Significant technical advance during the past decade have influenced the manner in which electrical stimulation may be administered to assist the functional recovery of paralyzed organ. Functional electrical stimulation (FES) is defined as the use of electrical stimulation to activate paralyzed or paretic muscles in precise sequence and intensity to assist in the performance of activities of daily living. An FES system generally consists of a control unit, stimulator unit, and electrode. The control unit determines the intensity of electrical stimulus applied to the patient through the electrodes. The stimulator unit generates the electrical stimulus. Depending on the application, FES components may be worn externally or surgically implanted. Hand neuroprosthesis system can enhance significantly the upper extremity functions of quadriplegics. Several lower extremity systems with and without bracing are being investigated for the purpose of ambulation, transfer, and standing for persons with paraplegia. Diaphragmatic pacing can be used as more physiologic artificial ventilator for high quadriplegic patient with respiratory failure. System for bladder contraction can provide catheter-free micturition for persons with supra-sacral cord injury. While there appears to be great potential for its use in a number of medical conditions, further research and clinical study is needed to truly demonstrate its clinical benefit before it gains more widespread acceptance and use.

Conclusion:

Objective: The purpose of this study was to find out whether the duration of the silent period evoked by magnetic transcranial stimulation could be modulated by lorazepam.

Method: Ten healthy volunteers were tested using the transcranial magnetic stimulation. Responses were recorded in the active abductor digiti minimi muscle, and baseline values were compared to the data obtained at 2 and 5 hours after administration of a single oral dose of 2.5 mg lorazepam.

Results: The motor threshold and size of the motor evoked potential remained unchanged after administration of lorazepam. The duration of cortical silent period was prolonged from 169.9⁑33.7 msec at baseline study to 248.1⁑50.4 msec at 2 hours and 248.5⁑47.3 msec at 5 hours after administration of the drug (p＜0.01), but the peripheral silent period did not show any significant change.

Conclusion: We have shown that the cortical silent period evoked by magnetic transcranial stimulation can be prolonged by administration of lorazepam. And the lack of effect on the motor threshold and on the size of the motor evoked potential after administration of lorazepam may indicate that these parameters are physiologically distinct from the cortical silent period. Therefore, prolonged cortical silent period may be resulted from the reinforcement of GABA action by lorazepam at the level of the motor cortex.

Conclusion:

Objective: This study was undertaken to characterize the nutritional status, the status of growth and the relation to various factors in cerebral palsy.

Method: Forty patients with cerebral palsy (20 quadriplegia, 20 diplegia) were investigated. Information was obtained from medical record, clinical measure and anthropometric measure (weight for height, triceps skinfolds thickness per age, height for age). Values of weight for height or triceps skinfold below the 2.5 percentile were defined as "undernutrition", values of height for age below the 2.5 percentile were defined as "growth retardation". Denver Developmental Screening Test (DDST) at the 12 months old and at the examined time, oromotor score, pattern of defecation, duration of gait per day of patients were interviewed from caregivers. Spasticity was measured by using Modified Ashworth's scale.

Results: Eleven children (27.5%) were in undernutrition state and 9 (22.5%) growth retardation. Oromotor dysfunction was positive in 62.5% and constipation in 30%. Less gait time, more severe oromotor dysfunction and fine motor delay in DDST and more quadriplegic type (p＜0.05) were found in undernutrition group and no significant difference of spasticity and constipation. With logistic regression, quadriplegic type is the only significant factor to undernutrition.

Conclusion: Undernutrition is common in cerebral palsy and quadriplegic type is significantly related to undernutrition.

Objective: We documented childhood strokes in this hospital to ascertain the causes of childhood strokes and the proportion of stroke types.

Method: We reviewed the medical records and brain imaging studies of all children with possible strokes who were admitted to Asan Medical Center from 1990 to 1999. Our review of charts identified 131 acute childhood stroke patients aged from one to eighteen years old. Results: Seventy boys (53.4%) and 61 girls (46.6%) were involved in this study. The predominant diagnoses responsible for the stroke were arteriovenous malformation (42.0%) and moyamoya disease (24.4%). The diagnoses of 30 stroke patients (22.9%) were undetermined, 16 of them were ischemic and 14 hemorrhagic. The total number of hemorrhagic stroke was almost twice as that of ischemic stroke. As patients aged, the incidence of ischemic stroke decreased while the opposite trend was observed in hemorrhagic stroke. There were 14 death (10.7%) consisting of 13 hemorrhagic stroke patients and 1 ischemic during the admission period. Relapse of stroke were noted in 19 of 131 patients (14.5%) with the main cause being arteriovenous malformation.

