Axillary Nerve Injury after Swimming with Butterfly Stroke: A case report

Most of axillary nerve injury develops after dislocation of glenohumeral joint, proximal humeral fracture and direct blow to the deltoid muscle. Some cases in volleyball players and athletes playing contact sports like hockey, football have been reported. But axillary nerve injury after swimming with butterfly stroke has not been reported previously. We experienced a 34 year old female who had weakness in abduction and sensory impairment in lateral aspect of right arm after butterfly stroke. She was transferred from local clinic to our Rehabilitation Department because symptoms were not improved despite conservative treatment. We diagnosed her as axillary nerve injury by typical clinical manifestations and electrodiagnostic study. Additionally, we detected type II superior laburum anterior posterior lesion combined with axillary nerve injury in shoulder magnetic resonance image. We should consider possibility of axillary nerve injury in a patient with shoulder pain and weakness after swimming like butterfly stroke.

Comparison of Esophageal Acidity between Nasogastric Tube Feeding and Percutaneous Endoscopic Gastrostomy Tube Feeding in Brain Injured Patients

OBJECTIVE: The aim of this study is to evaluate the change of esophageal acidity when feeding via nasogastric tube is replaced by via percutaneous endoscopic gastrostomy (PEG) tube. METHOD: Fourteen patients with brain injury participated in the study. 24-hour pH monitoring was performed during nasogastric tubal feeding. After PEG tube insertion, 24-hour pH monitoring was followed up. There was no difference in medication affecting to esophageal acidity in same patient at both pH monitorings. The results of pH monitorings analyzed with Wilcoxon signed rank test. RESULTS: The total time below pH 4.00 was 135.43+/-190.69 minutes for the patients with nasogastric tube and 25+/-42.74 minutes for PEG tube (p=0.013). The numbers of acid reflux was 42.07+/-47.03 and 21.93+/-22.77 respectively (p=0.074). Of the 14 patients, 9 had acid reflux in nasogastric tubal feeding, which was improved in all 9 patients after PEG. Of the 14 patients, 5 had no acid reflux in nasogastric tubal feeding but 3 of the 5 developed new acid reflux in PEG tubal feeding. CONCLUSION: Percutaneous endoscopic gastrostmy tube feeding was better for acid reflex control. But careful observation is needed after PEG because PEG can develop new acid reflux.

One Case of Peripheral Polyneuropathy Associated with Klippel-Trenaunay Syndrome: A case report

Klippel-Trenaunnay syndrome is characterized by three typical clinical manifestations; 1) Capillary malformations (port-wine stains), 2) bony and soft tissue hypertrophy, 3) varicosities or venous malforamation, but many other clinical manifestations can be presented. Although many associated clinical manifestations were reported in Klippel-Trenaunay syndrome, peripheral polyneuropathy or any other results of electrodiagonostic study were not reported previously. We experienced a 22 year old male who was transfered in rehabiliation program after surgical management of intra cerebral hemorrhage. During rehabilitation program we diagnosed him as Klippel-Trenaunay syndrome by three typical clinical manifestations associated with dilated cardiomyopathy. He also presented sensory impairment in distal part of all extremites. Electrodiagonostic study revealed peripheral polyneuropathy. We concluded that the possibility of peripheral polyneuropathy should be considered in Klippel-Trenaunnay syndrome.

The Proper Timing of the Replacement of the Percutaneous Endoscopic Gastrostomy Foley Catheter in Brain Injured Patients

OBJECTIVE: To help adjusting the proper timing of replacement of the percutaneous endoscopic gastrostomy (PEG) Foley catheter in brain injured patients. METHOD: Twenty one brain injured patients with PEG Foley catheter were studied and divided into three groups by indwelling duration. The balloon of Foley catheter was inflated with 5 ml of normal saline. We calculated the deflating velocity of the balloon by estimating remained amount of normal saline and indwelling duration at the time of replacement. RESULTS: In 6 patients, the PEG Foley catheter was pulled out easily before aspiration of remained normal saline. In all of these cases, remained amount of normal saline was less than 2 ml. The deflating velocities of the balloons were 0.057 +/- 0.024 ml/day in cases with 3 to 4weeks of indwelling duration, 0.066 +/- 0.005 ml/day with 4 to 5 weeks, 0.067 +/- 0.012 ml/day with above 5weeks. The mean deflating velocity was 0.063 +/- 0.016 ml/day in human. The deflating velocity was slower than that of the previous study in vitro. CONCLUSION: The mean days of deflation of the balloon of total PEG Foley catheter down to 2.5 ml were 42.1 days. We suggest that the PEG Foley catheter would be replaced within 42 days after exchange.