BACKGROUND: Chronic refractory angina pectoris is defined as a condition with coronary insufficiency that cannot be controlled by a combination of medical therapy, angioplasty or bypass surgery. Different treatment options are evaluated in this patient group; spinal cord stimulation (SCS) is the one that is best documented. We have used this method since 1996 and present our experience. MATERIALS AND METHODS: From 1996 to 2001, spinal cord stimulators were implanted in 21 patients. A follow-up study was performed after 27 months (range 7-71) with a questionnaire. Preoperative clinical and angiographic data were retrieved from our records. RESULTS: 17 men and 4 women aged 55-88 years (median 73) were treated with SCS. Preoperatively all patients were in CCS (Canadian Cardiovascular Society) class III-IV. 81% had previously undergone coronary artery bypass surgery. At follow up, 81% were alive. Lead fracture occurred in two patients, displacement of the electrode in one. There were no other complications. 71% reported symptomatic improvement, mean CCS class was reduced from 3.5 prior to SCS to 2.2 at follow up, and use of nitroglycerin was reduced. INTERPRETATION: In chronic refractory angina pectoris, spinal cord stimulation is an alternative. We report "beginners' experience" that is positive including substantial symptomatic effect and a low complication rate. More hospitals in Norway should consider establishing SCS in order to offer this treatment option to a growing patient group.
BACKGROUND: We wanted to study the cause and the segmental level of traumatic spinal cord injuries. MATERIAL AND METHODS: All 238 patients (208 men) with traumatic spinal cord injuries admitted to the Department of Neurology, Haukeland University Hospital in Bergen, Norway, from 1952 to 1999 were included. Data were obtained from medical files and studied retrospectively. RESULTS: The initial clinical level of injury was the cervical spine in 50% of the patients, the thoracic spine in 33%, and the lumbar spine in 18%. Falling (45%) and road accidents (35%) were the main causes. The mean annual number of patients with traumatic spinal cord injuries increased from three in 1952-60 to eight in 1991-99; there was an increase in high cervical injuries among those older than 60. The proportion of work-related traumatic spinal cord injuries was 42% in 1952-74 and 26% in 1975-99. INTERPRETATION: Although there has been a reduction of work-related spinal cord injuries, there is still a potential for further prevention, especially among persons of more than 60 years of age.
Respiratory complications are the most common cause of acute and long-term morbidity and mortality in patients with spinal cord injury.
The article is based on a non-systematic search in PubMed and the authors' clinical experience in treatment and follow-up of respiratory complications in patients with spinal cord injury.
The extent of respiratory complications is dependent on the level of spinal cord injury and the degree of motor completeness. In acute spinal cord injury, 80 % of patients may suffer from respiratory complications. Long-term follow-up indicates that respiratory complications are the most common cause of death in these patients. The most common respiratory complications are atelectasis, pneumonia and respiratory failure. Prevention of respiratory complications must be initiated immediately, independent of the level of spinal cord injury. The question of mechanical ventilation in the acute setting, and also during long-term follow-up must be addressed, along with aggressive secretion management. Patients with spinal cord injury have a high prevalence of sleep apnea that may influence their quality of life and rehabilitation.
Respiratory complications are common in patients with spinal cord injury. These patients need a multidisciplinary approach. All disciplines involved must obtain knowledge of respiratory complications in the acute phase and in the longer term, to ensure patients are referred for necessary pulmonary review and follow-up.