Conclusion: Although the main diagnoses of childhood strokes were arteriovenous malformation and moyamoya disease, the cause of strokes in 23% could not be confirmed. The incidence of ischemia decreased while that of hemorrhage increased with the increase in age. Death, relapse, and complication occurred more frequently in hemorrhagic than ischemic stroke.

Objective: We used music as a rhythmic cue in gait training of patients with hemiplegia and analysed its effect on gait parameters.

Method: Twenty hemiplegic patients were included in the study. Gait cycle, foot contact area, and center of pressure pathway were measured by F-scan with and without music. Four subjects were followed after 3 weeks of gait training using rhythmic cue with music.

Results: 1) In involved limb, stance phase was slightly increased from 65.8⁑9.9% to 67.8⁑7.9%, and single limb support was changed from 17.1⁑6.3% to 17.2⁑6.2%, without statistical significance. 2) Stance and swing symmetry was slightly increased from 0.77⁑0.13 and 0.52⁑0.21 to 0.83⁑0.09 and 0.54⁑0.16 respectively, without statistical significance. 3) Foot contact area and anteroposterior distance of center of pressure were not changed significantly. 4) All 4 subjects who were followed after 3 weeks showed increased single limb support of involved limb (from 14.5% to 18.8%) and swing symmetry (from 0.47 to 0.67).

Conclusion: Though it was not proved to be effective for every hemiplegics, use of rhythmic cue with music in gait training may be helpful in some patients. Further study is needed to confirm these results.

Objective: To confirm the merit of a newly-developed computer system that detects gaze in diagnosing unilateral visual neglect syndrome.

Method: The subjects were 20 normal adults and 2 left hemiplegic patients with prominent unilateral visual neglect. The 'line bisection' test and the 'star cancellation' test were performed, and their modified forms of tests-the 'center scanning in vacant 2-dimension space' and the 'one object scanning' among 25 different objects were also performed on a table with right hand and on a computer monitor with head motion.

Results: Normal subjects didn't show difference in line bisection and center scanning tests. However, center scanning time was shorter in the methods that used a computer. By comparing horizontal shifting in the line bisection test and the center scanning test, the center was more shifted toward left side than in the line bisection test when the tests were performed using a computer. Duration to perform the star cancellation was longer than to perform the one object scanning test. It took 3 minutes for each subject to obtain the results from the line bisection and the center scanning on papers, whereas the results from the tests with a computer were displayed at the moment of marking by the subjects. By the results from the patients, the marked centers were deviated toward right side and longer duration was needed to perform the tests in comparison with normal subjects.

Conclusion: Visual perception can be changed by dimension even in normal adults, and the program using a computer that was developed in this study has merit especially by shortening the testing time. However, continuous study is needed for practical use of this program in the patients with unilateral neglect.

Objective: The aim of this study is to develop the PC-based Mini-mental Status Examination (PC-MMSE) including its protocol to improve the reliability of MMSE, to have convenience for administration, and to evaluate the test-retest reliability.

Method: The factors of decreasing the reliability on MMSE are analyzed such as following. 1) The way of question, pronunciation, and loudness of speech can be different between the test-retest or tester-tester, 2) the learning effect can occur when the test is repeatedly administrated, and 3) the test protocol is not determined in detail. The PC-MMSE and its protocol are designed to solve this problem. PC-MMSE has been developed to have functions such as following. 1) It was made constant verbal stimulation, 2) the question contents of the same level of difficulty in changeable items were developed and some of those can be randomly selected, and 3) it was made the adminstration of test and the management on the test results, conveniently. Protocol on PC-MMSE was also developed for standardization in the administration of test. These two tests of PC-MMSE on 26 stroke patients are administrated for the evaluation of test-retest reliability.

Results: The test-retest Spearman's correlation coefficient of PC-MMSE is 0.967 (p＜0.01). The Spearman's correlation coefficient of PC-MMSE which is related with sex, education, lesion site, and hemiplegic side is more than 0.89.

