Investigation for Shoulder Kinematics Using Depth Sensor-Based Motion Analysis System / 대한정형외과학회잡지

Purpose@#The purpose of this study was to analyze the motion of the shoulder joint dynamically through a depth sensor-based motion analysis system for the normal group and patients group with shoulder disease and to report the results along with a review of the relevant literature. @*Materials and Methods@#Seventy subjects participated in the study and were categorized as follows: 30 subjects in the normal group and 40 subjects in the group of patients with shoulder disease. The patients with shoulder disease were subdivided into the following four disease groups: adhesive capsulitis, impingement syndrome, rotator cuff tear, and cuff tear arthropathy. Repeating abduction and adduction three times, the angle over time was measured using a depth sensor-based motion analysis system. The maximum abduction angle (θmax ), the maximum abduction angular velocity (ωmax ), the maximum adduction angular velocity (ωmin ) , and the abduction/adduction time ratio (tabd / tadd ) were calculated. The above parameters in the 30 subjects in the normal group and 40 subjects in the patients group were compared. In addition, the 30 subjects in the normal group and each subgroup (10 patients each) according to the four disease groups, giving a total of five groups, were compared. @*Results@#Compared to the normal group, the maximum abduction angle (θmax ), the maximum abduction angular velocity (ωmax ), and the maximum adduction angular velocity (ωmin ) were lower, and abduction/adduction time ratio (tabd /tadd ) was higher in the patients with shoulder disease. A comparison of the subdivided disease groups revealed a lower maximum abduction angle (θmax ) and the maximum abduction angular velocity (ωmax ) in the adhesive capsulitis and cuff tear arthropathy groups than the normal group. In addition, the abduction/adduction time ratio (tabd /tadd ) was higher in the adhesive capsulitis group, rotator cuff tear group, and cuff tear arthropathy group than in the normal group. @*Conclusion@#Through an evaluation of the shoulder joint using the depth sensor-based motion analysis system, it was possible to measure the range of motion, and the dynamic motion parameter, such as angular velocity. These results show that accurate evaluations of the function of the shoulder joint and an in-depth understanding of shoulder diseases are possible.

Proteome Analysis of Alkylhydroxide Peroxidase-Deficient Isogenic Mutant of Helicobacter pylori 26695

In order to investigate the antioxidant effect of alkylhydroxide peroxidase (ahpC) of Helicobacter pylori (H. pylori) 26695, an ahpC-deficient mutant (H. pylori 26695 ahpC::cat) was generated. ahpC-deficient mutant was grown slowly at lower pressure of oxygen (5% oxygen) compared to the H. pylori 26695. Whole cell proteins isolated form H. pylori 26695 and H. pylori 26695 ahpC::cat were analyzed by MALDI-TOF and tandem-MS. The expression of 15 proteins, including Ppa, HypB, GrpE, Elp, RecA, GroES, Mda66, RibE, NapA, GlnA, BioB, TrxB, Tsf, FumC and Icd, was more than doubled in H. pylori 26695 ahpC::cat. Production of 10 proteins such as UreG, FabE, Adk, Pnp, OorC, AtpA, AtpD, Nqq3, Pfr, and TagD decreased below 50% in H. pylori 26695 ahpC::cat compared to the H. pylori 26695. In microarray analysis, 9 genes including sul1, amiE, frxA, fecA, hyuA, and katA increased in transcription level in H. pylori 26695 ahpC::cat compared to H. pylori 26695. A total of 24 genes, including flaB, protein kinase C inhibitor, cag16, pabC, and sabA, reduced in transcription. 27 genes, including HP0889, showed common expression changes in ahpC, katA, and sodB-deficient mutations. As a result of this study, there were not many genes whose expression was commonly changed by the deletion of each of the three major antioxidant enzymes of H. pylori. These results showed the functions and regulation of the three antioxidant enzymes were different in H. pylori.

