Iliac Vein Compression Syndrome in Spinal Cord Injury

OBJECTIVE: Iliac vein compression syndrome is a well-recognized anatomic variant that is associated with the development of symptomatic deep venous thrombosis (DVT) of the left iliac vein. However, its relation with DVT in spinal cord injury has not been established. The purpose of this study was to determine the relation between iliac vein compression syndrome and DVT in spinal cord injured patients. METHOD: Thirteen spinal cord injured patients diagnosed with DVT from January 2002 to December 2003 were evaluated. After ascending venography, the catheter-directed thrombolytic therapy and balloon angioplasty with stent insertion after 24 hours of thrombolytic therapy were done. RESULTS: Twelve of 13 patients showed that the left iliac vein was compressed by the right iliac artery, with thrombosis shown in the distal venous segment of the crossover point and had a collateral formation. All 12 patients had residual stenosis of left iliac vein in spite of the thrombolytic therapy. The unimpeded venous flow of iliofemoral veins was revealed after the balloon angioplasty with stent insertion. CONCLUSION: We suggested that the proper evaluation and management about iliac vein compression syndrome be considered when residual stenosis was persistent through the chemical dissolution in spinal cord injured patient with left iliac vein thrombosis.

The Diagnosis of Upper Urinary Tract Infection Using Abdominal Computerized Tomography in Spinal Cord Injured Patients

OBJECTIVE: To reveal the usefulness of abdominal computerized tomography (CT) for the detection of complicated and uncomplicated upper urinary tract infection (UTI)s in patients with spinal cord injury (SCI). METHOD: Twenty-two patients with SCI were included in this study. They had UTIs with persistent high fever despite conservative treatments. In all patients, abdominal CT was performed. RESULTS: Acute pyelonephritis (APN) with or without complications was detected in 13 patients (59.1%). Four patients were accompanied with complications, 1 perirenal abscess, 1 renal and perirenal abscess with staghorn stone, 1 urosepsis with renal abscess and 1 urosepsis. Simple nephrectomy was performed in a patient with perirenal and renal abscesses with a staghorn stone. Percutaneous abscess drainage was performed in one patient with perirenal abscess. They all recovered without further complications. CONCLUSION: Abdominal CT should be considered to detect uncomplicated and complicated upper UTIs in SCI patients who present persistent UTI symptoms despite conservative treatments.

Sex Hormone Profiles in Spinal Cord-Injured Patients

OBJECTIVE: It is known that spinal cord injury (SCI) in adult men may result in sex hormonal changes. To investigate this change, we compared sex hormone levels of male SCI patients, uninjured normal, and infertile subjects. METHOD: Serum levels of follicular-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testosterone were determined in 67 male SCI patients, 20 uninjured normal men and 39 idiopathic infertile men. One-way analysis of variance (ANOVA) procedures were performed with a significance level of 0.05. RESULTS: Compared with normal and infertile control groups, SCI patients had lower levels of testosterone and higher levels of prolactin. FSH levels of SCI patients were only lower than those of infertile controls. LH levels of SCI patients showed no significant difference. Compared with hormone levels of acute SCI patients, those of chronic SCI patients showed a tendency to increase in FSH, LH and testosterone, and a tendency to decrease in prolactin. Etiology of injury, completeness of injury and voiding method for neurogenic bladder did not influence the sex hormone levels in SCI patients. CONCLUSION: In our study, male SCI patients showed sex hormonal abnormalities of hypothalamo-pituitary type. And elevated serum prolactin level might influence hormonal changes and sexual dysfunction in male SCI patients.

The Efficacy of Pulmonary Rehabilitation Using Mechanical In-Exsufflator in Cervical Cord Injured Patients

OBJECTIVE: It is known that Mechanical in-exsufflator (MI-E) can reduce pulmonary complications such as pneumonia, atelectasis in tetraplegia by increasing inspiratory and expiratory capacity. The aim of this study is to clarify the effectiveness of MI-E on pulmonary function and coughing capacity in tetraplegia. METHOD: Thirty tetraplegic patients who had neither history nor radiologic finding of pulmonary disease were divided into two groups; control (n=15) and experimental (n=15) groups. Control group received conventional pulmonary rehabilitation, while experimental group received additional MI-E therapy for one month. The pulmonary function was evaluated by measuring percentage of predicted value of vital capacity (% VC), maximal insufflation capacity (MIC), unassisted peak cough flow (UPCF), volume assisted peak cough flow (VPCF), manual assisted peak cough flow (MPCF), manual and volume assisted peak cough flow (MVPCF). These data of pulmonary function before and after treatment were compared between two groups. RESULTS: 1) There are significant improvement of pulmonary function in both groups (p<0.05) except UPCF in control group before and after treatment. 2) The experimental group showed more improvement in MIC, VPCF, MPCF and MVPCF than control group (p<0.05). Conclusion: MI-E therapy can be used as an effective therapeutic modality for the improvement of pulmonary function in combination with conventional pulmonary rehabilitation.