A Survey on the Actual Condition of the Use of Powered Wheelchair and Scooter

OBJECTIVE: To evaluate the efficiency of powered wheelchair and scooter and to investigate the factors affecting the accidents and injuries. METHOD: We investigated 90 subjects with mobility disability who had used powered wheelchair or scooter more than a year. The subjects responded to a questionnaire of the 34 items. RESULTS: Seventy (77.7%) of respondents used powered wheelchair or scooter more than 3 days a week. More than 50% of them regarded the obstacles such as curbs or thresholds as the most common hindering factor to outside mobility. The causes of breakdown were due to battery, wheel, gear box and motor. About a third of 58 respondents were dissatisfied with the result of repair. The high cost of the repair was regarded as the leading cause of dissatisfaction. Contusions were the most common, with abrasion and sprain accounting for most of the remainder. Of the 18 users who were affected by injuries, only 11.1% wore a safety seatbelt. Only 25 of 89 respondents had a safety education. CONCLUSION: Our study showed that the efficiency of power wheelchair and scooter was relatively high. But the obstacles such as curbs, recurrent breakdown, and concerns about the accident were regarded as the hindering factors to the outside mobility. The degree of satisfaction to the safety education is relatively low, so more systemic and practical programs need to be devised.

Atrophy of Multifidus Muscle on Low Back Pain Patients

OBJECTIVE: To investigate the correlation of multifidus muscle atrophy on MRI findings with clinical findings in low back pain patients. METHOD: Medical records of 80 patients presenting with low back pain were retrospectively reviewed. Their MR images were visually analysed to know lumbar multifidus muscle atrophy, disc herniation, disc degeneration, spinal stenosis and nerve root compression. RESULTS: Multifidus muscle atrophy increased from the upper lumbar level to the most caudal intervertebral level. It was bilateral in the majority of the cases. Multifidus muscle atrophy was well correlated with patient's age, referred leg pain, and disc degeneration. However, duration of low back pain, disc herniation, spinal stenosis, nerve root compression, sex, weight, height and BMI had no correlation with multifidus muscle atrophy. CONCLUSION: Examination of multifidus muscle atrophy should be considered when assessing MR images of lumbar spine. It may help for further evaluation and planning the treatment modalities of low back pain.

MR Findings of Facial Nerve on Oblique Sagittal MRI Using TMJ Surface Coil: Normal vs Peripheral Facial Nerve Palsy

PURPOSE: To evaluate the findings of normal facial nerve, as seen on oblique sagittal MRI using a TMJ (tem-poromandibular joint) surface coil, and then to evaluate abnormal findings of peripheral facial nerve palsy. MATERIALS AND METHODS: We retrospectively reviewed the MR findings of 20 patients with peripheral facial palsy and 50 normal facial nerves of 36 patients without facial palsy. All underwent oblique sagittal MRI using a TMJ surface coil. We analyzed the course, signal intensity, thickness, location, and degree of enhancement of the facial nerve. According to the angle made by the proximal parotid segment on the axis of the mastoid seg-ment, course was classified as anterior angulation (obtuse and acute, or buckling), straight and posterior angu-lation. RESULTS: Among 50 normal facial nerves, 24 (48%) were straight, and 23 (46%) demonstrated anterior angula-tion; 34 (68%) showed iso signal intensity on T1WI. In the group of patients, course on the affected side was either straight (40%) or showed anterior angulation (55%), and signal intensity in 80% of cases was isointense. These findings were similar to those in the normal group, but in patients with post-traumatic or post-operative facial palsy, buckling, of course, appeared. In 12 of 18 facial palsy cases (66.6%) in which contrast materials were administered, a normal facial nerve of the opposite facial canal showed mild enhancement on more than one segment, but on the affected side the facial nerve showed diffuse enhancement in all 14 patients with acute facial palsy. Eleven of these (79%) showed fair or marked enhancement on more than one segment, and in 12 (86%), mild enhancement of the proximal parotid segment was noted. Four of six chronic facial palsy cases (66.6%) showed atrophy of the facial nerve. CONCLUSION: When oblique sagittal MR images are obtained using a TMJ surface coil, enhancement of the proximal parotid segment of the facial nerve and fair or marked enhancement of at least one segment within the facial canal always suggests pathology of the facial nerve. The use of this modality, together with the coil, is, therefore, an effective complementary technique for the evaluation of a facial nerve.

