Multimodal Treatment of Skull Base Inflammatory Pseudotumor: Case Report

lnflammatory pseudotumor (IPT) is a rare, non-neoplastic inflammatory process. It is most commonly occurs in the orbit, but extension into brain parenchyma is uncommon. In a confirmed case of IPT, most cases show good improvement with steroid theraphy. A 50-year-old man with progressive left-eye visual disturbance and mass lesion was admitted in a hospital. A left orbital mass biopsy revealed what was highly suspected as an inflammatory pseudotumor. Steroid pulse therapy with dexamethasone, radiation therapy, and chemotherapy with amphotericin B were performed, but they were not effective in improving the condition of the patient. Revision open surgery was then performed. A follow-up brain enhancement computerized tomography showed an enlarged mass volume and hydrocephalus with periventricular enhancement. As an additional procedure, ventriculoperitoneal shunt and tuberculosis medication were administered. About 2 weeks later, clinical symptoms and radiologic findings improved. We present a case of intra-cranial IPT and discuss further treatment methods.

Anesthetic management of a patient with amyotrophic lateral sclerosis (ALS): A case report / 대한마취과학회지

Amyotrophic lateral sclerosis (ALS) is a progressive, neurodegenerative disorder involving primarily motor neurons in the cerebral cortex, brain stem and spinal cord, which leads to respiratory failure and death. The impairment of respiratory function, together with weakened upper airway muscles, may affect anesthetic management. The response to muscle relaxants, either depolarizing or nondepolarizing, is also altered in patients with ALS. Patients with ALS require special care throughout the perioperative period. We experienced the anesthetic management of a 63-year-old female patient with ALS under general anesthesia without the use of muscle relaxants for closed reduction with percutaneous screw fixation to treat a right femur neck fracture.

Anesthetic management of a patient with amyotrophic lateral sclerosis (ALS): A case report / 대한마취과학회지

Amyotrophic lateral sclerosis (ALS) is a progressive, neurodegenerative disorder involving primarily motor neurons in the cerebral cortex, brain stem and spinal cord, which leads to respiratory failure and death. The impairment of respiratory function, together with weakened upper airway muscles, may affect anesthetic management. The response to muscle relaxants, either depolarizing or nondepolarizing, is also altered in patients with ALS. Patients with ALS require special care throughout the perioperative period. We experienced the anesthetic management of a 63-year-old female patient with ALS under general anesthesia without the use of muscle relaxants for closed reduction with percutaneous screw fixation to treat a right femur neck fracture.

Gender Differences in Adult Foot Shape with 3D Foot Scanner

OBJECTIVE: To analyze gender differences in adult foot shape with 3D foot scanner METHOD: Subjects included 1,107 feet of 872 healthy volunteers (male: 325, female: 547) without foot deformity. Total 23 foot parameters (foot length, inside joint length, outside joint length, ball girth, ball width, grading point length, vamp height, vamp length, waist girth point length, waist point length, waist height, waist girth, instep girth point length, instep point length, instep height, instep girth, short heel girth, long heel girth, throat opening, vamp waist angle, waist instep angle, instep-vamp height ratio, instep- ball girth ratio) were measured with 3D foot scanner. Univariate t-test was used to assess significant differences between men and women for each foot parameter, standardized to stature and foot length. RESULTS: For a given stature, 20 of 23 foot parameters were greater in men than women (p<0.05). For a given foot length, 13 of 23 foot parameters were greater in men than women (p<0.05). CONCLUSION: This study demonstrated that female feet were different from male feet in a number of shape characteristics. These differences should be taken into account in the manufacture of women's shoes.

The Change of In-shoe Plantar Pressure according to Lever-point of Metatarsal-Bar

OBJECTIVE: To find the most effective lever-point to manufacture the rocker-outsole. METHOD: Ten healthy men were participated. Metatarsal-bar, 12x1x0.5 cm, was clung to the outsole of shoes. In the first experimental-group, we set the center of the metatarsal- bar to an imaginary line which across the center of the 1st metatarsal head with that of the 5th metatarsal head. In turns, we experimented the other groups as moved the center of the metatarsal-bar 0.5 cm backwards, each naming 2nd, 3rd, 4th group. Plantar peak pressures were measured at T0 (whole foot), M1 (heel), M2 (midfoot), M3 (1st, 2nd metatarsal area), M4 (3rd, 4th, 5th metatarsal area), M5 (great toe), M6 (2nd, 3rd toe) and M7 (4th, 5th toe). RESULTS: There was significant decrease in the peak pressure of M3 in the first experimental-group, which the center of metatarsal-bar was set to an imaginary line. CONCLUSION: In the first experimental-group, there was significant decrease in the peak pressure of M3. Therefore, the lever-point of rocker-outsole should be set to an imaginary line which connects the center of the 1st metatarsal head with that of the 5th metatarsal head.

