H-reflex in known as a useful electrodiagnostic test in the diagnosis of S1 radiculopathy. But, only the latency difference has been the useful parameter by previous method.

Under the assumption that the constant initial negative biphasic appearance of H-wave in essential so that the parameters such as amplitude, area and shape could be used as another significant parameters, we developed new H-reflex study method.

To validate our assumption and to compare the diagnostic value between the previous method and the new one, we studied H-reflex study in 330 subjects.

162 subjects were studied by previous method and 168 subjects were studied by our new method.

There was no definite differences in diagnostic values between two methods by latency criteria. But new method was more specific for S1 radiculopathy than previous method by amplitude and area criteria and the parameters such as amplitude, area and shape can be used as significant parameters only in the new method.

So, we suggest new diagnostic criteria as follows;

1) H-latency difference over 1.0 msec and H/H amplitude ratio less than 0.5 seems to be abnormal.

2) or, H-latency over 30 msec seems to be abnormal.

3) or, Unilateral no evoked H response seems to be abnormal

Electrophysiologic assessments of the autonomic nervous system include tests of cardiovascular function, sweat test and tests of vasomotor function in which both parasympathetic and sympathetic pathway are evaluated. R-R interval variation(RRIV) among the cardiovascular tests has been shown to be a sensitive test for the detection of parasympathetic dysfunction. But RRIV is infrequently used in clinical practice because it is complex and tie consuming to measure RRIV by conventional EKG equipment. Sympathetic skin response(SSR) test represents the difference in voltage which is determined by the sweat glands between two skin surfaces. SSR reflects only sympathetic function.

In this study we measured RRIV and SSR using routine EMG machine easily. The aim of this study is to describe the method and to establish a normal basis of control values.

Thirty one healthy persons were tested.

The results were as follows:

1) The mean 30:15 ratio was 1.34 and the mean Valsalva ratio was 1.67.

2) The mean E:I ratio and the mean difference between the longest and the shortest R-R interval during deep breathing were 1.42 and 293.23 msec respectively.

3) 30:15 ratio was significantly correlated with Valsalva ratio, E:I ratio and difference between the longest and the shortest R-R interval during deep breathing.

4) The SSR responses were obtained in all subjects. Stimulating the right median nerve at wrist, the mean latency and the mean amplitude were measured at right palm(1.42 sec, 5.33 mV), left palm(1.42 sec, 5.73 mV), right sole(1.96 sec, 3.16 mV), and left sole(1.98 sec, 2.93 mV).

5) Stimulating the right tibial nerve at ankle, the mean latency and the mean amplitude were measured at right palm(1.38 sec, 4.27 mV), left palm(1.37 sec, 4.51 mV), right sole(1.89 sec, 2.29mV), and left sole(1.91 sec, 2.07 mV).

6) The latencies of the SSR recorded at the sole were delayed than those recorded at the palm regardless of the site of stimulation.

7) The amplitude of the SSR recorded at the palm were greater than those recorded at the sole regardless of the site of stimulation.

8) When 5 stimulations were given in right median nerve separated by 2 minutes, five all sequential responses of SSR were obtained and there was no meaningful habituation among each stimulation.

For many years, pelvic nerve damage causing vesico-urethral dysfunctions after radical hysteretomy for carcinoma of the cervix uteri has been a well-recognized long term complication. Therefore, many women represented the difficulty in urination, urinary incontinence, and high residual urine after that operation. This study showed the urodynamic and electrophysiologic findings in 22 women undergoing radical abdominal hysterectomy for carcinoma of the cervix uteri and the importance of early rehabilitative therapy for the functional recovery of the bladder.

The results were ad follows;

1) In urodynamic study, there were 22 patients with areflexic bladder, and 2 with normoreflexia.

2) In electrodiagnostic study, bulbocavernosus reflex latencies were acceptable ranges in 14 patients, but not so in 8. And pudendal somatosensory evoked potential study showed normal for 20, and prolonged in 2 patients.

3) We have obtained a satisfactory functional recovery of the bladder activity in all patients within mean 20.8 days after Foley catheter removal and early rehabilitation treatment with kinesitherapy and/or pharmacological therapy.