In vivo 3-dimensional Kinematics of Cubitus Valgus after Non-united Lateral Humeral Condyle Fracture

BACKGROUND: Nonunion of lateral humeral condyle fracture causes cubitus valgus deformity. Although corrective osteotomy or osteosynthesis can be considered, there are controversies regarding its treatment. To evaluate elbow joint biomechanics in non-united lateral humeral condyle fractures, we analyzed the motion of elbow joint and pseudo-joint via in vivo three-dimensional (3D) kinematics, using 3D images obtained by computed tomography (CT) scan. METHODS: Eight non-united lateral humeral condyle fractures with cubitus valgus and 8 normal elbows were evaluated in this study. CT scan was performed at 3 different elbow positions (full flexion, 90° flexion and full extension). With bone surface model, 3D elbow motion was reconstructed. We calculated the axis of rotation in both the normal and non-united joints, as well as the rotational movement of the ulno-humeral joint and pseudo-joint of non-united lateral condyle in 3D space from full extension to full flexion. RESULTS: Ulno-humeral joint moved to the varus on the coronal plane during flexion, 25.45° in the non-united cubitus valgus group and −2.03° in normal group, with statistically significant difference. Moreover, it moved to rotate externally on the axial plane −26.75° in the non-united cubitus valgus group and −3.09° in the normal group, with statistical significance. Movement of the pseudo-joint of fragment of lateral condyle showed irregular pattern. CONCLUSIONS: The non-united cubitus valgus group moved to the varus with external rotation during elbow flexion. The pseudo-joint showed a diverse and irregular motion. In vivo 3D motion analysis for the non-united cubitus valgus could be helpful to evaluate its kinematics.

Risk Factors for Wound Infection in Spinal Surgery: A Focus on Diabetes Mellitus / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: To identify risk factors for infection after spinal surgery. SUMMARY OF LITERATURE REVIEW: Infection after spinal surgery is relatively uncommon. However, such infections cause serious consequences and increased costs and sequelae. Risk factors for infection after spinal surgery include a posterior approach, instrumentation, the use of an allogenic bone graft, transfusion, and a long operating time. Patient-related factors include diabetes and obesity. MATERIALS AND METHODS: From January 2009 to December 2013, 350 patients who underwent surgery at our hospital due to spinal disease, including 10 patients with a postoperative spinal infection, were evaluated. We investigated patients' age, gender, morbidity due to diabetes mellitus, body mass index, level of surgery, approach, location, instrumentation, and operation type. RESULTS: Ten of the 350 patients developed a spinal infection after surgery. The proportion of diabetic patients among the infected patients was higher than among the non-infected patients, although the difference was not statistically significant. Additionally, the proportion of diabetic patients with hemoglobin A1c levels greater than 7.0% was higher among the infected patients. Operating time, the surgical approach, drain tube insertion, transfusion, and the use of an allogenic bone graft were not significantly different between the infected and non-infected patient groups. CONCLUSIONS: Uncontrolled diabetes is the most important risk factor for the development of spinal infection after surgery. Therefore, in order to prevent infection after surgery, blood glucose should be controlled before surgery.

Risk Factors for Wound Infection in Spinal Surgery: A Focus on Diabetes Mellitus

OBJECTIVES@#To identify risk factors for infection after spinal surgery.SUMMARY OF LITERATURE REVIEW: Infection after spinal surgery is relatively uncommon. However, such infections cause serious consequences and increased costs and sequelae. Risk factors for infection after spinal surgery include a posterior approach, instrumentation, the use of an allogenic bone graft, transfusion, and a long operating time. Patient-related factors include diabetes and obesity.@*MATERIALS AND METHODS@#From January 2009 to December 2013, 350 patients who underwent surgery at our hospital due to spinal disease, including 10 patients with a postoperative spinal infection, were evaluated. We investigated patients' age, gender, morbidity due to diabetes mellitus, body mass index, level of surgery, approach, location, instrumentation, and operation type.@*RESULTS@#Ten of the 350 patients developed a spinal infection after surgery. The proportion of diabetic patients among the infected patients was higher than among the non-infected patients, although the difference was not statistically significant. Additionally, the proportion of diabetic patients with hemoglobin A1c levels greater than 7.0% was higher among the infected patients. Operating time, the surgical approach, drain tube insertion, transfusion, and the use of an allogenic bone graft were not significantly different between the infected and non-infected patient groups.@*CONCLUSIONS@#Uncontrolled diabetes is the most important risk factor for the development of spinal infection after surgery. Therefore, in order to prevent infection after surgery, blood glucose should be controlled before surgery.

