Diagnostic Approach in Patients Presenting with Inflammatory Back Pain

OBJECTIVE: To investigate the etiologic diseases of inflammatory back pain (IBP) and to propose a diagnostic algorithm for approaching the patients with IBP. METHOD: One-hundred-and-forty patients with IBP visiting the clinic for spinal disorders were involved. Clinical features of spondyloarthropathy (SpA) through medical records, presence of intervertebral disc disease, sacroiliitis and degenerative spondylosis through plain radiography and magnetic resonance image (MRI) of spine and pelvis, HLA B27 positivity, and quantitative laboratory results of acute phase reactant were retrospectively reviewed. RESULTS: Diverse spinal disorders were indentified as etiologic diseases for IBP that were SpA (44 patients), diffuse idiopathic skeletal hyperostosis (DISH) (15 patients), degenerative spondylosis (15 patients), HLA B27 associated IBP (14 patients), lumbosacral radiculopathy (4 patients), and others (48 patients). When onset age was less than 45 years, the most frequent cause was SpA. When onset age was more than 45 years, DISH and degenerative spondylosis were the most frequent causes. Onset age (p=0.002), age at presenting to clinic (p=0.001), number of items satisfying IBP criteria (p=0.001), HLA B27 positivity (p=0.000), and elevated acute phase reactant (p=0.002) were statistically associated with SpA. CONCLUSION: The relative frequency among various etiologic disease of IPB is different depending on the onset age of IPB. Onset age of IBP, numbers of items satisfying IBP criteria, and laboratory test for HLA B27 and acute phase reactant can be useful factors for determining the causes of IBP, especially for diagnosing SpA. Diagnostic algorithm for approaching the patients with IBP is proposed according to the sensitivity and specificity of the factors which have statistically meaningful relationship with diagnosis of SpA.

Treatment of Spontaneous Psoas Hematoma in a Hemiplegic Patient Undergoing Anticoagulation Therapy: case report

Spontaneous psoas hematoma in patients receiving anticoagulation therapy is a rare condition, but sometimes very serious even fatal, if not properly treated on time. One of our patients developed large spontaneous psoas hematoma while intensive rehabilitation therapy due to recent stroke with global aphasia and right hemiplegia. He had undergone anticoagulation therapy with warfarin and prothrombin time was within therapeutic range. Patient revealed sudden cold sweating with change of vital sign. Because of global aphasia, he could not explain subjective symptoms, but revealed rebound tenderness in right lower quadrant on physical examination. Emergency abdominal & pelvic CT scan showed large hematoma on right iliopsoas area with retroperitoneal extension. Because of unstable hemodynamics and high risks for surgery, transcatheter arterial emboilzation was recommended. Bleeding was controlled successfully after transcatheter arterial embolization, and vital sign was stabilized without other neurologic change.

Brain Lesions in Conduction Aphasia

OBJECTIVE: To investigate the neuroanatomical correlation of conduction aphasia by analyzing neuroimage data of patients who were diagnosed as conduction aphasia after stroke. METHOD: Nine patients with conduction aphasia after stroke were retrospectively reviewed with their medical records. Language functions of patients were assessed by Korean-version Western Aphasia Battery (K-WAB). Stroke lesions were assessed by brain computed tomography or magnetic resonance images taken within 1 month after onset of stroke. RESULTS: The stroke subtypes were cerebral infarction in 5 patients and intracranial hemorrhage in 4 patients. The lesions were located in left hemisphere in 8 subjects and right hemisphere in 1 subject. The left hemispheric lesion were located in the insula and superior temporal lobe in 3, the inferior parietal lobe in 2, the corona radiate in 1, the basal ganglia in 1 patient and both corona radiata and basal ganglia in 1. The right hemispheric lesion was located in the inferior parietal and superior temporal lobe. CONCLUSION: 6 of 9 patients with conduction aphasia had brain lesions in the path of arcuate fasciculus in the left hemisphere, however, 3 of 9 patients showed other brain lesions. These findings suggested that conduction aphasia could be caused by heterogeneous brain lesions. The characteristic features of conduction aphasia according to diverse brain lesions may need further investigation.

