A Case of Overlap Syndrome with Rheumatoid Arthritis and Polymyositis / 대한류마티스학회지

Overlap syndrome is a combination of major features of more than one rheumatic disease present in the same patient such as rheumatoid arthritis (RA), systemic lupus erythematosus, systemic sclerosis, and polymyositis. Polymyositis and RA are independent rheumatic diseases that may have a variety of overlapping clinical, radiological, and pathological manifestations according to different accepted criteria. Overlap syndrome with RA and polymyositis is rarely reported worldwide. We reported a rare case of overlap syndrome RA and polymyositis with relevant literatures.

The Change of Bone Metabolism in Stroke Rat

OBJECTIVE: The purpose of this study was to investigate the effect of ischemic stroke on bone metabolism. METHOD: Female Sprague-Dawley rats (12 weeks old, n=48) were randomly divided into 4 separate groups; sham operation group (group A), stroke group (group B), ovariectomy group (group C), and stroke-ovariectomy group (group D). Two weeks after performing ovariectomy, cerebral ischemia was induced. The bone mineral density (BMD) and osteocalcin and carboxy-terminal telopeptide (CTX) were measured on three periods: the day before ischemia and 1 and 3 weeks post-stroke. All data were statistically analyzed. RESULTS: One week after cerebral ischemia, lumbar spine BMD of group B and D although statistically insignificant showed a lower BMD score in comparison to group A and C, respectively. Three weeks after ischemia, compared to group C, the BMD score of lumbar spine in group D was reduced significantly (p<0.05). At one week post-stroke, compared with group A and C, the value of osteocalcin in group B and D were reduced significantly, respectively (p<0.05). One and three weeks after ischemia, the CTX value in all groups showed no statistical difference. CONCLUSION: The authors concluded that ischemic stroke affected bone metabolism by decreasing osteoblastic activity in the early phase of stroke rat.

Functional Recovery of Patients with Traumatic Central Cord Syndrome

OBJECTIVE: The aim of this study was to identify factors influencing the degree of neurological injury, show the natural course of recovery, and evaluate the relationship between degree of neurological injury and functional recovery from traumatic central cord syndrome. METHOD: We reviewed 15 patients retrospectively and investigated their demographic and treatment data. Initial ASIA motor scales and functional recovery at 4 weeks and 8 weeks after injury were analyzed. RESULTS: The age of patients showed significant correlation with degree of neurological injury (r= 0.55145, p<0.05) while mechanism of injury, surgical intervention and gender difference showed no correlation. Only 2 patients (13.3%) ambulated independently at initial period but subsequently 13 patients (86.7%) at 8 weeks. The number of patients who independently voided increased from 2 (13.3%) to 11 (73.3%) during the 8 weeks. Early ASIA motor score differed significantly according to the degree of functional recovery of bladder and ambulation in 4 weeks, 8 weeks after injury (p<0.05). CONCLUSION: Only the age of patients related to the initial neurologic severity. Most patients regained their bladder and ambulatory functions considerably within 8 weeks, and the degree of early neurological injury by ASIA motor scale reflected the degree of functional recovery in 4 and 8 weeks after injury.

Two Cases Report of Subacute Combined Degeneration in Association with Folate Deficiency

Subacute combined degeneration is the clinical syndrome associated with vitamin B12 deficiency and characterized by usually symmetrical weakness and progressively worsening of, and abnormal sensations of the legs, arms, trunk, or other area, mental abnormalities, and vision difficulties. Subacute combined degeneration primarily affects the spinal cord, but it also includes damage to the brain, the nerves of the eye, and the peripheral (body) nerves. In this study, we report two patients with subacute combined degeneration of the cord in association with folate deficiency. Subacute combined degeneration of the spinal cord and optic atrophy occurred only in the patients with vitamin B12 deficiency. However, diet-induced folic acid deficiency and subacute combined degeneration of the spinal cord which improved significantly after treatment with folic acid has been recorded.

