Comparison of phenol and alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle for treatment of spastic foot after stroke: a randomized controlled pilot study

AIM

The aim of this paper was to determine whether the injection of alcohol or phenol into the tibialis posterior nerve relive the symptoms and signs of ankle plantar flexor spasticity.

METHODS

Twenty patients with hemiplegic stroke were included. Patients were randomly assigned to receive a single treatment of alcohol or phenol injection to the motor branches of tibial nerve. Clinical outcome parameters were measured before Motor branch block, immediately, and at 1, 3, and 6 months after blocking. These parameters included a. Ankle plantar flexor spasticity assessed by Modified Ashworth Scale, b. Clonus of the ankle; c. The passive range of motion changes measured by goniometer and d. Motor strength of the ankle plantar flexors measured by the Medical Research Council grades 0-5.

RESULTS

In the alcohol group the spasticity score for the ankle plantar flexor was reduced in all 10 patients immediately after motor branch block and this was maintained over the 6 month follow up period in 9 patients. In the phenol group the spasticity score for the ankle plantar flexor was reduced in all 10 patients immediately after motor branch block and it was maintained over the 6 month follow up period in 7 patients.

CONCLUSION

It was observed that both two methods are effective in reducing spasticity however the use of 50% alcohol as a neurolytic agent in the management of ankle plantar flexor spasticity appears to be long lasting method of regional spasticity treatment.

Urethral cultures in patients with spinal cord injury

STUDY DESIGN

Prospective analysis.

OBJECTIVES

To investigate the colonization of the distal urethra and bladder during the initial stages of rehabilitation in acute spinal-cord injury (SCI) and to examine the association between bacteriuria and colonization of the distal urethra.

SETTING

Selcuk University Meram Faculty of Medicine, Konya, Turkey.

METHODS

A total of 27 patients with SCI (13 females and 14 males) and 40 controls without evidence of disease of the urinary tract were studied. Cultures were taken from the patients who applied clean intermittent catheterization and compared with normal subjects.

RESULTS

Escherichia coli was predominantly isolated from the urine and urethral cultures of both female and male SCI patients. Colonization of other bacteria in the urine and urethral cultures was similar in both female and male patients, except for Pseudomonas, which was colonized in male patients. In all, 72% of patients who had E. coli positive urethral cultures also had E. coli colonization in their simultaneous urine cultures. There was concordance between urethra and urine cultures concerning the growth of E. coli (P=0.82). When urethral cultures collected 1 week before were evaluated in patients with E. coli positive urine cultures (n=24 cultures), 15 of these urethral cultures also had E. coli colonization. There was concordance between urethra and urine cultures concerning the growth of E. coli (P=0.66).

CONCLUSIONS

Our study suggested that urethral flora was a significant source for the development of urinary infection in spinal cord-injured patients.

Fluoroscopy-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with ankylosing spondylitis

PURPOSE

Our goal was to prospectively study the therapeutic efficacy of CT-marking and fluoroscopy-guided intraarticular corticosteroid instillation of inflamed sacroiliac joints in patients with ankylosing spondylitis.

MATERIAL AND METHODS

A total of 22 fluoroscopy-guided intraarticular corticosteroid injections in the sacroiliac joints were performed in 17 patients with ankylosing spondylitis and severe low back pain. Needle puncture point, angle of intervention and distance of sacroiliac joint from the skin were determined by sacroiliac joint axial CT examination in prone position. 14 mg of betamethasone were instilled in each joint under fluoroscopy.

RESULTS

Twenty of 22 joints (90.9%) reported good improvement during a month after corticosteroid injection of the sacroiliac joint. The remaining 2 joints reported fair improvement.

CONCLUSION

CT-marking and fluoroscopy-guided intraarticular corticosteroid instillation in the sacroiliac joints may be regarded as an effective therapy. This technique was useful, rapid and safe.

Fluoroscopy-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with ankylosing spondylitis

PURPOSE

Our goal was to prospectively study the therapeutic efficacy of CT-marking and fluoroscopy-guided intraarticular corticosteroid instillation of inflamed sacroiliac joints in patients with ankylosing spondylitis.

MATERIAL AND METHODS

A total of 22 fluoroscopy-guided intraarticular corticosteroid injections in the sacroiliac joints were performed in 17 patients with ankylosing spondylitis and severe low back pain. Needle puncture point, angle of intervention and distance of sacroiliac joint from the skin were determined by sacroiliac joint axial CT examination in prone position. 14 mg of betamethasone were instilled in each joint under fluoroscopy.

RESULTS

Twenty of 22 joints (90.9%) reported good improvement during a month after corticosteroid injection of the sacroiliac joint. The remaining 2 joints reported fair improvement.

CONCLUSION

CT-marking and fluoroscopy-guided intraarticular corticosteroid instillation in the sacroiliac joints may be regarded as an effective therapy. This technique was useful, rapid and safe.

Lumbar spinal root compression caused by Brucella granuloma

STUDY DESIGN

A case report of rarely seen extradural brucellosis granuloma causing spinal root compression in the lumbar region.

OBJECTIVE

To point out the possibility of extradural compression caused by brucellosis.

SUMMARY OF BACKGROUND DATA

Many investigators have indicated that myelopathy or radiculopathy caused by irritation or compression by tiny abscess, disc herniation, or extradural granuloma may occur in brucellosis. Failure to make the correct diagnosis is possible because of the absence of such symptoms of brucellosis as fever, sweating, or fatigue and because findings of physical examination, radiography, and myelography indicate intervertebral disc herniation.

METHODS

Review and discussion of the case history are presented.

RESULTS

Brucella granuloma compressing the right L5 root and dural sac was diagnosed on computed tomographic scans and was excised subtotally after laminectomy and facetectomy.

CONCLUSION

The possibility of extradural compression caused by brucellosis should be considered in endemic areas and must be differentiated from an intervertebral disc herniation by means of agglutination testing and bone scan.