Pediatric Acute Confusional Migraine / 계명의대학술지

Acute confusional migraine (ACM) is a rare type of migraine variant. It is primary seen in adolescent with migraine history. The specific symptom is an acute confusional mental change after acute onset headache. Symptoms include decreased alertness, disorientation, speech disturbance, agitation, difficulty in recognizing family and familiar locations, and amnesia. Patients mainly visit to emergency department due to acute mental problems. But there are no specific findings in neuroradiologic examinations and laboratory tests in ACM patients. And ACM is not widely known disease to physicians. So it takes long time to exclude other disorders and dysfunctions until to reach the diagnosis. Patient’s history of migraine, family history, and spontaneous relief of symptoms after deep sleep without medication can be helpful in diagnosis. We experienced a rare case of ACM of 13-year-old male patient, therefore we report the case with literature review.

Pediatric Acute Confusional Migraine / 계명의대학술지

Acute confusional migraine (ACM) is a rare type of migraine variant. It is primary seen in adolescent with migraine history. The specific symptom is an acute confusional mental change after acute onset headache. Symptoms include decreased alertness, disorientation, speech disturbance, agitation, difficulty in recognizing family and familiar locations, and amnesia. Patients mainly visit to emergency department due to acute mental problems. But there are no specific findings in neuroradiologic examinations and laboratory tests in ACM patients. And ACM is not widely known disease to physicians. So it takes long time to exclude other disorders and dysfunctions until to reach the diagnosis. Patient’s history of migraine, family history, and spontaneous relief of symptoms after deep sleep without medication can be helpful in diagnosis. We experienced a rare case of ACM of 13-year-old male patient, therefore we report the case with literature review.

Changes in Range of Motion after Intra-Articular Corticosteroid Injection in Frozen Shoulder: A Retrospective 3-Month Follow-Up Study

OBJECTIVE: To examine (1) the degree of reduction of passive range of motion (PROM) on the affected side compared to that on the unaffected side and (2) the degree of increase in PROM following intra-articular corticosteroid injection (IACI) in patients with frozen shoulder.METHOD: The medical records of 120 patients with frozen shoulder were retrospectively reviewed. PROM of the unaffected and affected shoulder (flexion, extension, abduction, internal rotation, external rotation) was compared, and changes in PROM of the affected shoulder after a single IACI (triamcinolone 20 mg) were evaluated after 12 weeks.RESULTS: At the time of diagnosis, PROM of the affected shoulder was most limited in external rotation, followed by internal rotation, abduction, extension, and flexion, compared to that of the unaffected shoulder. Compared to before IACI, PROM of external rotation demonstrated the greatest increase compared to all the other movements after IACI.CONCLUSION: Limitation in PROM of the frozen shoulder at the time of diagnosis was greatest for external rotation. Moreover, external rotation experienced the greatest improvement after IACI. Our findings should help to further clarify the clinical characteristics of frozen shoulder, aid in its diagnosis, and allow the prediction of the effects of IACI.

A superficial hyperechoic band in human articular cartilage on ultrasonography with histological correlation: preliminary observations

PURPOSE: To demonstrate the superficial hyperechoic band (SHEB) in articular cartilage by using ultrasonography (US) and to assess its correlation with histological images. METHODS: In total, 47 regions of interest (ROIs) were analyzed from six tibial osteochondral specimens (OCSs) that were obtained after total knee arthroplasty. Ultrasonograms were obtained for each OCS. Then, matching histological sections from all specimens were obtained for comparison with the ultrasonograms. Two types of histological staining were used: Safranin-O stain (SO) to identify glycosaminoglycans (GAG) and Masson's trichrome stain (MT) to identify collagen. In step 1, two observers evaluated whether there was an SHEB in each ROI. In step 2, the two observers evaluated which histological staining method correlated better with the SHEB by using the ImageJ software. RESULTS: In step 1 of the analysis, 20 out of 47 ROIs showed an SHEB (42.6%, kappa=0.579). Step 2 showed that the SHEB correlated significantly better with the topographical variation in stainability in SO staining, indicating the GAG distribution, than with MT staining, indicating the collagen distribution (P<0.05, kappa=0.722). CONCLUSION: The SHEB that is frequently seen in human articular cartilage on high-resolution US correlated better with variations in SO staining than with variations in MT staining. Thus, we suggest that a SHEB is predominantly related to changes in GAG. Identifying an SHEB by US is a promising method for assessing the thickness of articular cartilage or for monitoring early osteoarthritis.

