SummaryChanges in different aspects of sexuality were investigated and related to overall quality of life and physical, psychological and social adjustment in 73 SCI subjects, who were sexually active both before and after injury. Items on sexual interest and satisfaction were treated as one composite variable, the SIS scale, measuring sexual adjustment after injury.Despite severe genital dysfunction, more than half of the subjects (57%) rated their sexual relations after injury as satisfying or at least rather satisfying. The majority continued having intercourse, although many of them more seldom than before, and about half experienced orgasm.Sexual adjustment after injury was closely and positively correlated to frequency of intercourse, willingness to experiment with alternative sexual expressions and young age at injury. Physical and social independence and a high mood level were further positive determinants of sexual adaptation after injury, whereas the neurological level and completeness of injury showed no significant correlation with sexuality.It is suggested that sexual information and counselling should be integrated in the total care of the SCI patient to reduce the negative effects on sexuality, caused by the lnJury.

SummaryVast community provisions in Sweden are intended to offer spinal cord injury (SCI) subjects equal opportunities and the same living standards as the able-bodied. This study on all 56 subjects representing 3 distinct functional subgroups, out of a consecutive series treated at a Spinal Unit, explored the skills used in a wide range of community living activities and the details of these subjects' quality of life (QL). C6-tetraplegics with complete lesions (n = 15), wheelchair-bound paraplegics (n = 23) and ambulant paraplegics (n = 18) varied in physical independence in proportion to their disabilities but disturbances of mood states and QL perception did not differ between groups or from a control population sample. Eighty per cent of the subjects were engaged in gainful employment or education. Work/education, home management and mobility in the neighbourhood were clearly restricted by more severe disability but social and recreational activities were not. Degree of social activity and ability to drive a car were closely associated with levels of mental well-being and of perceived QL. Access to transport and home-help services, appropriate housing and technical aids included few unmet subjective needs, possibly explaining why these environmental factors did not inhibit the activity levels of the study population. Extensive society support and stimulation can satisfy important needs and expectations of well-functioning SCI subjects. The spinal cord injured person is affected in several ways, both during the process of adjustment after injury and in his or her life situation following it. The limitations are both physical and psychological in nature, but some that can be improved are environmental and practical. We feel that it is timely to allow spinal QUALITY OF LIFE OF SWEDISH SPINAL CORD INJURY PATIENTS 477 cord injury (SCI) persons themselves describe what constitutes the limitations of their community living.A few studies have examined the impact of physical functioning and of mental well-being on skills and activities of SCI persons' lives. Goldberg et al. (1980) found that the level of injury and the ability to perform self-care skills were related to their vocational status after discharge. MacDonald et al. (1987) reported that even mildly depressed SCI subjects were engaged in fewer self-care activities than were those who were not depressed, and that tetraplegics were overall less active than paraplegics. De Jong et al. (1984) found that marital status, education, transport barriers, economic disincentives and dependence in activities of daily living were the most important predictors of independent living.A better knowledge of the skills and activities actually practiced by the SCI persons in their own environment would make it possible to improve the strategy to train SCI persons and to further develop their environment. However, no such comprehensive studies appear to have been presented, to date.The primary aim of this study was thus to establish which social, recreational and vocationa...

Arteriovenous malformations of the brain are rare disorders. Embolisation has emerged as an effective treatment with an acceptable, low complication rate. Previously presented results are completed with results from 1994 to 1996. Ninety-six percent of the patients were treated with no or very minor sequelae resulting in total obliteration in 32% and supplementary stereotactic radiation in 49%. Ninety percent of all patients are in excellent or good health at follow up. These results may be jeopardised by the ongoing proliferation of endovascular treatment for AVMs.

A brief quality-of-life (QL) questionnaire was derived empirically from a cross-sectional study of 98 SCI-patients (83% men, median age 33.5 years, and median time after injury 2.3 years). A comprehensive general battery of well-established questionnaires (Sickness Impact Pro®le (SIP), Mood Adjective Check List (MACL), and Hospital Anxiety and Depression (HAD) scale) was combined with a study-speci®c set of questions to constitute patients' QL. A stepwise analysis model was used to de®ne key areas and questions to be included in a brief SCI-adapted questionnaire. The central areas that independently mattered for SCI-patients' perception of good QL included mental health (no depressive feelings), physical and psychosocial dysfunction (no, or few and minor, limitations in mobility, body care and movement and social interaction), and SCI-related problems (no or little perceived di culty with loss of independence due to injury). A 22-item questionnaire is suggested for routine clinical follow-up to assess more accurately when optimal treatment and services have been delivered.

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