To evaluate the effect of treatment techniques used to reduce the edema in the paralyzed hand of the hemiplegic patients, EST(Electrical Stimulation Therapy), hand CPM(Continuous Passive Motion), elevation of affected arm and sequential IPC(Intermittent Pneumatic Compression), were tried to 9 hemiplegic patients. Hand volumeter was used to measure hand volume of pre- and posttreatment to quantify the amount of edema reduced by the treatment.

1) Mean difference of hand volume between the affected and the unaffected prior to treatment was 93.9 cc(19.8%) and mean duration after onset of hemiplegia was 46.6 weeks.

2) After EST, hand CPM, elevation and sequential IPC, mean differences of hand volume between pre- and posttreatment were 41.7 cc(7.6%), 41.1 cc(7.4%), 35.0 cc(6.6%), 37.8 cc(6.7%) respectively(p<0.005).

3) There was no statistically significant difference in the effects among 4 treatment technique used in this study.

4) There was no significant correlation between treatment effect and the duration of hemiplegia or pretreatment hand volume.

The result of this study suggest that EST, CPM, elevation of affected arm and sequential IPC are effective for the reduction of paralyzed hand edema volume in hemiplegic patients. Further research should include the duration of persistent effect of each treatment in different intensities and sequence for the development of the adequate treatment protocol of edematous hand in hemiplegic patients.

Somatosensory evoked potentials(SEPs) provide non-invasive methods for the evaluation of the nervous system from peripheral nerve to cerebral cortex. In patients with CNS degenerative disease responses recorded over the caudal and rostral spinal cord are similar to normals, thus SEPs are related to cerebral function and is valuables to evaluate the maturation, especially with auditory(brainstem evoked potentials) and visual evoked potentials.

The short latency SEPs were studied in 34 children with cerebral palsy aged from 1 to 5 years(mean, 2 year 5 months), These SEPs were then analyzed and graded into 4 categories by the waveforms, amplitudes and latencies.

The results were as follows;

1) By the grade of SEPs, normal response was 43.5%, slight alteration 20.4%, severe alteration was 16.6% and no response was 22.3% in the median nerve SEPs. In the tibial nerve SEP, normal response was 16.7%, slight alteration was 20.0%, severe alteration was 33.3% and no response was 30.3%.

2) In children with spastic diplegia, the abnormal SEPs were 35.3% in median SEPs and 89.5% in tibial SEPs. In spastic quadriplegia, the abnormal SEPs were 70.0% in median SEPs and 100.0% in tibial SEPs. In hemiplegia, 77.8% showed abnormal median SEPs and 60.0% in tibial SEPs. The abnormal SEPs were shown in the unaffected limbs as well as the affected limbs.

3) The mean points of no head control was 4.0±0.0 by scoring system and it was gradually lower toward the developmental stage of walk alone as 1.65±1.06 on median SEPs. The mean points of no head control was 3.0±0.0 and that of walk alone 1.80±1.07 on tibial SEPs.

The purpose of this study is to check sympathetic skin response(SSR) and to determine factors of influence in SSR in spinal cord injury patients, and to know relation between SSR with autonomic nervous symptom.

The major results were as follows:

1) The higher the level of injury, the higher was the rate of no response, Eleven patients(100%) with lumbar and sacral spinal cord injury showed sympathetic skin response on right palm and left sole with stimulation of right wrist. When left ankle was stimulated, only 1 patients(10%) with cervical spinal cord injury showed SSR.

2) SSR did not show any correlation with the type of spinal cord injury(complete or incomplete) or the state of bladder by cystometrogram or the results of bulbocavernosus reflex latency and pudendal somatosensory evoked potential.

3) There was no significant difference between the patients with and without autonomic nervous symptom. And among the patients with positive SSR, there was no difference in latency and amplitude.

4) The latency of SSR in palm and sole with right wrist stimulation was longest in cervical spinal cord injury patients and the amplitude of SSR in palm and sole with wrist stimulation was largest in lumbar and sacral spinal cord injury patients.

5) Compared with normal individuals, the latency and amplitude of the sympathetic skin response was longer and larger in spinal cord injury patients.