Effect of a Unilateral Ankle Brace on Postural Sway and Limb Load Asymmetry

OBJECTIVE: This study was designed to evaluate the effect of ankle bracing (Aircast) on postural sway and limb load asymmetry (LLA) in normal adults. METHOD: 263 healthy subjects volunteered. These subjects were performed the balance test on three different conditions, 1st test fulfilled without ankle brace, 2nd test with aircast on one ankle and 3rd test with aircast on the other ankle. All subjects were divided into two groups; younger( or = 65 years) group. Postural sway and body weight distribution were recorded while the subjects were standing on two adjacent force platforms during 30 seconds trial. All subjects chose a comfortable stance with feet apart and asked to look straight ahead at a fixed point in a quiet room. RESULTS: There were significant differences not only in LLA but also in postural sway between younger and older group. The difference of postural sway and LLA in older group was more prominent that in younger group (p<0.05). CONCLUSION: The results indicated that ankle bracing improved postural sway irrespective of age. Moreover in older group, ankle bracing on one ankle that was in the absence of LLA improved postural sway by far.

The Effect of Metatarsal Pad for Foot Pressure

OBJECTIVE: To compare the foot pressure of the insole with medial longitudinal arch support and metatarsal pad and insole with medial longitudinal arch support only. METHOD: Thirty three normal subjects participated in this study. Insole were fabricated by Hana-meditec company after shaping the subjects' foot. The left insole had only medial longitudinal arch support and right insole had medial longitudinal arch support with metatarsal pad. Bare foot pressure were measured by EMED system(r) during comfortable gait. Shoes were manufactured by Osan University. Foot pressure in the shoes was measured by PEDAR system(R) during comfortable gait. Plantar pressure were analyzed by PEDAR C-expert program at T0 (whole foot), M1 (heel), M2 (midfoot), M3 (1st and 2nd metatarsal area), M4 (3rd, 4th and 5th metatarsal area), M5 (great toe), M6 (2nd and 3rd toes area), and M7 (4th and 5th toes area) zone. RESULTS: Right bare foot plantar peak pressure was identical with left side. Right plantar peak pressure with metatarsal pad in shoes was lower than left side with medial longitudinal arch support only at M1, M2 and M4 zone. CONCLUSION: For reducing the plantar peak pressure, the insole with medial longitudinal arch support and metatarsal pad were better than the insole with medial longitudinal arch support only.

Voxel-based Morphometry (VBM) Based Assessment of Gray Matter Loss in Medial Temporal Lobe Epilepsy: Comparison with FDG PET / 대한핵의학회잡지

PURPOSE: The aims of this study were to find brain regions in which gray matter volume was reduced and to show the capability of voxel-based morphometry (VBM) analysis for lateralizing epileptogenic zones in medial temporal lobe epilepsy (mTLE). The findings were compared with fluorodeoxyglucose positron emission tomography (FDG PET). MATERIALS AND METHODS: MR T1-weighted images of 12 left mTLE and 11 right mTLE patients were compared with those of 37 normal controls. Images were transformed to standard MNI space and averaged in order to create study-specific brain template. Each image was normalized to this local template and brain tissues were segmented. Modulation VBM analysis was performed in order to observe gray matter volume change. Gray matter was smoothed with a Gaussian kernel. After these preprocessing, statistical analysis was performed using statistical parametric mapping software (SPM99). FDG PET images were compared with those of 22 normal controls using SPM. RESULTS: Gray matter volume was significantly reduced in the left amygdala and hippocampus in left mTLE. In addition, volume of cerebellum, anterior cingulate, and fusiform gyrus in both sides and left insula was reduced. In right mTLE, volume was reduced significantly in right hippocampus. In contrast, FDG uptake was decreased in broad areas of left or right temporal lobes in left TLE and right TLE, respectively. CONCLUSIONS: Gray matter loss was found in the ipsilateral hippocampus by modulation VBM analysis in medial temporal lobe epilepsy. This VBM analysis might be useful in lateralizing the epileptogenic zones in medial temporal lobe epilepsy, while SPM analysis of FDG PET disclosed hypometabolic epileptogenic zones.

