The Correlation between Spondyloarthropathy and Peripheral Neuropathy in Chronic Renal Failure Patients Undergoing Hemodialysis

OBJECTIVE: To investigate the relationship between spondyloarthropathy and peripheral neuropathy in spinal pain patient undergoing hemodialysis due to chronic renal failure. METHOD: Subjects were 60 patients complaining posterior neck or back pain, undergoing regular hemodialysis for chronic renal failure. They were divided into two groups according to the radiologic findings: spondyloarthropathy group (SAG, n=28) and no-spondyloarthropathy group (NSAG, n=32). Nerve conduction studies of extremities, simple spinal radiologic examination and bone mineral density at the lumbar spine were taken. RESULTS: Electrodiagnostic study revealed 26 patients (43%) had carpal tunnel syndrome, 32 (53%) had ulnar neuropathy, and 32 (53%) had peripheral polyneuropathy. Carpal tunnel syndrome was more frequent in SAG, but other neuropathic fingings, bone mineral density and duration of hemodialysis were not different between two groups. CONCLUSION: Nerve conduction study could be useful to screen the peripheral neuropathy in patients undergoing hemodialysis due to chronic renal failure. If they complained spinal pain, and diagnosed as spondyloarthropathy by radiologic examination, we might need to do electrodiagnostic study for early detection and treatment of carpal tunnel syndrome.

Herpetic Multiphasic Disseminated Encephalomyelitis

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating conditions, which is usually monophasic. Recurrent ADEM and multiphasic disseminated encephalomyelitis (MDEM) is much less characterized entity, and its differentiation from multiple sclerosis (MS) poses a diagnostic challenge. We report a case of multiphasic disseminated encephalomyelitis (MDEM). The patient had two episodes of paraparesis and other neurologic symptoms, which were separated by 2 months. The patient presented with fever, headache, mental change, lower extremity weakness, voiding difficulty as well as focal neurologic deficits, which showed good response on steroid and acyclovir. Brain MRI revealed variable sized, multifocal, subcortical white matter lesions with gray matter involvement, and spine MRI revealed high signal intensity from C3 to T9 spinal cord. The CSF study showed elevated protein count and negative oligoclonal band.

Screening Test for Depression Using the SF-36 Health Survey in Patients with Chronic Musculoskeletal Pain

OBJECTIVE: To evaluate the usefulness of the mental component summary (MCS) from the short form 36-item health survey (SF-36) as a screening test for depression in patients with chronic musculoskeletal pain and identify the optimal cut-off value that predicts a positive depression score measured by the center for epidemiological study depression survey (CES-D). METHOD: This study was designed as a questionnaire survey. 502 patients who visited our outpatient clinics due to chronic musculoskeletal pain were evaluated. They completed the SF-36 and the CES-D. The correlation between the MCS score from the SF-36 and the CES-D was identified, and also the cut-off value of the MCS score was determined with ROC curves used the CES-D as the standard measure for depression. The MCS scores were compared according to age, sex, duration of diseases, diagnosis, and the presence of depression. RESULTS: The mean overall score of CES-D and the MCS score were 17.5+/-10.2, 52.2+/-16.4 respectively. The MCS scores negatively correlated with the CES-D (gamma=-0.879, p0.05). However, patients with depression had significantly lower MCS scores than patients without depression (p<0.05). The cut-off value was 42.4 with 88.1% of sensitivity and 92.6% of specificity. CONCLUSION: The MCS scores would be useful screening test for depression with cut-off value of 42.4 that predicts the closest result of the CES-D.

The Effect of Cold Spray on Reducing Pain during Needle Electromyography

OBJECTIVE: To examine the effect of cold spray (Ethyl chloride) on reducing pain during needle electromyography (EMG). METHOD: Seventy-six adults, who had experienced needle electromyographic examination, were studied. They were randomly assigned to either experimental or control group. In experimental group, cold spray was applied to needling point of examining muscles before each needle examination. In control group, needle examination was performed without pre-treatment. The intensity of pain was assessed by the Visual analogue scale (VAS) and Verbal rating scale (VRS). Denial to re-examination was evaluated after EMG study. RESULTS: The VAS, VRS and denial to re-examination were significantly lower in experimental group (p<0.05). CONCLUSION: The application of cold spray before needle examination decreased the intensity of pain and denial to re-examination.