The effect of early therapeutic electrical stimulation on bone mineral density in the paralyzed limbs of the rabbit

The purpose of this animal experiment was to evaluate the changes of bone mineral density in paralyzed limbs, and to assess the effects of electrically stimulating muscle contraction upon bone mineral density (BMD) in paralyzed limbs during the four week period immediately following spinal cord injury (SCI). Ten rabbits were used for the study, spinal cords were totally transected at the T11 spine level. The paralyzed quadriceps femoris of one limb was contracted by electrical stimulation for 60-minutes daily, while the other side was not stimulated as a control. The BMD of each lower limb was measured by Dual Photon Absorptiometry before and four weeks after acute SCI. BMD of both limbs decreased in all rabbits four weeks after SCI. The decrease in BMD for stimulated and non-stimulated limbs was 6.130 +/- 3.212% and 9.098 +/- 3.831%, respectively during the four-week period after SCI. The BMD of stimulated limbs decreased significantly less than that of the non-stimulated limbs. Electrically induced muscular contraction reduced bone mineral loss in the paralyzed limb during the early stage of SCI in the rabbit.

Diagnosis of Osteoporosis of the Foot in Patients with Diabetes Mellitus Using Bone Densitometry

OBJECTIVE: The purpose of this study was to evaluate the severity and frequency of osteoporosis of the foot in patients with diabetes mellitus using bone densitometry, and to determine whether plain radiologic evaluation can be used as a cheap and reliable screening of osteoporosis. METHOD: We studied plain X-ray including AP and lateral views of the feet of the patients. Bone densitometry studies were performed on the feet of both diabetic and age-matched control groups. RESULTS: Forefoot bone densitometry scores were significantly lower in the male diabetic group compared to the control group (p<0.05). Furthermore, the female diabetics had significantly lower bone densitometry scores for forefoot and hindfoot than the control group (p<0.05). Bone densitometric evaluation of the diabetic patients' feet revealed scores significantly lower than those of the controls in cases which the radiologist interpreted as normal finding in plain roentgenogram alone (p<0.05). CONCLUSION: Plain radiologic studies of the feet in patients with diabetes mellitus are not effective in identifying osteoporotic change; thus, they should not be used as the screening method of diabetic foot lesions.

Sympathetic Skin Responses after Stellate Ganglion Block in the Patient with Reflex Sympathetic Dystrophy

OBJECTIVE: The purposes of this study were to measure the effect of Stellate ganglion block(SGB) objectively and quantitatively by the use of sympathetic skin response(SSR), and to evaluate the cumulative effects and complications of repetitive SGB and to find out optimal numbers of injection per one cycle in the patients with reflex sympathetic dystrophy(RSD). METHOD: Six patients with RSD were evaluated with a SSR test before and after the injection of 1% lidocaine 4 ml by SGB method. RESULTS: There was a significant prolongation of latencies in SSR of the lesion side of sixty mixed cases by the SGB methods and SSR tests. There were no significant changes in the latency and amplitude of SSR from the lesion side between pre- and post injection states. There was a significant decrease of amplitude in the sound side after the injection. The differences of the amplitudes between pre- and post injections were significantly higher in the lesion side than the sound side. The degree of pain of the patients with RSD was evaluated by visual analogue scale(VAS), which scored on pre and post injection state decreased from 10 to 6.5 by 5 times injections, but did not decrease by more injections. CONCLUSION: We concluded that SGB is more effective in the RSD lesion side than the sound side and the SSR is a useful test for evaluating the effect of SGB.

Evoked EMG Monitoring During Transpedicular Fixation of Lumbosacral Spine

OBJECTIVE: The purpose of this study is to evaluate the searching stimulus intensity at each pedicle and to identify the most vulnerable roots in transpedicular screw fixation of lumbosacral spine. METHOD: Thirty-two patients with unstable lumbosacral vertebra were treated with intrapedicular screw fixation. Small holes were made by an air drill on the pedicle from L2 to S1 for screw fixation. Constant current stimulation pulses(0.2 msec duration) were delivered through a ball-tipped nasopharyngeal probe used to palpate the walls of each pedicle, and observation was made of electromyogram(EMG) evoked lower extremity muscles. The probes were placed in each pedicular wall manually, and evaluated for searching stimulus intensity, the current necessary to evoked EMG. RESULTS: The cases that the searching stimulus intensity was above 5 mA were 99 cases(97%), above 10 mA were 61 cases(59.8%) and below 5 mA were 3 cases(2.9%). The vastus medialis muscle is most sensitive in L2(100%) and L3(78.9%), tibialis anterior is in L4(81.8%), Peroneus longus is in L5(50.5%) and gastrocnemius is in S1(87.5%). CONCLUSION: We can regard the searching stimulus intensity as 5 mA and the root located at Infero-medial side of pedicle is most vulnerable in transpedicular screw fixation. Furthermore, stimulus-evoked EMG monitoring during transpedicular spine instrumentation is helpful to avoid neural tissue injury.