Antibiotic Resistance Patterns and Serotypes of Salmonella spp. Isolated at Jeollanam-do in Korea

OBJECTIVES: Few long-term studies have been conducted on the serotype and antibiotic resistance patterns of Salmonella speices (spp.) The aim of this study was to determine the serotypes and antibiotic resistance patterns of Salmonella spp. isolated at Jeollanam-do in Korea from 2004 to 2014. METHODS: A total of 276 Salmonella samples were evaluated. Serotyping was carried out according to the Kauffmann–White scheme. Antibiotic susceptibility was determined using the Vitek II system with an AST-N169 card. RESULTS: A total of 22 different serotypes were identified, and the major serotypes were Salmonella Enteritidis (116 strains, 42.0%) and Salmonella Typhimurium (60 strains, 21.7%). The highest resistance was observed in response to nalidixic acid (43.4%), followed by ampicillin (40.5%) and tetracycline (31.6%). Resistance to nalidixic acid was detected in 81.0% of S. Enteritidis. Multidrug resistance was detected in 43.3% of Salmonella spp. S. Enteritidis and S. Typhimurium presented the highest resistance (98.3%) and multidrug resistance rate (73.3%), respectively. The most highly observed antibiotic resistance pattern among Salmonella spp. in this study was ampicillin-chloramphenicol (14 strains, 5.7%). CONCLUSION: Overall, S. Enteritidis and S. Typhimurium showed higher antibiotic resistance than the other Salmonella serotypes tested in this study. Our study will provide useful information for investigating the sources of Salmonella infections, as well as selecting effective antibiotics for treatment.

Shikonin Induces Apoptotic Cell Death via Regulation of p53 and Nrf2 in AGS Human Stomach Carcinoma Cells

Shikonin, which derives from Lithospermum erythrorhizon, has been traditionally used against a variety of diseases, including cancer, in Eastern Asia. Here we determined that shikonin inhibits proliferation of gastric cancer cells by inducing apoptosis. Shikonin's biological activity was validated by observing cell viability, caspase 3 activity, reactive oxygen species (ROS) generation, and apoptotic marker expressions in AGS stomach cancer cells. The concentration range of shikonin was 35–250 nM with the incubation time of 6 h. Protein levels of Nrf2 and p53 were evaluated by western blotting and confirmed by real-time PCR. Our results revealed that shikonin induced the generation of ROS as well as caspase 3-dependent apoptosis. c-Jun-N-terminal kinases (JNK) activity was significantly elevated in shikonin-treated cells, thereby linking JNK to apoptosis. Furthermore, our results revealed that shikonin induced p53 expression but repressed Nrf2 expression. Moreover, our results suggested that there may be a co-regulation between p53 and Nrf2, in which transfection with siNrf2 induced the p53 expression. We demonstrated for the first time that shikonin activated cell apoptosis in AGS cells via caspase 3- and JNK-dependent pathways, as well as through the p53-Nrf2 mediated signal pathway. Our study validates in partly the contribution of shikonin as a new therapeutic approaches/ agent for cancer chemotherapy.

