AIM:To assess the prevalence of bowel dysfunction in hemiplegic patients, and its relationship with the site of neurological lesion, physical immobilization and pharmacotherapy.

Autonomic dysre¯exia (AD) is an acute syndrome characterised by inappropriate and massive autonomic response that occurs in patients with spinal cord injury above the T6 level. Aims: to evaluate the incidence of AD during cystometry and the relationships with clinical and urodynamic features. Patients and methods: Forty-eight spinal cord injury patients were studied by neurological and urological examination and urodynamic evaluation with concurrent recording of blood pressure, heart rate and symptoms and signs of AD. Patients were considered to have AD if blood pressure reached values higher than 150/100 mmHg. Results: All the patients showed a signi®cant increase of both systolic and diastolic blood pressure, although only 20 showed pressure values higher than 150/100 mmHg (in seven of them without AD symptoms). AD was more frequent in cervical patients (P=0.034), but did not correlate with any other clinical features: sex ratio, age, disease duration, completeness of lesion, incidence of detrusor hyperre¯exia/are¯exia and detrusor-sphincter dyssynergia, voiding modalities, usage of anticholinergic drugs. In three patients blood pressure increase began when uninhibited contraction started, in 11 it was coincident with unhibited contraction peak and in the other six it appeared at maximum bladder capacity. Conclusions: (1) during urodynamic evaluation all the patients with lesion level above T6 showed signs of sympathetic stimulation, although only some showed dangerous blood pressure values; (2) the relationship between urodynamic data and dysre¯exia crisis shows that both the presence of detrusor uninhibited contractions and bladder distension are able to stimulate the crisis; (3) treatment with anticholinergic drugs is not sucient to prevent autonomic dysre¯exia starting from the bladder, unless it induces detrusor are¯exia. These patients are at risk of developing autonomic dysre¯exia following bladder distension.

Objective: To examine the in¯uence of social, physical and psychological factors in determining the usage/non usage of reciprocating gait orthosis (RGO) in spinal cord injury (SCI) patients. Design: Prospective clinical trial. Setting: A large rehabilitation hospital in Rome, Italy. Participants: Twenty four SCI patients of traumatic aetiology (all ful®lling the criteria to prescribe the device). Methods: Social, physical and neurological examination according to ASIA standards; psychological enquiry by means of the Eysenck Personality Questionnaire (EPQ) and the scale for self rating anxiety and depression of the Cognitive Behavioural Assessment. Results: After 1 year follow up 11 (46%) of our patients no longer used the RGO. There was no statistically signi®cant dierence between patients who used the RGO and those who rejected the orthosis with regard to social and physical data. There was a signi®cant dierence (P=0.005 at the end of training and P=0.003 at 1 year follow up) with regard to functional ambulation level. With regard to psychological enquiry RGO-non users showed a higher frequency of values over the mean in the E scale (extroversion) of the EPQ than RGO-users (P=0.05). Conclusions: None of the identi®ed parameters were useful to predict the use/rejection of the orthosis. Although they need to be con®rmed, our psychological data suggest that extensive psychological testing could be useful to sharpen the ability to predict. Spinal Cord (2000) 38, 555 ± 558

Study design: Spinal cord injury (SCI) patients with pressure sores were studied before and after surgical intervention for ulcer healing and compared with matched SCI patients without sores and with patients with pressure sores and other diseases. Objective: To analyse the relationship between pressure sores and anaemia and serum protein alteration in SCI patients. To study the pathogenesis of these alterations and suggest appropriate therapy. Setting: Spinal cord unit in Rome, Italy. Subjects: A total of 13 SCI patients with pressure sores, 13 comparable patients without pressure sores and four patients with other diseases and pressure sores. Main measures: Haematochemical parameters. Results: Patients with pressure sore showed significant decreased red cells, decreased haemoglobin and haematocrit, increased white cells and ferritin and decreased transferrin and transferrin saturation; total hypoproteinemia and hypoalbuminemia with increased Alfa-1 and gamma globulins increased erythrocyte sedimentation rate and C-reactive protein were also present. The alterations returned to normal after surgical intervention for pressure sore healing. Conclusions: Patients with pressure sores suffer from anaemia and serum protein alteration that fells within the range of metabolic alteration of chronic disorders and neoplastic diseases. The alterations depend on a decreased utilisation of iron stores in the reticuloendothelial system and on inhibition of the hepatic synthesis of albumin. With regard to treatment, iron treatment should be avoided because of the risk of haemochromatosis.