Skin Lesions Other than Pressure Ulcers of the Patients in a Rehabilitation Unit

OBJECTIVE: The purpose of this study is to investigate the incidence and types of skin lesions occurring in the patients with a spinal cord injury(SCI), traumatic brain injury(TBI), cerebrovascular accident(CVA), and an amputation. METHOD: Five hundred and eighty-nine charts from 1991 to 1997 were retrospectively reviewed. During the hospitalization, the skin lesions were examined by the dermatologists upon consultations. The patients were divided by their diagnosis of the SCI, TBI, CVA, and amputation. The incidence of the skin lesions were analysed. RESULTS: The number of patients was as follows; SCI 228, TBI 181, CVA 143, and amputation 37. The skin lesions occurred in 72 cases(12.9%) of which 30 cases(13.2%) occured in SCI, 21 cases(11.6%) in TBI, 15 cases(9.8%) in CVA and 7 cases(18.9%) in amputation. These include dermatophytosis 23 cases(23.9%), seborrheic dermatitis 21 cases(21.8%), pilosebaceous disorder 17 cases(17.7%) such as folliculitis, acne, and acneiform eruption, eczema 11 cases(11.4%), drug eruption 9 cases(9.4%), candidiasis 6 cases(6.3%), and others 9 cases(9.4%) such as steatocytoma multiplex, epidermal cyst, intertrigo, alopecia areata, and etc. The incidence of ANS related skin lesion such as seborrheic dermatitis and pilosebaceous disorder in SCI was significantly higher than in TBI and stoke, which the defect is in the brain(p0.05). The number of cases of ANS related skin lesions was 21(52.5%) and 3(42.9%) in SCI patients whose level of injury was from C1 to T6(in 40) and at or below T7(in 7) respectively. In contrast, the number of cases of other skin lesions such as dermatophytosis, eczema, and candidiasis was 15(37.5%) of C1 to T6 level and 4(57.1%) of at or below T7 level in the same SCI patients groups. CONCLUSION: This study illustrates that the incidence of skin lesion in rehabilitation unit is 72 cases of 589 patients(12.9%). The incidence of ANS related skin lesion is higher in the patients with spinal cord injury than brain lesion. And the level of injury is higher in SCI, the more skin lesions occur.

Early Onset Cerebellar Ataxia with Retained Tendon Reflexes Developed in Brothers: Report of two cases

Early onset cerebellar ataxia with retained tendon reflexes is distinctive clinical syndrome characterized by progressive cerebellar ataxia of unknown etiology with an onset within the first two decades. This disorder was distinguished from Friedreich's ataxia by the preservation of the deep tendon reflexes. There is 22-year-old male with 13 year history of slowly progressive cerebellar ataxia and dysarthria. His elder brother, also, has milder clinical manifestations, electrophysiological and radiological abnormalities. We experienced two cases of early onset cerebellar ataxia with retained tendon reflexes developed in brothers which was diagnosed by clinical manifestations, electrophysiologic, radiologic studies and report with brief review of related literatures.

Neurogenic Bladder in the Patients with Tethered Cord Syndrome: A case report

Tethered spinal cord syndrome can be defined as a low conus medullaris extending below L2 vertebral level and/or a thickened filum terminale above 2 mm in diameter. Among the neurologic symptoms, neurogenic bladder and bowel is the most common and leaves significant sequale that the patients being disabled not physically but socially. Early recognition and detethering operation are recommended but proper bladder management with regular follow-up should be accompanied for better prognosis. Here, three cases of the neurogenic bladder with tethered spinal cord syndrome who primarily had myelodysplasia are presented with review of the articles.