Usefulness of Ultrasound Examination in Evaluation of Breast Cancer-Related Lymphedema

OBJECTIVE: To evaluate the usefulness of ultrasound examination as an adjunctive measurement tool in breast cancer-related lymphedema. METHOD: Twenty healthy volunteers and 20 women who had been treated for unilateral breast cancer and had subsequently developed lymphedema were recruited. Examiners measured the volume of both arm with volumeter and the circumference of both forearm and upper arm with tape measure. Then the thickness of the skin and subcutis on the ventral aspect of forearm and upper arm were measured by ultrasonography. These results were compared with each other. RESULTS: The ICCs for interrater reliability of ultrasound examination was high (mostly>0.98). The volume of the swollen arm (2,308 ml) was larger than contralateral arm (1,873 ml). The circumference of swollen forearm (24.50 cm) and upper arm (30.81 cm) were larger than contralateral forearm (21.54 cm) and upper arm (27.60 cm). In the swollen side, average thickness of the forearm skin, forearm subcutis, upper arm skin and upper arm subcutis were 0.23 mm, 1.03 mm, 0.19 mm and 0.95 mm respectively. In the contralateral side, average thickness of the forearm skin, forearm subcutis, upper arm skin and upper arm subcutis were 0.12 mm, 0.69 mm, 0.13 mm, 0.73 mm respectively. The degree of increase in mid-forearm skin thickness were correlated with the degree of swelling calculated with volumeter (r=0.651, p=0.002). CONCLUSION: Ultrasonography is able to give valuable information on the extent of edema and fibrosis of skin and subcutis. It will be a useful tool to follow the results of lymphedema treatment and its progression over time.

Relationship between Physical Examinations and Two-Dimensional Computed Tomographic Findings in Children with Intoeing Gait

OBJECTIVE: To evaluate the validity of physical examinations by assessment of correlation between physical examinations and CT measurements in children with intoeing gait and the causes of intoeing gait by age using CT measurements. METHOD: Twenty-six children with intoeing gait participated in this study. The internal and external hip rotation, thigh-foot angle and transmalleolar angle were measured. In addition, femoral anteversion and tibial torsion of the subjects were assessed using a CT scan. The measurements of torsional angles were performed twice by two raters. The correlation coefficients between physical examinations and CT measurements were calculated using Pearson correlation. The data was analyzed statistically using SPSS v12.0. RESULTS: The correlation coefficients between physical examinations and CT measurements were not high. Before 5 years of age, intoeing gait was caused by femoral anteversion in 17.86%, tibial torsion in 32.29% and the combination of causes in 35.71% of cases. After 6 years of age, the contributions changed to 29.17%, 8.33% and 45.83%, respectively. CONCLUSION: Before 5 years of age, the common cause of an intoeing gait was tibial torsion, whereas after 6 years of age it was femoral anteversion. Regardless of age, the most common cause of intoeing gait was a combination of causes. This study shows poor correlation between physical examinations and CT. Therefore, it is limiting to use physical examination only for evaluating the cause of intoeing gait in clinical practice.

Measurement of Proprioception of the Knee in Hemiplegic Patients Using an Isokinetic Dynamometer

OBJECTIVE: To measure knee joint proprioception quantitatively in hemiplegic patients after brain injury using an isokinetic dynamometer. METHOD: Thirty healthy subjects and 24 hemiplegic patients participated in this study. Joint position sense was evaluated with passive angle reproduction of 30degrees and 60degrees of knee flexion and kinesthesia was evaluated with the threshold for detection of passive movementfrom 45degrees of knee flexion. We used toe-"up or down"-test for conventional clinical method. RESULTS: Significant proprioceptive deficit was observed not only in paretic knees of both right and left hemiplegic patients (p0.05). CONCLUSION: The quantitative test using an isokinetic dynamometer is a reliable method to measure knee proprioception, and it is possible to detect proprioceptive deficit in hemiplegic patients. Conventional clinical assessments are poor for predicting the results of the quantitative measure in the nonparetic knee. This quantitative method may be useful in diagnosis and follow-up of knee proprioception of hemiplegic patients after brain injury.

Percutaneous Endoscopic Gastrostomy Versus Percutaneous Radiologic Gastrostomy: A Comparison of Complications in Brain Injured Patients

OBJECTIVE: To compare complications of percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) in brain injured patients. METHOD: The records of brain injured patients who received either PEG or PRG between January 2001 and July 2008 in Busan paik hospital were reviewed retrospectively. Documented complications (infection, leakage, blockage/delayed feeding, aspiration pneumonia, tube displacement, pain, ileus, bleeding, tube fell/pulled out, bradycardia/hypotension) were recorded and compared. RESULTS: There were 44 brain injury patients with dysphagia. All patient received PEG or PRG successfully. (32 PEG, 12 PRG) The incidences of complications were 50% in both PEG group (16 in 32) and PRG group (6 in 12). In PEG group sixteen patients developed complications, 27 minor and two major. In PRG group six patients developed complications, 11 minor and one major. The most common complication of PEG was wound infection (37.9%). But there were no wound infection in PRG group. And there were no deaths in both PEG and PRG group. CONCLUSION: Both endoscopic and radiologic gastrostomy tube placements are safe and effective methods. But in high infection risk group such as old ages, DM or CRF patients who have brain injury with dysphagia, PRG is safer method than PEG.

The Effect of Cognitive-behavioral Characteristics on Depression of Caregivers in Brain-injured Patients

OBJECTIVE: To evaluate the relationship between depression and cognitive-behavioral characteristics of caregivers using social problem solving inventory (SPSI), social support or conflict scale (SSS or SCS) and somatic symptoms (SS). METHOD: Fifty five couples of brain-injured patients and caregivers participated in this study. We conducted a questionnaire survey of caregivers with Beck depression index (BDI), SPSI, SSS, SCS and SS for cognitive-behavioral characteristics. And also we studied demographic factors of patients and caregivers, clinical features of brain-injured patients, care- giving duration and time per day through interview and review of medical records. The statistical analyses were performed by independent t-test, one-way ANOVA, Pearson correlation test and linear regression analysis-stepwise method. RESULTS: BDI of the caregivers showed a negative correlation with SPSI, SSS, patients' MMSE and caregivers' education level, also a positive correlation with SCS, SS and patients' GDS (p<0.05). And married caregivers showed more depressive mood (p<0.05). Of these factors, the most influencing factors on BDI were GDS and SCS through linear regression analysis (p<0.01). CONCLUSION: MMSE, GDS and education level as cognitive- mental factors rather than physical and economic strain had a statistical correlation with depression of caregivers. Especially, SPSI, SSS and SCS as cognitive-behavioral characteristics should be considered on evaluation of depression of caregivers and will be helpful for successful rehabilitation for patients and caregivers.

A Case of Adult Acute Myeloid Leukemia Presenting with Musculoskeletal Manifestations / 대한류마티스학회지

Leukemia is a heterogenous group of neoplasms that arise from the malignant transformation of hematopoietic cells. The usual presentation is one of lethargy, pallor, fever, purpura, bleeding, etc, and all this is secondary to a decrease in the production of normal blood components. However, leukemia often manifests with musculoskeletal symptoms without a systemic presentation. Musculoskeletal symptoms that precede the recognition of leukemia are much less frequent in adults as compared to those in children, and this causes diagnostic confusion and a delayed diagnosis. We describe here a case of adult acute myeloid leukemia in which pain and weakness of the limbs were the main manifestations and these were suspected as being symptoms of musculoskeletal disease.