A Case of Buried Bumper Syndrome; A case report

Percutaneous endoscopic gastrostomy is used for long-term nutritional support to the patients who cannot maintain the adequate oral intake and can be performed with relatively few complications. Among the complications, migration of the internal bumper into the abdominal wall, so called "buried bumper syndrome" has been described more recently. We decribed a case of buried bumper syndrome in stroke patient with percutaneous endoscopic gastrostomy. He experienced peritubular leakage, resistance of tubal feeding, and abdominal pain which were developed 4 weeks after percutaneous endoscopic gastrostomy. On endoscopic examination, the gastrostomy lumen coud not be found. The gastrostomy tube was replaced with careful manual traction and replaced to new one with endoscopic technique. No complication was occurred and the function of tube has been well preserved.

The Effects of Electrical Stimulation on Upper Extremity Spasticity in Hemiplegic Patients

OBJECTIVE: To evaluate immediate and long term effects of electrical stimulation on upper extremity spasticity following stroke. METHOD: The subjects were 13 hemiplegic patients with cerebral infarction and cerebral hemorrhage. Electrical stimulation was applied to skin over the biceps muscle and the triceps muscle for a period of twenty minutes. The evaluation of spasticity was done by using the modified Ashworth scale, free amount of elbow extension, active range of motion and motor strength of elbow flexion and extension at baseline, immediately, 1 week and 4 weeks after electrical stimulation. RESULTS: Immediately after treatment, free amount of elbow extension increased from 63.8+/-19.1 degrees to 77.7+/-22.5 degrees (p<0.05) and active flexion of elbow flexor increased from 45.0+/-34.8 degrees to 55.3+/-39.1 degrees (p<0.05). The active range of motion of elbow flexor was increased on the 4th week during electrical stimulation (p<0.05). The free amount of elbow extension and modified Ashworth scale of elbow flexor spasticity was improved on the 18th day after treatment cessation (p<0.05). CONCLUSION: The results of this study showed that spasticity tended to decrease and maintain a lower level after a varying number of treatment sessions.

Extensive Longitudinal Myelitis Associated with Systemic Lupus Erythematosus: A case report

Myelopathy is a rare but serious central nervous system complication associated with systemic lupus erythematosus (SLE). Acute transverse myelitis is the most usual involvement of SLE-related myelopathy. We reported a 17-year-old girl who developed a very extensive SLE related transverse myelitis with longitudinal involvement of the spinal cordfrom C4 to the conus medullaris. There were motor and sensory loss of both lower extremities, and bladder dysfunction over the course of 5 days. She presented T9 paraplegia ASIA A. Her neurological dysfunction was not responded to treatment with methyprednisolone and cyclophosphomide.

Extraperitoneal Bladder Rupture during the Bladder Distension Therapy: A case report

A 75-year-old woman presented a cauda equina syndrome with epiconus involvement from the compression fractures of T12, L1, and L3 vertebrae as a result of fall accident. Cystometrogram performed at three months after the injury showed a small bladder capacity and low compliance. Anticholinergic medications including intravesical instillation of oxybutynin solution failed to increase the bladder capacity or lower the intravesical pressure. Bladder distension therapy using normal saline infusion with a volume surpassing the previous measured maximal bladder capacity was performed. The procedures were repeated four times per day. At the fifth day of the distension therapy, the patient complained of acute low abdominal pain and gross hematuria. The cystogram revealed the extraperitoneal bladder rupture. The patient was treated successfully with antibiotics and continuous urinary drainage through the Foley catheter for 14 days. We report a case of extraperitoneal bladder rupture during the bladder distension therapy.