Bowel care for individuals with spinal cord injury: comparison of four approaches.
Amir I. Sharma R. Bauman WA. Korsten MA.
Gastroenterology Section, Bronx VA Medical Center, NY 10468, USA.
The efficacies of four bowel care regimens (bisacodyl suppositories, glycerin suppositories, mineral oil enemas and docusate sodium mini-enemas) were compared in seven subjects with traumatic spinal cord injury. Efficacy was assessed in terms of colonic transit time, bowel evacuation time and subjective responses to a questionnaire. Both docusate sodium mini-enemas and mineral oil enemas decreased total and left-sided colonic transit time. However, docusate sodium mini-enemas were superior to mineral oil enemas in terms of the decrease in bowel evacuation time and symptom reduction. Results in this small group of subjects suggest that docusate sodium mini-enemas may have advantages in the management of bowel evacuation in individuals with spinal cord injury.
Viral hepatitis in patients with spinal cord injury is explained by known risk factors.
Rosman AS. Chinigo AS. Spungen AM. Drexler HJ. Bauman WA.
Medical Service, Veterans Affairs Medical Center, Bronx, NY, USA.
Spinal cord injury (SCI) has been reported to be associated with viral hepatitis. However, this association may be related to other confounding factors, such as intravenous drug abuse or blood transfusions. Screening for viral hepatitis associated risk factors and serum serologies, including HBsAg, anti-HBc, anti-HBs and anti-HCV testing, were performed in 78 randomly selected SCI patients and 93 non-alcoholic patients attending a general medical clinic. Hepatitis B and C seropositivies in SCI patients were 29.5 percent and 14.1 percent, respectively, and were significantly associated with a history of intravenous drug abuse. In contrast, hepatitis B and C seropositivities in non-alcoholic general medicine clinic patients were 22.6 percent and 2.2 percent, respectively. In the subgroup of patients without known viral hepatitis risk factors, there were no significant differences between SCI and non-alcoholic patients with respect to hepatitis B (21.4 percent vs. 22.1 percent) or hepatitis C (0 percent vs. 1.3 percent) seropositivity. Stepwise logistic regression also failed to detect an association of SCI with viral hepatitis. In conclusion, the increased seroprevalence of hepatitis C in SCI patients is secondary to intravenous drug use and blood transfusions. Further preventive measures such as improved hepatitis screening of blood donors and substance abuse treatment should decrease viral hepatitis exposure in SCI patients.