Increased Risk of Asymptomatic Gallstones in Patients With Ulcerative Colitis

BACKGROUND/AIMS: The relationship between Crohn's disease and gallstones is established. However, the prevalence and risk factors for gallstones in patients with ulcerative colitis (UC) are not yet well understood. The aim of this study was to evaluate the prevalence and risk factors of gallstones in patients with UC. METHODS: This study was a retrospective single center study. A total of 87 patients with UC and 261 healthy controls were enrolled. Age, sex, and body mass index were matched. To investigate risk factors, the extent of UC, duration of disease, number of hospital admissions, and number of steroid treatments in patients with UC were evaluated. RESULTS: The prevalence of gallstones in patients with UC was 13.8%, whereas that in healthy controls was only 3.1% (P or =50 years of age had a 3.6-times higher risk of gallstones compared to that in those <50 years of age, and the difference was statistically significant (odds ratio, 3.60; confidence interval, 1.03-12.61) in univariate analysis. There were no statistically significant disease-related risk factors for gallstones in UC patients. CONCLUSIONS: This is the first study of gallstone prevalence in Korean UC patients. In this study, patients with UC had a higher prevalence of gallstones compared to that in well-matched healthy controls. Age seemed to be a possible risk factor, and more studies are needed. Further prospective, large-scale studies will be required to confirm the risk factors for gallstones in UC patients.

Increased Risk of Asymptomatic Gallstones in Patients With Ulcerative Colitis

BACKGROUND/AIMS: The relationship between Crohn's disease and gallstones is established. However, the prevalence and risk factors for gallstones in patients with ulcerative colitis (UC) are not yet well understood. The aim of this study was to evaluate the prevalence and risk factors of gallstones in patients with UC. METHODS: This study was a retrospective single center study. A total of 87 patients with UC and 261 healthy controls were enrolled. Age, sex, and body mass index were matched. To investigate risk factors, the extent of UC, duration of disease, number of hospital admissions, and number of steroid treatments in patients with UC were evaluated. RESULTS: The prevalence of gallstones in patients with UC was 13.8%, whereas that in healthy controls was only 3.1% (P or =50 years of age had a 3.6-times higher risk of gallstones compared to that in those <50 years of age, and the difference was statistically significant (odds ratio, 3.60; confidence interval, 1.03-12.61) in univariate analysis. There were no statistically significant disease-related risk factors for gallstones in UC patients. CONCLUSIONS: This is the first study of gallstone prevalence in Korean UC patients. In this study, patients with UC had a higher prevalence of gallstones compared to that in well-matched healthy controls. Age seemed to be a possible risk factor, and more studies are needed. Further prospective, large-scale studies will be required to confirm the risk factors for gallstones in UC patients.

A Case of Anaphylaxis Induced by Contact with Young Radish (Raphanus sativus L)

Young radish (Raphanus sativus L), a member of the mustard family (Cruciferae), is a common ingredient of Kimchi. Although few reports have described anaphylaxis to cruciferous vegetables, we report the case of anaphylaxis induced by contact with young radish. A 46-year-old female with a history of contact allergy to metal presented to our emergency room (ER) with dizziness, generalized eruption and gastrointestinal upset. Her symptoms developed after re-exposure to young radish while chopping it. Hypotensive blood pressures were noted. Three days prior, the patient had experienced generalized urticaria with pruritus immediately after chopping the fresh young radish, which resolved spontaneously. In the ER, her symptoms improved by the administration of epinephrine (0.3 mL), antihistamine (chlorpheniramine) and isotonic saline hydration. A skin prick test with young radish extract showed positive reactivity. The same skin test was negative in five adult controls. IgE-mediated hypersensitivity could be an important immunologic mechanism in the development of young radish-induced anaphylaxis.

Primary Amyloidosis with Involvement of Stomach, Duodenum and Colon

We report the case of a 57-year-old woman with abdominal discomfort. The patient had anemia and hypoalbuminemia. Esophagogastroduodenoscopy and colonoscopy revealed diffuse infiltrative lesions at the stomach, duodenum, and ascending colon. Multiple biopsies were taken and histological examination of the biopsies from the stomach, duodenum and colon showed amyloid deposits stained positively with Congo red. Immunohistochemistry study showed positive sign of kappa and lambda chain at light chain stain. In addition, monoclonal components at serum electrophoresis confirmed the diagnosis of amyloid light-chain amyloidosis. The patient was treated with thalidomide and dexamethasone.

Two Cases of Refractory Pseudomembranous Colitis that Healed Following Fecal Microbiota Transplantation / 대한내과학회지

The incidence, recurrence, and mortality of Clostridium difficile infection are increasing and the standard therapy is oral metronidazole or vancomycin. Since treatment failure with standard therapy is increasing, an alternative therapy is needed. Fecal microbiota transplantation is one effective method in patients with refractory or recurrent C. difficile infection, including pseudomembranous colitis. Here, we report two cases of refractory pseudomembranous colitis treated with fecal microbiota transplantation.

