Introduction: Bowel management is a significant source of concern for patients with spinal cord injury (SCI) and may significantly alter quality of life. The effect of colostomy formation on both quality of life and time taken for bowel care is well recorded. We report our experience of intestinal stoma formation in SCI patients. Methods: Medical records from the spinal unit, operating theatres and stoma clinics were reviewed to identify SCI patients for whom a stoma had been formed. Patients were interviewed using a standard questionnaire. Average age at injury was 29 years (range 6-62 years). Mean time from injury to stoma formation was 17 years (range 0-36.25 years) and the mean period of poor bowel function prior to stoma was 8 years (range 1.5-25). Results: The average time spent on bowel care per week decreased from 10.3 h (range 3.5-45) prior to stoma formation to 1.9 h (range 0.5-7.75) afterwards (Po0.0001, paired t-test). In all, 18 patients felt that a stoma gave them greater independence and quality of life was described as much better by 25 patients. Complications occurred in 14 patients -eight described leakage of mucus and occasionally blood and pus per rectum, three developed parastomal hernias and three developed bowel obstruction. Conclusion: Elective stoma formation is a safe and well-accepted treatment for the management of chronic gastrointestinal symptoms in patients with SCI.

In the long term following spinal cord injury, bowel dysfunction causes major physical and psychological problems. A retrospective review of intestinal stomas performed in patients with spinal cord injury over a 10 year period was performed to investigate their role in alleviating these problems. Twelve patients underwent left iliac fossa end colostomy and two patients right iliac fossa end ileostomy. The mean age of patients at operation was 54.8 years (20 ± 65), and the mean time from injury to stoma formation was 15 years (2 ± 37). The mean period of unsatisfactory bowel management before stoma formation was 5.4 years (1.5 ± 25). Following colostomy the mean time spent on bowel care per week fell from 8.8 h (0.6 ± 12.2) to 1.4 h (0.3 ± 3.5) and independence in bowel care rose from 50 to 92%. All patients stated that their bowel care was easier and 83% said their independence had increased. Ninety-two per cent wished colostomy had been o ered earlier and no patient undergoing colostomy wanted it reversed. The most common complication following colostomy was exclusion colitis. The mean time of follow-up post colostomy formation was 38 months (7 ± 130). Formation of an intestinal stoma is a safe, e ective and well accepted treatment for selected patients with intractable problems of bowel management following spinal cord injury.

Objectives: Evaluation of a FES (Functional Electrical Stimulation) device for the relief of postural hypertension and augmentation of cough in a C3 ventilator-dependent tetraplegic. Study design: A single case study. Setting: A supra regional spinal unit in the UK. Method: A dual channel stimulator was designed that allowed selection and initiation of two predetermined stimulation intensities using a chin controlled joystick. Two sets of 70 mm diameter electrodes were placed either side of the abdomen. Approximately 80 mA, 300 ms, 40 Hz was required for assisted cough while about 40 mA was required for maintenance of blood pressure. After eating, the lower level stimulus is self-administered every 3 to 5 min gradually increasing the time between groups of burst to once every hour after 90 min. Results: Following eating, a blood pressure of 60/45 mmHg was recorded. After ®ve 1 s bursts of stimulation in quick repetition, this was increased to 133/92 mmHg. After 2 min blood pressure had fallen to 124/86 mmHg and to 93/66 after a further 4 min. The electrical stimulation was then repeated, returning the blood pressure to the previous higher level. Measurement of peak expiratory¯ow showed an increase from 275 l/min for an unassisted cough to 425 l/min when using the device. Conclusion: The device is used every day. The user is now independent in coughing function and no longer requires suction or manual assistance. Maintenance of blood pressure has signi®cantly improved his quality of life.

Study design: The bone mineral density (BMD) in 22 male subjects with complete lesion paraplegia sustained 1.8 to 27 years previously was measured. The measurements were used in screening each subject for a research programme investigating the restoration of standing using functional electrical stimulation (FES). Objectives: To assess the extent of bone loss in this group of subjects and correlation to age, time post-injury and level of lesion. Setting: District General Hospital in the UK. Methods: BMD was measured by dual energy X-ray absorptiometry (DEXA) in the lumbar spine and femoral neck and expressed as an indirect index to an age matched`normal' population. Fracture risk was described from this score using published data indicating that the risk increased with each standard deviation dierence from the`normal' mean. Results: The bone density in the lumbar spine was better preserved than in the femoral neck. BMD in the lumbar spine was found to be greater than the mean from the age matched population in 57.1% of subjects. Bone loss at the femoral neck suggested that 81.8% of the subjects were at increased risk of fracture, but only 22.7% were at a high risk. No correlation was found between BMD at the lumbar spine or the femoral neck and age, lesion level or time post-injury. Conclusion: The study indicates that further investigation into baseline BMD values for the SCI population is required to improve information provided to patients and assessment of fracture risk on an individual basis.

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