A Case Report of Antiphospholipid Syndrome Present with Deep Venous Thrombosis

Antiphospholipid syndrome is a thrombotic disorder characterized by arterial or venous thrombosis with the presence of antiphospholipid antibodies (aPA). We reported a 38- year-old man suffering deep vein thrombosis associated with antiphospholipid antibody syndrome. He underwent an interventional procedure of intravascular thrombolytic therapy and stent insertion due to deep vein thrombosis in the lower extremities. On the next day of the procedure, he complained of low back pain, motor weakness in lower extremities, sensory loss and voiding difficulty. Lumbar MRI revealed epidural hematoma between T12 and L2 spine, resulting in cauda equina syndrome. Twenty days later, pulmonary thromboembolism was newly diagnosed. In laboratory test, aPA was detected. Therefore, he was finally diagnosed as antiphospholipid syndrome. We reported this unusual case with the review of literatures.

The Analgesic Effect of Intraarticular Morphine in Osteoarthritis of Knee

OBJECTIVE: This study was conducted to assess the analgesic effect of intraarticular injection with morphine and hyaluronic acid in comparison with intraarticular injection with hyaluronic acid only in the patients with osteoarthritis of knee. METHOD: Twenty four patients with degenerative osteoarthritis of the knee were assigned randomly to a morphine group (morphine+hyaluronic acid) and a hyaluronic acid group. In the morphine group, intraarticular injection with morphine and hyaluronic acid at first was applied to the knee 2 times. Then intraarticular injection with hyaluronic acid without morphine was applied in the remaining 3times. In the hyaluronic acid group, intraarticular injection with hyaluronic acid was applied to the knee 5 times. Effects were assessed on the 1st week, 5th week after treatment, and on the last follow up day by pain rating score (PRS). RESULTS: Significant change of PRS improvement was noticed in the morphine group in the 1st week after treatment compared with the hyaluronic acid group. CONCLUSION: These results showed that intraarticular injection with morphine and hyaluronic acid was a more effective treatment method than intraarticular injection with hyaluronic acid only for pain control in patients with osteoarthritis of knee.

Changes of Voiding Methods in Patients with Spinal Cord Injury

PURPOSE: To investigate the changes of voiding methods according to the time after discharge and to clarify the reason of changing voiding method. MATERIALS AND METHODS: One hundred and seventeen patients with spinal cord injury were enrolled. We classified these patients into five groups such as normal voiding, reflex voiding, intermittent catheterization, Foley catheter, and suprapubic cystostomy group. We interviewed the patients for necessary information including current voiding method and reason of changing voiding method. RESULTS: 50% of intermittent catheterization patients changed to reflex voiding method. 66% of these patients changed the voiding method without consult with their physician. Higher percentage of the paraplegic patients with intermittent catheterization changed to reflex voiding than the quadriplegic patients. Moreover, female patients indwelt the catheters due to absence of external collecting device than males. CONCLUSION: It is necessary to follow up the voiding methods of patients with spinal cord injury more closely to avoid the following inadvertent complications.

Disability Scale for Patients with Spinal Cord Injury: Spinal Cord Independence Measure

OBJECTIVE: The objectives of this study were to evaluate the reliability of the Korean version of Spinal Cord Independence Measure (SCIM) and to compare the sensitivity of the SCIM to functional changes of spinal cord injury (SCI) patients with that of the Functional Independence Measure (FIM). METHOD: Seventeen subjects with SCI were studied. The SCIM was translated and modified to convert as SCIM Korean-version. All patients were evaluated with the SCIM and the FIM by two raters every other week. To determine inter-rater reliability, the relationship between the SCIM scores obtained by two raters was evaluated by Kappa coefficient and linear regression. To determine relative sensitivity of the test to functional changes, changes in the scores on the SCIM and FIM were compared by McNemar test. RESULTS: The Kappa coefficient of the various individual tasks in SCIM ranged between 0.63 and 1.00. High correlations were also found between the total SCIM scores for the paired raters (r=0.99, p<0.01). The SCIM detected all the functional changes detected by FIM total scoring, but in 3 (14%) of 22 sequential test batteries, the FIM missed changes detected by SCIM total scoring. CONCLUSION: These results demonstrated that the SCIM is reliable and more sensitive than the FIM in reflecting the functional changes of SCI patients.

Effects of Methylphenidate on Cognitive Impairment Following Brain Injury: A double-blind placebo-controlled study

OBJECTIVE: To evaluate the effect of methylphenidate on cognitive function especially on working memory and visuospatial attention in the patients with traumatic brain injury (TBI). METHOD: Eighteen subjects, 16 males and 2 females, with TBI were enrolled. Their mean age was 34.2 years old. A double-blind placebo-controlled study was designed. The baseline cognitive assessment was performed before the administration of drug. Two days after the baseline study, 20 mg of methylphenidate or placebo was administered. The second cognitive assessment was performed 2 hours after the treatment. The follow-up assessment conducted two days after the second test. Cognitive assessments consisted of 'one-back working memory task' and 'endogenous visuospatial attention task', designed using SuperLab Pro 2.0 software. RESULTS: In one-back working memory test, there was significant improvement of response accuracy in methylphenidate group in comparison with placebo group (p<0.01). Significant shortening of reaction time was also seen after the administration of drug in methylphenidate group (p<0.05). In endogenous visuospatial attention test, significant improvement of response accuracy was noticed after the administration of drug in methylphenidate group (p<0.05). CONCLUSION: These results demonstrated that the administration of methylphenidate was beneficial in improving cognitive function following TBI. The effect was prominent in the accuracy of working memory.