A Case of Behcet's Syndrome with Acute Myocardial Infarction and Intracardiac Thrombosis / 대한내과학회지

A 36-year-old man with a history of Behcet's syndrome and vascular complications visited the emergency room due to sudden chest pain and dyspnea. He had no coronary risk factors. Electrocardiography showed ST elevations in multiple precordial leads. Echocardiography showed akinesia of the anterior wall, interventricular septum, and apex, with a movable round mass measuring 1.4 x 1.5 cm in the right atrium. Cardiac computed tomography (CT) suggested the presence of a thrombus in the coronary sinus protruding into the right atrium. Coronary angiography revealed total occlusion with thrombi in the proximal left anterior descending coronary artery. Thrombectomy and stent insertion were performed. After the procedure, the patient was prescribed warfarin. Follow-up CT indicated the disappearance of the thrombi originating from the coronary sinus.

A Case of Behcet's Syndrome with Acute Myocardial Infarction and Intracardiac Thrombosis / 대한내과학회지

A 36-year-old man with a history of Behcet's syndrome and vascular complications visited the emergency room due to sudden chest pain and dyspnea. He had no coronary risk factors. Electrocardiography showed ST elevations in multiple precordial leads. Echocardiography showed akinesia of the anterior wall, interventricular septum, and apex, with a movable round mass measuring 1.4 x 1.5 cm in the right atrium. Cardiac computed tomography (CT) suggested the presence of a thrombus in the coronary sinus protruding into the right atrium. Coronary angiography revealed total occlusion with thrombi in the proximal left anterior descending coronary artery. Thrombectomy and stent insertion were performed. After the procedure, the patient was prescribed warfarin. Follow-up CT indicated the disappearance of the thrombi originating from the coronary sinus.

The Experience and Competence of Physicians Who Provide Emergency Health Care at Public Health Sub-Centers on Remote Islands in Korea / 農村醫學 地域保健

OBJECTIVES: To investigate the experience and competence of physicians providing emergency medical services at public health sub-centers on remote Korean islands. METHODS: This study enrolled 79 doctors who work at public health sub-centers on remote Korean islands. Data were collected in December 2009 via self-administered e-mail questionnaires. The response rate was 44.3%. RESULTS: Emergent situations occurred at most (58.68%) of the public health sub-centers that were surveyed in December 2009. An average of 1.92 cases required treatment by public health physicians. Only 20.25% of the physicians were specialists in emergency medicine, while the remainder were general practitioners (GPs) without clinical experience as emergency doctors. We also found that the physicians we surveyed had insufficient knowledge of emergency medical care. At some health centers only one doctor was available, and there was no medical team in holiday, although most of the physicians indicated that the ideal number of doctors per center was two or three. In cases of emergency, patients were often sent to the mainland by ship without receiving first-aid treatment. The public health sub-centers lacked the necessary medical equipment to save lives in emergencies and lacked escort systems for emergency patients. CONCLUSIONS: The Korean government should address the importance of providing emergency care in remote areas. Health administrators should provide suitable manpower, medical equipment, guidelines for emergency medicine, and education for public health physicians on remote islands.

Results of Two Stage Revision of Infected Total Knee Arthroplasty (A Minimum 5-year Follow-up Analysis) / 대한정형외과학회잡지