Comparison of Dynamic Peak Plantar Pressure and Hindfoot Contact Time in Diabetic Patients and Healthy Adults

OBJECTIVE: To investigate and describe the peak plantar pressures and ground contact times of the foot during walking in diabetic patients and healthy adults. METHOD: 17 age-matched diabetic patients without any complications and 33 healthy adults participated in this study. The foot was divided into 10 different areas, and peak plantar pressures and ground contact times were measured during walking by EMED system . RESULTS: There were no significant differences in peak plantar pressures of both feet in both groups, but there were significant increases in peak plantar pressures of hindfoot and hindfoot contact times in the diabetic group. CONCLUSION: Despite having no definite diabetic neuropathy and vascular disease, diabetic patients have higher peak plantar pressures of hindfoot and prolonged hindfoot contact times because limb muscle dysfunction or impairment of proprioception may induce faster descent of the foot towards the ground or improper pattern of stance phases.

Effects of Bone Density as Injections of Salmon Calcitonin Micropheres in Ovariectomized Rats

OBJECTIVE: This study was evaluated the bone protective effects of the salmon calcitonin microspheres against the cancellous bone loss in the ovariectomized rats. METHOD: The experimented rats were total 50 Sprague-Dawley female rats. They were divided randomly 5 groups. The treatment was initiated on the first day after surgery and continued for a period of 4 weeks. Bone measurements were performed in the distal femoral metaphysis and 5th lumbar vertebrae with dual energy x-ray absorptiometry at the time of 2nd week and 4th week after drug injection in all groups. RESULTS: The cancellous bone density in the ovariectomized rats treated with high dose of the salmon calcitonin microspheres was significantly higher than that of the free salmon calcitonin-treated ovariectomized rats, but less than that of the sham-operated control rats. CONCLUSION: This study shows that the salmon calcitonin microspheres were evaluated for protection against the can cellous bone loss in the ovariectomized rats. The bone protective effect of the salmon calcitonin microspheres was greater than that of the free salmon calcitonin.

The Evaluation of Functional Status in Adult Cerebral Palsy in Rehabilitation Facility

OBJECTIVE: The aim of this study was to investigate the medical status, the complication and the functional status in adult patients with cerebral palsy in rehabilitation facility. METHOD: The subjects comprised 113 patients with cerebral palsy in Holt Ilsan Home. We performed the previous medical history review, the physical examination, and investigated the functional independency with modified Barthel index. Result was compared between over the 20-years-old age group and the younger age group. RESULTS: Patients in older age group had more contractures of one or more joints in 67.4%, subluxations in 19.0% and dislocations in 8.1%. The modified Barthel index scores of older age group was significantly higher than juvenile group, and significantly lower within mixed type and quadriplegic type group. Patients in older age group with microcephaly were significantly lower than those with hydrocephalus or seizure, and those without microcephaly, hydrocephalus, or seizure were significantly higher. CONCLUSION: These results showed that older-aged cerebral palsy in rehabilitation had more musculoskeletal complications and higher functional status than the younger group. The musculoskeletal complication and associated disease like microcephaly significantly affected the activities of daily living. Therefore, a detailed long-term follow-up study with more medical attention is needed.

The Effect of Infrared to Cold Pain in Cold-jet Stream Application at the Knee

OBJECTIVE: To investigate the efficacy of infrared for lengthening applying time of cold-jet stream therapy without cold pain. METHOD: Each of the two methods of cryotherapy, cold-jet stream (CS) and cold-jet stream combined with infrared therapy (CSCI), was applied to the medial aspect of 32 volunteers' knees. The first phase was the required time that skin was dropped to 10oC with CS/CSCI. The second phase was the time for rewarming to 20oC without CS/CSCI. The third phase was the required time that skin dropped to 10degrees C again with CS/CSCI. The fourth phase was the time for re-warming to 20oC again without CS/CSCI. RESULTS: The required time which cold pain appeared after CS/CSCI were 51.3 sec and 62.3 sec, respectively, with significance (p<0.01). In CS and CSCI, first phase was 71.6 sec and 90.7 sec, respectively, and third phase was 33.2 sec and 39.9 sec, respectively (p<0.01). At second and fourth phases, it took 46.9 sec and 56.6 sec in CS (p<0.01), and took 46.9 sec and 54.6 sec in CSCI (p<0.01). CONCLUSION: As compared with CS, CSCI delayed sensation time of cold pain and prolonged application time of CS at the knee.