A Case of Lagophthalmos after a Corrective Rhinoplasty / 대한이비인후과학회지

Corrective rhinoplasty, a commonly performed plastic surgery, is occasionally followed by numerous risks and complications. In this report, we present, with discussion of the causes and proper management, a case of lagophthalmos that occurred after a rhinoplasty. A 35-year-old female visited our outpatient clinic due to continuous nasal obstruction even after septoplasty. After thorough evaluation, corrective rhinoplasty was performed to release the patient's nasal symptoms and manage the deviated external nose and nasal septum. During the surgery, we encountered excessive nasal bleeding after percutaneous osteotomy. In addition, immediate postoperative findings presented left periorbital edema without limited eye movement or reduced eye vision associated with the paralysis of the eyelid localized to the medial side of the left upper palpebra. Surgeons should be aware of rare but possible complications of corrective rhinoplasty such as lagophthalmos, and a rapid and intensive care is recommended for early management and better prognosis of postoperative complications.

Assessing PCV2 antibodies in field pigs vaccinated with different porcine circovirus 2 vaccines using two commercial ELISA systems

Porcine circovirus type 2 (PCV2) is the primary causative agent for post-weaning, multisystemic, wasting syndrome. Consequently, serologic detection of and vaccination against PCV2 are important for the swine industry. Among several serological tests, the enzyme-linked immunosorbent assay (ELISA) is commonly used to measure anti-PCV2 antibody levels. In the present study, we used two commercial ELISA systems to comparatively evaluate anti-PCV2 antibodies in field pigs treated with three different PCV2 vaccines. Among a total of 517 serum samples, the results of the two ELISAs were fully concordant for 365 positive and 42 negative samples, indicating 78.7% agreement. In addition, the Pearson coefficient (0.636) indicated a moderate correlation between data from the two ELISAs. Results from the farms with pigs vaccinated with the three different PCV2 vaccines demonstrated that most of the vaccinated animals underwent seroconversion. However, the increase and duration of antibody titers varied depending on the vaccine, the presence of maternal antibodies, and the vaccination program. PCV2 serologic status and anti-PCV2 antibody levels of herds from this study could be utilized to determine the best timing for vaccination and assessing vaccination compliance.

Complications of Hook-Plate Fixation for Distal Clavicle Fractures

PURPOSE: To report on the complications of hook-plate fixation for distal clavicle fractures. MATERIALS AND METHODS: Eighteen patients who underwent surgery for distal clavicle fracture with a hook-plate from April 2008 to April 2011 were enrolled with a minimum of 4 months follow-up. The reduction was qualified and evaluated according to the radiologic findings. We analyzed the results by UCLA score, Kona's functional evaluation, and VAS pain score. RESULTS: By radiologic evaluation, 17 of 18 cases showed anatomical reduction and solid unions. Although satisfactory results were found in the clinical study as shown by the UCLA score, Kona's functional evaluation, and VAS pain score, complications arose in 7 cases, including osteolysis of the acromion in 2 cases, nonunion in 1 case, periprosthetic fracture in 2 cases, subacromial pain in 1 case, and skin irritation in 1 case. 2 cases of all required reoperation. CONCLUSION: To reduce the complications of the hook-plate, a precise surgical technique and the choice of an appropriate size for the hook-plate are needed. We suggest that early removal of the plate is necessary to decrease the risk of subacromial impingement and erosion in hook-plate fixation.

Sequential Changes of CX3CR1 in Dorsal Root Ganglion in a Rat Model of Lumbar Disc Herniation

OBJECTIVE: To investigate the pain-related behaviors and the changes of CX3CR1 expression in the dorsal root ganglion (DRG) in a rat model of lumbar disc herniation. METHOD: A total of 90 male Sprague-Dawley rats were used. A laminectomy was performed to expose left L5 nerve roots and corresponding DRG. Autologous nucleus puplosus was implanted on the left L5 nerve root proximal to the DRG without mechanical compression. Sham operation was also done with the same procedure as mentioned above. Thermal hyperalgesia and mechanical allodynia were assessed at 1, 5, 10, 20 and 30 days after surgery. Real time PCR and immunohistochemistry after behavioral test were performed. RESULTS: In the lumbar disc herniation rats, significant reduction of thermal withdrawal latency indicating thermal hyperalgesia was shown on the ipsilateral hindpaw on postoperative day 1 (p<0.01) and peaked on day 10 (p<0.05) and maintained throughout day 30 (p<0.05). The reduction of mechanical allodynia threshold, indicating mechanical allodynia, was observed on the ipsilateral hindpaw on postoperative day 1 (p<0.01) and continued throughout day 30 (p<0.01). Real time PCR showed the decrease in mRNA expression of CX3CR1 in the ipsilateral DRG on day 1 (p<0.05) and the significant increase on day 20 (p<0.05). The immunoreactivity for CX3CR1 was also increased in ipsilateral DRG on day 10 and 20. CONCLUSION: These data suggest that lumbar disc herniation induces thermal hyperalgesia and mechanical allodynia and upregulates the expression of CX3CR1 in dorsal root ganglion. Expression of CX3CR1 might be associated with subacute neuropathic pain after intervertebral disc herniation.