Conclusion: The PC-MMSE and its protocol are thought to be useful for the repeated evaluation of cognitive function

Objective: Nasogastric (NG) tube feeding and percutaneous endoscopic gastrostomy (PEG) feeding have been used for dysphagic patients as tube feeding methods. In 1988, Campbell introduced oro-esophageal (OE) tube feeding as a new feeding method, but there are no reports of safety or complications of this method.

Method: The patients 1) who could not do oral feeding and reject other tube feedings, or started oral feeding but could not be provided enough calories by this methods, 2) who had the reduced gag reflex, and 3) who had intact cognitive functions, were applied OE tube feeding and twenty patients from March 1998 to May 1999 were selected and followed up. We retrospectively reviewed their average using time, final feeding methods and complications of long term OE tube feedings.

Results: The average using time was 74⁑107 days. 13 patients used OE tube feedings continuously, and seven changed their feeding methods (two used NG tube feedings, one PEG, and 4 oral feedings). Only one patient was developed aspiration pneumonia, so he was prescribed for NG tube feeding, but others had no problems such as diarrhea.

Conclusion: The complication rate of OE tube feeding was 5%, and it was relatively safe for long term users.

Objective: The purpose of this study is to determine neurotrophin effect in Fe^⁢⁢-induced experimental spinal cord injury in adult female rat.

Method: Thirty Long-Evans rats (weight, 250 to 300 gr) were divided into 6 groups. Group I was control group. Group II was Fe-only group. Group III was NGF-only group. Group IV was NGF-Fe group. Group V was NT4-only group. Group VI was NT4-Fe group. For all experimental animals spinal cord was exposed by T10 laminectomy. Neurtrophin and Fe^⁢⁢ was injected at spinal cord directly by glass needle with ∼100 um diameter mounted on Hamilton syringe. Animals were sacrificed, spinal cord was extracted and prepared in sagittal section. Tissues were stained with LFB, NeuN and APC staining method. The amount of spinal cord damage was measured at 3 different locations under the microscope.

Results: Fe-only group showed more damage than the control group. NGF-only group showed the same result as the control group. NT4-only group showed more damage than the control group in LFB staining. NGF-Fe group showed the same result as Fe-only group. NT4-Fe group showed more damage than Fe-only group.

Conclusion: NGF has no additional effect, but NT4 potentiated Fe toxicity in Fe-induced experimental spinal cord injury. NT4 seems to be toxic to rat spinal cord in high dose.

Objective: In the management of spasticity, intramuscular neurolysis with small amount of dilute aqueous phenol has proved to be a useful measure. But, considerable problem has taken place in utilization of phenol. This study was attempted to compare the effect of phenol and alcohol for the peripheral nerve blocking in the management of spasticity.

Method: Intraneural injection of 5% phenol, 50% alcohol and 90% alcohol solution carried out in each group of 10 rats. A total of 30 rat were injected and examined electrophysiologically before and after blocking the nerve (24 hour, 1 weeks, 2 weeks, 4 weeks, 8 weeks). The randomized one rat of each group was sacrificed for the histological examination of the sciatic nerve at every examined day.

Results: There was no difference of the distal latencies and amplitudes of compound muscle action potentials among the groups before injection. The latencies were prolonged at 24 hours post-injection and shortened at 1 week post-injection in all the groups. The amplitudes were markedly decreased at 24 hours post-injection and increased at 1 week post- injection and reached the pre-injection value at 8 week post-injection in all the groups. Histologic studies showed necrosis at 1 week post-injection and regeneration at 2 week post- injection in 50% and 90% ethanol groups. Phenol injection group showed necrosis at 4 week post-injection and regeneration after 8 weeks.

Conclusion: Our preliminary experience with alcohol for peripheral nerve blocking with encouraging result has been described.

Objective: To evaluate the effect of local cooling on the parameters of electrodiagnostic study of the patients with carpal tunnel syndrome.

Method: Twenty subjects with carpal tunnel syndrome and fifteen normal subjects were enrolled. The latency and conduction velocity of median motor and sensory nerves at wrist and elbow were measured with the different skin temperature at 32^oC as a baseline, and at 20^oC after cooling of mid-palm area by cold water immersion.