The Skin Temperature Change of Cold-jet Stream with Infrared Combination Therapy on Buttock

OBJECTIVE: To investigate the changes of the intramuscular temperature on buttock according to the application methods of cold jet-stream and to find the more effective method which reduces the intramuscular temperature. METHOD: Twenty eight healthy volunteers were examined. Cold-jet stream (CS) was applied on buttock (5 cm below of iliac crest, surface of gluteus medius muscle). We measured the time that skin temperature fall from room temperature to 10 degrees C (first period), the time rewarmed from 10 degrees C to 20 degrees C (second period), the time fall again to 10 degrees C (third period) and the time rewarmed again to 20 degrees C (fourth period). Cold-jet stream with infrared combination (CSIC) therapy was performed with the same method. RESULTS: At the first and third cooling periods, It took longer in CSIC group than CS group to decrease skin temperature. At fourth period, It took longer in CSIC group than CS group to rewarm skin. In CS and CSIC groups, fourth period is longer than second period. CONCLUSION: It took longer in CSIC method than CS only to decrease skin temperature to 10degrees C. Rewarming speed of skin temperature was slower twice cold-jet stream applies than once. Rewarming speed of skin temperature was slower at old-jet stream and infrared combination therapy than cold-jet only.

Pain Relief Effect of Calcitonin Injection in Ovariectomized Rats

OBJECTIVE: To confirm the effect of calcitonin injection relieving pain in ovariectomized rats. METHOD: Thirty five Sprague-Dawley rats were randomly divided into five groups (high dose calcitonin group (112 U/ Kg), low dose calcitonin group (56 U/Kg), free calcitonin group, ovariectomy group, control group). To assess the pain in ovariectomized rats, the tail of rats were dived in waters of 50+/-1degrees C. Then the tail withdrawal time was measured (tail withdrawal test). The tail withdrawal test was performed in once a week for eight weeks. RESULTS: 1. At seven and eight weeks after injection, the tail withdrawal time of high and low dose calcitonin group compared with that of ovariectomy group were significantly prolonged (p<0.05). 2. At eight weeks after injection, the tail withdrawal time of free calcitonin group compared with that of ovariectomy group was significantly prolonged (p<0.05). CONCLUSION: The effect of calcitonin injection relieving pain in ovariectomized rats was found.

The Effect of Back Extensor Strengthening Exercise on Chronic Low Back Pain and Bone Mineral Density

OBJECTIVE: To evaluate the effects of back extensor strengthening exercise on improving the pain, activities of daily living (ADL) and bone mineral density in the chronic low back pain patients. METHOD: 21 patients with chronic low back pain participated in back school program. Before program, measurement of lumbar extensor strength with MedX(R) (Ocala, USA), visual analogue scale (VAS) for pain, level of ADL and bone mineral density (BMD) with DEXA (Lunar(R), GE, USA) were done. For 12 weeks subjects had received the training for strengthening of back extensor and then, checked up with the above variables again. RESULTS: The results were as follows: 1) After 12 weeks of lumbar extensor strengthening program, isometric lumbar extensor strength was increased significantly (p<0.01), 2) VAS and ADL were significantly improved from 5.1 to 3.3, and 8.1 to 9.9, respectively (p<0.01), 3) BMD of lumbar spine were significantly improved from 1.1 to 0.8 (p<0.05) CONCLUSION: Twelve weeks lumbar extensor strengthening program with pelvic stabilization may be the effective therapeutic program for patients with chronic low back pain.

Basic Demand Survey of Community Based Stroke Disabled in an Urban Area

OBJECTIVE: To investigate the status and basic demand of community based stroke-disabled for rehabilitation program development in an urban area. METHOD: The subjects were 46 residencial stroke disabled over 6 months after disease onset. Two teams (composed of one physiatrist and one nurse, respectively) visited patient's home, and evaluated physical and functional status and surveyed for the status and basic demand of community based rehabilitation. RESULTS: Forty two patients (91.3%) received primary medical care after onset of the stroke, and twenty two patients(47.8%) received rehabilitation therapy. The most common reason for not having received rehabilitation therapy was poor economic state. University hospital was the most common place of their rehabilitative management. Mean score of Modified Barthel Index (MBI) was 60.7. Mean score of Craig Handicap Assessment and Reporting Technique (CHART) was 223 and economic self-sufficiency scale presented the lowest score as 6.5+/-4.6. The desire of patients for rehabilitation and welfare service was rehabilitation management and the desire of subjects for the government and society was warrant for livelihood. CONCLUSION: We concluded that rehabilitation program utilizing common resource such as areal university rehabilitation team and facilities of community health center should be developed.