Risk Factors of Critical Illness Polyneuropathy on Intensive Care Unit Patients

OBJECTIVE: To find the risk factors of critical illness polyneuropathy (CIP) on intensive care unit patients using early electrodiagnosis. METHOD: The adult patient who were admitted to the ICU and taken ventilator care with endotracheal intubation were included. The time after admission was 48 to 144 hours. In case of axonal neuropathy of peripheral nerve, if affected nerves were in different two limbs or different three nerves were affected, CIP was diagnosed. If some nerves got abnormal results but did not satisfied the above criteria, the patient was classified as peripheral neuropathy group. The days of using neuromuscular blockade, continuous insulin infusion, catecholamine, vasopressor, corticosteroid, benzodiazepine, parenteral nutrition and fact for continuous renal replacement therapy, SOFA (sequential organ failure assessment) score were evaluated to find the risk factors. RESULTS: Eighteen patients were included. Six patients were CIP and another six were peripheral neuropathy. Risk factors for CIP were age, duration of intensive care, days of neuromuscular blockade and parenteral nutrition (p<0.05). There was no difference on mortality rate among the three groups. CONCLUSION: The result of early electrodiagnosis on ICU patients for CIP diagnosis revealed that risk factors of CIP were age, duration of intensive care, days of neuromuscular blockade and parenteral nutrition.

Effect of Repetitive Magnetic Stimulation and Transcutaneous Electrical Nerve Stimulation in Chronic Low Back Pain: A Pilot Study

OBJECTIVE: To evaluate the short and medium effect of peripheral repetitive magnetic stimulation therapy on chronic low back pain compared with transcutaneous electrical nerve stimulation therapy. METHOD: Twenty-three subjects with chronic low back pain were allocated randomly to repetitive magnetic stimulation group (n=13) and transcutaneous electrical nerve stimulation group (n=10). Each treatment consisted of 10-minutes sessions each day, totally 10 sessions over 2 weeks. Subjects were evaluated pre-treatment and post-treatment at 8 hours and 2 weeks. Outcome was measured with the Oswestry disability index, McGill pain questionnaire, and daily mean pain numeric rating scale. RESULTS: At 8 hours and 2 weeks post-treatment, transcutaneous electrical nerve stimulation therapy group showed a significant improvement in the mean pain numeric rating scale. Two weeks post-treatment, transcutaneous electrical nerve stimulation therapy group showed a significant improvement in the Oswestry disability index. But there were no significant therapeutic effect of repetitive magnetic stimulation therapy group at all period. CONCLUSION: This study showed that repetitive magnetic stimulation therapy may be less effective than transcutaneous electrical nerve stimulation therapy for the treatment of chronic low back pain.

Ultrasonography-guided Subacromial Bursal Injection of Corticosteroid: A Comparative Study of Two Dose Regimens

OBJECTIVE: To investigate the treatment efficacy between low and high dose of triamcinolone acetonide in the treatment of ultrasonographic-guided subacromial bursa injection. METHOD: Forty two patients with periarticular shoulder disorders were randomly assigned to receive injection with 10 mg (group 1, 20 patients) or 40 mg (group 2, 22 patients) triamcinolone acetonide. After a single injection, participants were followed up for 6 weeks. Treatment efficacy was measured upon pre-treatment and post-treatment on week 1, 3, 6, using visual analog scale for average pain intensity during 24 hours (24 h VAS), Shoulder Function Assessment scale (SFA), Shoulder Disability Questionnaire (SDQ), and active range of motion (AROM). Participants and the assessor were blinded for group assignment. RESULTS: Six weeks after injection, the 24 h VAS, the SFA, the SDQ, and the AROM (internal rotation, external rotation, and abduction) showed a significantly greater improvement in group 2 than group 1 (p <0.05). CONCLUSION: This study showed that in the treatment of periarticular shoulder disorders greater pain relief and functional improvement were obtained with a dose of 40 mg triamcinolone acetonide than with a dose of 10 mg.

