Ultrasound-Guided 50% Ethyl Alcohol Injection for Patients With Malleolar and Olecranon Bursitis: A Prospective Pilot Study

OBJECTIVE: To evaluate the feasibility and effect of ultrasound-guided ethyl alcohol injection on malleolar and olecranon synovial proliferative bursitis. METHODS: Twenty-four patients received ultrasound-guided 50% diluted ethyl alcohol injection at the site of synovial proliferative bursitis after aspiration of the free fluid. RESULTS: Swelling and symptoms significantly decreased in 13 of the 24 patients without any complications. Eleven patients had partial improvement in swelling and symptoms. CONCLUSION: Ultrasound-guided alcohol injection could be an alternative therapeutic option before surgery in patients with chronic intractable malleolar and olecranon synovial proliferative bursitis.

Changes in Hyolaryngeal Movement and Swallowing Function After Neuromuscular Electrical Stimulation in Patients With Dysphagia

OBJECTIVE: To investigate immediate changes in hyolaryngeal movement and swallowing function after a cycle of neuromuscular electrical stimulation (NMES) on both submental and throat regions and submental placement alone in patients with dysphagia. METHODS: Fifteen patients with dysphagia were recruited. First, videofluoroscopic swallowing study (VFSS) was performed before NMES. All patients thereafter received a cycle of NMES by 2 methods of electrode placement: 1) both submental and throat regions and 2) submental placement alone concomitant with VFSS. The Penetration-Aspiration Score (PAS) and the NIH-Swallowing Safety Scale (NIH-SSS) were measured for swallowing function. RESULTS: During swallowing, hyolaryngeal descent significantly occurred by NMES on both submental and throat regions, and anterior displacement of hyolaryngeal complex was significant on submental placement alone. NMES on submental placement alone did not change the PAS and NIH-SSS. However, NMES on both submental and throat regions significantly reduced the NIH-SSS, although it did not change the PAS. Patients with no brainstem lesion and with dysphagia duration of <3 months showed significantly improved the NIH-SSS. CONCLUSION: Immediate hyolaryngeal movement was paradoxically depressed after NMES on both submental and throat regions with significant reductions in the NIH-SSS but not the PAS, suggesting improvement in pharyngeal peristalsis and cricopharyngeal functions at the esophageal entry rather than decreased aspiration and penetration. The results also suggested that patients with dysphagia should be carefully screened when determining motor-level NMES.

The Assessment of Reliability of Cognitive Evoked Potential in Normal Person

OBJECTIVE: To evaluate intra-tester reliability of P300 more precisely, this study was designed. Event-related potential (ERP) is the result of endogenous brain response following cognitive stimulus. The P300 component of the human ERP is a positive wave with a latency of 300 ms or greater. Our purpose of this study was to estimate reliability of P300 latency and amplitude with 30 normal persons without head injury, as well as to set up them as the reference values in the event that they would be found to be highly reliable. METHODS: ERP was performed at three separate times on 30 normal adults in their 20s and 30s. We measured P300 latency and amplitude among ERP. RESULTS: P300 latency show excellent reliability with intraclass correlation coefficient (ICC) of 0.81. As to P300 amplitude, reliability was good to fair with ICC of 0.53. Average value of P300 latency was 311.3+/-37.0 ms, shorter than reference value of previous study in Korea. CONCLUSION: P300 latency revealed higher reliability than P300 amplitude, although reliability of P300 was confirmed in both component. After further study including precise mechanism, influence factor on measurement and method standardization, it is expected to be an objective indicator to assess the cognitive state and predict prognosis.

Voiding Dysfunction after Stroke and Traumatic Brain Injury: Multi-center Study

OBJECTIVE: Voiding dysfunction after stroke and traumatic brain injury has been known to be a predictive factor of death or severe disability, and an important factor on hospital discharge. Thus we aim to investigate its prevalence, related factors and natural course of brain injury related voiding dysfunction for proper rehabilitation after brain injury. METHOD: Two hundred ten brain injury patients (male 130, female 80) admitted in 5 university hospitals were included. The cognitive function was assessed using the Korean version-Mini mental state examination (K-MMSE), and bladder function was evaluated with the International Prostate Symptom Score (IPSS) and voiding diary. We excluded the patients that had previous urologic and gynecologic problem. RESULTS: Overall, 43.7% of total patients had voiding difficulty and the most common symptom was nocturia (80.6%), which was followed by frequency (72.6%) and urgency (40.3%). Patients with incontinence had lower K-MMSE scores than continent patients. There was no significant difference of rate of incontinence in relation with sex, cause of brain injury, and lesion site. Prevalence of urinary symptoms decreased as the duration after brain injury was longer. The quality of life score showed a high correlation with the total IPSS score (p<0.05). CONCLUSION: The overall results demonstrate that voiding dysfunction after brain injury is influenced by onset time and cognitive function after brain injury.