Sensory anal examination in spinal cord injury

Article (PDF Available)inSpinal Cord 47(12):901 · July 2009with18 Reads
DOI: 10.1038/sc.2009.85 · Source: PubMed
Abstract
Spinal Cord is the official journal of the International Spinal Cord Society. It provides complete coverage of all aspects of spinal injury and disease.
LETTERS TO THE EDITOR
Sensory anal examination in spinal cord injury
Spinal Cord (2009) 47, 901; doi:10.1038/sc.2009.85;
published online 30 June 2009
I enjoyed reading the paper by Krogh et al.
1
I would
recommend the addition of sensory anal examination to
their physical examination. This would involve superficial
anal examination with cotton and pinprick and asking about
the amount of sense perceived on both the right and left
sides. Comparison between both sides and with areas of
normality is recommended. Observation of anal wink
during sensory examination is a helpful test to see the
tone of the anus. For example, if the examiner asks the
patient to contract the anal sphincter and the patient
answers that he/she cannot do so, but an anal wink is seen
during the pinprick stimulation, it shows that tone is
present. The bulbocavernous reflex and observation of the
anus during a gentle pinch of glans penis should also be
performed.
Acknowledgemen ts
I thank Professor Alexander R Vaccaro for his edit of the
letter.
V Rahimi-Movaghar
Sina Trauma and Surgery Research Center, Sina Hospital,
Tehran University of Medical Sciences, Tehran, Iran
E-mails: v_rahimi@sina.tums.ac.ir and v_rahimi@yahoo.com
References
1 Krogh K, Perkash I, Stiens SA, Biering-Sorensen F. International
bowel function extended spinal cord injury data set. Spinal Cord
2009; 47: 235–241.
Re: Case report: A fatal metastasis of Klebsiella pneumonia
to the lungs
Spinal Cord (2009) 47, 901902; doi:10.1038/sc.2009.96;
published online 28 July 2009
Dr Frisbie presents a case of a 61-year-old tetraplegic who
developed a respiratory tract infection with Klebsiella
pneumonia, which he suggests migrated to the lungs and
caused an overwhelming infection from which the patient
died. He suggests that the origin of pulmonary infections can
be extra-pulmonary.
There is a very rich literature on the subject, which I feel
should be acknowledged in such a presentation.
Charcot in 1877 showed that pressure sores became
infected and caused septic emboli in the lungs.
‘We shall also notice gangrenous emboli. In this
variety, thrombi impregnated with gangrenous ichor
are transported to a distance and give rise to gang-
renous metastases, which are principally observed in
the lungs. This is a point upon which Dr Ball and
myself have insisted in a work published in 1857.
1
But
long before us, and even long before the theory of
embolism had been Germanised, M Foville had
expressed his opinion that a considerable number of
cases of pulmonary gangrene, observed in the insane,
and in different diseases of the nervous centres, are
caused by the transport into the lungs of a part of the
fluid which bathes the eschars of the breech’.
2
Wagner who set up a dedicated spinal unit also described
the systemic effect of pressure sores.
3
‘Prior to the opening of centres for the treatment of
paraplegic patients, the majority died soon after injury from
the effects of renal sepsis. In 1917 Thompson Walker found
that 47.2% of the patients admitted with spinal injuries to
the King George V military Hospital died from urinary
infection 8 to 10 weeks after admission. With the advent
of specialised centres during the 1939–45 war, this early
mortality was reduced largely due to the better under-
standing of the management of the paralysed bladder,
regular turning and the availability of antibiotic therapy
and blood transfusions. If the patient survived the dangerous
six weeks immediately after injury they still were liable to die
from the long-term complications of low grade infection of
Spinal Cord
(2009) 47, 901 902
&
2009 International Spinal Cord Society All rights reserved 1362-4393/09
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