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ABSTRACT: An acute spontaneous spinal epidural hematoma (SSEH) is a rare spinal pathology. A 57-year-old man who had hypertension and had been on dual antiplatelet therapy with aspirin and clopidogrel for primary prevention presented with the sudden onset of mid back pain and monoplegia of the left lower extremity. Magnetic resonance imaging revealed an epidural hematoma, and the patient underwent emergency hemilaminectomy for evacuation. However, the symptoms worsened, and complete paraplegia developed. A second procedure to remove the recurrent hematoma was performed. No vascular malformation or other possible cause for SSEH was found other than the aspirin and clopidogrel medication. This case report describes relapsed SSEH caused by the combination of aspirin and clopidogrel medication and urges caution in prescribing dual antiplatelet agents.
Neurological Sciences 03/2011; 32(4):687-9. · 1.32 Impact Factor
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ABSTRACT: The aim of this study was to identify the detectable threshold of knee effusion by ultrasonography while infusing saline.
Forty knee osteoarthritis patients were allocated randomly to either the midline or the lateral group. Intra-articular injection of 20 ml normal saline was performed under ultrasonographic guidance with the transducer fixated at the midline longitudinal or lateral longitudinal scan in the midline and lateral groups, respectively. We obtained ultrasonography images after infusing each milliliter and measured the maximum depth of effusion.
The smallest amount of infusion detected by ultrasonography was 4.37 ± 2.11 ml in the midline group and 4.13 ± 1.71 ml in the lateral group. An effusion more than 2 mm deep was observed after infusing 7.84 ± 3.85 ml and 7.38 ± 3.01 ml in the midline and lateral groups, respectively. To obtain a 4-mm depth, infusions of 11.58 ± 5.68 ml and 13.13 ± 4.88 ml were needed in the midline and lateral groups, respectively.
To detect knee effusion by ultrasonography, infusion of 4.26 ml (SD, 1.92 ml) of solution is needed. We think that a depth of 2 mm is more appropriate than 4 mm as the definition of knee effusion using ultrasonography.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 02/2011; 90(2):112-8. · 1.56 Impact Factor
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ABSTRACT: To assess the effects of joint effusion on proprioceptive status in patients with knee osteoarthritis (OA).
A single-blind, randomized, controlled clinical trial in 40 female subjects aged 50 years and over with painful knee OA. All subjects were randomly assigned to either the control or experimental group. A volume of 20 mL of normal saline was injected into the knee joint cavity of subjects in the experimental group under ultrasonographic guidance. Proprioceptive acuity was assessed by active repositioning of the lower limb using an electrogoniometer to measure knee joint position sense (JPS) under both non-weight-bearing (NWB) and weight-bearing (WB) conditions twice, with a 20-min rest interval. The experimental group performed the task twice (Test 1 and Test 2) before and within 5 min after joint infusion. The control group also performed Test 1 and Test 2 without joint infusion. The outcome of interest was the absolute angular error (AAE), ignoring the direction of the error, between the randomized target angle and the patient's reproduced angle of JPS values.
Compared with the control group, JPS was significantly compromised in the experimental group in the NWB test after joint infusion (P=0.025). However, no significant differences in the angular error were observed between Test 1 and Test 2 in the control group for the NWB or WB test or in the experimental group for the WB test after infusion (P>0.05).
This study showed that joint effusion impairs proprioceptive function in osteoarthritic knee joints.
Osteoarthritis and Cartilage 10/2010; 19(1):22-8. · 3.90 Impact Factor
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ABSTRACT: The purpose of this study was to assess which scan view was sensitive in detecting knee effusion by ultrasonography while infusing normal saline in cadaveric specimens.
Intraarticular injection of normal saline with contrast dye was done in increments (5, 10, 15, and 20 ml) into the knee joint of eight fresh cadavers. After infusion of each amount, sonographic images were obtained with five different scans: medial, midline, and lateral on longitudinal scans, and medial and lateral on transverse scans. When 20 ml had been injected, the knee was flexed at 30 degrees and serial images were taken.
After infusion of 10 ml, effusion of more than 2 mm depth with ultrasonography was most frequently seen in lateral transverse scans (14/14), and the next most frequent view was a lateral longitudinal scan (11/14). After knee flexion, the amount of effusion was increased on medial and middle longitudinal scans and was decreased on transverse scans.
For detecting knee effusion by ultrasonography, lateral transverse and longitudinal scans were the most sensitive in the knee extension posture. With knee flexion at 30 degrees, effusion was more readily detected on the medial and midline longitudinal scans than with knee extension.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 09/2010; 89(9):715-21. · 1.56 Impact Factor
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ABSTRACT: Several postpartum neurologic injuries have been described in detail, while obturator nerve injuries are rarely reported. We report a woman who had weakness of the right leg and groin pain after cesarean delivery under general anesthesia. Obturator neuropathy was confirmed by electromyography and no compressive lesion of the nerve was seen on magnetic resonance imaging. The patient was treated conservatively and followed until she recovered fully.
Archives of Gynecology 03/2010; 282(3):349-50. · 0.91 Impact Factor
