Effect on the Bone Mineral Density According to Weight-bearing Exercise in Children with Spastic Quadriplegic Cerebral Palsy: A Preliminary Study

OBJECTIVE: To evaluate the effect of weight-bearing exercise on the bone mineral density (BMD) in children with spastic quadriplegic cerebral palsy (CP). METHOD: A heterogeneous group of 18 prepubertal children with CP (age, 8.9+/-2.9 years; GMFCS level, IV and V) participated. Patients underwent a dual-energy X-ray absorptiometry scan of the lumbar spine (L1-L4) and proximal femur, and the Z scores were calculated by using data obtained from the control group who were normal children (age, 8.8+/-2.9 years). We divided the patients into 2 groups: group A standing for 2 hours a day, 5 days a week; group B standing for 30 minutes a day, 1 or 2 days a week. We measured BMD after 1 year and compared it to baseline measurements. RESULTS: BMD was significantly higher on L2-L4 vertebrae, femoral neck and trochanter area after exercise in group A (p0.05). BMD according to static weight-bearing exercise for 1 year were significantly different between groups A and B on the L1, L4 vertebrae, femoral neck and trochanter area (p<0.05). CONCLUSION: This study suggests that weight-bearing exercise may be an important part of a rehabilitation protocol to maintain and improve BMD in children with spastic quadriplegic CP.

Porcine abortion outbreak associated with Toxoplasma gondii in Jeju Island, Korea

This report deals with the acute onset of an abortion outbreak and high sow mortality in one pig herd consisted of 1,200 pigs and 120 sows on Jeju Island, Korea. Affected pregnant sows showed clinical signs, including high fever, gradual anorexia, vomiting, depression, recumbency, prostration, abortion, and a few deaths. Four dead sows, five aborted fetuses from the same litter, and 17 sera collected from sows infected or normal were submitted to the Pathology Division of the National Veterinary Research and Quarantine Service for diagnostic investigation. Grossly, hepatomegaly and splenomegaly were observed in sows. Multiple necrotic foci were scattered in the lungs, liver, spleen, and lymph nodes. Microscopically, multifocal necrotizing lesions and protozoan tachyzoites were present in the lesions. Tachyzoites of Toxoplasma (T.) gondii were detected immunohistochemically. Latex agglutination showed that the sera of 7 of 17 (41.2%) sows were positive for antibody to T. gondii. The disease outbreak in this herd was diagnosed as epizootic toxoplasmosis. To our knowledge, this is the first report of porcine toxoplasmosis with a high abortion rate and sow mortality in Korea.

Quantitative Analysis of Bulbocavernosus Reflex Activity in Patients with Spinal Cord Injury

OBJECTIVE: To quantify activities of bulbocavernosus reflex (BCR) using root mean square (RMS) value of motor unit action potentials in power spectrum analysis. METHOD: Twenty-six male patients with spinal cord injury were studied. The BCRs were evaluated by one examiner. The patients were assigned into absent, hypoactive and normal reflex groups according to the degree of BCR activity. The electrophysiological activities of the BCRs were evaluated by the RMS value of the motor unit action potentials in power spectrum analysis recorded from the bulbocavernosus muscle using concentric needle electrode. RESULTS: The BCR by clinical examination was absent in 6 patients, hypoactive in 10 patients and normal in 10 patients. RMS values of absent, hypoactive and normal BCR groups were 15.1+/-3.6 uV, 26.7+/-13.2 uV and 36.3+/-4.8 uV, respectively. RMS values of three groups were significant different (p=0.028) and showed significant correlation (r=0.714, p= 0.005). CONCLUSION: There was strong correlation between RMS value of motor unit action potentials of bulbocavernosus muscle and degree of BCR activities estimated by clinical examination in patients with spinal cord injury.

Compression Neuropathy of the Hypoglossal Nerve Following Orotracheal Intubation: A case report

Hypoglossal nerve injury is an uncommon complication following endotracheal intubation. A transoral procedure including endotracheal intubation may result in hypoglossal nerve compression at the lateral margin on the hyoid bone and inner mandibular margin at the tongue base. A 50-year-old patient undergoing rotator cuff repair developed a transient unilateral postoperative hypoglossal nerve injury following uncomplicated endotracheal intubation for general anesthesia. The following day the patient complained of difficulty with tongue movement and buccal manipulation of food, and had slurred speech. An electrophysiologic assessment confirmed a diagnosis of unilateral hypoglossal nerve palsy. The symptoms resolved spontaneously and completely by 6 weeks. The possible etiology of the injury is discussed, and related literatures are reviewed.

