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Pulmonary complications remain a major cause of morbidity and mortality in patients with higher level spinal cord injury. Neurologically intact individuals can cough in order to clear their air passage of lung secretions and foreign material. Patients with higher level cord injuries, with paralysis of the trunk and abdominal muscles, may not have the ability to generate an effective cough. If coughing is dependent on a caregiver, these patients will cough with reduced frequency. Because the innervation to the muscles involved in cough consists of nerves that arise from varying levels of the spinal cord, some patients with spinal cord injury have partial control over these muscles and thus can cough, though with reduced efficacy. Two hundred patients with varying levels of spinal cord injury were studied to determine if motor level and cough ability are correlated. Cough efficacy was measured using a peak expiratory flowmeter while patients were seated at 90 degrees. We concluded that there is indeed a direct relationship between motor level and peak expiratory flow produced during coughing.

Objective: To determine whether rapid correction of anemia improves the functional and cognitive performance of postoperative orthopedic patients. Design: A randomized, double-blind, placebo-controlled clinical trial. Setting: A rehabilitation institute. Patients: Persons having orthopedic surgery at least 2 weeks previously, and a hemoglobin concentration Interventions: Recombinant human erythropoietin (rH-EPO) or the EPO vehicle for up to 8 weeks. All patients received ferrous sulfate. Measurements: Blood counts were performed at weekly intervals, and functional and cognitive tests at baseline and weeks 4 and 8. Results: In patients receiving vehicle only, hemoglobin levels increased from a mean of 9.0 at baseline to 11.0 at 4 weeks and 11.7 at 8 weeks; corresponding values for rH-EPO were 8.8 ( p = NS ), 12.6 ( p = .02), and 13.5 ( p = .01). However, functional improvement in dressing, toileting, and mobility was similar between groups, and the results of neuropsychological tests showed no trends favoring rH-EPO. Conclusions: ) Although hemoglobin increases more rapidly in anemic orthopedic patients treated with rH-EPO, equally rapid functional improvement occurs in those who receive only iron therapy.

Pulmonary complications are the major causes of morbidity and mortality for persons with cervical spinal cord injury. Diminished ability to cough constitutes a major contribution to the high incidence of pulmonary morbidity in this population. This article reports preliminary results for a new technique for providing assisted cough in this population. In this study, efficacy of cough (as measured by peak expiratory flow rate) was measured under three conditions: volitionally with no assistance, with manual assist of a therapist, and with electrical stimulation of abdominal muscles. Coughs produced by electrical stimulation were approximately as effective as manually assisted coughs. The results suggest this technique is worthy of more detailed study and may be a potentially effective new modality for assisting spinal cord injured persons to clear their airways.

Anemia in patients with grade IV pressure sores is usually refractory to therapy with iron salts, and red cell transfusions are commonly required when reconstructive surgery is performed. The anemia is characterized by hypoferremia, reticulocytopenia, and normal-to-increased serum ferritin. Five patients with this anemia were treated with recombinant human erythropoietin (rHuEPO) in doses of 50 to 100 U/kg, given subcutaneously three times per week. The hemoglobin increased in every patient; the mean (+/- SD) value at the initiation of treatment was 8.8 +/- 1.0 g/dL, and after a median of 4 weeks of therapy, it was 12.4 +/- 1.6 g/dL (p less than .001). No adverse effects of treatment were observed. It is concluded that rHuEPO is a promising new agent for pressure sore anemia, but randomized, controlled clinical trials will be required to firmly establish its place in the management of patients with this type of anemia.

Retroperitoneal bleeding from splenic rupture occurred after initially uneventful arthroscopy. The diagnosis was finally set up in CT-scan, whilst peritoneal lavage was negative. Since there was no incidence of previous abdominal trauma and no abnormal findings in histology, spontaneous perioperative splenic rupture has been discussed.

The applicability of whole-cell protein patterns obtained by sodium dodecylsulfate-polyacrylamide gel electrophoresis as a typing method for Clostridium difficile was examined using a total of 227 strains isolated from 191 patients and their surroundings. Computer-aided densitometric analysis was used to establish a reliable standardization technique with which a large number of protein patterns could be efficiently classified. The normalized tracks could be electronically superimposed and compared to give reproducible results. The influence of sample preparation for electrophoresis was found to be negligible. By this technique 35 subgroups could be differentiated, and further discrimination was possible within each subgroup using minor, even very weak protein bands. Epidemiologically related strains of Clostridium difficile yielded absolutely identical patterns, allowing unequivocal identification. Thus protein electrophoresis combined with densitometric analysis was shown to be useful for typing Clostridium difficile isolates.