Ultrasonographic Findings of Carpal Tunnel Syndrome in Patients with Paraplegia

OBJECTIVE: To assess the diagnostic value of ultrasonography for the median nerve, the state of life style activities and the pain degree of upper extremities in paraplegics with carpal tunnel syndrome (CTS). METHOD: Eighteen wheelchair ambulators with spinal cord injury who had neurological level below T2 were studied. Patients with peripheral or central neuropathies were excluded. Patients were assigned to either the electrodiagnostic CTS (group CTS, 7) or electrodiagnostically negative (group non- CTS, 11), and healthy volunteers (15) were classified as control group. The cross sectional area of the median nerve (MN-CSA) at carpal pisiform level was ultrasonographically measured. The degree of painful restriction to execute ADL by hands (TR-ADL), the pain grade (visual analog scale, VAS) of upper extremities and revised version of Korean spinal cord independence measure (KSCIM-R) for functional level were measured and analyzed. RESULTS: Nine hands (14.3%) of 7 patients out of 34 hands had CTS in electrodiagnostic study. There were significant difference among groups in TR-ADL hours (CTS group; 5.0 vs non-CTS group; 10.2, p0.05), MN-CSA (12.3 mm2 vs 7.9 mm2 vs control group; 8.0 mm2, p<0.05). Using the ROC curve, the cut-off value of MN-CSA produced 8.5 mm2 providing a diagnostic sensitivity of 77.8% and specificity of 59.6%. CONCLUSION: The ultrasonographic measurement of the median nerve may be a useful non-invasive screening test for the diagnosis of CTS in paraplegic patients with wrist pain.

Multiorgan Thrombotic Occlusions after Acitretin Treatment in a Patient with Chronic Psoriasis: A case report

Psoriasis, whose symptom is shown in around 1~3% American people, is a chronic and inflammatory skin disease. There are many treatments for pustular and erythrodermic psoriasis and oral retinoid which is a synthetic derivative of vitamin A is the most popular drug of them. Acitretin called as the second generation retinoid is a kind of active retinoid metabolite, which shows some drug toxicities in hepatic, skeletal and cardiovascular systems including atherosclerosis after a long term use. Even though that, we have just one case which has ever reported on acitretin-associated thrombotic stroke so far. We report a case on a patient who has multiorgan thrombotic occlusions resulted from longstanding psoriatic treatments by using acitretin for five years. This patient suffers from lots of complications such as superior mesenteric artery thrombosis, small cerebellar infarctions, cerebral infarction, acute renal failure concomitant with both small renal infarctions and atherosclerosis obliterans in his two legs.

Electromyographically Triggered Electrical Stimulation on Shoulder Subluxation in Hemiplegic Stroke Patients

BACKGROUND: The aim of this study is to evaluate the effect of electromyographically triggered electrical stimulation (ETES) on shoulder subluxation in stroke patients. METHOD: Twenty-three patients, who had hemiplegic shoulder subluxation within 3 months after stroke attack, were included. They were assigned randomly to either a control group (11 subjects) or a study group (12 subjects), and divided clinically to mild and severe subgroups by the degree in subluxation. Patients in both groups were received physical therapy and used an arm-sling. Subjects in the study group were taken ETES using biofeedback training on posterior deltoid and the supraspinatus muscle of hemiplegic subluxation side, daily 30 minutes a session, five days a week for 6 weeks. Electromyographic signals, which are derived from patient's voluntary muscle contraction, that exceeded a preset threshold trigger an immediate stimulation to force movement completion. The effect of ETES was assessed by the degree of subluxation using radiologic measurements at pre-treatment and 6 weeks post-treatment. RESULTS: In the control group, the degree of subluxation was increased after 6 weeks (p>0.05). In the study group, the subluxation was significantly reduced (p<0.05). The significant difference after treatment 6 weeks in mild and severe subgroups implied similar improvement between subgroups. CONCLUSION: The ETES may be the one of effective treatment methods for reducing the severity of hemiplegic shoulder subluxation in stroke patients.

Functional Evaluation of the r-nailing Treatment of Intertrochanteric Fracture Older than 60 years Old Patient

PURPOSE: To evaluate the functional status after Gamma nailing in inter-trochanteric fractures in elderly with functional recovery score (FRS). MATERIALS AND METHODS: We reviewed 285 patients of intertrochanteric fracture treated by gamma nailing from January 1993 to May 2002 with follow up more than 3 years. We analized recovery of functional status concerned with sex, age, fracture pattern, functional recovery index. RESULTS: The intertrochanteric fractures in elderly resulted in 15.8% loss of function after 3 years. The more functional loss was observed in female, the older age, and Boyd-Graffin type II fracture but, were not signifily related with functional loss except age. CONCLUSION: We concluded that the age is the important factor to functional recovery to pre-injury status in elderly patients.

Visual Evoked Potential in Preterm Infants

OBJECTIVE: The maturation in the central nervous system and the myelination of visual pathway were shown to be reflected by the visual evoked potential (VEP) response recordings. The purpose of this study was to establish normal value of flash visual evoked potentials in preterm infants, especially left to right difference. METHOD: Forty-one preterm infants from 31 to 40 weeks of corrected age had been made VEP records using Cadwell Excel EMG/EP system. Some in whom weekly VEP records had been made at least 3 times were included in longitudinal study and others in occasionally VEP records were included in cross-sectional study. Infants with neurological problems or anomalies, perinatal infectious and other severe systemic disease were excluded. RESULTS: 1) In the VEP study, we were able to establish the reference ranges for N300 peak latency at various corrected ages. 2) The latency of N300 peak latency was not significantly correlated with birth weight, sex, head circumference. 3) The latency of N300 peak decrease linearly, the age increased and also the decrement of N300 peak latency was accelerated at 37 weeks of gestational ages. CONCLUSION: Although VEPs from preterm infants have several peaks, N300 latency is the most prominent and the most reproducible. It has been considered the most important component of the preterm VEPs.