Urodynamic Findings and Voiding Symptoms according to LesionSites in Stroke

OBJECTIVE: To investigate urodynamic findings and voiding symptoms according to the location of brain lesion after stroke. METHOD: Twenty-six patients with stroke (19 infarction, 7 hemorrhage) who had complained of voiding dysfunction were studied. Brain MRI was performed to identify the suprapontine lesion or pontine lesion. Intravesical pressure and voiding control function of the external urethral sphincters were evaluated by urodynamic study with electromyographic study of the external urethral sphincter. Also voiding symptoms were evaluated. We classified voiding dysfunction into three subgroups by urodynamic findings as follows: detrusor hyperactivity, detrusor hypoactivity, and normal. Functions of the external urethral sphincters were divided into normal, impairment of external urethral sphincter volitional control (IEUS), and detrusor-sphincter dyssynergia (DSD). The symptoms of voiding dysfunction were categorized into three types as a irritative, obstructive or mixed type. RESULTS: In patients with suprapontine lesion (n=22), 11 (50%) showed hyperactive detrusor and 6 (27.3%) showed hypoactive detrusor. However, in the pontine lesion (n=4), one patient (25%) was normal and the others were hypoactive detrusor. Fourteen cases (64%) of the suprapontine lesion and 1 case (25%) of pontine lesion demonstrated normal external urethral volitional control. Seven of 11 patients with irritative symptoms showed detrusor overactivity. Five of 9 patients with obstructive symptoms showed hypoactive detrusor. CONCLUSION: We concluded that hyperactive detrusor in suprapontine lesion and hypoactive detrusor in pontine lesion were dominant. However, voiding symptoms in stroke patients were various according to the external urethral sphincter function as well as the detrusor activity.

Symptom Recurrence Pattern after Radiofrequency Thermocoagulationfor Facet Joint Syndrome

OBJECTIVE: To investigate the rates and mean duration of symptom recurrence after repeated radiofrequency thermocoagulations of the lumbar medial branch nerves for facet joint syndrome. METHOD: Medical records of 284 patients who had consecutive radiofrequency thermocoagulations for facet joint syndrome were reviewed. Responses of repeated radiofrequency thermocoagulations were compared with the initial radiofrequency thermocoagulation for mean duration of symptom recurrence and visual analogue scale (VAS). RESULTS: Forty-one (14.4%) among the patients who had radiofrequency thermocoagulation for facet joint syndrome were treated with additional radiofrequency thermocoagulation because of symptom recurrence. Thirty-seven patients were treated twice and four patients were treated three times. The mean duration of symptom recurrence of these patients was 7.3 months (2.3~12.3 months). Reduction of the VAS pain scores were significantly lower after repeated radiofrequency thermocoagulations compared with initial radiofrequency thermocoagulation (p<0.05). CONCLUSION: With well-defined diagnostic criteria for facet joint syndrome and a meticulous technique of radiofrequency thermocoagulation, radiofrequency thermocoagulation would be a useful treatment modality for patients with facet joint syndrome.

Determination of Neurological Impairment Level in Thoracic SpinalCord Injuries using Dermatomal Somatosensory Evoked Potentials

OBJECTIVE: To determine sensory levels of injury using dermatomal somatosensory evoked potentials (SEPs) and compare with the neurological level of injury determined by ASIA standard in patients with thoracic spinal cord injury. METHOD: By stimulating segmental thoracic dermatomes, cortical SEPs were studied in nine spinal cord injured patients from T2 to T12 (9 men, mean age 41.8) and 20 normal adult men (mean age, 28.3). The SEP studies were performed bilaterally. RESULTS: In eight cases (44%) of the paraplegics tested, the neurological level of injury by dermatomal SEPs was same compared to the level of injury assessed by ASIA standard. In 15 cases (83%), there were no or one level difference of the level of injury between the levels by SEPs and ASIA standard. CONCLUSION: This study suggests that dermatomal SEP can be a useful tool in determination of the neurological level of injury in patients with thoracic spinal cord injury.

