Comparison of the effectiveness of extensor muscle strengthening exercise by itself, exercise with polydeoxyribonucleotide injection, and exercise with extracorporeal shockwave therapy in lateral epicondylitis: a randomized controlled trial

Extensor muscle strengthening exercises with counterforce braces (EX) is a conventional conservative treatment for lateral epicondylitis (LE) of the elbow. In addition, polydeoxyribonucleotide (PDRN) or extracorporeal shockwave therapy (ESWT) has been recently used for LE. Methods: Sixty-three patients with chronic LE participated in this study and randomly allocated in three groups (G1: EX, G2: EX+PDRN injection, and G3: EX+ESWT). All of the three groups were taught to perform EX at the first out-patient department (OPD) visit. Group 2 was injected with 3 mL PDRN (5.625 mg/3 mL), while group 3 received ESWT at the first OPD visit. Visual analog scale pain score, Mayo elbow performance score (MEPS), and ultrasonographic examination were checked before, 6 weeks, and 12 weeks after the treatments. Results: Overall functional scores and ultrasonographic findings in all three groups improved after treatment. The mean MEPS in group 2 improved more than groups 1 and 3 at 6 weeks (G1, 56.9>62.4; G2, 54.3>65.0; G3, 55.7>62.6), and more than group 1 at 12 weeks (G1, 56.9>67.9; G2, 54.3>73.6). The mean common extensor tendon depth (CETD) on ultrasonography in group 2 increased more than groups 1 and 3 at 6 and 12 weeks (6 weeks: G1, 0.385>0.386; G2, 0.332>0.392; G3, 0.334>0.357; 12 weeks: G1, 0.385>0.409; G2, 0.332>0.438; G3, 0.334>0.405 [cm]). Conclusions: PDRN injections combined with EX exhibited a greater improvement in mean MEPS and mean CETD compared to EX only or EX combined with ESWT for LE within the 12 weeks follow-up.

A Case of Polymyositis with Normal Creatine Kinase / 대한내과학회지

Proximal muscle weakness can be induced by many diseases, such as muscular dystrophies, inflammatory muscle diseases, and polymyalgia rheumatica. Differential diagnosis of these diseases is important. The patient had proximal muscle weakness with a normal creatine kinase (CK) level. Our initial diagnosis was polymyalgia rheumatica because the CK level was normal. The patient was treated with low-dose corticosteroid. However, the muscle weakness did not improve. The diagnosis of polymyositis was confirmed by a muscle biopsy. We suggest that if the patient has typical symptoms with normal CK, then evaluations for inflammatory muscle diseases are essential.

The analysis of Trends and Contents of Nursing Intervention Research for Cancer Patients in Korea

PURPOSE: In this study, the articles which developed and applied nursing interventions for patients with cancer were reviewed and analyzed. METHODS: The analysis was performed in light of 171 pieces of literature on nursing interventions for patients with cancer published between 1991 and 2010. RESULTS: Approximately half of the studies have been published between 2006 and 2010. The quasi-experimental designs using nonequivalent control group and no-synchronized design were the most common form of research design among the 71 papers constituting 41.52% of the total. The most commonly used nursing intervention was education (25.2%), followed by massage (20.4%) and exercise (11.5%). The most common outcome variable was anxiety (11.8%), followed by pain (8.0%) and nausea and vomiting (7.3%). CONCLUSION: The results of this study can provide useful information for the development of nursing interventions in specialized areas. Systematic literature review or meta-analysis is needed in this area.

