Biomedical subjects

N Bharatwal

Publications and source records attributed to N Bharatwal.

4 recordsLinked to original sources

PubMed2002

High-dose methylprednisolone for acute closed spinal cord injury--only a treatment option.

BACKGROUND: A systematic review of the evidence pertaining to methylprednisolone infusion following acute spinal cord injury was conducted in order to address the persistent confusion about the utility of this treatment. METHODS: A committee of neurosurgical and orthopedic spine specialists, emergency physicians and physiatrists engaged in active clinical practice conducted an electronic database search for articles about acute spinal cord injuries and steroids, from January 1, 1966 to April 2001, that was supplemented by a manual search of reference lists, requests for unpublished additional information, translations of foreign language references and study protocols from the author of a Cochrane systematic review and Pharmacia Inc. The evidence was graded and recommendations were developed by consensus. RESULTS: One hundred and fifty-seven citations that specifically addressed spinal cord injuries and methylprednisolone were retrieved and 64 reviewed. Recommendations were based on one Cochrane systematic review, six Level I clinical studies and seven Level II clinical studies that addressed changes in neurological function and complications following methylprednisolone therapy. CONCLUSIONS: There is insufficient evidence to support the use of high-dose methylprednisolone within eight hours following an acute closed spinal cord injury as a treatment standard or as a guideline for treatment. Methylprednisolone, prescribed as a bolus intravenous infusion of 30 mg per kilogram of body weight over fifteen minutes within eight hours of closed spinal cord injury, followed 45 minutes later by an infusion of 5.4 mg per kilogram of body weight per hour for 23 hours, is only a treatment option for which there is weak clinical evidence (Level I- to II-1). There is insufficient evidence to support extending methylprednisolone infusion beyond 23 hours if chosen as a treatment option.

Acute Disease↗

PubMed2002

Posttraumatic syringomyelia: predisposing factors.

Posttraumatic spinal cord cavitation (syrinx) and progressive myelopathy associated with a posttraumatic syrinx (PTS) have been recognized for many years. Predisposing factors for PTS have not been well defined. All symptomatic PTS patients (n = 58) treated at the University of Toronto neurosurgical units over 30 years were analysed retrospectively to discover risk factors for the development of PTS. There were 46 males and 12 females (mean age 42.2 years); 28 patients had cervical (CSCI), and 30 had thoracic and lumbar spinal cord injuries (TSCI). Neurological deficit was complete in 40 (69%) compared with 43% complete injuries in the concurrent spinal and injury (SCI) population in general (p = 0.0003). Onset of PTS was earlier with: increasing age (p < 0.02), cervical and thoracic levels of injury (p < 0.007 and p < 0.02, respectively, compared with lumbar injuries), dislocated fractures (p < 0.003) and spinal surgery (p < 0.001) and, marginally, with complete SCI (p = 0.06). Mean time to onset of PTS appears to have decreased in recent years (p < 0.0001). PTS follows complete spinal cord injury (SCI) more often than incomplete and is frequently associated with arachnoiditis. Onset is earlier with increasing age, cervical and thoracic levels compared with lumbar, displaced fractures and spinal instrumentation without decompression. A group of SCI patients who are at greater risk of developing early PTS is thus identified, facilitating cost-effective follow-up.

Adolescent↗

PubMed1984

Management of acute spinal cord injuries.

This report describes the results achieved in 144 patients with spinal cord injury admitted during the period 1974 to 1979 to the Acute Spinal Cord Injury Unit of Sunnybrook Medical Centre in Toronto. Several innovations have been made. These are based on a systems analysis approach to care and documentation. It includes epidemiologic studies of, and programs for, urologic and respiratory management and the use of halo devices. The unit has achieved a marked reduction in both mortality and morbidity. Patients have been transferred to the unit earlier after trauma and have been discharged earlier to rehabilitation hospitals partly because of the coordination of the acute and rehabilitation phases of care. There has been a marked reduction in the cost of care, because of fewer complications and a shorter stay in the acute hospital. The study confirms the advantages of regionalization and specialization in the field of acute spinal cord injury.

Acute Disease↗

PubMed1983

The urologic care of the spinal cord injury patient.

From 1974 to 1979, 141 acute spinal cord injury patients in the acute phase were managed by sterile, intermittent catheterization without complication. Of these patients 101 have been followed to the present. We used urodynamic criteria to determine whether these patients should be in retention on intermittent self-catheterization, or voiding with or without an appliance. When compared to a matched control group managed by indwelling catheterization in the acute phase and conventional criteria in the rehabilitation phase, 1 of 10 complications and 1 of 7 infections occurred in the study group. This analysis confirms that intermittent catheterization in the acute and rehabilitation phases, and the use of urodynamic criteria to follow lower tract management to achieve a low pressure voiding system represent major advances in the care of the urinary tract in patients with acute spinal cord injury.

Adolescent↗