Juvenile Muscular Atrophy of the Upper Limb (Hirayama Disease): A case report

Hirayama disease is characterized by focal amyotrophy of the upper limb associated with unilateral or asymmetric bilateral muscle weakness. It occurs in young men in their late teens or early twenties. Repeated or sustained neck flexion is thought to be a cause of the disease. It is important to prevent the progression of the disease through early recognition and management. We reported a patient with Hirayama disease in order to review the typical clinical, electrodiagnostic and radiological findings of Hirayama disease.

Conservative Treatment of Stage of Pressure Ulcers with Ulmus

OBJECTIVE: To investigate the treatment effect of Ulmus, which has been traditionally used for the treatment of the pressure ulcers in Korea. METHOD: Thirteen cases with stage IV pressure ulcers (according to the National Pressure Ulcer Advisory Panel, 1989) were enrolled for the study. Seven cases were treated with Ulmus and 6 cases were treated with wet gauze as a control group. The sizes and stages of pressure ulcers were evaluated every 2 week for 12 weeks. RESULTS: After 12 weeks, the size of pressure ulcers decreased from 78.17+/-47.77 cm3 to 8.14+/-13.17 cm3 (mean S.D., n=7) in Ulmus treated group, whereas from 62.10+/-40.89 cm3 to 36.69+/-36.23 cm3 (mean+/-S.D., n=6)in wet gauze treated group. The size of pressure ulcers decreased more significantly (p<0.05) in Ulmus treated group than wet gauze dressed group. Among seven cases treated by Ulmus, 2 cases completely healed, 3 cases improved to stage II, and 2 cases remained to stage IV, whereas among 6 cases treated by wet gauze, 1 cases improved to stage II, 1 case to stage III, and 4 cases remained to stage IV. CONCLUSION: Ulmus was more effective in management of pressure ulcers than wet gauze. We suggest that Ulmus can be used as a useful method of conservative treatment for the stage IV pressure ulcers.

Local Steroid Injection in Carpal Tunnel Syndrome

OBJECTIVE: The purpose of this study was to evaluate therapeutic effect of local steroid injection in carpal tunnel syndrome, and to make a comparison between therapeutic effect in patients with and without diabetic neuropathy. METHOD: 30 patients (40 hands) with carpal tunnel syndrome diagnosed clinically and electrophysiologically were injected with 40mg of methylprednisone. Patients were evaluated with the visual analogue scale after 4 weeks and 8 weeks. According to the therapeutic responses, the patients were grouped into: excellent; good; poor; failed; recurrent. RESULTS: After 4 weeks, symptom relief was noted in the 95% of all cases: 100% of the patients without diabetic neuropathy; 82% of the patients with diabetic neuropathy. After 8 weeks, symptom relief was noted in the 82.5% of all cases: 86% of the patients without diabetic neuropathy; 73% of the patients with diabetic neuropathy. There was no statistically significant difference between the patients with and without diabetic neuropathy (p>0.05). CONCLUSION: We concluded that local steroid injection in carpal tunnel syndrome was an effective therapeutic modality for a short term and local steroid injection in the carpal tunnel syndrome with diabetic neuropathy diagnosed by palmar test also had a good effect.

Tuberculous Spondylitis Aggravated by Spinal Manipulative Therapy: A case report

A 43 years old woman had suffered from a lower back pain for 2 months. She experienced pain aggravation after spinal manipulative therapy that was practiced by non-licentiate. Physical examination showed tenderness on L1 and L2 spinous processes. Radionuclide bone scan with 99mTc-MDP showed increased radioactivity of L1, L2 vertebral bodies. The MRI finding showed low signal intensity of L1 and L2 vertebral bodies in T1-weighted image and high signal intensity in T2-weighted image. Needle biopsy finding showed fibrosis and inflammatory cell invasion of bone marrow. We concluded that she had tuberculous spondylitis and non-detection or negligent treatment of a preexisting disease contributed to aggravation of her symptoms. We report one case of tuberculous spondylitis aggravated by spinal manipulative therapy with review of literatures.

The Trends of Urinary Tract Infection in Patients with Neurogenic Bladder

The urinary tract infection(UTI) is a very common complication of rehabilitation patients with neurogenic bladder. Proper diagnosis and early treatment are very important for the long term rehabilitation outcomes. Many reports are available in the literature on the characteristics of UTI in spinal cord injury(SCI) patients, however only few reports appear on non-SCI patients. We have done comprehensive chart reviews of 1,251 patients with neurogenic bladder who were admitted to the rehabilitation medicine department, PMC from January 1982 to August 1996. Patients were divided into 4 groups: patients with stroke, spinal cord injury, traumatic brain injury and other neurologic diseases, and we have studied: incidence of UTI, commonly cultured organisms, antibiotic sensitivities, urinary pH, voiding methods, and residual urine volumes. The incidences of UTI are 50.9% for all patients, 48.1% in Stroke, 72.3% in Spinal cord injury, 38.9% in Traumatic brain injury, and 34.1% in other neurologic diseases. There has been increase of Gram(+) cocci and decrease of Gram(-) rod during study period. Commonly cultured organisms are Escherichia coli(E. coli), Pseudomonas, Klebsiella. The decreased antibiotic sensitivities are noted in almost all organisms. Positive correlations are found between the incidence of UTI, high urine pH, high residual urine volumes, and use of catheters. In conclusion, despite of many variable factors, the trends of UTI in each groups show no significant difference.