The Analysis of Trends and Contents of Nursing Intervention Research for Stroke Patients in Korea / 기본간호학회지

PURPOSE: This study was conducted to provide background information on nursing interventions to further enhance the quality of nursing practice and related professions, based on those performed for stroke patients. METHODS: The analysis was performed in light of 84 researches papers on nursing intervention published between 1990 and 2010, and based on NIC(Nursing Interventions Classification) and NOC(Nursing Outcomes Classification). RESULTS: 1. The quasi-experimental design was used as the most primary form of research design across 69 papers that constitute 82% of the total. 2. The number of nursing intervention methods identified throughout 84 research papers was 144. Based on the NIC that 90(62.5%) of those interventions fell into the physiological basic domain while 53(36.8%) belonged to the behavioral domain. 2) Interventions on activity and exercise management, physical comfort promotion, patient education conducted by class level of NIC were 40(27.78%), 34(23.61%), and 31(21.53%) respectively. 3) Outcomes of mobility, psychological well-being, energy maintenance, health & life quality measured by class of NOC among 317 dependent variables 79(24.92%), 64(20.19%), and 63(19.87%) respectively. CONCLUSION: Most interventions were classified as belonging to few particular domain types, which triggers needs for the development and application of multidisciplinary intervention methods through a more collective approach.

Ruptured Heterotopic Tubal Pregnancy for a Patient with a History of Segmental Salpingectomy from Ectopic Pregnancy: A Case Report

Heterotopic pregnancy refers to the simultaneous development of an intrauterine pregnancy and an extrauterine pregnancy. We experienced a case of a ruptured heterotopic pregnancy for a patient with a history of a right segmental salpingectomy from an ectopic pregnancy. The 30-year-old patient with amenorrhea for six weeks complained of lower abdominal pain with hypovolemic shock. Transabdominal ultrasonography showed diffuse hemoperitoneum with a structure similar to an ectatic tube or a deformed cyst with no echogenic double ring or peripheral hypervascularity in the right adnexa and an intrauterine gestational sac. We considered a ruptured corpus luteum cyst as an ultrasonographic finding and found a ruptured tubal mass in the right salpinx and hemoperitoneum through an emergency laparotomy. We performed a right salpingectomy, and the histopathologic report confirmed ectopic pregnancy.

The Development and Effects of an Upper Extremity Exercise Program Based on Patterned Sensory Enhancement for Home-bound Stroke Patients

PURPOSE: This study was conducted to develop and assess the feasibility of an upper extremity exercise program based on Patterned Sensory Enhancement (PSE) for home-bound stroke patients by measuring the level of upper extremity function, depression, and interpersonal relationship. METHODS: The experiments were performed on stroke patients at three different rehabilitation centers in Incheon City. Twenty patients participated in the experimental group or in the control group. The program was executed three times a week for 6 weeks. Data were collected from August to October, 2006. Manual Function Test was used to quantify and evaluate upper extremity function. The depression level and the effectiveness of interpersonal relationship were quantified and measured using CES-D and Interpersonal Relationship Scale, respectively. RESULTS: The effectiveness of upper extremity function of stroke patients who participated in the PSE upper extremity exercise program was higher than that of non-participating patients. The depression level decreased and interpersonal relationship improved in the stroke patients who participated in this program compared to those who did not. CONCLUSION: These findings prove that the PSE upper extremity exercise program for home-bound stroke patients was an effective strategy for enhancing upper extremity function, decreasing the depression level, and improving interpersonal relationships.

The Efficacy of Ultrasonography in Identifying Fracture Patterns of Nasal Bone

PURPOSE: The purpose of this study was to know whether ultrasonography is proper diagnostic tool for decision of treatment method or not, as compared the efficacy of US in allowing identifying fracture patterns of nasal bone with that of CT. MATERIALS AND METHODS: Fifty patients with nasal trauma were investigated prospectively by CT and US. According to CT and ultrasonographic findings, each case of nasal bone injury were rated as grade 1 (nasal injury but not fracture), grade 2 (simple fracture without displacement), grade 3 (unilateral simple fracture with displacement), grade 4 (bilateral simple fractures with displacement), and grade 5 (bilateral comminuted fractures with depression). Assessment for ultrasonographic method were defined as overestimations or underestimation according to whether the nasal fracture had been assigned a higher or lower grade at the review of the findings of CT. The correlation between the results of CT and ultrasonography were measured. RESULTS: In ultrasonographic estimation of grade of 50 cases of nasal bone injuries, there were correctly graded in 42 cases, overestimated in 5 cases, underestimated in 3 cases. In allowing accurate grading of nasal bone injury, images of nasal ultrasonography correlated closely with those of CT (r = 0.796). CONCLUSION: Nasal ultrasonography is a reliable method that allows appropriate grading of nasal bone injury and would be a useful first line imaging method in providing the detail necessary for proper management of patients with mild simple nasal bone injury.