The somatosensory evoked potentials have been considered as one of the objective prognostic factors of the hemiplegic patients. Many studies were done about the relationships of the median nerve somatosensory evoked potential with recovery of the upper extremities. But the recovery of lower extremities is thought to be different from that of upper extremities, so somatosensory evoked potential of lower extremities, for example, posterior tibial nerve somatosensory evoked potentials may be more suitable for prediction of recovery of lower extremities in the hemiplegic patients. However, studies about posterior tibial nerve evoked potentials as a prognostic factor in the hemiplegic patients are a few.

We studied median nerve and posterior tibial nerve somatosensory evoked potentials of the 72 hemiplegic patients, and follow up studies were done in 21 of them with interval of average 15 months. We compared correlations of the above two kinds of somatosensory evoked potentials with physical findings and their prognostic significance.

In result, sensory recovery was accompanied with improvement of somatosensory evoked potentials, but motor recovery was present in all patients with or without improvement of somatosensory evoked potentials. Better results in the somatosensory evoked potentials were accompanied with significantly shorter length of hospital stay, but modified Barthel Index score was not different significantly except the score of lower extremities. We suggest that both median nerve and posterior tibial nerve somatosensory evoked potentials are considered to be the prognostic factors of the hemiplegic patients because they represent mainly sensory recovery and both of them are needed for more complete prediction of the prognosis.

Somatosensory evoked potentials(SEPs) provide non-invasive methods for the evaluation of the nervous system from peripheral nerve to cerebral cortex. In patients with CNS degenerative disease responses recorded over the caudal and rostral spinal cord are similar to normals, thus SEPs are related to cerebral function and is valuables to evaluate the maturation, especially with auditory(brainstem evoked potentials) and visual evoked potentials.

The short latency SEPs were studied in 34 children with cerebral palsy aged from 1 to 5 years(mean, 2 year 5 months), These SEPs were then analyzed and graded into 4 categories by the waveforms, amplitudes and latencies.

The results were as follows;

1) By the grade of SEPs, normal response was 43.5%, slight alteration 20.4%, severe alteration was 16.6% and no response was 22.3% in the median nerve SEPs. In the tibial nerve SEP, normal response was 16.7%, slight alteration was 20.0%, severe alteration was 33.3% and no response was 30.3%.

2) In children with spastic diplegia, the abnormal SEPs were 35.3% in median SEPs and 89.5% in tibial SEPs. In spastic quadriplegia, the abnormal SEPs were 70.0% in median SEPs and 100.0% in tibial SEPs. In hemiplegia, 77.8% showed abnormal median SEPs and 60.0% in tibial SEPs. The abnormal SEPs were shown in the unaffected limbs as well as the affected limbs.

3) The mean points of no head control was 4.0±0.0 by scoring system and it was gradually lower toward the developmental stage of walk alone as 1.65±1.06 on median SEPs. The mean points of no head control was 3.0±0.0 and that of walk alone 1.80±1.07 on tibial SEPs.

Posterior rhizotomy was proposed in 1908 by Otfrid Foerster for the treatment of spasticity and modified by Gros and Fasano to sacrifice the rootlet believed to be most responsible for spasticity on the bases of electrophysiologic techniques. Selective posterior rhizotomy(SPR) was frequently performed at the lumosacral roots to reduce the spasticity and improve the function of lower extremities in diplegic or quadriplegic patients. SPR can be applied at cervical roots to manage the spastic upper extremity dysfunction as suggested by Gros et al in 1979.

We performed SPR in 8 patients who had the spastic upper extremity dysfunction with the 8-channel electromyographic monitoring. The spasticity and han function were evaluated before and after surgery. The results are as follows:

1) The subjects were 7 patients with cerebral palsy and one with spinal cord injury. Six patients were hemiplegic and 2 patients were quadriplegic. All had spasticity in affected side and 3 had combined dystonia.

2) In all the patients spasticity was decreased and deformity of hand was improved after receiving SPR.

3) Five patients out of 8 showed improvement in hand function evaluated by the grip and pinch strength, 9-hole peg test, and Jebsen hand function test.

4) The performance in activities of daily living was improved after surgery in 4 patients including all quadriplegic patients.

5) Six patients expressed satisfaction to the results of surgery in terms of improvement in cosmetic view, function and ease for hygienic care.

SPR of cervical nerve roots was considered as an effective method of treatment for the spastic dysfunction of upper extremity without noticeable complication.