Results: The distal motor and sensory onset latencies were prolonged, and the sensory nerve conduction velocity was decreased after local cooling in both the patients and normal control group (p＜0.01). The differences of distal motor and sensory onset latencies, and sensory nerve conduction velocity between before and after local cooling were statistically significant in patients group (p＜0.01) compared with control group.

Conclusion: These results showed that the patients with carpal tunnel syndrome reacts differently to temperature changes compared with normal control in electrodiagnostic study.

Objective: To investigate the association of the muscle contraction with gating of the sensory input at central and peripheral levels according to the intensity of muscle contraction and location of the muscles, somatosensory evoked potentials (SSEPs) studies were evaluated at different levels of isometric contraction in the different muscles.

Method: Median nerve SSEPs were recorded at Erb's point and scalp in the ten healthy adult subjects with isometric contraction of ipsilateral abductor pollicis brevis (APB), ipsilateral abductor digiti minimi (ADM) and contralateral APB. Median nerve SSEPs were recorded in each of these conditions during precontraction, weak contraction, strong contraction and 4 minutes after contraction.

Results: 1) N9 amplitudes of median SSEPs recorded at Erb's point were augumented during weak contraction and these amplitude augumentations were statistically significant in the ipsilateral APB contraction (p＜0.05). 2) N20 amplitudes recorded at scalp were inhibited during strong isometric contraction and these amplitude inhibitions were statistically significant in the ipsilateral APB contraction (p＜0.05). 3) The latencies of N9 and N20 potentials were not significantly changed during isometric contraction.

Conclusion: Therefore peripheral nervous system as well as central nervous system is responsible for gating, so the subject should be asked for the best relaxation possible for higher reliability of SSEPs.

Objective: To establish the posterior cutaneous nerve of arm (PCNA) conduction technique and set up the reference values.

Method: A PCNA conduction study was performed in 80 nerves of 40 neurologically healthy adult subjects with a mean age of 38 years (range, 20 to 56). Dantec Counterpoint MK2 machine was used. The recording bar electrodes were placed 10 cm distal to the axillary fold on a line connecting the posterior axillary fold and the olecranon. Supramaximal stimulation was applied to the axilla posterior to the brachial artery. Onset latency, baseline to peak amplitude and negative spike duration of sensory nerve action potentials were obtained. Skin temperature was measured in the posterior arm and maintained at 34^oC or above.

Results: Compound sensory action potential for the PCNA was recordable in all the subjects. The results were as follows: onset latency, 1.7⁑0.1 msec; baseline to peak amplitude, 4.6⁑1.4μV; negative spike duration, 1.1⁑0.2 msec.

Conclusion: PCNA response is readily obtainable. This study may help to assess the pain or paresthesia in the posterior aspect of the arm, although more studies are required for clinical application.

Objective: To investigate the patterns of the temperature effect on motor nerve conduction parameters according to various warming methods and to obtain the most valuable method of warming in clinical setting.

Method: Twenty normal subjects were studied. After limb cooling in cold water, the cooled hands were warmed by hot pack, fan heater, and whirl pool. The median motor responses were recorded at abdnctor pollicis brevis after the stimulation at the wrist during warming at 1 min interval until the temperature increment reached plateau. We measured the temperature changes and conduction parameters were measured at each examination.

Results: The time constants for temperature increment and distal motor latency, duration, area of compound muscle action potentials showed shorter tendency by hot pack and whirl pool than by fan heater (p＜0.05). For the measurement of distal motor latency, time constant of whirl pool (2.49⁑1.21 min) was shorter than that of fan heater (7.12⁑3.12 min) or hot pack (5.96⁑1.98 min) (p＜0.05).

Conclusion: These findings suggest that the use of whirl pool is the most effective method for warming of the cooled limb.

Objective: The purpose of this study was to determine whether quantitative sensory test can be used as a screening test of peripheral polyneuropathy in patients with diabetes mellitus, and to evaluate the severity of peripheral polyneuropathy in patients with diabetes mellitus using quantitative sensory test.

Method: We performed nerve conduction study to right upper and left lower extremity of the patients. Quantitative sensory test was performed using TSA-2001 thermal sensory analyser on right thenar and left foot dorsum in both diabetic and control groups.

