Duration of Treatment Effect of Extracorporeal Shock Wave on Spasticity and Subgroup-Analysis According to Number of Shocks and Application Site: A Meta-Analysis

OBJECTIVE: To investigate duration of the treatment effect of extracorporeal shockwave therapy (ESWT) on spasticity levels measured with Modified Ashworth Scale (MAS) regardless of the patient group (stroke, multiple sclerosis, and cerebral palsy) and evaluate its spasticity-reducing effect depending on the number of shocks and site of application. METHODS: PubMed, EMBASE, the Cochrane Library, and Scopus were searched from database inception to February 2018. Randomized controlled trials and cross-over trials were included. All participants had spasticity regardless of cause. ESWT was the main intervention and MAS score was the primary outcome. Among 122 screened articles, 9 trials met the inclusion criteria.

Rehabilitation of Advanced Cancer Patients in Palliative Care Unit

OBJECTIVE: To evaluate the compliance and satisfaction of rehabilitation recommendations for advanced cancer patients hospitalized in the palliative care unit. METHODS: Advanced cancer patients admitted to a hospice palliative care unit were recruited. Patients with advanced cancer and a life expectancy of less than 6 months, as assumed by the oncologist were included. Patients who were expected to die within 3 days were excluded. ECOG and Karnofsky performance scales, function ambulatory category, level of ambulation, and survival days were evaluated under the perspective of comprehensive rehabilitation. Problem-based rehabilitations were provided categorized as physical therapy at the gym, bedside physical therapy, physical modalities, medications and pain intervention. Investigation of compliance for each category was completed. Patient satisfaction was surveyed using a questionnaire. RESULTS: Forty-five patients were recruited and received evaluations for rehabilitation perspective. The subjects were reported to have gait-related difficulties (71.1%), pain (68.9%), poor medical conditions (68.9%), bladder or bowel problems (44.4%), dysphagias (11.1%), mental status issues (11.1%), edemas (11.1%), spasticity (2.2%), and pressure sores (2.2%). In the t-test, patients with good compliance for GymPT showed higher survival days (p < 0.05). In the satisfaction survey, patients with performance scales showed a greater satisfaction in Spearman's correlation analysis (p < 0.05). CONCLUSION: Advanced cancer patients admitted to the hospice palliative care unit have many rehabilitation needs. Patients with a longer survival time showed better compliance for GymPT. Patients with a better performance scale showed a higher satisfaction. Comprehensive rehabilitation may be needed to advanced cancer patients in the hospice palliative care unit.

Hypothermia Presenting in Wernicke Encephalopathy: A Case Report

Wernicke encephalopathy (WE) is a neurologic disorder characterized by clinical symptoms, such as nystagmus, ataxia, and mental confusion. Hypothermia in patients with WE is a rare complication, and its pathogenic mechanism and therapy are yet to be ascertained. Herein, we presented a case of a 61-year-old man who was diagnosed with WE 3 months earlier. We investigated the cause of hypothermia (35.0℃) that occurred after an enema (bowel emptying). Brain magnetic resonance imaging revealed mammillary body and hypothalamus atrophy. In the autonomic function test, the sympathetic skin response (SSR) test did not evoke SSR latencies on both hands. In addition, abnormal orthostatic hypotension was observed. Laxative and stool softener medication were administered, and his diet was modified, which led to an improvement in constipation after 2 weeks. Moreover, there was no recurrence of hypothermic episode. This is the first reported case of late-onset hypothermia secondary to WE.

Esthetic implant restoration in the maxillary anterior missing area with palatal defect of the alveolar bone: a case report

It is challenging to produce esthetic implant restoration in the narrow anterior maxilla region where insufficient volume of alveolar bone could limit the angle and position of implant fixture, if preceding bone augmentation is not considered. Ideal angle and position of implant fixture placement should be established to reproduce harmonious emergence profile with marginal gingiva of implant prosthesis, bone augmentation considered to be preceded before implant placement occasionally. In this case, preceding bone augmentation has been operated before esthetic implant prosthesis in narrow anterior maxilla region. Preceded excessive bone augmentation in buccal area allowed proper angulation of implantation, which compensates unfavorable implant position. Provisional restorations were corrected during sufficient period to make harmonious level of marginal gingiva and interdental papilla. The definite restoration was fabricated using zirconia core based glass ceramic. Functionally and esthetically satisfactory results were obtained.

Clinical Application of 3D-FIESTA Image in Patients with Unilateral Inner Ear Symptom

BACKGROUND AND OBJECTIVES: Unilateral auditory dysfunction such as tinnitus and hearing loss could be a warning sign of a retrocochlear lesion. Auditory brainstem response (ABR) and internal auditory canal magnetic resonance image (MRI) are suggested as novel diagnostic tools for retrocochlear lesions. However, the high cost of MRI and the low sensitivity of the ABR test could be an obstacle when assessing patients with unilateral ear symptoms. The purpose of this study was to introduce the clinical usefulness of three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) MRI in patients with unilateral ear symptoms. SUBJECTS AND METHODS: Two hundred and fifty-three patients with unilateral tinnitus or unilateral hearing loss who underwent 3D-FIESTA temporal bone MRI as a screening test were enrolled. We reviewed the abnormal findings in the 3D-FIESTA images and ear symptoms using the medical records. RESULTS: In patients with unilateral ear symptoms, 51.0% of the patients had tinnitus and 32.8% patients were assessed to have sudden sensory neural hearing loss. With 3D-FIESTA imaging, twelve patients were diagnosed with acoustic neuroma, four with enlarged vestibular aqueduct syndrome, and two with posterior inferior cerebellar artery aneurysm. Inner ear anomalies and vestibulocochlear nerve aplasia could be diagnosed with 3D-FIESTA imaging. CONCLUSIONS: 3D-FIESTA imaging is a highly sensitive method for the diagnosis of cochlear or retrocochlear lesions. 3D-FIESTA imaging is a useful screening tool for patients with unilateral ear symptoms.