Reliability of Dynamic Posturography with Unstable Platform to Evaluate Seated Postural Control

OBJECTIVE: To examine the repeatability and the reproducibility of a new evaluation system for seated postural control. METHOD: A total of 30 healthy volunteers (12 male, 18 female, mean age 25.1+/-3.4) participated in this study: 15 for repeatability and 15 for reproducibility study. We invented a new device for the assessment of seated postural control. The device was consisted of unstable platform, force plate, frame, safety harness, monitor and computer. Force plate on unstable platform measured the center of pressure (COP) of subject. COP maintaining time, COP moving time and COP sine curve trace were recorded. Each subject was tested three times with an interval of 3 days between the test sessions. The intraclass correlation coefficients (ICC) were calculated. RESULTS: There were no significant differences between male and female in each parameter. There were no significant differences in COP maintaining time, COP moving time and COP sine curve trace when tested repetitively. ICC for both the repeatability and the reproducibility showed good to excellent reliability for all variables (ICC, 0.60~0.99) except posterior and right-posterior moving time. CONCLUSION: This newly designed system for seated postural control using unstable platform proved to be a reliable tool. It may be a useful method to assess the seated postural control.

Expression of Voltage-dependent Na+ Channels in the Albino Guinea Pig Cochlea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The endolymph produced from cochlear lateral wall regulates fluid and maintains positive endocochlear potential. Although many immunohistochemical studies of ion transport enzymes in the cochlear lateral wall have been reported, their mechanisms are still not completely understood. And there are no reports on the studies of anti-Na+ channels in the cochlea of the guinea pig. The voltage-dependent ion channels are fundamental components of neuronal activity. The Na+ channel has a single alpha subunit with 4 pseudosubunits of 6 transmembrane segments each. Expression of the pore-forming and voltage-sensing alpha or alpha1 subunit typically leads to the appearance of channels with voltage- and time-dependent gating and ion conductance. The purpose of this study is to evaluate the expression of the Na+ channel type I and II in the cochlea lateral wall. MATERIALS AND METHODS: We investigated the protein identification by western blot after homogenization and immunohistochemical localization by FITC to the anti-Na+ channel type I and II in the cochlea of the Preyer's positive, white guinea pigs. RESULTS: The results showed that the anti-Na+ channel type I and II were expressed strongly in the intermediate cells of the stria vascularis, and weakly in the stria vascularis. CONCLUSION: We suggest that there are voltage-dependent Na+ channels in the stria vascularis of cochlea and those functions are further evaulated physiologically by the patch clamp technique.

A Study for Changes of Acoustic Parameters between Pre and Postoperative Voice in Laryngeal Nodule and Polyp / 대한이비인후과학회지

BACKGROUND: Laryngeal nodule and laryngeal polyp are the most common diseases that cause hoarseness and their incidences are increased currently. Since the invention of computerized voice analysis, it became possible to display voice quantitatively and visibly. MATERIALS AND METHODS: To evaluate the voice of 30 patients with laryngeal nodule and polyp before and after laryngomicrosurgery, the sound spectrogram of the Korean vowel /e/ were analyzed. RESULTS: 1) The valuable parameters for measuring the voice improvement were the range of fundamental frequency fluctuation, jitter and shimmer before and after surgery of laryngeal nodule and polyp. 2) On the first postoperative day, the change of the acoustic parameters of laryngeal nodule and polyp on postoperative showed statistically significant improvements. 3) The acoustic parameters of laryngeal nodule and polyp came within the normal range by the 7th postoperative day. 4) The extent of change in the acoustic parameters of laryngeal polyp was greater than in laryngeal nodule. CONCLUSION: We concluded that the valuable parameters for measuring the voice improvement were the range of fundamental frequency fluctuation, jitter and shimmer. The normalization of this parameter occurred at the first operative week.