Results: 1) The warm sense and heat pain threshold were higher, the cold sense and cold pain threshold were lower in diabetic group than age-matched control group (p＜0.05). 2) The warm sense and heat pain threshold were higher, the cold sense and cold pain threshold were lower in diabetic group than young-aged control group (p＜0.05). 3) As nerve conduction study results were severe, the cold sense threshold in right thenar were decreased (p＜0.05).

Conclusion: Quantitative sensory study in patients with diabetes mellitus are sensitive to identify neuropathic change; thus, they would be used as the screening method of diabetic peripheral polyneuropathy.

Objective: Using Lee et al (1996) model, we assessed the effect of opioid within the PAG on the manifestations of the neuropathic pain, and we studied the effects of naloxone on the analgesic effects of opioid.

Method: Under pentobarbital anesthesia, male Sprague-Dawley rats were implanted with cannula in the ventral (n=10) and dorsal (n=6) PAG after the unilateral tibial and sural nerves were ligated and cut, leaving the common peroneal nerve intact. Pain sensitivity was assessed using the von Frey filament (8 mN) and acetone applied to the sensitive area for 1 week postoperatively. Rats with neuropathic pain were intracerebrally microinjected with DAMGO (0.1μg/5μl) and enkephaline (20μg/5μl) into the ventral and dorsal PAG and the pain sensitivity was assessed. Naloxone was injected to assess the observed change of pain sensitivity.

Results: Intracerebral microinjection of DAMGO and enkephaline into the ventral PAG, but not the dorsal PAG, increased the pain threshold which was reversed by naloxone.

Conclusion: The results suggest that stimulation of the ventral PAG in neuropathic rats may reduce neuropathic pain via opioid-mediating pathway of the descending pain inhibition system.

Objective: To evaluate usefulness of the current withdrawal threshold (CWT) on evaluation of the neuropathic pain in animal model.

Method: Surgical neuropathy was induced in 40 Sprague-Dawley rats. Fourteen days after the surgery, neuropathic rats were evaluated by von Frey hair. The CWT was determined by various stimulus intensities which induce the tail-withdrawal response or vocalization of rats. The experimental group was compared with the control group by CWT. Then the experimental group was subdevided to two groups. The experimental group 1 was injected with beta-methasone 0.1 mg/kg, intra-peritoneally and experimental group 2 was injected with normal saline with the same amount as steroid. The CWT of two experimental subgroups were measured before and 30 minutes after injections.

Results: The experimental group showed significant decrease of the CWT compared with the control group after the neuropathic pain was induced. The CWT of experimental group 1 was increased after steroid administration (p＜0.01).

Conclusion: This preliminary study suggests that the measurement of CWT would be an useful tool to study the neuropathic pain in experimental animal model.

Objective: This study was designed to evaluate the demand for lumbosacral corset and to get a base line data for rehabilitation approach, management trends, demand for education of back pain, and incidence of back pain during pregnancy in Korean population.

Method: One hundred and fifty two postpartum women were included in this study. Each subject's demographic data, gynecologic data, back pain associated factors, and neonatal factors were collected.

Results: The incidence of back pain during pregnancy was 81%. Average age of back pain group and pain⁣free group were 29.8⁑4.51 and 26.8⁑5.50, respectively. Average age of back pain group was significantly older than pain⁣free group. Patients with previous back pain suffered from back pain during pregnancy more frequently than the patients without previous back pain. Sites of back pain were lumbar area (49.2%), midback area (29.5%), and sacroiliac area (21.3%).

Conclusion: Correlation factors of back pain during pregnancy were maternal age, previous history of back pain, and history of back pain during menstruation. Long term follow up study for back pain after delivery and early evaluation of back pain during antenatal care are recommended.

Objective: The goal of this study was to determine the efficacy of prolotherapy in relieving the pain of patients with tendon or ligament laxity.

Method: The subjects were 67 patients (40 male, 27 female) who were suffering from chronic musculoskeletal pain, excluding those with metabolic diseases that could influence the nature of the pain. The effect of the treatment was evaluated by checking the VAS score after a monthly injection of 15% dextrose solution injected around the patient's ligaments and teno-osseous junction that were suspicious of laxity. This same procedure was followed after a second injection. To make an accurate evaluation before and after the treatment, the use of NSAID, physical therapy or exercise therapy was prohibited.

