Increase of Independence in a Hemipelvectomy Patient with a Custom-Molded Supportive Seating and a Cosmetic Prosthesis : A case report

We report a case of hemipelvectomy, which was successfully treated with custom-molded supportive seating and a cosmetic prosthesis. A 32-year-old woman with a history of right traumatic hemipelvectomy, 24 years ago, visited our outpatient clinic for proper prosthetic rehabilitation. After injury, she was not able to use functional prostheses because of persistent skin problems of the hemipelvectomy site. She was able to perform all activities of daily living independently, but had to rely on crutch walking and was not able to sit on an even surface for longer periods of time. With the molded supportive seating the patient was able to perform outdoor activities for up to 10 hours. This case shows an approach in amputee rehabilitation, in which the ultimate goal of prosthetic fitting is not independent walking, but the improvement of independence and hence the improvement of quality of life.

Difference of Organism and Their Antibiotics Sensitivity from Urine Culture in Symptomatic Urinary Tract Infection of Spinal Cord Injury Patients

OBJECTIVE: To assess the necessity of extra rounds of urine culture when symptom of urinary tract infection (UTI) is developed from asymptomatic bacteriuria in spinal cord injury patients. METHOD: A total of 226 patients who took a urine culture at least twice during their stay and did not show symptoms of UTI at the admission were chosen. We then divided them into two groups: the one with patients who showed symptoms of UTI, and the other with ones who did not. Follow-up urine culture was performed when patients had symptoms of UTI or after one month from admission. RESULTS: 1) Of the 226 patients, 60 patients showed symptoms of UTI, while 166 patients did not. 2) From the UTI group, there were 38 (63.3%) patients whose organism from their urine culture changed. From the non-UTI group, 79 (47.6%) patients saw their organism from their urine culture changed. 3) From the UTI group, there were 31 (56.4%) patients whose organism was more resistant to the antibiotics. From the non-UTI group, there were 80 (68.4%) patients whose organism was more resistant to the antibiotics. CONCLUSION: If UTI occurs in spinal cord injury patients, new organism might be detected in urine culture. Therefore, we should choose the proper antibiotics based on results of follow-up urine culture performed when the patients had symptoms of UTI.

Application of New Combined Ortho-prosthesis to Severe Leg Length Inequality: A case report

We presented a case which showed clinical improvements after fabricating new ortho-prosthesis to a patient with severe leg length inequality. He was 51 years old and had developed the leg length inequality on the right due to osteomyelitis that he experienced when he was seven. He had been using the orthosis fabricated by a private orthotic shop for more than twenty years from his twenties. We prescribed a new ortho-prosthesis composed of patellar tendon bearing ankle foot orthosis combined with endoskeletal shank and dynamic SACH foot. With this new ortho-prosthesis, there were significant improvements in initial abnormal gait patterns of excessive knee flexion at mid-stance and decreased maximal knee flexion peak at swing phase in the kinematic parameters on transverse plane. And step width, step length and step time were also improved. He got pain relief and improvement of gait endurance

Desire to Void in Patients with Complete Spinal Cord Injury

OBJECTIVE: To classify complete spinal cord injury (SCI) patients based on the preservation of desire to void and to make clear the difference between each group METHOD: This study was performed retrospectively on 117 complete SCI patients with lesions above T11 who were referred to the urodynamic laboratory. Patients were classified according to the preservation of desire to void during conventional urodynamic study. The clinical and urodynamic characteristics of each group were analyzed. RESULTS: There were 37 patients (31.6%) with the preservation of desire to void. There were significantly lower compliance of bladder and longer duration from onset to examination in the sensory preservation group than the nonpreservation group (p<0.05). There were no significant difference in clinical features such as voiding method, the presence of autonomic dysreflexia between each group. CONCLUSION: The presence of desire to void was noted in 31.6% of complete SCI patients observed.

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.