Neuroradiologic and Neurophysiologic Findings of Neuralgic Amyotrophy

OBJECTIVE: Neuralgic amyotrophy (NA) is a distinct clinical syndrome that is characterized by the acute onset of shoulder and arm pain, weakness, and sensory loss. The purpose of this study was to assess the clinical characteristics of NA and to determine appropriate diagnostic modalities. METHODS: We reviewed the medical and radiologic records of 10 patients diagnosed with NA retrospectively. Neurophysiologic studies were performed in all patients and magnetic resonance neurography was performed in the last three patients. RESULTS: A total of 10 patients were enrolled in our study. All patients had clinical findings compatible with NA. The most common clinical presentation was severe shoulder pain and weakness in seven patients (70%). Neurophysiologic study results were abnormal in all patients. Brachial plexus magnetic resonance neurography showed that the affected brachial plexus showed a thickened and hyper-intense trunk. All patients were managed conservatively with analgesics and physical therapy. The pain and paralysis of all patients improved clinically within 6 months of the initiation of treatment. CONCLUSION: NA is a rare disease but the symptoms of NA can mimic those of other diseases. Neurophysiologic studies and magnetic resonance neurography are extremely useful tools for the diagnosis of NA.

Alterations in the Kinetics of CD4+ T Cell Responses with Aging / 대한류마티스학회지

OBJECTIVE: Alterations in the immune system occur with aging, and these contribute to an increased risk of infection and malignancy. The age-associated changes in T cell immunity range from single cell function to the maintenance of cell populations. We investigated the kinetics of CD4+ T cell activation and proliferation in young and elderly subjects after stimulating their peripheral blood mononuclear cells with anti-CD3 and anti-CD28 antibodies (Abs). METHODS: The expressions of the activation markers CD69, CD40L and CD25 on the CD4+ T cells from young (n=14) and elderly (n=19) were analyzed at 6, 24 and 48 hours (hrs) of T cell receptor (TCR) stimulation by using flow cytometry. In the same individuals, the CD4+ T cell proliferation was determined at 48 and 96 hrs of TCR stimulation by using the CFSE dilution method. RESULTS: The elderly had decreased CD69 and CD40L expressions on the CD4+ T cells at 6 hrs of stimulation, as compared to that of the young patients. The elderly also had a decreased CD25 expression on the CD4+ T cells at 24 hrs of stimulation. However, the two groups had similar levels of the CD25, CD69 and CD40L expressions at 48 hrs of stimulation. The elderly had decreased CD4+ T cell proliferation at 96 hrs of stimulation, as compared to that of the young, although both groups had similar levels of CD4+ T cell proliferation at 48 hrs of stimulation. CONCLUSION: Our findings suggest that the elderly have altered kinetics of CD4+ T cell activation and proliferation in response to anti-CD3 and -CD28 Ab stimulation, and that such an altered response is governed by the duration of stimulation.

Radiologic Findings of a Recurrent Thyroidal and Perithyroidal Soft Tissue Infections Associated with a Pyriform Sinus Fistula: A Case Report / 대한내분비외과학회지

We report here on a case of a recurrent left anterior neck infection and focal left suppurative thyroiditis that were associated with a congenital pyriform sinus fistula (PSF) in an 18-year-old male. Acute suppurative thyroidits is a very rare clinical condition and it is usually caused by infection that's derived from infected perithyroidal tissue or a congenital internal fistula. The PSF can lead to recurrent episodes of neck inflammation and abscess, and it is the most common cause of acute suppurative thyroiditis in young man. In this current case, the CT scan showed an air-containing tract of a PSF from the left pyriform sinus to the left thyroid gland and the perithyroidal soft tissue. The CT scan also showed a neck inflammatory infiltration or abscess along the course of the sinus tract. The focal low density of the thyroid parenchyma was seen and this was suggestive of suppurative thyroiditis. Barium esophagography demonstrated the fistulous tract in the PSF. We performed laryngoscopy, and the internal opening of the pyriform sinus fistula was successfully cauterized with AgNO3 and the post procedure course was fair. When an air-containing tract and a recurrent inflammatory infiltration or abscess are present at the left anterior neck with including the thyroid and perithyroidal soft tissue, a PSF should be strongly suspected.

