Sexual aspects in paraplegic patients.
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Biomedical subjects
Publications and source records attributed to M Maury.
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The beta-adrenoceptor blocking properties and pharmacokinetics of bucindolol 150 mg were compared to those of propranolol 80 mg and a placebo in a double-blind trial in 6 healthy volunteers. Heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressures and peak expiratory flow rate (PEFR) at rest and during vigorous exercise, and plasma renin activity (PRA) at rest, were measured before and at intervals up to 24 h after oral administration of the drugs. Bucindolol reduced exercise tachycardia and decreased exercise PEFR, thus behaving as a non-selective beta-adrenoceptor blocking drug. In contrast to propranolol, bucindolol did not reduce resting HR and PRA, probably because of its intrinsic sympathomimetic activity. It decreased resting DBP in relation to its peripheral vasodilator properties. The effects of bucindolol developed as early as 30 min after administration and lasted up to 24 h, whereas its Tmax and T 1/2 were 1.6 and 3.6 h respectively. Comparison of the time courses of plasma bucindolol and the cardiac beta-adrenoceptor blockade strongly suggests that in man bucindolol undergoes an extensive first-pass effect, leading to the formation of one or more active metabolites.
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The time course of the plasma lignocaine concentration, following caudal anaesthesia, was studied in 11 healthy children (3.5-9 yr). Plasma lignocaine concentrations were measured for up to 6 h after administration (5 mg kg-1). Peak plasma concentration was 2.05 +/- 0.08 micrograms ml-1 and occurred at 28.2 +/- 2.9 min after administration. Pharmacokinetic parameters determined from a two-compartmental model were similar to those observed after the i.v. or extradural administration of lignocaine in adults, except for a longer half-life of elimination (155 +/- 32 min). Since the total body clearance of lignocaine was similar in children (15.4 +/- 1.2 ml min-1 kg-1) to that in adults, the longer half-life of elimination was attributed to a larger volume of distribution in the children (3.05 +/- 0.40 litre kg-1).
Serum angiotensin I-converting enzyme activity (SCEA) was investigated in 15 healthy premature (gestational age ranging from 30 to 36 weeks) and in 14 healthy full-term (gestational age ranging from 37 to 41 weeks) newborns as well as in 16 healthy adults (32.0 +/- 2.6 years). SCEA mean values in the three groups, respectively, 23.3 +/- 1.3, 24.4 +/- 1.6 and 23.2 +/- 1.7 nM . min-1 . ml-1, did not differ significantly from each other and in the newborns there was no correlation between SCEA values and gestational age.
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The characteristics of the semen of the paraplegic men were studied on 57 examinations of the semen of 21 patients. The technic of ejaculation stimulation had an influence on the volume, which was much more important with vibromassage, and the spermatozoa mobility, which was lower with electrostimulation. The comparison with the semen of a reference population of fertile and infertile men reveals that the diminution of the volume, of the normal forms and specially of the mobility are the main semen characteristics of the paraplegic. All the parameters have higher values in the semen of the fertile paraplegic than in these of the infertile paraplegic.
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The authors have studied the possibility of walking after rehabilitation and bracing in the paralysed of the lower limbs, it is variable with aetiological factors and age of patients. In children, walking after bracing is almost always indicated-it should be discussed case after case in adults. The authors analyse the role of different types of braces such as pneumatic braces and orthoptic systems using electrical stimulation. Some views on the future are exposed.
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Apart from pains by removal of inhibition, there are pains by hyperstimulation as well, even with apparently complete paraplegia. Successively, the author first reviews specific sub-lesional pains, then lesional pains (some of them are probably due to deafferentation), and at last, supra-lesional pains which are the most numerous ones and for which examples of hyperstimulation are given. The therapeutic rules used by the author are enumerated. To ease their suffering about 8 per cent of the patients are given antidepressive drugs, which most of the time can be gradually stopped after several months.
After having experimented with electro-stimulation on monkeys, the authors have put it into practice with the paraplegic. They report observations on pregnancy of a woman with a complete paraplegic below T4 who was injured 15 years ago. Nineteen electro-stimulations and seven artificial inseminations were necessary. The electro-stimulation is easy and can be repeated at will.
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