Results: The mean pain duration of the subjects was 5.48⁑7.04 years, and the mean age of the subjects was 49.58⁑16.52 years. The result from VAS showed a statistically remarkable reduction after the injection (p＜0.01). The VAS decreased from 7.00⁑0.17 to 4.31⁑0.21 after the first injection and this score further decreased to 2.55⁑0.19 after the second injection. There was no statistically significant relationship between the duration of pain and the effect of the treatment (p＞0.05).

Conclusion: This research demonstrated that prolotherapy is an effective method in treating patients with chronic musculoskeletal pain caused by tendon or ligament relaxation.

Objective: To evaluate the usefulness of the diagnostic ultrasound (US) to diagnose carpal tunnel syndrome (CTS) and the correlation between electrodiagnosis and US findings.

Method: Forty hands of 30 patients diagnosed with CTS by electrodiagnosis and 28 hands of 19 controls were examined with US. The 7.5 MHz probe of the US was used to view the median nerve in the carpal tunnel. The short and the long axis and the area at the two points, 2 cm proximal and 1 cm distal to the distal wrist crease were measured. The flattening and compression ratio and the ratio of the area in both groups were analysed. The correlation between the eletrodiagnostic severity and compression ratio were analyzed.

Results: The compression ratio of CTS was significantly increased comparing with that of control group. The compression ratio of severe CTS was significantly increased comparing with that of mild and moderate CTS.

Conclusion: These results suggest that US is useful in diagnosis of CTS.

Objective: Ultrasound has been therapeutically applied for pain control in rheumatoid arthritis although little physiologic effects of sonication on rheumatoid tissue were known. This investigation was conducted to determine the effects of sonication on the cell proliferation and matrix metalloproteinase (MMP) production of cultured fibroblast like synoviocytes (FLS) derived from synovial tissues of rheumatoid arthritis.

Method: Pulsed ultrasound (1.0 MH_Z, 20 msec on, 80 msec off) with varying intensities (0, 0.1, 0.25, 0.5, 0.75, 1.0 W/cm²) was applied to experimental cell groups growing as monolayers in culture plates for varying durations (0, 30, 90, 180 seconds) in the presence and absence of interleukin-1β (IL-1β).

Results: There were no significant differences in thymidine incorporation between 0, 30, 90 and 180 second sonication groups with 0.5 W/cm² after 1 day and 2 days. There were no significant differences in thymidine incorporation between 0, 0.1, 0.25, 0.5, 0.75, 1.0 W/cm² sonication groups 1 day and 2 days after 90 second sonication. There were significant increase in MMP-1 (p=0.025) and MMP-3 production (p=0.000) of FLS after sonication in the absence of IL-1β but there were no significant differences in MMP-1 and MMP-3 production in the presence of IL-1β. And MMP-1 and MMP-3 production were increased significantly in the presence of IL-1β but not than in the absence of IL-1β.

Conclusion: While comparisons made between a limited number of FLS cell lines must be open to question, the overall consistency of the findings suggest sonication with nonthermal effect is not the contraindication in rheumatoid arthritis treatment but further study is needed in vivo in animal and in clinical studies.

Objective: To study the relationship between plantar pressure and diabetic foot ulcer and the assessment the usefulness of plantar pressure measurement in diabetic patients.

Method: The total 94 diabetic patients were enrolled in this study. The plantar pressure was measured by using EMED-SF. And the nerve conduction studies, physical examination, and history taking were done. Patients were divided into 3 subgroups, Group A: without neuropathy and past ulcer history (n=31), Group B: with neuropathy and without past ulcer history (n=44), Group C: with neuropathy and past ulcer history (n=19).

Results: 1) There were significant increase in the maximum peak pressure (MPP) and the pressure-time integral (PTI) values in the Group C as compared with the Group A and B (p＜0.05). 2) As compared among the groups for each areas, the MPP and the PTI significantly higher in group C for heel, medial fore-foot, and lateral fore-foot area than in another two groups (p＜0.05).

Conclusion: The high plantar pressure was significantly related with diabetic foot ulcer history. The plantar pressure measurement may be useful in diabetic patients as a predictive and management aids of diabetic foot ulcer.

Objective: Sagittal imbalance in lumbar degenerative kyphosis (LDK) is usually more evident when walking, suggesting its dynamic nature. Radiographic examination which only revealed the static status of the spine was considered to be inadequate for assessment of this condition. Gait analysis allows estimation of dynamic spinal imbalance associated with the pelvis and lower extremities in LDK. This study was designed to predict the success of surgery for LDK with gait analysis.

