A report of the outcome of fitting ICEROSS prostheses to trans-tibia] amputees from a sub-regional amputee rehabilitation centre is presented. This work has mainly concentrated on obtaining patients' own views to judge advantages and disadvantages of ICEROSS compared to their previous patellar-tendon-bearing (PTB) prostheses. Sixty-nine patients were entered for this study, but the results of the study are based on 54 patients who responded. Fifteen patients (27.7%) had rejected their ICEROSS prosthesis at the time of the study. Provision of ICEROSS prostheses did not improve indoor and outdoor walking abilities in terms of distance or use of other walking aids, nor were they more comfortable to wear. An increase in sweating in the first 3 months of wearing ICEROSS was significant, but settled afterwards. The amputees considered that the rate of stump skin breakdown with ICEROSS compared to their PTB prostheses was significantly less. Walking up and down stairs was more comfortable and in a general overall rating of ICEROSS prostheses they were scored significantly higher by the amputees themselves. It is concluded that appropriate patient selection is vital and in certain cases ICEROSS will provide considerable benefits to the amputees.

Patients with chronic tetraplegia are prone to develop unique clinical problems which require readmission to specialised centres where the health professionals are trained speci®cally to diagnose, and treat the diseases aicting this group of patients. An appraisal of the readmission pattern of tetraplegic patients will provide the necessary data for planning allocation of beds for treatment of chronic tetraplegic patients. Hospital records of patients with tetraplegia readmitted to the Regional Spinal Injuries Centre, Southport, UK between 1 January 1994 and 31 December 1995 were analyzed to ®nd out the number of tetraplegic patients who required readmission, reasons for readmission, duration of hospital stay, and mortality among patients readmitted.During the 2-year period, 155 tetraplegic patients were readmitted and 44 of them (28.4%) required more than one readmission (total readmission episodes: 221); these patients occupied 4.5 beds which is equivalent to 11.5% of the total bed capacity of the spinal unit. Among the reasons for the readmissions, evaluation and care of urinary tract disorders topped the list with 96 readmission episodes (43.43%) involving 70 patients; the median hospital stay was 3 days, and 18 patients (26%) required more than one readmission during this period. One hospital bed was occupied by the tetraplegic patients requiring treatment/evaluation of urinary tract disorders. Assessment and treatment of cardio-respiratory diseases was the second most common reason for readmission with 51 readmission episodes pertaining to 27 patients having a median hospital stay of 6 days; 13 patients (48%) were readmitted more than once within this 2-year period. Treatment of cardio-respiratory diseases in chronic tetraplegic patients required 1.2 hospital beds yearly. Only ®ve tetraplegic patients were readmitted for treatment of pressure sore(s); however they had a prolonged hospital stay (median duration: 101 days). Social reasons accounted for 13 readmission episodes concerning nine patients who stayed in the hospital for varying periods (median: 6.5 days; mean: 35 days).Four tetraplegic patients readmitted with acute chest infection expired. An 81 year-old tetraplegic died of myocardial infarction. Urinary sepsis, renal insuciency, respiratory failure and intra-cerebral haemorrhage accounted for the demise of a 41 year-old tetraplegic patient following surgical removal of a large, impacted stone at the pelviureteric junction. A tetraplegic patient who was admitted with haematuria subsequently underwent cystectomy for squamous cell carcinoma of the urinary bladder; he developed secondaries and expired 5 months later.As more patients with high cervical spinal cord injury survive the initial period of trauma, and as the life expectancy of tetraplegic patients increases, it is likely that greater numbers of tetraplegic patients will be requiring readmission to spinal injuries centre. Although it may be possible to prevent some of the complications of spinal cord injury and hence the need for a readmiss...

Study design: A cross-sectional study that assessed people with spinal cord injury (SCI) and their carers who attended the 3-day health care program. Objectives: The study examined the nature and prevalence of the factors associated with psychological morbidity among carers of people with SCI. Setting: A community reintegrated population of persons with SCI and their carers attended the 3-day program in the Department of Physical Medicine and Rehabilitation, Christian Medical College Hospitals, Vellore, South India. Methods: Thirty-eight people with SCI and their carers participated in this cross-sectional study. Results: Thirty (78.9%) carers of people with SCI were psychologically distressed. While carers were distressed, they were not signi®cantly depressed. Educational level of carers and suicidal behavior of people with SCI were signi®cantly associated with psychological distress. Conclusion: The ®ndings of this study suggest that health care workers should have a high index of suspicion of psychological morbidity, in carers of people with SCI. Identi®cation of risk factors may lead to useful target interventions. Sponsorship: Nil. Spinal Cord (2000) 38, 559 ± 562

Glucose intolerance and dyslipidaemias have been reported among paraplegics and tetraplegics. In this study we determined the lipid pro®les and the glucose tolerance in a group of 48 persons with spinal cord lesions who had been rehabilitated in our Department of Physical Medicine and Rehabilitation. This non-randomised, descriptive study was conducted as part of the annual medical follow-up of these individuals. Hypertension was observed in only 6% of the subjects. Fasting hyperglycemia was observed in 19% and glucose intolerance in 23% of the subjects. Total cholesterol was abnormal in 2%, but 58% had low levels of high density lipoprotein (HDL). 10% of the subjects had raised low density lipoprotein (LDL) levels. The cardioprotective HDL fraction may remain very low even while the total cholesterol level is within normal limits, and unless a lipid pro®le estimation is done, this group of individuals who are at cardiovascular risk may remain undetected. We conclude that glucose intolerance and dyslipidaemias are common among paraplegic and tetraplegic individuals, and these metabolic derangements may contribute to increased cardiovascular morbidity.

No abstract