Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

Traumatic lumbar hernia describes the extrusion of intraperitoneal or extraperitoneal contents through a defect in the posterolateral abdominal wall caused by a trauma. This is a rare entity and usually diagnosed by computed tomography. A 64-year-old male received an injury on his cervical spinal cord after an accident in which he fell down. He complained of a mass on his left posterolateral back area. We diagnosed the mass as a traumatic lumbar hernia by ultrasonography and confirmed it by computed tomography. We conclude that the ultrasonography can be a useful diagnostic tool for traumatic lumbar hernia.

Epidural Abscess and Vertebral Osteomyelitis Induced by Epidural Injection: A case report

Epidural abscess and vertebral osteomyelitis induced by epidural injection is rare but one of the most serious complications. A 58-year old woman complained of aggrevating radicular pain to bilteral lower legs, tenderness on coccygeal area and claudication, after epidural injection for management of intractable sciatica. MRI and ultrasound revealed epidural abscess compressing dural sac at the level of L5-S1 vertebral body, sacrococcygeal abscess, and later S5- 1stcoccyx osteomyelitis. We report epidural abscess and vertebral osteomyelitis induced by caudal epidural injection.

Nocturnal Polyuria Developed in Patients with Central Pontine Myelinolysis: A case report

Central pontine myelinolysis is a demyelinating disease of central pons. Nocturnal polyuria is defined as increased urination during nighttime with a nocturnal fraction exceeding from 20% to 33%. We have experienced nocturnal polyuria developed in two patients with central pontine myelinolysis. In these cases, serum antidiuretic hormone and urine osmolality were lower at nighttime than daytime. It suggests that nocturnal polyuria is caused by abnormal diurnal variation of antidiuretic hormone. In the first case, nocturnal polyuria was recovered spontaneously and also follow up brain MRI showed decreased signal intensity in pons. In the second case, nocturnal polyuria was improved after the treatment of intranasal desmopressin. It appeares that central pontine myelinolysis can cause nocturnal polyuria due to the interruption of antidiuretic hormone pathway. The symptom of nocturnal polyuria can be treated by desmopressin.

Usefulness of Scintigraphic Swallowing Study in Brain Injury Patients with Laryngeal Aspiration

OBJECTIVE: We investigated the usefulness of the scintigraphic swallowing study in selecting the patients with low risk of aspiration pneumonia among those who showed small amount of laryngeal aspiration in videofluoroscopy. METHOD: Scintigraphic swallowing study was performed in 22 patients with brain injury who showed small amount of laryngeal aspiration in videofluoroscopy. Oral feeding was tried in the patients who showed airway clearing function or no aspiration in scintigraphic swallowing study, and they were followed up for possible aspiration pneumonia. RESULTS: Total of sixteen patients showed no aspiration in scintigraphic swallowing study. Five patients showed laryngeal aspiration, but preserved airway clearing function. One patient showed impairment of airway clearing function. Oral feeding was tried in 21 patients. Oral feeding was successful in 18 of 21 patients but not in 3 patients because of dysphagia or cough. Only 1 patient developed pneumonia after 246 days of follow up. CONCLUSION: Scintigraphic swallowing study is useful to select the patients with low risk of aspiration pneumonia among the patients who showed small amount of laryngeal aspiration in videofluoroscopy.

The Shoes Designed to Inhibit Excessive External Rotation of Hemiplegic Foot with Plastic Ankle Foot Orthosis: A case report

Hemiplegic patients with an ankle foot orthosis (AFO) has a tendency to show external rotation of affected side foot. External rotation inhibiting shoes (ERIS) were designed to inhibit excessive rotation of hemiplegic foot. ERIS were applied to two hemiplegic patients who were able to walk independently with a plastic AFO. Both of them showed an excessive external rotation of hemiplegic foot after AFO apply. Each patient tried to walk with a pair of common shoes first and ERIS later. The external rotation angle, step length, stride length, cadence, speed were measured by footprint method. The external rotation angle of hemiplegic foot was significantly decreased with ERIS than with common shoes. However they did not show consistent improvement in the step length, stride length, cadence and speed. We reported that hemiplegic patients who walked with ERIS showed remarkable reduction in excessive external rotation of hemiplegic foot.

