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Biomedical subjects

A B Rossier

Publications and source records attributed to A B Rossier.

At least 19 recordsLinked to original sources
PubMed1990

[Effects of Botulinum A Toxin on the periurethral striated sphincter of the neurogenic bladder. Preliminary study].

The goal of this study was to try to determine the effects of the Botulinum A Toxin on the spasticity of the rhabdosphincter in 9 men with spinal cord injury and detrusor-sphincter dyssynergia. The cystometrography, before and after the endoscopic injection of 100 units of Botulinum A Toxin, consisted of recording the bladder, urethral and rectal pressures with microtip transducers the anatomical position of which was radiographically controlled. The subjective and objective results of that study allow us to conclude that the Botulinum A Toxin has a place in the treatment of spinal injuries with detrusor-sphincter dyssynergia. Due to his blocking effect on the release of acetylcholine in the motor nerve endings, the Botulinum A Toxin suppresses or decreases the spasticity of the rhabdosphincter and improves voiding. Although its relatively short living action (2-3 months) may require renewed injections, it has the advantage to hold off a surgical treatment such as a sphincterotomy and to give the patient another chance to reach a balanced bladder function secondary to the postinjection changes of reflexes which may have taken place between the bladder and the rhabdosphincter and vice versa.

Botulinum Toxins↗
PubMed1989

A case of post-traumatic syringomyelia. Neuropathological findings after 1 year of cystic drainage.

A 58-year-old man sustained C4-C5 post-traumatic myelopathy with C3-C4 subluxation, slight compression of C3 vertebral body, C4 spinous process fracture and C6 compression fracture. He subsequently developed syringomyelia from C4 to C6, which was shunted into the subarachnoid space. Postoperatively, there was some but insignificant improvement of his symptoms although a postoperative metrizamide spinal computerised tomography showed complete drainage of the cyst. This patient died 1 year later. Autopsy examination of the spinal cord showed extensive damage of the posterior half of the cord at C3-C4 but the damage was much less extensive from C4 to C6 (where the syrinx was located), affecting mainly the right dorsal column at C4 and the right dorsal column and right anterior horn at C5-C6. In this patient, the syrinx developed in the partially damaged segments of the cord at the level of the spinal fractures and complete drainage of the cyst was not followed by satisfactory relief of his symptoms.

Humans↗
PubMed1987

Experience in vibratory and electro-ejaculation techniques in spinal cord injury patients: a preliminary report.

More than 90 per cent of complete spinal cord injury patients have major fertility problems, depending upon the site and type of injury. During the last 5 years 34 patients were treated by vibratory and/or electrostimulation at our center, and semen was produced in all but 5. In 8 patients ejaculation was attempted by vibratory stimulation alone and in 22 electrostimulation also was used. Vibratory stimulation is the easier and less cumbersome of the 2 methods. No major side effects were noted with either technique. Stimulation was performed by a rectal electrode incorporated in a silicone finger glove with a current of 0.1 msec. in duration, a frequency of 30 Hz. and an average of 60 volts. Vibratory stimulation was applied to the frenulum and/or glans penis with a specially constructed vibrator at a frequency of 80 Hz. and a peak-to-peak oscillation of 1.6 to 2.4 mm. Semen obtained during the first 6 months after injury was not of a quality consistent with successful fertilization owing to poor motility. However, semen quality and motility were better in patients who had been injured for more than 6 months. Repeated electro-ejaculation did not improve the quality of semen. The effects of bladder outlet surgery and autonomic blockers were noted in 5 patients.

Adolescent↗
PubMed1986

5-microtransducer catheter in evaluation of neurogenic bladder function.

Recent use of the multiple microtransducer catheter in the evaluation of neurogenic bladder due to spinal-cord injuries leads us to believe that the use of the inferior edge of the symphysis pubis as the zero point for resting bladder pressure is more accurate than its superior edge, changes in resting bladder pressure at various volumes are influenced more by body position than by intravesical position of the sensor, back-to-back microtransducers indicate significant pressure difference at the external sphincter zone, and detrusor bladder neck dyssynergia during autonomic dysreflexia in patients with spinal cord injury is more likely of skeletal than of smooth muscle origin.

Adult↗
PubMed1986

Carcinoma in chronic pressure sores: a fulminant disease process.

