Traumatic hemipelvectomy before body image has developed

Traumatic hemipelvectomy is rarely observed because very few patients have survived from the initial trauma. We describe one male child who survived from this massive trauma with a good functional outcome. The boy was 28 months old when he was accidentally struck by a truck. He had severe open trauma of the pelvis and hemorrhage of the left lower limb. Amputation of the left hemipelvis, colostomy, cystostomy and removal of the left avulsed testicle were performed. Once healing had been achieved, he was transferred to our Department of Physical Medicine and Rehabilitation and rehabilitative management was begun, including prosthetic measurement and psychologic intervention for the patient and his parents. For 13 years of long-term follow-up, his prosthesis was readjusted annually. Now he is a 16-year-old middle school student. He is functioning remarkably well with a prosthesis. The psychologic report shows that he is emotionally stable and has good scholastic performance. Although hemipelvectomy appears to be a radical procedure in children, the potential for rehabilitation in a group of children before body image has developed appears to be unexpectedly good.

Assessment of Autonomic Function in Stroke Patients by Power Spectral Analysis of Heart Rate Variability

OBJECTIVE: To evaluate the effects of orthostatic stress with a head-up tilt on the autonomic nervous system and to determine how a cerebral stroke influences the cardiac autonomic function, using the power spectral analysis(PSA) of heart rate variability(HRV). METHOD: We studied 11 stroke patients with a left hemiplegia and 14 patients with a right hemiplegia. Their hemispheric brain lesions were confirmed by the MRI. The ECG and respiration signals were recorded at the tilt angle of 0o and 70o for 5 minutes under the condition of frequency controlled respirtaion(0.25 Hz). Data were compared with the age- and sex-matched 12 healthy controls. RESULT: In a control group, the normalized high frequency power showed a significant decrease during the head-up tilt(p0.05). Compared with the right hemiplegia and control groups, the left hemiplegia group was associated more with a reduced low and high frequency power and showed no significant changes under the orthostatic stress. CONCLUSION: PSA of HRV can identify the reduced cardiac autonomic activity in stroke patients, with a greater reduction in the left hemiplegia group than in the right hemiplegia group, which may cause a high risk of cardiac arrhythmias and sudden death.

Sympathetic Skin Responses after Stellate Ganglion Block in the Patient with Reflex Sympathetic Dystrophy

OBJECTIVE: The purposes of this study were to measure the effect of Stellate ganglion block(SGB) objectively and quantitatively by the use of sympathetic skin response(SSR), and to evaluate the cumulative effects and complications of repetitive SGB and to find out optimal numbers of injection per one cycle in the patients with reflex sympathetic dystrophy(RSD). METHOD: Six patients with RSD were evaluated with a SSR test before and after the injection of 1% lidocaine 4 ml by SGB method. RESULTS: There was a significant prolongation of latencies in SSR of the lesion side of sixty mixed cases by the SGB methods and SSR tests. There were no significant changes in the latency and amplitude of SSR from the lesion side between pre- and post injection states. There was a significant decrease of amplitude in the sound side after the injection. The differences of the amplitudes between pre- and post injections were significantly higher in the lesion side than the sound side. The degree of pain of the patients with RSD was evaluated by visual analogue scale(VAS), which scored on pre and post injection state decreased from 10 to 6.5 by 5 times injections, but did not decrease by more injections. CONCLUSION: We concluded that SGB is more effective in the RSD lesion side than the sound side and the SSR is a useful test for evaluating the effect of SGB.

Assessment of Autonomic Nervous Function in Young Adults by Power Spectral Analysis of Heart Rate Variability

The powers of the low-frequency(LF) and high-frequency(HF) components characterizing heart rate variability (HRV) appear to reflect, in their reciprocal relationship, changes in the state of the sympatho-vagal balance occurring during orthostatic stress with head-up tilt. We studied 24 healthy volunteers (median age, 23.1 years) who were subjected after a rest period to a series of passive head-up tilt steps chosen from the following angles: 0 degree. 15 degrees, 30degrees, 45degrees, 70degrees, and 90degrees under the condition of frequency controlled respiration(0.25Hz) in order to get data of the Korean young adults. During head-up tilt, heart rate and normalized low frequency power(LF(N : 0.05-0.15 Hz) of HRV showed significant increase(p=0.000), but normalized high frequency power(HFN : 0.2-0.3 Hz) and total power showed progressive decrease(p=0.000, p<0.01 respectively). Male showed significantly higher LF(N and lower HFN than female at tilt table angle 0degree(p<0.01). Power spectral analysis of HRV appears to be capable of providing a noninvasive quantitatibve evaluation of graded changes in the state of the sympatho-vagal balance.

Accuracy of a Portable Ultrasound Scanning in the Measurement of Post-void Residual Urine Volume in Patients with Spinal Cord Injury

As a standard method for the measurement of post-void residual urine volume, the urethral catheterization is commonly used. However, it is frequently associated with the discomfort of the patients, urethral trauma and urinary tract infection. A noninvasive method of determining the residual urine volume could minimize unnecessary catheterizations and be useful in the management of neurogenic bladder in the patient with spinal cord injury(SCI). This study was undertaken to evaluate the accuracy of a portable ultrasound scanner for measuring bladder volumes in SCI patients undergoing bladder training and to determine the factors affecting its accuracy. Sixty patients with SCI were included in this study. Two investigators performed the ultrasound measurement of the post-void residual urine volume alternately and the same procedures were repeated. After that, the urethral catheterization was done. In comparison of the residual volume measured by two different methods, the correlation coefficient(R2) of the two different methods was 0.996 and the mean value of difference between the residual volume measured by ulltrasound and by catheterization was 21.6 ml. The accuracy of the ultrasound measurements was not affected by gender, types of the neurogenic bladder, shape of the bladder, trabeculation of the bladder and central obesity. The results indicate that the portable ultrasound scanning method is a useful non-invasive method and can be substituted for the urethral catheterization in determination of bladder volumes in patients with SCI.

Dopa-Responsive Dystonia: A Case Report

Dystonia is a rare syndrome of sustained muscle contractions which frequently causes twisting and repetitive movements or abnormal postures. Dopa-responsive dystonia(DRD) is a slowly progressive dystonia with childhood on set. Initial gait disturbance with toe-walking, diurnal variation of symptoms, dramatic response to levodopa treatment and concurrent signs of parkinsonism are other characteristics of DRD. We report a 22 year old woman who showed the typical characteristics of DRD and was successfully managed with medical, surgical and rehabilitational methods. Better understanding of the disease entity and its treatment options are necessary for comprehensive rehabilitational management of DRD.