磁共振在脊髓栓系神经原性膀胱中的诊断价值

目的分析脊髓栓系神经原性膀胱的磁共振(MRI)特征,评价MRI在脊髓栓系神经性原膀胱诊断中的应用价值。方法对22例经MRI检查的脊髓栓系神经原性膀胱患者资料进行回顾性分析。结果和结论MRI可明确判断脊髓圆锥位置、终丝粘连部位,明确脊髓栓系的原因,并可准确显示伴发的脊髓畸形,对脊柱和椎体畸形也能较好显示。脊髓栓系神经原性膀胱MRI主要表现为脊髓圆锥低位,膀胱壁一处或多处局限性增厚并结节状隆起。     

Effects of intermittent claudication due to arterial disease on pain-free gait

IntroductionStudies of intermittent claudication gait report inconsistent outcomes. Changes in gait are often attributed to degradation of calf muscles, but causation has not been proven through real-time electromyographic data. Neither have effects of walking speed been fully considered. This study aimed to investigate the effect of intermittent claudication on kinematics, kinetics and muscle activity during pain-free gait.Methods18 able bodied individuals and 18 with intermittent claudication walked at their preferred speed while lower limb kinematic, kinetic and electromyography data were collected.FindingsPeople with intermittent claudication walk slower and with reduced step length. Internal ankle plantarflexion moment (P = 0.004, effect size = 0.96) and ankle power generation (P < 0.001, effect size = 1.36) in late stance were significantly reduced for individuals with intermittent claudication. Significant moment and power reductions at the knee and power reduction at hip occurred in early stance, with similar reductions in early and late stance for ground reaction forces. Peak electromyography of soleus activity was significantly reduced in late stance (P = 0.01, effect size = 1.1, n = 13). Effects were independent of walking speed.InterpretationReductions in ankle plantarflexion moments and power generation were consistent with reduced soleus electromyography activity and reduced peak vertical ground reaction forces during late stance. These effects are not due to a reduced walking speed. Changes in knee and hip function are also unrelated to walking speed. These outcomes provide a platform for the design and evaluation of interventions that seek to restore normal walking and improve pain-free walking distances for people with intermittent claudication.     

Neurogenic pulmonary edema due to traumatic brain injury: evidence of cardiac dysfunction.

BACKGROUND: Acute neurogenic pulmonary edema, a common and underdiagnosed clinical entity, can occur after virtually any form of injury of the central nervous system and is a potential early contributor to pulmonary dysfunction in patients with head injuries. OBJECTIVE: To explore myocardial function in patients with evident neurogenic pulmonary edema after traumatic head injury. METHODS: During a 1-year period in a university hospital in Sfax, Tunisia, information was collected prospectively on patients admitted to the 22-bed intensive care unit because of isolated traumatic head injury who had neurogenic pulmonary edema. Data included demographic information, vital signs, neurological status, physiological status, and laboratory findings. All of the patients had computed tomography and plain radiography of the neck and determination of cardiac function. RESULTS: All 7 patients in the sample had cardiac dysfunction. Evidence of myocardial damage was confirmed by echocardiography in 3 patients, pulmonary artery catheterization in 3 patients, and/or postmortem myocardial biopsy in 4 patients. Echocardiography studies, repeated 7 days after the initial study in one patient and 90 days afterward in another, showed complete improvement in wall motion, with a left ventricular ejection fraction of 0.65. CONCLUSION: All patients who had neurogenic pulmonary edema due to traumatic head injury had myocardial dysfunction. The mechanisms of the dysfunction were multiple. The great improvement in wall motion seen in 2 patients indicated the presence of a stunned myocardium. Further studies are needed to understand the mechanisms of this cardiac dysfunction.     

假性腰椎滑脱发生年龄与性别关系的研究

目的：作者分析４７３例腰椎假性滑脱的病例,旨在了解其发病年龄与性别的关系。方法：收集因腰腿痛患者的Ｘ线检查共５４２４例。结果：发现腰椎假性滑脱４７３例,其中男１０７例,女３６６例,５１￣７０岁３３０例,结论：在４０岁以上人群中,腰椎假性滑脱的发病率随年龄的增长而增加,女性发生率明显高于男性,而高龄患者腰椎假性滑脱发生率的性别２差异有所缩小,不随的增长而扩大。     

Intermittent claudication

Intermittent claudication is a painful, debilitating condition that reduces mobility in those affected and has a detrimental effect on quality of life. It is often the first symptom of peripheral arterial disease. This article explains the aetiology of intermittent claudication, the associated risk factors, vascular assessment and the nursing care involved in conservative treatment.     