Four cases of squamous cell carcinoma arising from chronic pressure sores in paraplegic and tetraplegic patients are presented and the literature reviewed. These pressure-sore carcinomas are characterized by a shorter latency period and a fulminant clinical course with a very high metastatic rate. Very aggressive treatment including even hemicorporectomy must be considered if a cure is to be achieved.

Carcinoma, Squamous Cell↗
PubMed1985

Electrodiagnostic abnormalities in 15 patients with posttraumatic syringomyelia: pre- and postoperative studies.

A review of 15 patients with posttraumatic syringomyelia indicates that the most reliable electrodiagnostic criteria for the diagnosis of syrinx are the loss of motor unit numbers with increase in motor unit amplitude and duration nd synchronous firing. Prolongation of F wave latency in a previously stable patient is a useful observation. Return of function and improvement of F wave latencies can occur rapidly following decompression of the syrinx. Forty per cent of the patients studied had concomitant involvement of at least one peripheral nerve as one would expect invoking the double crush hypothesis.

Adult↗
PubMed1985

Posttraumatic cervical syringomyelia. Incidence, clinical presentation, electrophysiological studies, syrinx protein and results of conservative and operative treatment.

In eleven years, 30 (3.2%) of 951 patients with spinal cord injury developed cervical syringomyelia. This condition was found in 22 (4.5%) of 488 posttraumatic tetraplegic and 8 (1.7%) of 463 posttraumatic paraplegic patients; the incidence was about 8 per cent in patients with complete tetraplegia. This study demonstrated the rarer clinical manifestations of syringomyelia, namely autonomic dysfunction, alterations in the sensory level with postural changes, the early occurrence of tendon areflexia and painless motor deterioration. Prolonged F wave latencies were present in all patients with a demonstrable syrinx and a higher protein content was found in the syrinx than in the cisternal fluid. Some of the symptoms and signs in a proportion of the patients treated conservatively remained stable without operative treatment over a number of years. Most of the patients in whom operation was performed for progressive motor weakness or severe pain had good postoperative results although a few developed late sensory or motor changes. There was no benefit in operating on a patient with a small syrinx.

Adult↗
PubMed1984

Indication and results of semirigid penile prostheses in spinal cord injury patients: long-term followup.

During the last 7 years semirigid intracorporeal penile prostheses were inserted in 36 spinal cord injury patients between 21 and 58 years old (average age 38.5 years). An operation was done 1 to 32 years after the initial injury (average 10 years). Surgical intervention was intended to provide an adequate body to the penile shaft so as to hold an external urinary drainage device in 11 patients, for treatment of sexual dysfunction only in 17 and for an external urinary drainage device plus treatment of sexual inadequacy in 8. Although a number of complications causing extrusion or removal of the prosthesis occurred in 6 patients (16.5 per cent), as well as an aborted operation in 1 (19.5 per cent), there were no permanent sequelae. Because of loss of sensation and vasomotor control, and pressure produced by the penile prosthesis spinal cord injury patients represent a higher operative risk than other patients without neurological or vascular impairments. In addition, urinary tract infection should not be overlooked as another major risk factor. Penile prostheses were most successful in maintenance of external urinary appliances in patients with a short or retractile penis. Whenever the prosthesis was intended for sexual intercourse an important prerequisite to a successful surgical outcome was the retention of some reflexogenic or psychogenic erection over and above the rods. Careful individual preoperative assessment is advised if a satisfactory result is to be achieved.

Adult↗
PubMed1984

Management of neurogenic bladder in female spinal cord injury patients.

Twenty-two female spinal cord injury patients were admitted to the Spinal Cord Injury Service at the West Roxbury VAMC during a period of 17 years (1965-1982). Bladder status and means of drainage were evaluated. Twelve patients (55%) required no means of drainage, nine of them were dry all the time, while the other three needed pamper support to counteract occasional wetness. Seven were on constant indwelling catheters, two were on self-catheterization, while one had an intestinal loop diversion. It appears that female spinal cord injury patients depend more on constant indwelling catheters than their male counterparts. In some instances, female paraplegics do well on self-catheterization. Catheter complications in female spinal cord injury patients appear to be less than in males.

Adolescent↗
PubMed1984

Complete sensory and motor recovery from anterior spinal artery syndrome after sprain of the cervical spine. A case report.