Dental Identification of the Victims of the Cold Storage Warehouse Fire in Icheon / 대한법의학회지

The fire broke out in the cold storage warehouse in Icheon, Gyeonggi-do, Korea on January 7th, 2008 and forty workers were died from the fire. Dental identification was carried out to the 25 victims among the 40 ones. The five remains were identified through dental approaches. The public ignorance about the importance of forensic odontology and the difficulty procuring antemortem dental records from the families of the victims were kind of hardships to use the victim's previous dental information. The availability of antemortem data was 12.5%. The public realization about the importance of dental identification and building-up an appropriate co-work system between relevant organizations are required to collect antemortem data more efficiently without wasting time.

Calf Muscle Shortening after Radiofrequency Muscle Reduction: A case report

Thirty-year old female developed limited range of motion (ROM) of both ankles after radiofrequency muscle reduction procedure for one month prior to her visit. Dorsiflexion of both ankles was severely limited to zero degree. Plantar flexion of both ankles was limited to 20 degree on the right and 15 degree on the left. The electrodiagnostic study and MRI showed normal nerve conduction study and inflammatory change of both gastrocnemius and soleus muscles. She received ROM and stretching exercise for 1 hour per day and twice per week for 4 weeks as an outpatient with continuous home programming. After 2 weeks of treatment, ROM improved to 20 degree plantar flexion and to 20 degree dorsiflexion on the right ankle and to 20 degree plantar flexion to 10 degree dorsiflexion on the left ankle. This is a case of severe muscles contracture after radiofrequency procedure reversible after intensive strengthening exercise.

Evaluation of Neurogenic Bladder with Newly Developed Natural-fill Cystometric Device : Cases report

We developed a new, affordable, and easy-to-use natural-fill cystometric device to overcome the limitation of conventional cystometry, long been criticized for being unphysiological. The device was composed of one transurethral catheter, one rectal catheter, two digital manometers, and a portable computer. The transurethral and rectal catheters were connected to manometers, which were then connected to the computer. Three persons with neurogenic bladder were recruited for testing the device. To shorten the test duration, we gave patients 500 ml water before the test. As urine filled inside the bladder, the transurethral and rectal catheters transmitted respectively the intravesical and abdominal pressures to the digital manometers. The pressures were stored within the portable computer and turned into graphs indicating pressure changes. The natural-fill cystometry is thought to be a physiological test that is affordable and convenient because of its simple structure and small size.

Comparison between Natural Filling Cystometry and Conventional Retrograde Filling Cystometry in Patients with Stroke

OBJECTIVE: To compare the personally developed natural filling cystometry (NFC) and conventional retrograde filling cystometry (RFC) METHOD: NFC and RFC were performed on 15 patients with stroke. RESULTS: Patients were classified into three groups according to their usual lower urinary tract symptom. Four patients without urinary symptom did not show any detrusor overactivity or detrusor underactivity during NFC or RFC. Of the nine patients with urinary frequency or urgency, five (55.6%) showed detrusor overactivity during NFC and two (22.2%) during RFC. Two patients with straining showed detrusor underactivity during both tests. CONCLUSION: There was no significant difference of cystometric findings between NFC and RFC in case of patients without urinary symptom or with detrusor underactivity, but those patients with urinary symptom that is suspected of detrusor overactivity showed a more frequent detrusor overactivity during NFC than RFC. Therefore, NFC is thought to be a useful tool in evaluating the neurogenic bladder of stroke patients suspected of detrusor overactivity since it can detect detrusor overactivity which were less detectable in RFC.

A New Method for Vestibulo-Collic Reflex

OBJECTIVE: Vestibulo-collic reflex (VCR) has been thought to be a simple and reliable test in evaluating the vestibular function. But it can only be examined by actively contracting the sternocleidomastoid muscle (SCM) and it would be impossible to conduct the examination without the cooperation of the subject. The aim of this study was to demonstrate a new method for VCR in the absence of the subject's cooperation. METHOD: Records were collected from 20 volunteers. Each subject was properly positioned on the bed with the head flexed, ipsilaterally bent and contralaterally rotated. An active electrode was placed over the belly of the SCM. 100 dB clicks were delivered through headphones. We compared the active contraction and passive positioning of the SCM in terms of the P1 latency and amplitude. RESULTS: Vestibular-evoked myogenic potentials (VEMPs) were recorded without actively contracting the SCMs for all the subjects by using our new method. There was no difference in P1 latency and amplitude between the active contraction and passive positioning of the SCM. CONCLUSION: With our new method, VEMPs can be recorded without actively contracting the SCM. It may be useful for evaluating the vestibular function of children and patients who cannot cooperate.