Neurogenic pain

Effective preoperative communication and an awareness of the mechanisms and treatment of neurogenic pain by nursing staff directly influence the choice of intraoperative and postoperative pain management. This article describes the case study of a young woman with neurogenic pain and highlights the importance of having a working knowledge of this type of pain, its assessment, and treatment.     

Neurogenic continence. Part 2: Neurogenic bladder management

This article addresses physical and psychosocial issues in neurogenic bladder management. The impact of neurogenic bladder and its assessment will be discussed. There are a wide range of treatment options available to manage neurogenic bladder dysfunction and this article offers an overview of key management techniques, including non-invasive techniques, self-intermittent and suprapubic catheters, medication and surgical management. The importance of the nursing role in assessment, teaching and supporting patients by enabling them to make informed choices about their bladder management is addressed.     

OnabotulinumtoxinA is Effective in Patients with Urinary Incontinence due to Neurogenic Detrusor Activity Regardless of Concomitant Anticholinergic Use or Neurologic Etiology

Introduction

To evaluate the efficacy and safety of onabotulinumtoxinA for the treatment of neurogenic detrusor overactivity (NDO) in subpopulations of etiology (multiple sclerosis [MS] or spinal cord injury [SCI]) and concomitant anticholinergics (use/non-use).

Methods

Data were pooled from two double-blind, placebo-controlled, pivotal, phase 3 studies including a total of 691 patients with ≥14 urinary incontinence (UI) episodes/week due to MS (n = 381) or SCI (n = 310). Patients received intradetrusor injections of onabotulinumtoxinA 200U (n = 227), 300U (n = 223), or placebo (n = 241). Change from baseline at week 6 in UI episodes/week (primary endpoint), urodynamics, quality of life (QOL), and adverse events (AEs) were assessed.

Results

Significant and similar reductions in UI episodes were observed regardless of etiology or anticholinergic use: at week 6, mean weekly decreases of ?22.6 and ?19.6 were seen in MS and SCI patients, respectively, and ?20.3 and ?22.5 in anticholinergic users and non-users, respectively, treated with onabotulinumtoxinA 200U. The 300U dose did not add to the clinical efficacy in any subpopulation. Similar proportions of patients achieved ≥50% or 100% reductions in UI episodes in all subgroups. Improvements in maximum cystometric capacity, maximum detrusor pressure during first involuntary detrusor contraction, and QOL were significant in both etiologies and were independent of anticholinergic use. The most common AEs in all groups were urinary tract infection and urinary retention.

Conclusion

Regardless of concomitant anticholinergic use or etiology, onabotulinumtoxinA significantly improved UI symptoms, urodynamics, and QOL in patients with UI due to NDO. OnabotulinumtoxinA was well tolerated in all groups.     

Neurogenic pulmonary oedema

Although neurogenic pulmonary oedema is an uncommon condition, it is found in 20% of victims with severe head injury. The onset is typically rapid with development of dyspnoea, cyanosis and hypoxia suddenly and unexpectedly after an intracranial injury. The pathogenesis is not entirely clear, but both increased hydrostatic pressure and capillary permeability are incriminated. It is important to differentiate neurogenic pulmonary oedema from aspiration pneumonia, because the treatment of the two conditions differ. A combination of measures to reduce intracranial pressure, optimize body oxygenation, decrease pre‐ and after‐load and improve cardiac contractility is the mainstay of treatment. Mortality is high despite these measures.     

A primary care approach to the patient with claudication

Peripheral arterial occlusive disease occurs in about 18 percent of persons over 70 years of age. Usually, patients who have this disease present with intermittent claudication with pain in the calf, thigh or buttock that is elicited by exertion and relieved with a few minutes of rest. The disease may also present in a subacute or acute fashion. Symptoms of ischemic rest pain, ulceration or gangrene may be present at the most advanced stage of the disease. In most cases, the underlying etiology is atherosclerotic disease of the arteries. In caring for these patients, the primary care physician should focus on evaluation, risk factor modification and exercise. The physician should consider referral to a vascular subspecialist when symptoms progress or are severe. While the prognosis for the affected limb is quite good, patients with peripheral arterial occlusive disease are at increased risk of myocardial infarction and stroke. Therefore, treatment measures should address overall vascular health.