Lactic Acidosis in Children: Clinical and Laboratory Evaluation / 대한소아신경학회지

PURPOSE: Lactic acidosis is one of the most common forms of metabolic acidosis. It is hard to fine the cause of lactic acidosis, because in many cases the clinical features of this disorder are non-specific and overlap with those of other metabolic or non-metabolic diseases. In this report, we tried to identify the causes of lactic acidosis and classified them into four groups:primary and secondary lactic acidosis, neurodegenerative disorders and others. METHODS: We analyzed the clinical characteristics of 22 patients who had arterial blood lactate levels over 2.5 mmol/L. They visited Ilsan Hospital because of seizures or delayed development. Clinical characteristics include laboratory findings, EEG, brain imaging study, chromosomal study and metabolic enzymatic evaluation. RESULTS: The mean age of the patients was 3.4 years. Most of them complained of delayed development(21 cases) and seizures(14 cases). One of the patients was revealed as primary lactic acidosis, and the other one secondary lactic acidosis. Also, there was a case of neurodegenerative disease. Furthermore, the other ten patients were affected by other causes of lactic acidosis:7 cases of epilepsy, a case of Rett syndrome, a case of 4p deletion syndrome, and a case of cerebral palsy. However, the causes of lactic acidosis of the remaining 9 patients were unknown. But 5 of them were thought to be affected by respiratory chain disorders diagnosed by modified Walker's criteria. CONCLUSION: There are numerous disorders in children which can produce lactic acidosis. Although metabolic work-ups of these patients are very complex and require coordinated efforts of clinicians and laboratory works, early diagnosis of the etiologic nature of the disease is essential to minimize the progression and the complications of the disease.

Sensory Thresholds of Normal Human Feet Using Semmes-Weinstein Monofilament

OBJECTIVE: To obtain the sensory thresholds of the feet from healthy adult using Semmes-Weinstein monofilaments. METHOD: Twenty male and twenty female volunteers aging from 24 to 38 years old were selected. There were no known medical conditions associated with decreased foot sensation and history of previous injury to the foot. The subjects were blindfolded with the leg resting on a chair as 14 plantar and 5 dorsal locations were tested on each foot. Each site on the foot had the Semmes-Weinstein monofilaments applied to it first, in an order of increasing stiffness, then repeated in decreasing order. A positive threshold response was recorded when the subject could feel the filament and could accurately locate where on the foot the stimulus had been applied. RESULTS: The mean sensitivity for all sites was 3.41+/-0.17. Sensation in the plantar surface of greater toe, 5th toe, arch, and dorsal surface of 1st web space, 3rd toe at the metatarsophalangeal joint level, 5th metatarsal head were the most sensitive. The least sensitive regions were the heel pad, lateral plantar midfoot, and medial and lateral heel. CONCLUSION: Normal data of sensory threshold using Semmes-Weinstein monofilament could be used for the early detection of peripheral neuropathy or loss of protective sensation.

Anatomical Locations of the Motor Points of the Triceps Surae Muscles

OBJECTIVE: To identify the range of the precise locations of the motor points of triceps surae muscles in relation to bony landmarks. METHOD: Eight limbs of four male cadavers were dissected. The number and location of the motor points from the tibial nerve to each head of the triceps surae muscle were identified related to the bony landmarks. Bony landmarks were medial and lateral epicondyles of the femur, and medial and lateral malleolli of the tibia. The length of the lower leg was defined as the distance from the intercondylar line of the femur to the intermalleolar line of the tibia. The locations of the motor points were expressed as the vertical distance from the intercondylar line, which was normalized to the length of the lower leg. RESULTS: The most proximal motor points of the medial gastrocnemius, lateral gastrocnemius, and soleus were located in 9.6+/-3.5%, 12.0+/-3.4% and 20.5+/-3.9% of the lower leg below the intercondylar line of the femur. The most distal points were in 37.5+/-5.5%, 37.9+/-2.3% and 46.7+/-3.6%. CONCLUSION: The identification of the locations of motor points related to the bony landmarks would increase the ease and accuracy of the motor point blocks to the triceps surae muscles.

MRI Findings of Adhesive Capsulitis of Shoulder

OBJECTIVE: MRI findings of adhesive capsulitis (AC) have been rarely documented even though the disease is a rather common disorder. To find reliable MRI parameters, we studied MRI findings of the patients with arthrographically-proven AC. METHOD: Eighteen patients with AC (patient group) and eight subjects without AC (control group) were enrolled. Mean age of the former was 55.1 years and that of the latter was 41.4 years. Mean duration of the diseases in patient group was 5.9 months. Oblique coronal and axial MRI images of the shoulder were measured for the thickness of capsule and synovium around the axillary fold (TAF), volume of axillary recess (VAR), and volume of biceps tendon sheath (VBTS), which were compared in both groups using unpaired t-test. RESULTS: TAF was significantly increased in patient group (p<0.0001), and the thickened axillary fold greater than 5.1 mm was a useful MRI criterion for the diagnosis of AC with sensitivity of 93% and with specificity of 100%. VBTS was also significantly diminished in patient group (p<0.05), whereas there was no significant difference in VAR between two groups. CONCLUSION: TAF, especially greater than 5.1 mm, and decreased VBTS are useful MRI parameters for the diagnosis of AC of shoulder.