The Operational Design of Clinical Skills Training Program in Gachon Medical School / 한국의학교육

PURPOSE: The purpose of this study is to introduce the operational design of clinical skills training program and to evaluate the outcome of one-year experience in Gachon Medical School. METHODS: The School set up a clinical skills training center(laboratories) helping preclinical year-students being able to improve their clinical competences by using simulators and models prior to start their clerkship so that they can apply accurate and stable clinical technical skills to the patients. The program was divided into two parts; one for the communication and interviewing skills(M3) and the other for development of basic clinical skills(M4). For the latter, a total of 32 skill units with model items were selected from the minimum essential clinical skills requirements. The training course was conducted 3 weeks for 37 students of the fourth year medical school(M4) students in the second semester of 2001. Pass/Fail system with 2 credits was applied as a student evaluation. Both advantages and disadvantages of the program were analysed by questionnaires. RESULTS: Every students met the school requirement and passed the requirements mostly by the second trial within the two weeks duration following self-directed hard practice for every items. Of 37 students, 80% became confident on their final performance, and 72% agreed themselves being much enthusiastic compared to other courses. The visiting frequency to the center was over 2~3 times/day during the course, and their average staying hours/week were 20~30 hours. Students(78%) were satisfactory to the appropriativeness of faculty's instructional skills and their evaluation results. CONCLUSION: We conclude that the clinical skills training program is a useful tool not only to improve the essential technical skills prior to take their responsibilities of subinternship but also to motivate students' learning during the preclinical studies.

'Global Citizenship' Course in Premedical Year Development and Outcome of Manner Program for Future Physicians / 한국의학교육

PURPOSE: This study aims to introduce a one semester 'Global Citizenship' program, being offered as a part of the premedical course at Gachon Medical School. The program was designed to meet the community needs in terms of etiquette and manner education for the future physicians and also to review the outcome of short-term experience. METHODS: The program was offered to M1(premedical students year-1) students from the first semester after entrance to the school with following objectives: to understand the anthropological aspect of culture, to motivate students in relation to medical scientific foundation, and to develop the appropriate human relations, including international etiquette and manners, prior to the subinternship in M5(medical student year-3). RESULTS: The program consisted of 12 sessions of lectures and/or practice-based learning such as etiquette for dormitory life, Korean traditional culture, gender role in the 21st century, dining etiquette in various cultural programs, netiquette(for computer usage), Korean housing and its architectural beauty, etiquette for alcoholic beverage drinking, dressing, and the respect and understanding of other cultures, services and manners. They were all instructed with presentations combined with site-visits or hands-on experience followed by a reflection paper and group discussion. Although the program was costly and time-consuming compared to the traditional theory-based natural science and humanity subjects, students expressed their strong motivation and concerns on their future responsibilities. CONCLUSION: We conclude that "Global Citizenship" course is a useful program to provide a meaningful motivation to the newly enrolled students, Further, it encourages students to understand human relations as a global citizen equipped with the appropriate etiquette and manners.

An Orthosis Designed to Control Contracture of the Shoulder and Forearm with Spasticity

OBJECTIVE: To develop and evaluate newly designed orthosis to control contracture of the shoulder and the forearm in the spastic upper limb. METHOD: Subjects were 6 hemiplegic patients and 1 tetraplegic patient who showed the features of spasticity. Volar wrist hand orthosis was modified to attach a plastic stick which can be easily separated. The orthosis was applied in supinated position for 8 weeks. The shoulder and elbow range of motion was measured every 2 weeks for 8 weeks. RESULTS: The subjects with spasticity showed significant improvement in the shoulder abduction (p<0.05), adduction (p<0.05) and external rotation (p<0.05) after applying modified volar wrist hand orthosis for 8 weeks. The forearm supination was well maintained for 8 weeks. CONCLUSION: The newly designed orthosis showed significant effects in the improvement of the shoulder abduction, adduction and external rotation and the forearm supination of spastic upper limbs.

Dextrose Swallowing Test to Detect Aspiration for Patient with Tracheostomy

OBJECTIVE: To evaluate the usefulness of 10% dextrose swallowing test (DST) to detect aspiration for patient with tracheostomy in comparison with modified blue dye test (MBDT). METHOD: Fifteen brain injured patients with tracheostomy were tested by DST and MBDT. The newly developed DST consists of 3 steps. In the first step, 5 cc 10% dextrose solution is fed 3 times by spoon. In the second step, tracheal secretion is sampled by suction catheter just before swallowing, and 30 seconds, 90 seconds after swallowing. In the third step, tracheal secretion is smeared to glucose oxidase test strip to detect aspiration with color change from pink to purple. MBDT with 0.01 % methylene blue solution was also performed in the same order. The tracheal secretion was smeared to the white paper to see the color change to blue. Videofluoroscopic swallowing study (VFSS) was performed for 9 out of 15 patients. RESULTS: Fourteen out of 15 patients showed the same outcome in DST and MBDT (kappa=0.815). Seven out of 9 patients showed the same outcome in DST and VFSS (kappa=0.571). Eight out of 9 patients showed the same outcome in MBDT and VFSS (kappa=0.780). CONCLUSION: The DST is a reliable method to detect aspiration for patient with tracheostomy.