The purpose of this study is the evaluation of the degree of post-injection soreness and autonomic symptoms after trigger point injection in patients with trigger points. We divided the subjects of the study into four groups such as, 2% lidocaine injection, normal saline injection, dry needling only, and dry needling with electrical stimulation group, including 20 patients, and measured the visual analog scale(VAS) before treatment and after treatment.

Before treatment, the VAS mean scores were 6.0±1.16 in dry needling with electrical stimulation group, 6.6±1.35 in dry needling group, 6.8±1.28 in lidocaine injection group, and 6.4±1.08 in normal saline injection group(p=0.1447). In postinjection 3rd day, the VAS mean scores were 0.8±0.63 in dry needling with electrical stimulation group, 1.7±1.08 in dry needling group, 1.6±1.53 in lidocaine injection group, and 4.3±1.11 in normal saline injection group(p=0.0001). As a result, dry needling with electrical stimulation group showed less post-injection soreness and better effect than other groups.

Motor and sensory nerve action potentials of the median and ulnar nerves were studied in 50 normal subjects. The distal latency, amplitude and area were compared between the two nerves of the same healthy subject. Regarding motor conduction study, the distal latency and amplitude ratio of the median to ulnar nerve were 1.26 and 1.03, respectively.

The amplitude and area of the median sensory nerve action potentials were significantly larger than those of the ulnar nerve, and the distal latency and amplitude ratio of the median to ulnar sensory action potential were 0.98 and 1.23, respectively. The difference of the sensory distal latency was -0.06msec.

A comparison of the parameters between median and ulnar nerve conduction study can be used in the diagnosis of the carpal tunnel syndrome and is particulary useful in those patients who show normal median motor and sensory latency.

Lumbar spinal stenosis is a well recognized clinical entity resulting in low back pain and leg pain.

However, our understanding of the neuropathophysiological changes is limited, and precise etiology of neurologic signs and symptoms associated with lumbar spinal stenosis is not clearly known yet. And the degree of narrowing of the spinal canal and its relationship to electrophysiologic changes is also not known.

So, to find out that certain types of the spinal configuration may be related to the development of spinal stenosis, we compared various radiologic parameters on plain radiographs and CT scanning between the control and the lumbar spinal stenosis groups, And to find out the relationship between the configuration of the spine and somatosensory evoked potentials, we measured various radiologic parameters on plain rediographs and CT scanning in radiologically proven 46 lumbar spinal stenosis patients, and compared these radiologic parameters between the two groups which elicited abnormal and normal somatosensory evoked potentials.

The results were as follows.

1) Convex, trefoil canal shape and type N lamina of L4 which had narrow interarticular and interlaminar distance and the more sagittal facet joints were more frequently found in lumbar spinal stenosis.

2) There was no relationship between the configuration of the spine and somatosensory evoked potentials in lumbar spinal stenosis. And radiologic findings which are morphlogic and anatomic should not necessarily be considered as responsible for the patients' physiologic complaints and small canal by itself may not have any predictive value in symptomatic patients. So, we think it is essential to include somatosensory evoked potential study which is a physiologic study in the diagnosis of spinal stenosis.

The isolated long thoracic nerve palsy is a rare, poorly understood and potentially disabling curiosity, and etiology of the disease is still uncertain. It is believed that most cases are due to trauma or traction injury or to neuralgic amyotrophy. 10 cases of isolated long thoracic nerve palsy were diagnosed in our EMG laboratory during nine year period.

This article presents three cases of traumatic etiologies, three cases of unknown etiologies and four cases of long thoracic nerve injury following surgery. The purpose of this study is to present information pertaining to the clinical features, anatomy, etiologies of the condition and to discuss our experience of 10 cases with literatures. It is considered that a number of these cases were examples of neuralgic amyotrophy and etiologies of postoperative long thoracic nerve palsy must include a coincidental neuralgic amyotrophy.

For many years, diabetic neuropathy has remained one of the most puzzling aspects of diabetes mellitus.

The purpose of this study is to evaluate the factors influencing n diabetic neuropathy as well as the value of peripheral nerve conduction study in diagnosing diabetic neuropathy.

Our study was bases on 95 cases of diabetes mellitus that were admitted to Wonju Christian Hospital and received electrodiagnostic examination.

