Effect of Combined Therapy of Cisapride and Lactulose on Neurogenic Bowel Dysfunction in Spinal Cord Injury

OBJECTIVE: To calculate the colonic transit time (CTT) and to evaluate the effect of combined therapy of cisapride and lactulose on neurogenic bowel dysfunction in patients with chronic spinal cord injury. METHOD: This study was prospectively designed. Right (rCTT), left (lCTT), rectosigmoid (rsCTT), and total (tCTT) colonic transit times were measured using the radio-opaque marker technique in twenty patients with spinal cord injury (SCI group), of which mean age was 39 years (range: 13~67 years) and median duration after SCI was 15 months (4-252 months). Ten ambulatory stroke patients (mean age 49 years, median duration, 12 months) were also evaluated as control group. All CTTs in both groups were compared by unpaired Student's t-test. In SCI group, the therapeutic effect of combined administration of cisapride (10 mg p.o. t.i.d) and lactulose (134.0 g/100 ml, 30-45 ml per day p.o.) was statistically analyzed by paired Student's t-test. RESULTS: Total (p<0.0001) and segmental CTT (p<0.01) except right colon were significantly delayed in SCI group when compared to the control group. In SCI group, tCTT of non-ambulatory patients (n=13) and rCTT, lCTT, rsCTT and total CTT of ambulatory patients (n=7) were significantly decreased after the combined drug therapy (p<0.05). In ambulatory SCI patients, duration after injury showed negative correlation with tCTT (Pearson's correlation coefficient r = 0.8407, p=0.0178). CONCLUSION: Combined therapy of cisapride and lactulose can improve tCTT in SCI patients with neurogenic bowel dysfunction.

Effects of Hyperosmolar Dextrose Water on Healing of Injured Achilles Tendon in Rats

OBJECTIVE: To assess the effects of intratendinous injection of 12.5% dextrose water on healing of injured Achilles tendon in rat. METHOD: Quantification of hydroxyproline concentration in Achilles tendons of 21 Sprague-Dawley rats was performed to assess the concentration of collagen, and hematoxyline-eosin and immunochemistry staining was performed to analyse histopathology. RESULTS: There was no significant difference in collagen concentration between the three groups (p>0.05). Light microscopic examination showed irregular arrangement of coarse collagen fibers and decreased number of fibroblasts in sham treatment and dextrose injection group and showed more irregular arrangement of coarse collagen fibers in dextrose injection group than in sham treatment group. The immunochemical staining of sham treatment and dextrose injection group showed more increased immunoreactivity for type I and III collagen than control group, but the same as in sham treatment group and dextrose injection group. CONCLUSION: The increase of collagen concentration in injured Achilles tendon of rat treated with hyperosmolar dextrose was not found. This implies that clinical observation of collagen remodelling process may alter biomechanical property other than collagen concentration which should be further investigated.

Significance of Intraoperative Monitoring with Median Nerve Somatosensory Evoked Potentials during Operation for Cerebral Aneurysm

OBJECTIVE: Intraoperative somatosensory evoked potentials (SEPs) are widely used for the early detections of cerebral ischemia during temporary occlusive procedures of the parent vessels in aneurysm surgery. This study intended to evaluate the usefulness of median nerve SEPs during intracranial aneurysm surgery. METHOD: Between September 1995 and June 1997, we monitored 42 aneurysm patients in Uijongbu St. Mary's hospital. Median nerve SEPs were detected on scalp and cervical spine during surgery. We measured latencies, amplitudes of N20 and N13 waveforms and central conduction time (CCT, N20-N13). We analyzed pre- and post-surgical radiologic findings and changes of neurologic signs. RESULTS: The delayed latencies, CCT, and reduced amplitudes of median nerve SEPs during intraoperative monitoring were closely related to neurological deficits after surgery. CONCLUSION: Intraoperative SEPs are useful in preventing clinical neurological injury during surgery of intracranial aneurysm and in predicting which patients will have unfavourable outcomes.