence James J. Peters VAMC, Bronx, NY, USAFind articles by Adrian M. Ivan

Miroslav Radulovic

²The Center of Excellence James J. Peters VAMC, Bronx, NY, USA; and The Medical Service, James J. Peters VAMC, Bronx, NY, USAFind articles by Miroslav Radulovic

Dwindally Rosado-Rivera

¹The Center of Excellence James J. Peters VAMC, Bronx, NY, USAFind articles by Dwindally Rosado-Rivera

Christina Yen

¹The Center of Excellence James J. Peters VAMC, Bronx, NY, USAFind articles by Christina Yen

William A. Bauman

³The Medical Service, James J. Peters VAMC, Bronx, NY, USA; Department of Medicine, The Mount Sinai School of Medicine, New York, NY, USA; and Department of Rehabilitation Medicine, The Mount Sinai School of Medicine, New York, NY, USAFind articles by William A. Bauman

Jill M. Wecht

³The Medical Service, James J. Peters VAMC, Bronx, NY, USA; Department of Medicine, The Mount Sinai School of Medicine, New York, NY, USA; and Department of Rehabilitation Medicine, The Mount Sinai School of Medicine, New York, NY, USAFind articles by Jill M. WechtAuthor information Copyright and License information Disclaimer¹The Center of Excellence James J. Peters VAMC, Bronx, NY, USA²The Center of Excellence James J. Peters VAMC, Bronx, NY, USA; and The Medical Service, James J. Peters VAMC, Bronx, NY, USA³The Medical Service, James J. Peters VAMC, Bronx, NY, USA; Department of Medicine, The Mount Sinai School of Medicine, New York, NY, USA; and Department of Rehabilitation Medicine, The Mount Sinai School of Medicine, New York, NY, USACopyright notice     

American Paraplegia Society 48th Annual Conference • September 2002 Poster Presentations #P1-P30 Sci Research • Pharmacology • Technology • Education

Abstract

Background/Objective: Salmonella spondylodiskitis is an uncommon type of vertebral infection. The aim of this study was to present a case of progressive paraplegia caused by Salmonella spondylodiskitis and epidural abscess after endoscopic cholecystectomy.

Methods: The patient underwent posterior instrumentation and posterior fusion between T6 and T12, hemilaminotomies at levels T8-T9-T10, and drainage of the abscess. Through a left thoracotomy, anterior T8-T10 corpectomy, debridement, anterior stabilization, and fusion were conducted.

Results: Fifteen months later, final follow-up showed no complications secondary to the vertebral and hip surgeries, and neurological status improved to Frankel grade E. Laboratory investigations showed no evidence of Salmonella infection.

Conclusion: Immunocompromised patients who undergo endoscopic intervention are vulnerable to Salmonella infections. One must consider Salmonella infection in those who develop acute progressive spondylodiskitis.