Method: Twenty-six patients who had corrective surgery after gait analysis and had been followed up for more than two years were included in this study. All patients were female, and in average 57.1 years of age (42∼70). Group I consisted of 21 satisfactory patients with marked improvement in stooping, and Group II consisted of five patients with persistent stooping, whose condition remained unsatisfactory despite surgery. In order to find the cause of postoperative persistent stooping, various radiographic and preoperative gait parameters were compared between the two groups.

Results: The average angle of anterior pelvic tilt, hip, and knee flexion were more increased in Group II than Group I. The pattern of hip internal moment in stance phase of gait cycle was biphasic in Group I, similar to the normal pattern, whereas it was monophasic and internal hip extensor hip moment was increased throughout the stance phase in Group II.

Conclusion: An available tool that permitts practical evaluation of dynamic sagittal imbalance of the spine is gait analysis as substantiated by the results of this study.

Objective: To present one case of dysphagia associated with jugular foramen syndrome (Vernet syndrome) by trauma. The jugular foramen syndrome refers to paralysis of the IX, X and XI cranial nerves. Dysphagia due to jugular foramen syndorme without pseudobular palsy is rare in traumatic brain injury.

Case Summary: A 16-year-old boy with the left occipital skull fracture and skull base fracture was not able to take any food by mouth. There was no other significant symptom without dysphagia. Physical examination, laryngoscopic examination and electromyography revealed paralysis of the left IX, X and XI cranial nerves. Videofluoroscopic examination demonstrated atonic ballooned pyriformis sinus and closed upper esophageal sphincter. Brain CT and MRI showed fracture line in the left jugular foramen without brain stem or diffuse cortical lesion. Feeding gastrostomy was performed.

Conclusion: We report an unusual case of dysphagia due to jugular foramen syndrome in traumatic brain injury patient.

The location of pelvic portion of the femoral nerve between the iliacus and psoas muscles makes the nerve particularly vulnerable in hemorrhage within iliacus. We report a uncommon case of bilateral femoral neuropathy resulting from unilateral retroperitoneal hematoma. A 28-year-old man developed zero-trace grade of muscular weakness on both knee extensor muscles, numbness over bilateral anteromedial thighs and medial lower legs, tenderness of both hip adductor muscles after stab wound at left abdominal region. Abdominal computerized tomographic finding showed hematoma of left psoas muscles. Electromyographic examination revealed no motor unit action potentials in both iliopsoas, vastus medialis and adductor longus muscles. Nerve conduction study noted no compound motor action potentials of both femoral nerves. The fascial walls and laminae of the pouches in the lower abdominal wall tend to reinforce the rigidity of the fibrous arch over the femoral nerve in the intermuscular groove. This neuropathy is suggested, when the pouches are filled with blood, would further increase pressure on the subjacent nerves, especially bilateral femoral nerves.

Carbamazepine is widely used to manage of seizures and symptomatic treatment of trigeminal neuralgia and central pain.

We experienced two cases of exceedingly rare but potentially fatal side effects following carbamazepine administration. One traumatic brain injured patient developed pancytopenia 3 weeks after beginning to take carbamazepine for prophylactic management of seizure and the other C6 incomplete spinal cord injured patient receiving carbamazepine for the management of central pain sequentially developed syndrome of inappropriate secretion of antidiuretic hormone (SIADH) 1 week after administration.

Because of more frequent indications of carbamazepine, these side effects must be borne in mind and cautious administration will be desirable.

Congenital lymphedema is usually confined to the lower extremities and an isolated unilateral arm involvement is very rare. We report a 36-year-old women who had congenital lymphedema of the right forearm and hand.

Infertility due to ejaculatory failure and poor semen quality is a main problem for sexual dysfunction of spinal cord injured (SCI) men. A 27-year-old paraplegic man who wished to father children was induced to repeated ejaculations for eight times with a rectal probe electrical stimulation at one or two weekly interval. For the 4th to 8th stimulations, the subject took pseudoephedrine 20 mg, three times a day orally to improve the semen quality. We report a triplet childbirth between the SCI man and his healthy wife through the ejaculatory stimulations in conjuction with advanced reproductive techniques such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).