Evaluation of Vascular Response using Impedance Plethysmography in Patients with Spinal Cord Injury

OBJECTIVE: To determine abnormal vascular response to cuff ischemia in patients with spinal cord injury (SCI). METHOD: Ankle blood pressure (ABP) and ankle-brachial index (ABI) in 20 SCI patients (14 men, 6 women, mean age 39.8 years) and control group (14 men, 6 women, mean age 40.2 years) were measured using impedance plethysmography at rest and after distal thigh cuff compression for 5 and 10 minutes. The patients were divided into tetraplegia (10), paraplegia (10), complete injury (8) and incomplete injury (12). RESULTS: There was no significant difference in ABP and ABI at rest and 5 minutes of ischemic compression between the patients and control groups. However, ABP and ABI decreased more at 10 minutes of ischemic compression in SCI compared to control groups (p<0.001). Changes of ABP and ABI between tetraplegia and paraplegia were not different. Complete injury of SCI decreased more than incomplete injury at 10 minutes of ischemia in the APB and ABI (p<0.001). CONCLUSION: Vascular control was significantly impaired in patients with spinal cord injury. Impedance plethysmography can be a useful and objective tool in evaluation of vascular response for the patients with spinal cord injury.

A Case of Type IV Sacral Agenesis: A case report

Sacral agenesis is an uncommon condition characterized by absence of different segments of lumbar spine along with total or partial absence of sacrum. It does not have an established etiology but may be associated with insulin dependent diabetes mellitus in the mother. Motor deficits are present and correspond to the level of vertebral agenesis. Sensation is better preserved than motor function. Orthopedic deformities such as hip dislocation, flexion contractures, genu recurvatum, posterior compartment atrophy, scoliosis and so on are observed. Urinary and bladder dysfunction are constant and it can lead to fatal kidney damage, finally. We report one case of type IV sacral agenesis with review of literature.

Dysphagia due to Esophageal Compression by Bronchial Artery Hypertrophy: A case report

Recurrent respiratory tract infections and dysphagia after the first years of life are rarely caused by vascular compression of the esophagus. We experienced a case of dysphagia and frequent vomiting resulted from esophageal compression by bronchial artery hypertrophy, which might had been aggravated by recurrent aspiration pneumonia caused by underlying swallowing difficulty. The patient initially had significant motor delay and swallowing difficulty. Videofluoroscopic swallowing studies demonstrated deglutition abnormalities and aspiration. In addition, significant amount of swallowed food was regurgitated through esophagus. On barium esophagography and angiography, posterior indentation of the esophagus without proximal dilatation and bronchial artery hypertrophy were noted without congenital heart disease. Pulmonary trunk and its branches showed normal appearance. Therefore, we considered that bronchial artery hypertrophy attributed to pulmonary artery fibrosis due to recurrent aspiration pneumonia may cause esophageal compression, which in turn contribute to dysphagia, frequent vomiting and recurrent aspiration pneumonia.

Type A Botulinum Toxin Therapy on Thoracic Outlet Syndrome: A case report

The true neurogenic thoracic outlet syndrome (TOS), one type of the TOS, has vague and controversial clinical symptoms, so a variety of diseases can mimic the presentation of TOS, especially ulnar neuropathy or cervical root lesion. For most patients with TOS, common practice is to offer a course of conservative treatment, but its kinds are not enough and pain is too severe to do that in the chronic state. We experienced a case of true neurogenic thoracic outlet syndrome with distinctive clinical symptom and abnormal electrodiagnostic findings. The symptom was not controlled by conservative management including oral medication or physical therapy. So we injected type A botulinum toxin (Botox(R)) in the scalene and pectoralis minor muscles with ultrasonography guide. After 2 weeks, the pain decreased in visual analogue scale nine to four, and the compliance to physical therapy was improved. The result appeared to demonstrate that botulinum toxin injection may be helpful in controlling symptoms and making the patient adapt in physical therapy in the difficult case to management by any other methods.

