Ultrasonographically guided obturator nerve block for bilateral adductor spasticity in a paraplegic patient.

STUDY DESIGN: A case report defining an interventional procedure. OBJECTIVES: To reveal the role of the ultrasonography in nerve blocks at difficult anatomical locations of the obturator nerve. SETTING: The study was conducted in Ankara, Turkey. METHODS: A paraplegic patient with lower limb adductor spasticity treated with phenol block using the guidance of ultrasonography. RESULTS: After treatment of the adductor spasticity by obturator nerve block the patient achieved an upright standing position with a walker. Hygienic care was improved and spasticity-related pain was reduced. CONCLUSION: Ultrasound is a challenging tool for nerve blocks. Ultrasound guidance seems as an essential approach for the blocking of the nerves with variable anatomical courses, such as the obturator nerve.

Incidence of acute hepatitis B in patients with spinal cord injury.

STUDY DESIGN: Retrospective case survey. OBJECTIVE: To examine incidence and clinical characteristics of hepatitis B infection in individuals with spinal cord injury (SCI). SETTING: Inpatient clinic within a physical medicine and rehabilitation hospital specialized in rehabilitation. PARTICIPANTS: A total of 161 patients with SCI. INTERVENTIONS: Patients' records were investigated and the status of hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV), anti-hepatitis B surface antigen positivity, alanine aminotransferase levels, duration of hospitalization and cost were recorded. MAIN OUTCOME MEASURES: Incidence of acute hepatitis B. RESULTS: Six patients were diagnosed with acute hepatitis B on the first hospitalization for rehabilitation. A total of 11 patients (4.2%) were HBsAg positive with a previously established diagnosis of hepatitis B virus infection, 1 patient (0.4%) was anti-HCV positive. After a follow-up of 6 months, three of the acute hepatitis B patients progressed into chronic hepatitis B stage. In acute hepatitis B patients' initiation of the rehabilitation was delayed, duration of hospitalization was increased. CONCLUSIONS: After SCI, patients are at high risk of acute hepatitis B infection. A high rate of chronicity may be associated with impaired immune response, secondary to neurological deficit. Screening and vaccination protocols may prevent the spread of the hepatitis B infection, healthcare losses and financial loss.