PURPOSE: We report the results of 26 cases of revised total knee joint arthroplasty (TKA) that were followed up for more than 5 years. MATERIALS AND METHODS: On a retrospective basis, we reviewed 26 cases of infected TKA that underwent 2-stage revision between January 1993 and June 2005. All cases were followed up for more than 5 years. Clinical results were evaluated using Range Of Motion (ROM), Hospital for Special Surgery (HSS) score and radiographic results as part of the Knee Society Roentgenographic evaluation and Scoring system. The mean follow-up period was 70 months (ranging from 60 to 108 months). RESULTS: Infection recurred in 3 out of 26 cases. Patients without recurrence of infection showed improvement in ROM and HSS score, which had decreased with time (p<0.001) (ROM: pre-op. 47.1degrees, 1-year 89.5degrees, 2-year 87.1degrees, last follow-up 79.2degrees and HSS score: pre-op. 54.5, 1-year 85.7, 2-year 84.5, last follow-up 80.7). CONCLUSION: Infection recurred in 11.5% after revision arthroplasty. Outcomes of stage 2 revision arthroplasty were satisfactory at early follow-up, but worsened at the last follow-up.

The Effect of Metabolic Syndrome on Myocardial Contractile Reserve during Exercise in Non-Diabetic Hypertensive Subjects

OBJECTIVE: Metabolic syndrome (MS) is associated with increased left ventricular (LV) mass and diastolic dysfunction. This study uses relatively load-independent Doppler tissue echocardiography to examine whether MS is associated with decreased longitudinal contractile reserve during dynamic exercise. METHODS: A total of 112 patients with relatively well-controlled, treated hypertension who complained of exertional dyspnea were enrolled (average age, 56.7+/-10.5 years). Fifty-six were non-diabetic patients with MS (group 1), and 56 were age-sex matched hypertensive patients without MS (group 2). Exercise stress echo was performed using a symptom-limited, multistage, supine bicycle exercise test. Multiple Doppler parameters were obtained at baseline, at each stage of exercise. RESULTS: There was no significant difference between the two groups in terms of age, gender, and hemodynamic variables. E/E', an index of LV filling pressure, was significantly higher in the MS group at rest and during exercise. The longitudinal contractile reserve, the change in S' (longitudinal tissue velocity) from baseline to peak exercise, was significantly lower in the MS group (2.00+/-1.65 vs. 2.90+/-1.66, P=0.015). Multiple regression analysis showed independent association of MS with longitudinal contractile reserve when controlled for confounding factors, such as LV mass index, gender, blood pressure, and age (beta=-0.235, P=0.035). CONCLUSION: Longitudinal contractile reserve was reduced in MS patients compared to others, although both groups demonstrated similar longitudinal contractile function at rest. We present the first demonstration that metabolic syndrome is independently associated with LV systolic dysfunction during exercise in hypertensive patients.

The Effect of Metabolic Syndrome on Myocardial Contractile Reserve during Exercise in Non-Diabetic Hypertensive Subjects

BACKGROUND: Metabolic syndrome (MS) is associated with increased left ventricular (LV) mass and diastolic dysfunction. This study uses relatively load-independent Doppler tissue echocardiography to examine whether MS is associated with decreased longitudinal contractile reserve during dynamic exercise. METHODS: A total of 112 patients with relatively well-controlled, treated hypertension who complained of exertional dyspnea were enrolled (average age: 56.7 +/- 10.5 years). Fifty-six were non-diabetic patients with MS (Group 1), and 56 were age-sex matched hypertensive patients without MS (Group 2). Exercise stress echo was performed using a symptom-limited, multistage, supine bicycle exercise test. Multiple Doppler parameters were obtained at baseline, at each stage of exercise, and during recovery. RESULTS: There was no significant difference between the two groups in terms of age, gender, and hemodynamic variables. E/E', an index of LV filling pressure, was significantly higher in the MS group at rest and during exercise. The longitudinal contractile reserve, the change in S' (longitudinal tissue velocity) from baseline to peak exercise, was significantly lower in the MS group (2.00 +/- 1.65 vs. 2.90 +/- 1.66, p = 0.015). Multiple regression analysis showed independent association of MS with longitudinal contractile reserve when controlled for confounding factors, such as LV mass index, gender, blood pressure, and age (beta = -0.235, p = 0.035). CONCLUSION: Longitudinal contractile reserve was reduced in MS patients compared to others, although both groups demonstrated similar longitudinal contractile function at rest. We present the first demonstration that metabolic syndrome is independently associated with LV systolic dysfunction during exercise in hypertensive patients.

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.

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.