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O32 Treatment of bowel dysfuction in patients with spinal cord injuries/diseases with Macrogol 3350 plus electrolytes (Movicol®) Author(s): Kalke YB, Baeuerle J, Röhl K, Rafler H, Niedeggen A, Lauer G, Gruss HJ, Kluger P Name of ISCoS Member (Author): Kalke YB Main institution where the work was done: SCI Centre of the University of Ulm Aims: Assessment of the therapeutic effectiveness, safety and tolerability of Macrogol 3350 plus electrolytes (Movicol®) to treat bowel dysfunction in patients with spinal cord injuries /diseases (SCI/SCD). Patients and methods: The bowel management of 119 patients (aged 10 to 88 years) with SCI/SCD was investigated in 3 German SCI/SCD centres. Patients initially received up to 3 sachets Movicol® per day, but could reduce the dose down to 1 sachet every other day, depending on the clinical response. Stool frequency, modality of evacuation, additional laxative use and relevant defecation symptoms were examined for 3 months. Laboratory values were measured at initiation of treatment and after 3 months. Results: Movicol® normalised or improved the bowel movements per week during the study. The mean daily required dosage decreased from 1.8 sachet at visit 1 (start) to 1.1 sachet at visit 5 (after 3 months). During the treatment with Movicol® a significant normalisation of all clinical defecation symptoms for most patients was observed. Particularly the percentage of patients with hard stools decreased from 43.7% (visit 1) to 3.6% (visit 5). Similarly, a normal stool consistency increased from 9.2% to 67.5%. Furthermore, the percentage of patients with abdominal bloating progressively decreased from 56.3% to 21.7%. Similarly the feeling of fullness decreased significantly from 34.4% to 4.8%. A regular stool rhythm could be reached for more than 90% of the included patients. The additional use of laxatives (mainly suppositories and enemas) was significant lower at visit 5 (40.3%) than at visit 1 (82,3%). Laboratory parameters were not altered by Movicol®. No serious adverse events were documented. Some minor gastrointestinal symptoms (e.g. nausea, diarrhoea) were observed. Conclusion: Movicol® was effective and well tolerated during the 3 months treatment period of bowel management in patients with SCI/SCD. All defecation symptoms decreased significantly or were normalised. Overall, Movicol® allowed to manage the severe, often therapy-refractory form of bowel dysfunction. A regular pattern of defecation with normalised stool evacuation and consistency could be reached for most patients with SCI/SCD. A monotherapy was possible in almost two third of patients. The use of Macrogol 3350 plus electrolytes (Movicol®) is an innovative, modern and well tolerated oral treatment option also for the management of constipation in the patients with SCI/SCD. O33 Epidemiology of Methicillin-Resistant Staphylococcus aureus (MRSA) in a national spinal cord injury center: A 10 years’ prospective study including molecular typing Author(s): Hans Knecht, Christoph Kappel, Veronika Geng, Patricia von Arx, Andreas Widmer, Reno Frei, Hans-Georg Koch, Guido A Zäch Name of ISCoS Member (Author): Guido A Zäch Main institution where the work was done: Swiss Paraplegic Center Nottwil, Switzerland Methicillin-resistant Staphylococcus aureus (MRSA) has become a major pathogen in long-term care facilities including centers for spinal cord injured (SCI). To evaluate the clinical utility of an infection control program in a patient cohort at high risk for MRSA infection we performed a prospective cohort study with medical record review of SCI patients hospitalized at the Swiss Paraplegic Center (SPC) Nottwil from April 1991 to April 2001. Of 5992 admissions 100 episodes of MRSA (colonization 22 cases, infection 78 cases) were identified in a total of 76 patients. Community acquisition was most frequent (56%) followed by nosocomial acquisition (34%). The risk of community acquisiton was significantly related to decubital ulcers and the geographic origin of patients. PFGE subtyping identified two nosocomial clusters with a total of 9 cases. Most of community acquired MRSA isolates were genetically unrelated and also distinct from epidemic strains identified in Switzerland during the study period. Decolonization was successful in 60 of 76 (78.9%) MRSA positive patients. Persistant MRSA-positivity was associated with several MRSA-positiv body sites and extended decubital ulcers, no more curable by plastic surgery. In the largest European SCI center MRSA controlling and decolonization are feasible if the SHEA guidelines are vigourously applied. O34 High prevalence of incontinence in adolescents with spina bifida Author(s): Please underline the presenting authorMarjolein Verhoef, Marloes Lurvink, Floris W.A van Asbeck, Marcel W.M. Post, Rob H.J.M Gooskens, Arie J.H. Prevo. Name of ISCoS Member (Author): Dr. Floris W.A. van Asbeck Main institution where the work was done: Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlands Study design: Cross-sectional study.Objectives: To study prevalence and determinants of urinary and faecal incontinence in adolescents with spina bifida. Setting: Nation-wide study in The Netherlands.Participants: Respondents were approached through spina bifida teams, other relevant institutions and the patients’ organization. 