The summary of results was as follows:

1) Of the 95 cases of diabetes mellitus, 52(54.7%) cases were diagnosed as diabetic neuropathy.

2) Mean duration of diabetes mellitus was 89.40±69.59 months in the neuropathy group and 32.83±42.12 months in the non-neuropathy group. Statistically the difference was highly significant(p<0.001).

3) Diabetic neuropathy significantly increases as the levels of HbA1c, AC and PC2hrs also increased(p<0.05).

4) In the diabetic neuropathy group, the most frequently involved nerve among sensory nerve fibers was the sural nerve(77%), and the median nerve(71%) was the most frequently involved nerve among motor fibers.

5) The abnormality of H-reflex was 41 cases(43.2%) in the neuropathy group, and was 5 cases(5.3%) in the non-neuropathy group, which had a very significant difference from each other(p<0.001).

According to these results, we concluded that the long duration of diabetes mellitus as well as high levels of HbA1c and blood glucose were highly related with diabetic neuropathy, and also concluded that the nerve conduction study including H-reflex was a useful method for early detection of diabetic neuropathy.

This study was planned to evaluate the clinical significance of MRI(Magnetic Resonance Imaging) findings in assessment of the children with developmental motor delay or motor pathology.

Brain MRI study was performed in 34 children with developmental motor delay or motor pathology evaluated at Department of Rehabilitation Medicine, St. Mary's Hospital, Catholic University Medical College, between March 1991 and March 1993. Of the 34 children 18 were boys and 16 were girls. Their ages ranged from 4 months to 4 years 5 months(mean 12.9 months).

Besides brain MRI, evaluation consisted of patients'

(1) medical, developmental, family and pregnancy histories,

(2) physical examination,

(3) developmental assessment(MFED: Munchener Functionelle Entwichlungs Diagnostik).

Excluded from this study were children with lower motor neuron disorders, known to primarily cause developmental motor delay or motor pathology.

To analyze the relationship between MRI findings and motor delay, MRI findings were divided into 4 groups:

Group 1: Cases showing normal myelination without associated abnormality and white matter pathology.

Group 2: Cases showing normal myelination with associated abnormality or white matter pathology

Group 3: Cases showing delayed myelination with or without associated abnormality and white matter pathology.

Group 4: Cases showing myelination disorder such as leukodystrophy.

Range and mean±standard deviation(S.D.) of Motor Quotient(M.Q.) were obtained in each group.

Motor age and the age estimated by myelination on MRI were compared in group 3.

The results were as follows:

1) 26(76.5%) of 34 children with developmental motor delay or motor pathology had significant abnormalities on brain MRI.

2) The number of cases in each group was 8 cases(23.5%) in group 1,16 cases(47%) in group 2,9 cases(26.5%) in group 3, and 1 case(2.9%) in group 4.

3) Range and mean±S.D. of motor quotient in each group were 50~73(63.6±6.8) in group 1,7~73(29.5±19.4) in group 2, 14~66(35.7±19.9) in group 3, under 10 in group 4.

4) In group 3 with delayed myelination, motor age corresponded to the age estimated by myelination on MRI in 7 out of 9 cases.

5) The findings observed in children under 6 months of age were white matter pathology, associated abnormality or myelination disorder and those in children over 6 months of age were delayed myelination as well as white matter pathology or associated abnormality.

In summary, the data obtained in this study were helpful for identifying and assessing the children with developmental motor delay or motor pathology.

When thoracic and lumbar spine fracture occurs, some degree of neurologic deficit is present in a significant percentage of cases. Knowledge of the fracture patterns in each anatomical area of the spine allows to assess the relative stability of the injury, the risk of an associated neurologic deficit, and the specific treatment needed. We studied the frequency of the neurologic deficits with various clinical findings.

Retrospective studies of 151 patients with thoracic or lumbar spine fractures from January 1987 to August 1992 were performed. There were 93 males and 58 females. The average age was 43.0. There were 20 (13.2%) fractures of the thoracic spine, 83 (55.0%) fractures of the thoracolumbar junction, and 48 (31.8%) fractures of the lumbar spine. The neurologic deficit was noted in 26.5% of the patients; 6.0% cord lesion in thoracic fracture, 14.5% cord or multiple root lesion in thoracolumbar fracture, and 6.0% multiple root lesion in lumbar fracture. Operative managements were performed in 37.1% of patients, and spinal orthoses were applied in 30.6% of patients. The average length of hospital stay was 53.3 days.