Estimation of Stress Level in Mothers with Cerebral Palsy Children

PURPOSE: To estimate the stress level and to evaluate the psychiatric symptoms in mothers of cerebral palsy (CP) children according to the clinical type and severity. METHODS: Sixty two mothers of CP children and 51 mothers of normal children (control) completed the Daily stress inventory, Schedule of recent life experience, Questionnaire on resources and stress-Friedrich and Symptom checklist-90-revision. The data were statistically analyzed. RESULTS: 1) Rather than the mothers of atonic CP, there were no significant differences in the stress level of every day life and events between mothers of CP children and control. 2) Mothers of CP children showed a higher level of stress related to children, and it was Mothers of statistically significant (p<0.05) quadriplegics and/or severe CP children showed the highest stress level. 3) Mothers of quadriplegic and diplegic types with a moderate disability showed the significantly (p<0.05) high scores in the categories of psychiatric symptoms of somatization, obsessive-compulsiveness, depression, anxiety, hostility, phobia and psychoticism, which may need therapeutic intervention. CONCLUSION: It seems to be very important to determine the level of stress and psychiatric symptoms in mothers of CP children for the comprehensive rehabilitation of CP children.

Somatosensory Evoked Potential and Nerve Conduction Studies in Diabetic Patients

OBJECTIVE: This study aims the electrophysiological documentation of possible neurological abnormalities in diabetic patients with or without neuropathy symptoms. METHOD: Forty five diabetic patients, 15 male and 30 female, were included in this study. They were divided into symptomatic and asymptomatic groups and received various electrophysiologic studies including a nerve conduction study, F-wave study and median and tibial SSEP study. The clinical parameters were the clinical symptom and sign of neuropathy, disease duration, complications, HbA1c, and fasting blood sugar. Statistical significances of the parameters were observed between symptomatic and asymptomatic groups. RESULTS: The most sensitive electrophysiologic parameter was the tibial SSEP. For the documentation of diabetic neuropathy, the electrophysiologic study of posterior tibial, median, superficial peroneal and sural nerves were most useful. F-wave study did not reflect the early involvement of proximal nerve segment in diabetic patients. CONCLUSION: Multimodal neurophysiological approaches including a tibial SSEP study rather than the conventional nerve conduction studies can depict a broader and more complete map of the possible abnormalities of diabetic neuropathy.

Congenital Insensitivity to Pain with Anhidrosis: Follow-up of 1 case

Congenital insensitivity to pain with anhidrosis (CIPA: a hereditary sensory and autonomic neuropathy, HSAN IV) is a rare disease characterized by the self-mutilation, bone fracture, multiple scars, osteomyelitis, joint deformities and anhidrosis. The pathophysiologic mechanism remains unknown. This is the report of a twelve years old boy who had been diagnosed as the CIPA at his age of five. Loss of unmyelinated and small myelinated nerve fibers have been noted in an abdominal skin biopsy. On follow up studies, no significant changes were noted in the clinical manifestations and in the findings of laboratory, radiologic and electrophysiologic studies when compared to the initial studies except for the minimally progressed neuropathic ankle joints. Long term follow up study including the sequential electrophysiologic examination and biopsy of nerve and muscle might be necessary to establish the natural course of the disease. Prevention of the injury should be emphasized for the good prognosis.

Brachial Plexopathy Associated with Thoracoscopic Sympathectomy for Treatment of Primary Hyperhidrosis: A Case Report

Brachial plexus is vulnerable to injury because it is close to shoulder joint of which the range of motion is very large and it is surrounded by many complex structures. Iatrogenic injuries are commonly associated with surgeries such as procedures in the posterior neck or in the shoulder and open thoracotomy, during regional anesthetic blocks, and during other procedures that use needles and cannulas. Radiation therapy can cause brachial plexus injury. A case of brachial plexus injury after thoracoscopic sympathectomy for treatment of primary hyperhidrosis is discussed in this report. Twenty eight years old male patient developed motor and sensory paralysis of Rt. upper extremity shortly after thoracoscopic sympathectomy performed with hyperabduction position of Rt. upper extremity for 2 hours and 30 minutes. Electrodiagno stic study was performed on the 11th day after paralysis. Electrodiagnostic findings from the which was compatible with showed abnormal spontaneous activities at rest and decreased numbers of MUAPs on volition sampled muscles innervated by brachial plexus. The motor power of these muscles was trace or fair grade. On the 14th day after paralysis the patient recoverd the motor power to near nomal on muscle testing. The reason of this complication is not clear, but it might have occurred most likely in association with tension and traction forces applied to patient's brachial plexus while hyperabducting the arm for a long period of time during surgery. In this study we have reviewed perioperative brachial plexus injuries and their possible mechanisms, of injury hoping to decrease the occurrence of perioperative brachial plexus injuries.