Bok Y. Lee

Autonomie Dysreflexia Revisited

Autonomic dysreflexia (AD) is a clinical phenomenon that affects patients with spinal cord injury (SCI) above the major sympathetic outflow tract. The lesion is most often at or above the T-6 level...

Ultra-Low Microcurrent Therapy : A Novel Approach for Treatment of Chronic Resistant Wounds

This study was undertaken to investigate the efficacy of ultra-low microcurrent delivered by the Electro Pressure Regeneration Therapy (EPRT) device for the management of chronic wounds. In this study, 23 patients with chronic skin ulcers and 2 with abdominal dehiscence that was present for an average of 16.5 mo, who were not responsive to standard conservative treatment in a hospital setting, were treated with the EPRT device. Wounds were treated with direct current (maximum of 3 mA) of 1 polarity for 11.5 min and then with a current of the opposite polarity for another 11.5 min. Treatment was applied through ultra-low microcurrents (in the mA to nA range) conducted through special wraps applied above and below the wound. The results revealed that 34.8% of cases achieved complete wound healing after an average of 45.6 h of treatment, and 39.1 % achieved ≥50% healing after an average of 39.7 h of treatment. Several patients achieved significant results after 1 to 2 treatments. The EPRT device not only accelerated healing but also appeared to negate the effect of a person’s age on wound healing.

Use of Square-Wave Electromagnetic Flowmeter During Direct Arterial Surgery, Before and After Lumbar Sympathectomy in Peripheral Vascular Surgery:

The opinion has been held by many that lumbar sympathectomy, although it does produce an increase in skin temperature, does not actually effect an increase in the blood supply to the sympathectomized limb. The specific aim of this study is to document, by the use of a square-wave electromagnetic flowmeter, that there is a quantitative increase in the blood supply to the lower extremity after lumbar sympathetic ganglionectomy, and also to measure the increase in blood flow after reconstructive arterial procedures, either alone or with lumbar sympathectomy. The efficacy of the sympathectomy in the long-term management of peripheral occlusive disease (experimentally) is also presented. The effects of the administration of intravenous papaverine on the peripheral arterial flow rate of the experimental animal are reported in order to evaluate

Lumbar sympathectomy for toe gangrene: Long-term follow-up

We carried out a retrospective review of 45 patients (50 limbs) with toe gangrene not amenable to direct arterial surgery, and thus managed by lumbar sympathectomy alone. Follow-up data regarding toe salvage, limb salvage, and limb loss were compiled. At 5 and 8 year follow-up cumulative limb salvage was 71 percent and cumulative toe salvage was 51 percent. The presence of diabetes did not significantly influence limb or toe salvage. Mortality during the immediate postoperative period was 2 percent. In the majority of patients with digital gangrene who are not amenable to arterial surgery, lumbar sympathectomy is of benefit for salvaging the limb and the toes.

Effect of lumbar sympathectomy on muscle blood flow: Distribution of perfusion measured by hydrogen clearance in skeletal muscle

Measurements of local tissue blood flow using a technique of hydrogen clearance were used to examine the effect of lumbar sympathectomy on skeletal muscle blood flow. Polarographic recordings on 25 hydrogen desaturations were obtained with platinized platinum electrodes. Lumbar sympathectomies were done on five canines leaving the contralateral limb as a control. The hydrogen clearance data were modeled with biexponential curves: the initial rapid component and the second slow component yielded a weighted average perfusion through tissue. Average volumetric blood flow in the control limb was 6.08 +/- 0.45 ml/min/100 g tissue while the sympathectomized limb averaged 9.54 +/- 0.61 ml/min/100 g tissue (p less than 0.005). Average blood flow increases ranged from 33 to 83 percent in the sympathectomized limb over the control limb. This significant increase in muscle blood flow following lumbar sympathectomy, if of prolonged duration, may be cause for re-evaluation of the role of sympathectomy in the management of arteriosclerotic occlusive disease.

Management of compartmental syndrome. Diagnostic and surgical considerations.

Compartmental syndrome is a condition in which swelling within a closed anatomic space increases the intracompartmental pressure to compromise the circulation and function of tissue within that space. Unless this condition is recognized early and treated by prompt surgical decompression, permanent neuromuscular deficits may result. In those instances in which early clinical evidence of this syndrome is difficult to assess, monitoring of intramuscular pressures may be valuable adjunct in the clinical evaluation of patients at risk for this syndrome. The association of compartmental syndrome with a wide variety of circumstances and the importance of an early diagnosis make it essential that all physicians be familiar with this condition. As physician awareness and recognition of this condition increase, the complications associated with it can be greatly reduced.

The adductor canal syndrome: Description of a case with quantification of arterial pulsatile blood flow

Abstract A case of the adductor canal syndrome, successfully treated, is presented. The use of the arterial pulsatile waveform obtained by square-wave electromagnetic flowmeter in the diagnosis and therapy of the syndrome is described. Analysis of the arterial waveform before and after surgery was an effective aid in the selection and evaluation of treatment.

The Spinal Cord-Injured Patient: Comprehensive Management

Covers the broad issues involved in the care of spinal cord injured patients. Scope includes diagnostic and evaluation methods, spinal cord injury, pathophysiology, medical/surgical management of complications of treatment, and issues of specialized care.

Blue digit syndrome: urgent indication for digital salvage

The sudden onset of digital ischemia due to microembolization from a proximal source (the blue digit syndrome) requires immediate attention because not only the digit, but also the entire extremity, may be at risk. In our experience, 11 patients with the blue digit syndrome were encountered. Treatment consisted of eradication of the proximal embolic source followed by lumbar sympathectomy in four patients, direct arterial surgery alone in five patients, and lumbar sympathectomy alone in two patients. The addition of lumbar sympathectomy was beneficial as it provides an additional increase in blood flow and tissue perfusion over and above that due to direct arterial surgery alone. Our experience indicates that the benefits of lumbar sympathectomy leads to enhancement of healing of pregangrenous lesions and digital salvage.

Therapeutic effect of hyperbaric oxygen in psoriasis vulgaris: two case reports and a review of the literature

IntroductionPsoriasis is an inflammatory and immunological cutaneous disease. The high morbidity in patients with psoriasis results from severe clinical manifestations and/or adverse effects of treatment. The Undersea and Hyperbaric Medical Society and Federal Medicare and Medicaid Services have approved the use of hyperbaric oxygen (HBO2) for more than 15 indications, including wound healing, infections and late effects of radiation, which are largely unresponsive to conventional treatments. Accumulated data show that HBO2 has anti-inflammatory effects and other positive influences on the immune system, making it a rational treatment in the management of psoriasis plaques and arthritis.Case presentationWe present the cases of two patients with long histories of psoriasis vulgarus who exhibited marked improvement with use of HBO2. The first patient was 40 years old and had pustular psoriasis and psoriatic arthritis. He was treated with six sessions of HBO2 (at 2.8 atmospheres of pressure for 60 minutes), which successfully controlled his symptoms. At the 18-month post-treatment follow up, the patient exhibited complete remission of psoriasis and marked improvement in psoriatic arthritis without medication. The second patient was 55 years old with extensive psoriatic lesions, and exhibited marked improvement within 15 sessions of HBO2. No adverse effects of HBO2 were identified.ConclusionsHBO2 may possess potential therapeutic efficacy in the management of psoriasis. We outline the pathogenesis of psoriasis and the selective anti-inflammatory and immunosuppressive effects of HBO2. We hope that this will provide a basis for elucidating the mechanisms of action and consequently pave the way for further controlled studies.