179 out of 350 patients responded. Method: Interviews, a physical examination, neuropsychological tests and medical records were used for data collection. Results: Urinary and faecal incontinence was common in adolescents with spina bifida (60.9% and 34.1% respectively), although most of them used a special bladder and bowel management and several were operated upon. The majority of urinary and faecal incontinent patients experienced this as a problem (69.7% and 77.0% respectively). Patients with spina bifida aperta, a level of lesion L5 or above and/or wheelchair dependency were significantly more often urinary and faecal incontinent. Patients with spina bifida occulta experienced their urinary incontinence more often as a problem than patients with spina bifida aperta did. Other variables as gender, level of lesion, cognition, mobility, use of diapers, assistance by daily toileting and daily time need for defecation were not related to urinary and/or faecal incontinence as a problem. Conclusion: A high percentage of Dutch adolescents with spina bifida suffered from incontinence and most experienced their incontinence as a problem. Therefore, it remains important to pay attention to incontinence in the care for patients with spina bifida. O35 Renal function and morphology in adults with meningomyelocele Author(s): Glott T, Stanghelle JK, Rand-Hendriksen S, Melhus M, Brabrand K, Fjeld JG, Bakke A Name of ISCoS Member (Author): Stanghelle JK Main institution where the work was done: Sunnaas Rehabilitation Hospital Aim: Describe renal function and morphology in a population above 16 years of age with meningomyelocele. Method and material: 48 out of 131 persons with meningomyelocele in our database were examined with ultrasound, renography and glomerular filtration rate (GFR) using 99mTc-DTPA. 31 persons had intact urinary bladder, 10 had Bricker diversion and seven continent reservoir. Mean age was 29 years (16-46 years). Twenty-two male and 26 female subjects were included.Results: Mean GFR was 98 ml/min/1.7m2 (range 51-159), and GFR was lower in the group with continent reservoir (p=0.13). Only 9 persons had GFR below 80 ml/min/1.7m2. Examinations with renography and ultrasound both showed normal findings in 22 persons. In 14 persons examination with ultrasound was normal, but there were pathological findings with renography. The most common pathological findings with renography were hydronephrosis in 14 and parenchyma defects in 3 persons. Only one patient had multiple cysts with ultrasound and normal renography. In 9 persons there were pathological findings both with ultrasound and renography. Conclusion: In our population of adults with meningomyelocele, most had GFR within normal limits. Pathological findings were more common with renography than ultrasound. O36 LONGSTANDING PAIN IN ADULTS WITH SPINA BIFIDA Author(s): Lars Werhagen and Carl Molander. Name of ISCoS Member (Author):Lars Werhagen Main institution where the work was done:The Department of Medical Rehabilitation, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden, and The Department of Public Health Care, Division of Rehabilitation Medicine, Karolinska Hospital, Norrbacka Bldg., SE-171 76 Stockholm, Sweden. We investigated the prevalence of longstanding pain in adults with spina bifida at their yearly check-up in a specialised spinal cord out-patient unit. When pain was present it was classified as neuropathic or nociceptive according to International Association for the Study of Pain (IASP) criteria. Patients with spina bifida without concomitant hydrocephalus were found to have neuropathic pain in 6/64(9%) and nociceptive pain in 3/64(5%). Patients with spina bifida and concomitant hydrocephalus had neuropathic pain in 2/59(3%) and nociceptive pain in 2/59(3%). The results indicate that neuropathic pain is much rarer in patients with spina bifida than in patients that acquire a spinal cord injury/disease as adults for which prevalences of 30-90% have been reported. Indeed, the patients with spina bifida and hydrocephalus were comparable to the general population. Possible explanations may be better adaptation of the pain system during development than after injury in the mature state, or diagnostic problems which particularly in the cases with concomitant hydrocephalus may involve cognitive dysfunctions and communication problems. Also the frequency of nociceptive pain was much less than would have been expected in the general population. We can not explain this finding. O37 Ambulation in adult spina bifida (SB). Is it possible to predict the level of ambulation in early life. Author(s): Aase Seitzberg, Marianne Lind, Fin Biering-Sørensen Main institution where the work was done: Physiotherapy section, Clinic for Medical Orthopaedics and Rehabilitation and Clinic for Para- and Tetraplegia, Rigshospitalet, Copenhagen University Hospital, Denmark Method: Information from medical reports including muscle charts, follow-up questionnaires and clinical examination. Material: 52 SB born 1965 – 1984. 