Changes of Cortical Somatosensory Evoked Potentials following Angular Rotations of the Cervical Spine in Rats

OBJECTIVE: To evaluate changes of the spinal cord conductivity by investigating the cortical somatosensory evoked potentials (SEPs) after angular rotations of the cervical spine in the rats. METHOD: Ten rats (Sprague-Dawley, 300~350 gm) were used. The trunk and head were fixed in the instrument for measuring rotational angles of the cervical spine. P1 latencies and P1-N1 amplitudes of the SEPs were obtained by stimulation of the posterior tibial nerve at the left hind paw. Thin scalp needle electrodes were placed subcutaneously at the 3 mm posterior to the vertex and nasion. We measured the parameters of the potentials at each 10o angular loading and compared the values measured immediately with those 5 minutes after each rotation. RESULTS: P1 latencies were 19.9+/-5.5 msec at rest, 20.1+/-5.8 msec at 90 degrees, 20.5+/-5.8 msec at 100 degrees, 21.2+/-6.2 msec at 120 degrees and 21.7+/-6.1 msec at 130 degrees, which were significantly prolonged above 100 degrees rotational loadings (p<0.05). The potentials disappeared at 140~170 degrees in some rats. The P1 latencies were prolonged according to increasing of the head rotational angles, however, P1-N1 amplitudes were not significantly decreased until absence of the potentials. There was no significant difference of the P1 latencies and P1-N1 amplitudes between potentials recorded immediately after rotational loading and at 5 minutes after rotation. CONCLUSION: P1 latencies of the SEPs according to the head rotation were significantly prolonged over 100 degrees loadings in the rats. This result suggested possible impairment of the spinal cord conductivity over 100 degrees rotational loading of the cervical spine in the rat.

Temporary Percutaneous Endoscopic Gastrojejunostomy : A case report

We reported a 56-year-old man who presented with vagus nerve injury after deep laceration in the neck. During being treated the neck insult, he was performed pyloplasty and vagotomy and used total parenteral nutrition due to peptic ulcer perforation and panperitonitis. He suffered from swallowing difficulty and underwent percutaneous endoscopic gastrostomy placement. As formerly, recurrent gastroesophageal reflux symptoms and gastric feeding intolerance were developed. We fixed a transgastrostomal jejunal tube in jejunum through the gastric stoma. The gastroeophageal reflux and feeding intolerance did not recur. After 30 days later, jejunal tube was removed, nutritional support was replaced by gastric tube. We were able to provide a temporary nutritional bridge with percutaneous endoscopic gastrojejunostomy placement for patients who suffered from dysphagia.

Coagulation Status of the Post-acute Spinal Cord Injured Patients

OBJECTIVE: Deep vein thrombosis (DVT) is one of the most common complications of acute spinal cord injury (SCI). It is well known that the incidence of DVT in post-acute SCI patients decreases to a level similar to that in the general population. The aim of this study was to evaluate the blood coagulation status and the possibility of DVT occurrence in post-acute SCI patients. METHOD: Twenty-three SCI patients (SCI group) were included in this study. Ten patients having spinal fracture with no evidence of SCI were used as the control group. Coagulation status was examined using factor VIII antigen, factor VIII procoagulant, fibrinogen, D-dimer, protein C, and protein S in both groups. Duplex ultrasonography was performed for the diagnosis of DVT. RESULTS: Prevalence of the abnormally decreased protein S level was significantly high in the SCI group (87%) than in the control group (30%). Prevalence of the abnormally increased F VIII:Ag, F VIII:C, and fibrinogen levels in the SCI group were significantly high in the SCI group (p<0.05). CONCLUSION: We conclude that post-acute SCI patients may have hypercoagulability. Proper physical prevention and thromboprophylaxis should be considered in post-acute SCI patients because they have relatively higher risk of thromboembolic complication.

Color-dilution alopecia in dogs

Color-dilution alopecia is a relatively uncommon hereditary skin disease seen in "Blue" and other color-diluted dogs. This syndrome is associated with a color-dilution gene. The initial clinical signs are the gradual onset of a dry, dull and poor hair coat quality. Hair shafts and hair regrowth are poor, and follicular papules may develop and progress to frank comedones. Hair loss and comedo formation are usually most severe on the trunk, especially color-diluted area on the skin. Six cases of color-dilution alopecia are reported in 3 months to 10 years old dogs. The breeds of dogs are blue Doberman Pinscher, Miniature Pinscher, Dachshund, and Schnauzer. Grossly, extensive partial hair loss was seen on the skin. Histopathologically, the epidermis is relatively normal but may be hyperplastic. Hair follicles are characterized by atrophy and distortion. Heavily clumped melanin is present in the epidermis, dermis and hair follicles.