A patient sustained C7-C8 incomplete myelopathy with dissociated sensory loss after a whiplash injury. Cervical radiograms showed no fracture or dislocation but separation of the C4-C5 and C5-C6 spinous processes and anterior tilting on C5 on C6 vertebral body only in the head-neck flexed position. Complete sensory and motor recovery occurred after neck immobilization. The patient's transient neurologic deficits were probably caused by vascular insufficiency of an anterior radicular artery at the C5-C6 intervertebral foramen.

Adult↗
PubMed1983

Treatment of acute autonomic dysreflexia.

Chlorpromazine has proved useful in the control of sustained dysreflexia in patients with spinal cord injury. Sustained autonomic dysreflexia can be life threatening and may occur after dysfunctional urethrovesical activity or after urological operations, such as external sphincterotomy. Given by injection chlorpromazine reduced blood pressure safely and effectively.

Adult↗
PubMed1983

Anterior spinal artery syndrome and its natural history.

The anterior spinal artery syndrome in three patients is described and from the literature 60 additional patients were collected. Motor recovery in the following groups of patients was noted: (1) Partial loss of motor function and pain sensation--70.4 per cent (19/27); (2) Complete motor loss but partial loss of pain--83.3 per cent (5/6); (3) Paresis but pain sensation absent--66.7 per cent (6/9); and (4) Absent motor function and pain--38.9 per cent (7/18). Motor recovery was also found to vary according to aetiology: (A) Unknown cause--92.9 per cent (13/14); (B) Post-infection or vaccination--88.9 per cent (8/9); (C) Anterior spinal artery occlusion--33.3 per cent (3/9); (D) Spinal cord angioma--20 per cent (2/10); and (E) Aortic lesion--20 per cent (1/5). Patients with sparing of motor function or pain sensation below the lesion do better than those without both functions. Neurological return also varies with the aetiology of the syndrome.

Adolescent↗
PubMed1983

Two spinal cord lesions in a patient with ankylosing spondylitis and cervical spine injury.

A patient with ankylosing spondylitis sustained C3-C4 vertebral subluxation and C4-C5 myelopathy after a hyperextension trauma. Autopsy showed that several segments below the main cervical cord lesion at the fractured site, there was a second spinal cord lesion at the T1 vertebral level with no corresponding local bony or ligamentous damage. The thoracic cord lesion was probably secondary to traction of the upper thoracic cord, where the blood supply is poor, in a narrow and rigid spinal canal at the moment of extreme hyperextension.

Fractures, Bone↗
PubMed1982

Role of striated and smooth muscle components in the urethral pressure profile in traumatic neurogenic bladders: a neuropharmacological and urodynamic study. Preliminary report.

Urodynamic investigations with urethral pressure profile, and vesical, intrarectal and anal pressure recordings were performed in 37 patients with spinal cord lesions. The recordings were done before and after phentolamine injections and/or pudendal nerve blocks to evaluate the respective contribution of sympathetic and somatic innervation to the maximum urethral closure pressure in the mid and distal portions of the membranous urethra. A pressure gradient was demonstrated in the membranous urethra with higher values in the distal than in the mid portion. These results emphasize that the interrupted withdrawal technique is superior to the continuous technique in patients with upper motor neuron bladders. Mid urethral striated and smooth muscle components were shown to represent approximately 60 and 30 per cent of the maximum urethral closure pressure, respectively. In the distal urethra striated and smooth components are more abundant than in the mid portion and contribute in equal proportion to the maximum urethral closure pressure. No substantial role was found for the vascular bed in the maximum urethral closure pressure. The greatest pressure decrease in the mid and distal urethra of patients with lower motor neuron bladders was believed to be an effect of denervation supersensitivity. The results of pudendal blocks showed sphincter dyssynergia to be mediated through pudendal nerves via spinal reflex arcs. Phentolamine effects on bladder activity suggest that blockade of alpha-adrenergic receptors inhibits primarily the transmission in vesical and/or pelvic parasympathetic ganglia and acts secondarily through direct depression of the vesical smooth muscle. Our neuropharmacological results raise strong doubts as to the existence of a sympathetic innervation of the striated urethral muscle in humans.

Adrenergic alpha-Antagonists↗