Accessory Scrotum Associated with a Perineal Lipoma / 대한비뇨기과학회지

The presence of accessory scrotum is a condition characterized by additional scrotal tissue with a normally developed scrotum. The condition is extremely rare and can be associated with a perineal lipoma. Herein, a case of accessory scrotum associated with a perineal lipoma is reported in a 4-day-old boy. He presented with a perineal mass and the diagnosis was confirmed by surgical excision and subsequent histological analysis. This is the first Korean report of an accessory scrotum associated with perineal lipoma. (Korean J Urol 2007;48:1096-1098)

Lemierre Syndrome: A Case Report

Lemierre syndrome is a rare disease characterized by internal jugular vein thrombosis and septic emboli, and it primarily occurs in healthy young individuals; this disease usually follows an acute oropharyngeal infection. To the best of our knowledge, only a few reports about this disease have appeared in the radiologic literature. We report here the radiologic findings of a case of Lemierre syndrome in a young healthy female adolescent who had a history of acute pharyngotonsilitis. Chest radiographs showed lung nodules that displayed cavitary changes with rapid progression on the serial studies. High-resolution CT scan showed multi-focal patchy consolidations that connect with vessels, and this was suggestive of septic pulmonary embolism. Ultrasonography and CT scan of the neck revealed right internal jugular vein thrombosis.

Evaluation of the Appendix Base Location in Acute Appendicitis Using Sonography and its Clinical Significance

PURPOSE: The purpose of this study is to investigate the location of appendiceal base using sonography in acute appendicitis and the usefulness of the appendiceal base marking in deciding the incision site of appendectomy. MATERIALS AND METHODS: We performed appendix sonography in 813 patients and 381 patients were diagnosed as acute appendicitis. During sonography, we marked the base of the appendix on the skin of the patients' abdomen. After appendiceal base marking, we measured the distance from McBurney's point to the appendiceal base. The marking was used as the guide for incision site for appendectomy by the surgeon. Among 381 patients, we excluded 78 patients due to nonvisualization of the cecoappendiceal junction (n = 6), pregnancy appendicitis (n = 2), false positive appendicitis (n = 3) and no reply from the surgeon (n = 67). So we investigated 303 patients prospectively. After operation, we asked the surgeon whether the appendiceal base marking was helpful for appendectomy or not. RESULTS: The base of the appendix at McBurney's point were 31%, lying within 2 cm from McBurney's point were 20%, within 5 cm were 28%, more than 5 cm were 21%. For the usefulness of appendiceal base marking, 95% showed good correlation with marking and surgical incision, and 5% revealed poor correlation. CONCLUSION: The base of the appendix was located in diverse areas of the abdomen, although most frequent in the McBurney's point and within 2 cm from the McBurney's point. Appendiceal base marking on the skin of the abdomen after diagnosis of acute appendicitis could be an useful method to guide the surgeon for decision of surgical incision site.

Intrinsic Endometriosis of Ureter: A Case Report

Endometriosis is a rare cause of an ureteral obstruction. We report a case of intrinsic ureteral endometriosis resulting in severe hydroureteronephrosis. The diagnosis of ureteral endometriosis may be considered in women with flank pain and ureteric obstruction within true pelvis.