Effects of Amantadine Therapy on Seizure Development in the Patients with Brain Injury and Stroke

OBJECTIVE: The objective of this study was to evaluate incidence and risk factors of seizure development during amantadine therapy for the patients with brain injury and stroke. METHOD: Thirty subjects (15 subjects with traumatic brain injuries and 15 subjects with strokes) who received a 4-week trial of amantadine from 100 mg/day to 400 mg/day were included. Control group, 40 patients (20 subjects with traumatic brain injuries and 20 subjects with strokes), did not take any brain stimulant. There were no differences in number, age, lesion area, and cognitive levels between two groups. Incidence of seizure in two groups was evaluated. RESULTS: Seizure occurred in 9 subjects in therapy group (30%) and in 1 subject in control group (2.5%). There was higher incidence of seizure in the group treated with amantadine than in the control group. In therapy group, most of the seizures occurred in high dose of 400 mg/day. CONCLUSION: Amantadine in high dose appeared to be associated with higher incidence of seizure. This study suggested that administration of amantadine in high dose in management of brain injury and stroke should be accompanied with careful monitoring of seizure.

The Effects of Electrical Stimulation on Upper Extremity Spasticity in Hemiplegic Patients

OBJECTIVE: To evaluate immediate and long term effects of electrical stimulation on upper extremity spasticity following stroke. METHOD: The subjects were 13 hemiplegic patients with cerebral infarction and cerebral hemorrhage. Electrical stimulation was applied to skin over the biceps muscle and the triceps muscle for a period of twenty minutes. The evaluation of spasticity was done by using the modified Ashworth scale, free amount of elbow extension, active range of motion and motor strength of elbow flexion and extension at baseline, immediately, 1 week and 4 weeks after electrical stimulation. RESULTS: Immediately after treatment, free amount of elbow extension increased from 63.8+/-19.1 degrees to 77.7+/-22.5 degrees (p<0.05) and active flexion of elbow flexor increased from 45.0+/-34.8 degrees to 55.3+/-39.1 degrees (p<0.05). The active range of motion of elbow flexor was increased on the 4th week during electrical stimulation (p<0.05). The free amount of elbow extension and modified Ashworth scale of elbow flexor spasticity was improved on the 18th day after treatment cessation (p<0.05). CONCLUSION: The results of this study showed that spasticity tended to decrease and maintain a lower level after a varying number of treatment sessions.

Mycobacterium bovis Infection in a Farmed Elk in Korea

A case of tuberculosis is reported in an eight-year-old, male, elk (Cervus elaphus nelsoni). The elk showed severe coughing, respiratory distress, abdominal breathing, anorexia, and severe progressive emaciation in the elk farm. At necropsy, the elk appeared in poor body condition. Mild enlargement of retropharyngeal and submandibular lymph node was observed in the head. Diffuse fibrinous pleuritis and purple red lobar pneumonia were found in the thorax. Well demarcated numerous dark yellow discrete or confluent nodules from 0.3 to 2 cm in diameter were scattered in the whole lung. Bronchial and mediastinal lymph nodes were also enlarged. Histopathologically, lungs had typical classical tuberculous granulomas, multiple abscesses, and numerous macrophages and Langhans giant cells infiltration in alveolar lumen. In the lymph nodes, there were small clusters of necrosis and infiltration of numerous macrophages, epithelioid cells, and Langhans giant cells. With the acid-fast staining, numerous mycobacteria were revealed in the lung and lymph nodes. According to this study, there are differences of the histopathologic lesions and the numbers of acid-fast bacilli in the lesions between this elk and cattle. Mycobacterium bovis was confirmed as a causative agent in this elk using bacterial isolation, biochemical characteristics, and PCR technique. The isolate was negative for niacin test, nitrate reductase, and pyrazinamidase. This is a first report for bovine tuberculosis of farmed elk in Asia.