In clinical practice, there is too often given to cardiac cause in explanation of chest pain and too little regard in paid to local structual causes. The purpose of this study was to evaluate frequency and clinical findings of noncardiac chest pain, initially believed to be cardiac in origin, were evaluated by chest X0ray, serial electrocardiogram, echocardiogram 24hours Halter monitering, Thallium²⁰¹ Heartscan, treadmill test, and cardiac angiogram. We found 50 patients without any abnormality on above examination and evaluate to identify noncardiac cause of anginal pain, including 24 hours PH monitoring, careful physical examination for musculoskeletal system, and occasionally cervical X-ray and electro-myography.

As a result, 50 patients(26.7%) had noncardiac anginal pain with no evidence whatever of underlying cardiac disease, and 17 patients(10.2%) with musculoskeletal problem cause anginal chest pain. Careful analysis of the history, physical findings, and recognition of noncardiac chest pain are essential to precise diagnosis and effective treatment of both cardiac and noncardiac chest pain.

We performed the rehabilitation care for the disabled persons and preliminary study for the Community Based Rehabilitation(CBR) project around Kangwon-Don community at fourteen times since July 1987 to July 1993, which was composed of medical care, speech evaluation, counselling for education, psychological counselling, physical and occupational therapy, vocational counselling and dermographic research for the disabled. We obtained the basic data from this work conclusively to establish the most appropriate and helpful CBR project for this community.

The results were as follows:

1) The total number of registered disabled persons in this community consulted to CBR project was 6,801 and the prevalence rate was 0.7% of the population.

2) The total number who was consulted to this project was 1358, male 920(68%) and female 438(32%). The most common age was the sixth decade as 20%. The physically disabled persons were counted to 61% as the most common type among the disabled.

3) Amputation was the most frequent cause of the physically disabled as 21% and next, cerebral palsy, brain injury, spinal cord injury.

4) Medical care and medication among the contents of rehabilitational service was the most common desire and service as 866(64%), followed by speech evaluation and counselling for education as 352, psychological counselling as 292, physical and occupational therapy as 245, vocational counselling as 135.

5) For successful CBR project in Kangwon-Do, rehabilitation program for amputee and cerebral palsy should be established more practically and the existing program must be modified to more effective and well organized plans.

6) Further CBR project for disabled persons should be established according to the characteristics for each local community.

Congenital bilateral perisylvian syndrome(CBPS) is a recently described entity diagnosed on the bases of neuroimaging and speech abnormality. All patients have severe orofacial paresis, moderate to severe dysarthria and bilateral and bilateral perisylvian dysplasia. Dysarthria is a striking clinical manifestation of this syndrome and the recognition of specific pattern of dysarthria has the diagnostic significance of this unique syndrome.

We evaluated the acoustic characteristics of dysarthria in 4 CBPS patients who were diagnosed by magnetic resonance imaging(MRI) scanning using digital computerized spectrograph, Visi-Pitch^Ⱂ and Nasometer^Ⱂ.

In the spectrographic analysis, loss of specific characteristics of formants of vowels and increment of noise in the high frequency regions were observed. The voice onset time(VOT) was prolonged in the bilabial and alveolar stop consonants. Total duration of meaningless words containing two syllables were increased as well. In the Visi-Pitch^Ⱂ analysis, mono-pitch and mono-loudness were characterized and diadochokinetic rate was decreased. Nasalance was increased and the slope of nasalance was flat in CBPS patients in comparison with normal subjects.

These findings are reflection of the impairment of facial motor area in the primary motor cortex, which results in altered movement of tongue, lips and velopharynx. The recognition and objective evaluation of the acoustic characteristics of dysarthria in the these patients can give a clue for the diagnosis of this syndrome.

The effect of electromyographically triggered electric muscle stimulation was evaluated in 41 consecutive postcerebral vascular accident patients. We classified the patients into 3 groups according to the duration from onset to the start of the treatment. The time from onset of the 3 groups were less than 3 months(group I), 3 to 6 months(group II), more than 6 months(group III).