Plugging the Biopsy Tract in Rabbit Liver: Gelfoam, Fibrin Sealant and NBCA

PURPOSE: To evaluate the effect of plugging the biopsy tract in rabbit liver and the pathologic changes caused by plugging materials. MATERIALS AND METHODS: Thirty-two New Zealand White rabbits were divided into four groups(eight rabbits in each) and compared with one another. They were labeled group A(control), B(gelfoam),C(fibrin sealant) or D(NBCA). The liver was exposed and biopsied with an 18G disposible biopsy gun. The inner Tru-cut needle was withdrawn and plugging was undertaken through the outer cannula of the biopsy gun. Bleeding times of each material were compared. The rabbits were sacrificed and pathologically evaluated for 17 days. RESULTS: Mean bleeding times were 46.7+/-34.5 sec in group A, 42.9+/-54.7 sec in group B, 12.6+/-15.0 sec in group C, and 0 sec in group D. In groups C and D, these results were statistically significant(p<0.01). Pathologically, fibrin sealant was lowest in foreign body reaction and fibrosis. NBCA was effective for the prevention of hemorrhage. CONCLUSION: NBCA and fibrin sealant effectively plug the biopsy tract through the outer cannula of an18 G biopsy gun.

Percutaneous biopsy of malignant hepatic tumor in patients with bleeding tendency: Usefulness of gelfoamplugging up the biopsy track

PURPOSE: To plug the biopsy site in eight patients with coagulopathy who had undergone percutaneous liverbiopsy. To this end, gelfoam cartridge was used as a sealant. MATERIALS AND METHODS: Using an 18G Tru-Cut-typedisposible automated biopsy gun(Soo Ho Medi-tech, Seoul, Korea) and under US guidance, eight patients underwentpercutaneous liver biopsy. After the gun had fired, the biopsy specimen in the inner stylet was retrieved whilethe outer cannula was held in place ; the cannula was then used to plug the biopsy tracks with gelfoam, using twoor three cartridges. If bleeding occurred, this was controlled by the use of more gelfoam cartridges. RESULTS: Diagnostic target tissue was obtained in seven of the eight patients(87.5%). Hepatocellular carcinoma wasdiagnosed in five cases and metastatic cancer in two. Profuse bleeding was observed in one patient(12.5%) andresolved by gelfoam plugging. CONCLUSION: We believe that in patients with coagulopathy who are required toundergo liver biopsy plugging the liver biopsy track with gelfoam cartridge is a simple, safe and useful method.

Intrathoracic Major Vessels, Trachea and Main Bronchi: The Effect of Respiration on Size

PURPOSE: To evaluate the effect of respiration on the sizes of intrathoracic vasculature, and the trachea,and the main bronchus. MATERIALS AND METHODS: Seventeen volunteers (10males aged 20-39 years and 7 females aged20-39 years) underwent spiral CT, between the apex and lowest base of the lung, collimation was 10mm, pitch was 1,and images were obtained at breath hold forced end-inspiration and breath hold forced end-expiration. Crosssecional areas or diameters were measured in each respiration state at the aorta (ascending, descending, lowerthoracic) and great branches, the IVC (thoracic, abdominal), the SVC, pulmonary artery (right main, leftdescending) and the tracheobronchus (trachea, left upper bronchus). Changes in the size of vessels and airwaysbetween the respiration states were evaluated and compared between inspiration and expiration. RESULT: Duringbreath-hold forced end-inspiration CT, the ascending, descending, and lower thoracic aorta and itsbranches(brachiocephalic, left common carotid, left subclavian) as well as the thoracic IVC and SVC and the rightmain and left descending pulmonary arteries decreased in size: during breath-hold forced end-expiration CT, thesize of all these vessels increased. For the trachea, left upper lobe bronchus and abdominal IVC, the situationwas reversed. Statistically significant changes(p<0.05) were noted in the ascending aorta and descending aorta,the lower thoracic aorta, the thoracic and abdominal IVC, the SVC, the right main and left pulmonary arteries, andthe trachea. CONCLUSION: During respiration, changes in the size of the thoracic vasculature and airways isprobably due to changes in intrathoracic pressure. In the measurement and diagnosis of stenosis or dilatation inthe intrathoracic vesculature and airways, respiration states should therefore be considered.