Study design: To study the short-and long-term medical complications encountered in tetraplegic spinal cord injured persons (TSCI) and to give prominence to both the medical and socio-economic factors with which they are respectively associated. Methods: The Tetra®gap Study is a multicentre epidemiological survey carried out using selfadministered questionniares studying the global long-term outcome of TSCI patients after the initial phase of rehabilitation. Results: The data for 1668 patients were analyzed. The rate of rehospitalisations was 74.4% with on average three stays per patient and as reported causes, in descending order: urinary complications, systematic follow-up, pressure sores, respiratory complications, contractures, bowel complications, pains and secondary fractures of the lower limbs. At the time of the survey, 84.7% of patients mentioned awkward contractures, 73.8% pains, 55.9% embarrassing urinary leakage and 14.1% pressure sores. With regard to persons su ering from complete motor lesion, urinary complications and pressure sores were more frequently reported, whereas for persons su ering from incomplete motor lesions, awkward contractures and pains were more frequent. In the elderly, pains were more often mentioned, and pressure sores and pain were also the most common in patients coming from lower socio-professional status. Contractures and pain decreased with time. All these complications but pressure sores and pain are statistically interrelated. Conclusion: The medical complications of spinal cord injured persons are frequent, they are linked to biological, psychological and environmental factors, and are interrelated. Therefore, seeking mid-and long-term risk factors must be given priority in order to better adapt attempts at increasing secondary prevention.

Purpose:Several recent open studies have provided encouraging results as to the e cacy of intravesical installations of capsaicin for neurogenic hyperre¯ectivity. The present trial was performed to verify these results under controlled conditions. Intravesical installation of capsaicin represents a new therapeutic hope for the treatment of the neurogenic hyperrelfexic bladder. Method: This randomized, double-blind study compared the results of the intravesical installation of 30 mg capsaicin in 100 ml of 30% alcohol (experimental group) with those of installing 100 ml 30% alcohol alone (control group). On day 0 and day 30, urodynamic and biopsic examinations were performed in all subjects of each group. Patients: All the subjects included in the study had a functionally disabling form of neurogenic hyperre¯exic bladder resistant to the usual therapies. Cystoscopy and retrograde cystography were performed to exclude any patient who presented with a tumor-like lesion or had vesicoureteral re¯ux. Results: Twelve paraplegic of tetraplegic subjects, seven women and ®ve men whose average age was 46, were included. Eight had multiple sclerosis, and four had sustained a traumatic spinal cord injury. The patients were randomly separated into two groups of six. Initially, there was no clinical or urodynamic di erences in these groups. Installation immediately triggered side e ects and during the ®rst 7 days (suprapubic burning sensation, sensory urgency, hot¯ushes, autonomic hyperre¯exia, hematuria) in ®ve of the six subjects in both groups. Bladder biopsy revealed no signi®cant deterioration. On day 30, there was improvement in all of the experimental-group of patients with signi®cant regression of leakage (P=0.002) and of sensory urgency (P=0.01). Only one control subject had amelioration. Urodynamic examination showed a rise in bladder capacity from 172.5 to 312.3 ml in the experimental group, signi®cantly greater (P=0.03) than the rise from 129 to 175.3 ml observed in the control group. Conclusion: This trial fully con®rms the e cacy of intravesical installations of capsaicin, an e cacy obtained at the cost of nonnegligible side e ects. An intermediate-term follow-up of this treatment will be necessary before considering more widespread use of this agent.

We studied the e cacy of endoscopic injection of Botulinum A toxin (150 I.U. Dysport 1 ) in the treatment of detrusor-sphincter dyssynergia in 17 patients with spinal cord disease. One month after the injection, the postvoiding residual urine volume (7176 ml, P50.001), the bladder pressure on voiding (719 cm water, P50.01), and the urethral pressure (724 cm water, P50.001) were signi®cantly decreased. The modality of voiding was improved in 10 patients (ie micturition by suprapubic tapping was easier to induce, discontinuation of indwelling catheter use, or decrease in frequency of intermittent catheterizations). The tolerance of the treatment was excellent. The therapeutic e ect lasted 2 to 3 months on the average. The low doses used in this study probably explain in part why the treatment sometimes failed. Botulinum A toxin could become an alternative treatment for detrusorsphincter dyssynergia in certain patients, notably in those who are refractory to sphincterotomy or in patients, such as those who are tetraplegic, and who are incapable of performing intermittent self-catheterization.

Symptomatic stenoses of the middle cerebral artery (MCA) are not uncommon, although Corston observed the occurrence of stroke in 24% of patients with MCA stenoses during a 6-year follow-up study. We tried to use transcranial Doppler (fCD) sonography for the detection and evaluation of MCA stenoses.Intra-arterial angiography demonstrated 16 MCA stenoses of more than 30% diameter reduction in 15 patients (14 atheromatous stenoses, 2 dysplasias). Severe as· sedated lesions were present in 2 cases (more than 75% internal carotid artery stenosis). These 15 patients with MCA stenosis were examined with TCD in a blind study.A Doppler signal from the MCA was obtained through the temporal bone and was recognized on the result of common carotid artery compression test. We ascertained MCA stenosis when TCD demonstrated 1) segmental Oow acceleration with peak systolic frequency of more than 3 KHz. with or without high en-T ranscranial Doppler sonography is able to detect and measure blood velocity in the first part of the middle cerebral artery (MCA) in 96% of nor· mal subjects.u However, its accuracy in the detection of MCA stenosis remains to be determined. As reported in x-ray contrast angiographic studies, MCA stenosis is un· common. Hass 3 reported 7.6% "isolated plaques" in more than 4000 intra-arterial contrast angiographies, while Resch' reported 14% MCA plaques in anatomical Received October 13, 1987, from the Cerebral Vascular Investiga~ ergy low frequency direct or reverse components; or 2) segmental increase in systolic peak frequency of more than 20%.Using these criteria, we confirmed through TCD the presence of MCA stenosis in nine out of 12 cases with diameter reduction of at least 50%, and one among four cases with less than 50% diameter reduction.Although our results are consistent with Aaslid and von Reutern's figures, methodological problems and diagnostic criteria have to be improved. Nevertheless, TCD seems to be a useful tool for the detection of stenosis with at least 50% diameter reduction, where it proved to offer a 75% sensitivity. Further studies are necessary to improve sensitivity and specificity. KEY WORDs: transcranial pulsed Doppler sonography, middle cerebral artery stenosis, Intra-arterial angiography. (/ Ultrasound Med 7:6ll, 1988) study on a similar number of cases. MCA stenosis appears to be seldom symptomatic. According to statistical evaluations, s-7 symptoms were found in 2% to 5.7% of cases. Nevertheless, an annual stroke occurrence was reported respectively in 4.2% 1 and 7.8% 9 of patients with MCA stenosis.We attempted to evaluate, in a blind study, the accuracy of transcranial Doppler sonography (TCD) in the detection of angiographically proven MCA stenosis with diameter reduction of more than 30%.

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