The patients were treated for 6 months and the effect of the treatment was evaluated for quantitative EMG interference of extensor digitorum communis muscle, active range of motion of midcarpal joint of the hand, spasticity of long finger flexor. To evaluate the effect of early treatment, we compared the effect of treatment with age, sex and duration matching control group. The control group consisted of 16 postcerebral vascular accident patients.

The early treated group(group I) showed more improvement than the control group in all 3 evaluation parameters. Group I showed more improvement than group II and group III. Group III improved especially in the spasticity of long finger flexor. All patients who showed improvement at 6 months of follow up improved within 2 months since the start of treatment, which means for the evaluation of the effect of treatment follow up evaluation must be conducted after 2 months of treatment. The factors for good treatment response were early treatment, Brunnstrom stage of the hand and somatosensory evoked potential of median nerve.

A major role in symptom production of lower back pain patient is nerve root inflammation. Sixteen patients who were complaining of lower back pain from various causes, received caudal epidural steroid injections of 20 ml solutions containing triamcinolone acetate of 80 mg and lidocaine hydrochloride of 160 mg.

The results were as follows:

1) Visual analogue scales were checked in preinjection time, immediate postinjection time and three days after the injection of intraspinal steroid. In whole group, they were 72, 14±13.51, 49.64±14.24, and 57.79±17.19 respectively. In root pain group, 62.00±18.63, 37.80±12.79, and 38.80±14.67 respectively. In mixed pain group, 77.78±4.79, 56,22±10.54, and 68.33±4.72 respectively.

2) Visual analogue scale differences between preinjection time and immediate postinjection time of intraspinal steroid were the highest percent in above 30 group.

3) Visual analogue scale differences were checked both between preinjection time and immediate postinjection time and between preinjection time and on the 3rd day of postinjection. In whole group they were 22.50 and 14.35 respectively. In root pain group 24.20 and 23.20 respectively. In mixed pain group 21.56 and 9.45 respectively.

Injuries to the brachial plexus in one of the serious complications of athletic injuries. Two cases of appear brachial plexopathy occurring during playing golf without associated falls or direct violence to the shoulder are reported.

The results of these cases were as follow;

1) The injury mechanism: The upper extremity extended to shoulder height and abducted, the head and neck hyperextended with the brachial plexus placed on stretch during "take away" and "follow through" swing motion. Traction is the most common mechanism of this type of injury to the brachial plexus.

2) The site of lesion: Two cases were supraclavicular lesions. The increase in the angle between shoulder and neck places greatest stress on the upper elements of the plexus, especially upper trunk is predominantly involved.

3) The duration of recovery: Injuries of this type occur from strech, and in a relatively short period of time the arm regain almost normal function without surgical intervention

Posttraumatic syringomyelia can be a subtle entity initially. Its variety of clinical features, awareness of the early clinical manifestations is a necessary adjunct in preventing disabling sequelae, Because the clinical manifestations of posttraumatic syringomyelia are variable and subtle, physicians who care for patients with spinal cord injury should be aware of the sings and symptoms of posttraumatic syringomyelia. Pain and autonomic symptoms should alert the physician to the possibility of this entity as initial symptoms. It can be suggested that as the location of syringmyelia is near the center of the spinal cord of the intermediolateral cell column and lateral reticulospinal tract, which related to control of the sympathetic nervous system, central cysts of the spinal cord can be expected to interfere with sympathetic function. We examined the eight spinal cord injured patients for the newly developed problems of aggravation of pain, orthostatic hypotension, excessive sweating, anhydrosis, autonomic hyperreflexia, aggravation of spasticity and paroxysmal episodes of unconsciousness following stable period of fixed neurologic and medical state after traumatic spinal cord injury. In three of these 8 patients, magnetic resonance imaging confirmed the presence of posttaumatic syringomyelia.

Spinal epidural anesthesia is safe and simple method, thus used widely, and successfully in anesthetic field. Neurological complication after epidural anesthesia is very rare.

We experienced a case of unilateral S1 radiculopathy immediately after epidural anesthesia with characteristic electrodiagnostic findings.

A review of previously reported cases show that S1 radiculopathy after epidural anesthesia or lumbar punture is absent.

The pathogenesis of S1 radiculopathy as a complication of epidural anesthesia in this case is probably related to that of direct trauma or local anesthetic toxicity to unilateral S1 nerve root.