Biphalangeal Toes in the Korean Foot

OBJECTIVE: The purpose of this study is to investigate the incidence and ratio of biphalangeal toes in Korean adult and to investigate whether this finding correlates with the evolution of human toes. METHOD: The materials used in this study consisted of 1,290 radiographs of the human feet obtained from 645 adults with foot symptom and complete osseous growth. The 1,290 radiographs consisted of anteroposterior weightbearing radiographs and nonweightbearing oblique radiographs. Those were retrospectively reviewed and carried out of detailed macroscopic examinations. RESULTS: Biphalangeal toe was observed for the 5th toe in 934 cases (72.40%), for the 4th toe in 161 cases (12.48%), for the 3rd toe in 7 cases (0.54%), and for the 2nd toe in 1 case (0.08%). Bilaterality of biphalangeal and triphalangeal toes for each toe was observed over 97.1%. CONCLUSION: Our results are in agreement with Nakashima and it is likely that over 70% of the Asian population have only two phalanges in their fifth toes, and it seems to be an example of microevolution or genetic adaptation to bipedalism.

The Effect of Cold Air Application on Intra-Articular and Skin Temperatures in the Knee

The present study was performed to investigate the effect on the skin and the intra-articular structures of 5-minutes of cold air application. During and after 5 minutes of cold air application on 20 healthy subjects, the skin and intra-articular temperatures were measured by means of an infrared thermogram and a digital k-wire probe, respectively. The results showed that 1) Skin temperature dropped very rapidly by a total of 22.1 degrees C after 5 minutes of cold air application. 2) Intra-articular temperature dropped by 3.9 degrees C after 5 minutes of cold air application. 3) Two hours after the start of treatment with cold air, intra-articular temperatures had still not returned to their baseline values (p 0.05).

The Significance and Limitation of MR Volumetry: Comparison between Normal Adults and the Patients with Epilepsy and Hippocampal Sclerosis

PURPOSE: Hippocampal atrophy is one of the characteristic pathologic findings of hippocampal sclerosis, for which MR imaging of the hippocampus is essential in the evaluation of hippocampal sclerosis. The purpose of this study is to present the normal MR volumetric data of the hippocampus in normal adult Korean and to compare those with MR volumetric data of hippocampus in patients with hippocampal sclerosis, providing the diagnostic volume criteria of the hippocampal atrophy. MATERIALS AND METHODS: MR volumetry was performed in 30 normal adults and 28 patients with temporal lobe epilepsy whose final diagnosis was hippocampal sclerosis. The volumetric data were compared between sexes, right and left sides, and normal and abnormal hippocampus, and the volume criteria for the diagnosis of hippocampal atrophy was determined. RESULTS: The mean volumes(+/-standard deviation) of normal Korean adult were 2.20+/- 0.73 cm3 (right) and 2.17+/-0.72 cm3 (left) in male and 2.27+/-0.47 cm3 (right) and 2.23 +/-0.48 cm3 (left) in female. The mean right-left differences were 0.14+/-0.11 cm3 and 0.19+/-0.13 cm3 in male and female, respectively. The MR volumetry showed no significant statistical differences between sexes and between right and left. The mean volume and standard deviation of the hippocampus in hippocampal sclerosis patients was 1.46+/-0.60 cm3, and the right-left difference was 0.51+/-0.41 cm3. In comparison of two volume distributions between normal adult group and hippocampal sclerosis patients group, the reasonable diagnostic volume criteria was 0.4 cm3 as right-left volume difference, in which the sensitivity and specificity are 0.61 ant0.90. In all patients with right-left volume difference more than 0.4 cm3, visual determination of unilateral hippocampal atrophy was possible. CONCLUSION: The MR-based hippocampal volumetry is a useful add-on of visual MR diagnosis, only when visual diagnosis of hippocampal sclerosis is difficult.

Congenital Lymphedema Seen as an Isolated Unilateral Arm Involvement

Congenital lymphedema is usually confined to the lower extremities and an isolated unilateral arm involvement is very rare. We report a 36-year-old women who had congenital lymphedema of the right forearm and hand.