Correlation between Ambulatory 24 Hour Dual Probe pH Monitoring and Reflux Finding Score, Reflux Symptom Index in the Laryngopharyngeal Reflux / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A 24-hour ambulatory dual probe for pH monitoring is the most specific and sensitive test for laryngopharyngeal reflux (LPR) disease. However, the use of this probe is not well tolerated in some patients due to discomfort and the invasive nature of the procedure. Thus, the diagnosis of LPR is usually made according to symptomatic responses to empirical treatment using a proton-pump inhibitor for patients with high score of reflux symptom index (RSI) and reflux finding score (RFS). The aim of this study is to evaluate the relationship between the RSI and RFS and pH monitoring using a 24-hour ambulatory dual probe, and determine the role of RSI and RFS in the diagnosis of LPR. SUBJECTS AND METHOD: We studied 100 patients who underwent pH monitoring using a 24-hour dual probe because of laryngopharyngeal reflux related symptoms or laryngoscopic findings. The various parameters of the 24-hour dual probe pH monitoring were compared with the scores of RSI and RFS. RESULTS: In 24-hour dual probe pH monitoring, 64 of 100 patients tested positive for LPR. The mean of RSI score was significantly higher in the positive LPR group than in the negative group. However, RFS did not differ between the two groups. RSI scores were significantly associated with the reflux number in the upright position of the 24-hour dual probe pH monitoring. There was no correlation between RFS and the parameters of the 24-hour dual probe pH monitoring. CONCLUSION: RSI can be a reliable diagnostic tool for laryngopharyngeal reflux disease instead of the 24-hour ambulatory dual probe pH monitoring.

Auditory Brainstem Response in Newborns with Hyperbilirubinemia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Neonatal hyperbilirubinemia is one of the important causative factors of sensorineural hearing loss including auditory neuropathy. The auditory brain stem response (ABR) is widely used as a screening or diagnostic tool for newborn hearing loss. This study aimed to analyze serial ABR results of newborns with severe hyperbilirubinemia. SUBJECTS AND METHOD: This study examined 120 full term infants treated for hyperbilirubinemia in the neonatal intensive care unit. The first ABR was performed within one month after birth. Follow-up tests were conducted in patients with abnormal results (25 cases). The control group was composed of 21 healthy newborns who passed the newborn hearing screening. RESULTS: The mean ABR threshold was higher in the newborns with hyperbilirubinemia than in the control group (43.8 dB nHL versus 30.0 dB nHL, p<0.001). Of the 25 newborns who underwent follow-up ABR, 15 newborns demonstrated recovery of the hearing threshold up to 30 dB nHL. The hearing threshold did not improve below 50 dB nHL for five newborns, of whom one was diagnosed with auditory neuropathy spectrum disorder. There was no difference in the mean ABR interwave latency between newborns with hyperbilirubinemia and the control group. CONCLUSION: Neonates with hyperbilirubimenia might suffer transient or permanent hearing loss. Serial ABR tests might be essential for the diagnosis of sensorineural hearing loss in patients with neonatal hyperbilirubinemia.

Audiologic Characteristics of Unilateral Tinnitus Patients without Subjective Hearing Disturbance / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus is an audiologic sensation without external sound stimuli. The aim of this study is to assess characterisistics in unilateral tinnitus patients without subjective hearing loss by analyzing their audiologic test results. SUBJECTS AND METHOD: We used results of audiologic tests including pure tone audiogram (PTA), tinnitogram and distortion products of otoacoustic emissions (DPOAE) from 96 unilateral tinnitus patients without subjective hearing loss. We compared the results of tinnitus ear with non-tinnitus ear individually, and also analyzed these data according to their age, symptom and duration. RESULTS: The hearing level of PTA of tinnitus ears compared to non-tinnitus ears was statistically significant at 4000 Hz and 8000 Hz, and it was more prominent at age over forty. DPOAE results were significantly low at 4000 Hz level in tinnitus ears compared to non-tinnitus ears. Loudness and duration of symptoms were louder and longer when hearing loss was accompanied. CONCLUSION: In unilateral tinnitus patients without subjective hearing disturbance, a pattern of high frequency hearing loss was found in PTA and DPOAE. The patients with hearing loss above 25 dB HL at any frequency are older and have longer duration with high pitch-louder tinnitus. Therefore, even though tinnitus patient has no subjective hearing loss, it is important to make treatment plan by sufficient audiologic evaluation.

Investigation of the Bovine Leukemia Virus Proviral DNA in Human Leukemias and Lung cancers in Korea

The bovine leukemia virus (BLV) is the causative agent of enzootic bovine leucosis. This study investigated the presence of the BLV in leukemia (179 acute lymphoblastic leukemia, 292 acute myeloid leukemia and 46 chronic myelogenous leukemia cases) and 162 lung cancer patients (139 adenocarcinoma, 23 squamous cell carcinoma) to determine if the BLV is a causative organism of leukemia and lung cancer in Koreans. A BLV infection was confirmed in human cells by PCR using a BLV-8 primer combination. All 517 cases of human leukemia and 162 lung cancer were negative for a PCR of the BLV proviral DNA. In conclusion, although meat has been imported from BLV endemic areas, the BLV infection does not appear to be the cause of human leukemia or lung cancer in Koreans. These results can be used as a control for further studies on the BLV in Koreans.