18-37 years at follow-up. Results: Of 20 SB assessed within the first year of life only 7 patients achieved the function predicted from the muscle chart, while 6 had a better and 7 a poorer function than predicted, of those 4 were predicted to be walking, but ended up in a wheelchair. Of 51 patients with a described function level at the age of 5-8 years, 35 had retained the functional level at the survey, 10 of those had ceased walking in training situation and were in wheelchair. 13 of the 51 had a worse function level at the survey. 9 patients with a functional walking at the age of 5-8 years had lost that function at the time of follow-up. 3 had a better function at the survey as they didn’t wear foot-ankle orthoses any longer. Conclusion: To predict future ambulation in children with SB muscle testing performed within the first year of life cannot stand alone. Neither can the function level at the age of 5-8 years be used alone to predict future functional level. Other problems such as hydrocephalus, tethered cord and abnormal weight-bearing should also be considered. O38 Social and personal life outcome for adults with Spina Bifida. Author(s): Annette Liebach, Liselotte Skov, Aase Seitzberg, Marianne Lind, Fin Biering-Sørensen Name of ISCoS Member (Author): Fin Biering-Sørensen Main institution where the work was done: Clinic for Para- and Tetraplegia, Rigshospitalet, Copenhagen, Denmark. Aim: To evaluate how adults with Spina Bifida (SB) manage socially and within specific handicap related domains. Methods: Structured interview focusing on daily life tasks, social contacts, sex life, knowledge of handicap, dependence on parents, ability to take care of specifik physical problems, problems related to parenthood. Regular checkups included bladder- and bowel management, sexual function, vocational and marital status. FIM and SF-36 was accomplished. Patients: 53 SB (27 female, 26 male) aged 18-35 years at examination. Results: 45% received pension. 21% were married/ with long-term partner (25-35 years). 11% had children. 2/3 claimed to manage daily life tasks independently. 19% reported only few friends, and 32% experienced their handicap as a barrier for new social relationships. 42% had no partner within the last year.50% reported sex life as bad or completely missing. However, 75% expressed acceptance or satisfaction with sex life. Of 26 men 62% were able to have erection.2/3 was incontinent for urine and/or faeces. 35% gave limited or no explanation concerning the nature of their handicap. 43% knew of the inheritability.FIM, SF-36, social and vocational characteristics available. Conclusions: Problems with incontinence and sex life dominates. Nonetheless 75% express acceptance of sex life and 21% manage married life. There is a need for education of teenagers with SB and efforts in social integration. O39 Relationships and sex life in young adults with spina bifida Author(s): Marjolein Verhoef, Hans A. Barf, Jos A. Vroege, Marcel W.M. Post, Floris W.A van Asbeck, Rob H.J.M Gooskens, Arie J.H. Prevo. Name of ISCoS Member (Author): Dr. Floris van Asbeck Main institution where the work was done: Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlands Objective: To explore problems concerning sex education, relationships, sexual activity and sexual functioning of young adults with spina bifida (SB) in subgroups of male and female patients with (HC+) and without (HC-) hydrocephalus in the Netherlands.Design: Cross-sectional, structured interview and physical and neuropsychological examination. Setting: community Patients: 168 SB patients (occulta and aperta) aged 16-25 years (mean age 20.8; 40% male).Interventions: Not applicableMain outcome measures: Structured interview on sex education, relationships, sexual activities and sexual functioning Results: Sex education was given to almost all patients and specific SB information to less than one quarter, 27% had a relationship, 71% desired sexual contact, 49% had sexual contact and 25% sexual intercourse last year; 53% was satisfied with their present sex life. Incontinence and lack of self-confidence were important obstacles. HC+ patients didn’t have a partner as often as HC- patients. Besides they were sexually less active and more often had problems with sexual functioning. Conclusion: More HC+ patients than HC- patients suffer from problems with regard to relationships and sexuality. Physicians should be aware of the problems SB patients have to face and actively approach the different topics concerning relationships and sexuality. Key words: Spina bifida; Relationship; Sexuality; Sexual behavior O40 |
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