Comparisons of MR Findings of the Spinal Metastasis and the Spinal Tuberculosis

PURPOSE: MR findings of the spinal metastasis and the tuberculosis are well known, but sometimes it might be difficult to differentiate these lesions. Therefore we reviewed and analyzed the MR findings which would be useful for the differentiation. MATERIALS AND METHODS: T1- and T2-weighted spin echo images and gadolinium-enhanced Tl-weighted images were obtained with 1. 5T and 1. 0T superconductive MR imager. We reviewed MR findings in 16 cases of spinal metastases and 24 cases of spinal tuberculosis in terms of signal intensity, contrast enhancement pattern, disc space involvement, spinal canal compressing feature and paraspinal soft tissue mass. RESULTS: The signal intensities of both lesions were hypointense on T1WI and hyperintense on T2WI except those of the metastatic lesions from the prostatic carcinoma. Heterogeneous enhancement was noted in 63% of metastasis, whereas peripheral rim enhancement was noted in 83% of spinal tuberculosis(p (.001). Spinal canal compression by collapsed vertebra was only noted in spinal metastasis, and that by paraspinal soft tissue was noted in both spinal metastasis and tuberculosis(p (.001). Disc space invasion was noted in 19% of spinal metastasis and 88% of spinal tuberculosis. Spinal tuberculosis was common at lower thoracic spine(T10) and typically involved two or more adjacent vertebral bodies(96%). CONCLUSION: The important differential point between spinal metastasis and tuberculosis was the enhancement pattern, involvement of two or more contiguous vertebral bodies and the feature of spinal canal compressing. The secondary importance was the disc space involvement pattern.

Pedal Indirect Lymphangiography

PURPOSE: Recently, indirect lymphangiography has been developed as a relatively good and noninvasive imaging modality of the lymphatic system at extremities. But the disadvantage of the indirect lymphangiography is a low contrast ratio between the surrounding tissues and the contrast media in lymphatic vessels, because dimeric nonionic contrast media is water soluble and diluted in the proximal leg lymphatic vessels. We could have relatively better image than previously published images for the leg lymphatic system, when we injected contrast media with adequate high pressure in intradermal space of the interdigital areas at the foot dotsum. So, we would like to report the results. MATERIALS AND METHODS: We could study all 9 lymphedemas(primary :6, secondary: 3) from April 1990 to May 1993 on outpatient base. They were diagnosed as lymphedema clinically and radiologically. Ten ml of dimeric nonionic aget, iotrolan(Isovist 300 ) was injected into intradermal space with five 30-gauge needles The injection speed was more than 0.2mi/min. We have done one side pedal lymphangiogram in 30 minutes. The evaluation of the anterior superficial lymphatics was accordig to the criteria of the Weissleder(2). RESULTS: The results were as follows:1. All lymphatic vessels from foot to inguinal area could be visualized. 2. Two or three inferior inguinal lymph nodes could be visualized about 42%. 3. The most common abnormal finding of the lymphedma was the neovascularization of the lymphatics on indirect pedal lymphangiogram. CONCLUSION: If we use adequate technique relatively high pressure injection, correct intradermal needle insertion, adequate soft tissue exposure technique indirect lymphangiography is considered to be a safe and noninvasive imaging modality for the evaluation of the lymphedema of lower extremity lymphatics including inferior inguinal lymph nodes.

MR Cholangiography: Usefulness in Obstructive Jaundice

PURPOSE: Three-dimensional(3D) magnetic resonance(MR) projection imaging was evaluated as a noninvasive alternative to direct cholangiography for the assessment of its reliability in patients with obsructive jaundice. METHODS AND MATERIALS: A heavily T2-weighted gradient-echo sequence(PSIF) was used for 3D MR projecion imaging of the biliary system in five healthy volunteers and 25 patients with obstructive jaundice. The 3D images of the bile ducts were formed by stacking consecutive coronal MR images obtained with a fast imaging method to a maximum-intensity projection algorithm. RESULTS: In the volunteers, MR cholangiography could demonstrate the anatomy of the biliary tract in only two subjects. The extrahepatic and intraheparic bile ducts were well visualized in 23 patients with obstructive jaundice. The leve of obstruction and the grade of dilatation were dipicted with MR cholangiography in all cases. And the cause of obstruction could be determined with MR cholangiography in 18 cases, MR cholangiography was successful in two patients in whom ERCP failed. The gallbladder or dilated pancreatic duct not demonstrated by means of direct cholangiography was demonstrated with MR cholangiography in six cases.