Quality of Life in Primary Caregivers for the Home-Bound Severe Stroke Patients

OBJECTIVE: To evaluate the level of depression, anxiety and quality of life in primary caregivers for the severe stroke patients. METHOD: We studied a sample of 44 severe stroke patients and their primary caregivers. Functional status of the severe stroke patients was evaluated by Modified Barthel Index (MBI). We collected the data through interviewing the caregivers and using the Beck Depression Inventory (BDI), State- Trait Anxiety Inventory (STAI), Ego-strength scale, Short Form Health Survey-36 (SF-36) and Family APGAR (Adaptation, Partnership, Growth, Affection and Resolve) score. RESULTS: The average level of depression in caregivers was low. The mean socres of STAI were 41.5 for state anxiety and 44.3 for trait anxiety, respectively. Ego-strength scale was significantly inversely related to BDI score and trait anxiety inventory score, but positively related to SF-36 score. The most influencing factor for the SF-36 score was the BDI score. CONCLUSION: Primary caregivers for the home-bound severe stroke patients demonstrated a lower level of quality of life, especially mental health, general health and vitality component. Community based rehabilitation should more focus on the evaluation and support for caregiver's psychologic status and their quality of life.

Intravesical Capsaicin Instillation Therapy for the Management of Hyperreflexic Neurogenic Bladder

OBJECTIVE: The aim of this study was to investigate the efficacy of capsaicin, a neurotoxin for C-fiber afferents, applied intravesically in the treatment of neurogenic bladder with detrusor hyperreflexia (DH). METHOD: Six subjects, three women and three men with traumatic spinal cord injury who had neurogenic bladder manifested with DH and urinary incontinence resistant to oral and intravesical anticholinergic instillation treatment were tried with intravesical administration of capsaicin (1 mmol/l 100 ml) for 30 minutes. Single instillation was given in five subjects and two instillations in one. Maximal detrusor pressure and maximal bladder volume were monitored by the portable cystometer. Follow-up monitor of pressure and volume was recorded after 1 week and every 3 weeks afterwards for 21 weeks, with one exception (31 weeks). RESULTS: Average maximal detrusor pressure decreased by 50.8% and average bladder capacity at maximal detrusor pressure increased by 68% in five subjects after single instillation of capsaicin. Clinical benefit from single instillation lasted over 21 weeks and same as the subject with two instillations. Maximal effect on detrusor pressure appears during 6~9 weeks period and bladder capacity during 9~15 weeks period. Although autonomic dysreflexia in 5 of 6 subjects during instillation and macroscopic hematuria in 2 subjects during the 1st two days were noted, they were resolved spontaneously. CONCLUSION: Single and repeated intravesical instillation of capsaicin were safe and effective in the management of neurogenic bladder with DH in traumatic spinal cord injured patients.

Usefulness of the Portable Cystometer

OBJECTIVE: To evaluate the usefulness of a newly devised portable cystometer to measure the pressure of bladder in a low cost and easier accessability. METHOD: This study was performed in 47 patients with a conventional instrumental cystometer (Jupiter 8000, Wiest) and the newly devised portable cystometer. In the supine position, we measured the maximal intravesical pressure, abdominal pressure and bladder volume with the portable cystometer just after the measurement of the maximal detrusor pressure and bladder volume with the conventional instrumental cystometer. Paired t-test was utilized to analyze and compare the result. RESULTS: 1) There was no significant difference in the average maximal detrusor pressures measured by maximal intravesical pressures minus abdominal pressures, which were 38.32 20.97 cmH2O by the conventional instrumental cystometer and 40.02 20.70 cmH2O by the portable cystometer (p>0.05). 2) There was no significant difference in the average bladder volumes at maximal detrusor pressure, which were 302.13 83.92 cc by the conventional instrumental cystometer and 314.04 94.17 cc by the portable cystometer (p>0.05). CONCLUSION: We conclude that there is no significant difference between the conventional instrumental cystometer and the portable cystometer in the measurement of detrusor pressure and bladder volume. We believe this portable cystometer would be a useful tool to evaluate the function of bladder in a low cost and easier accessability.

Bladder Volume Measurement using Bladder Manager PCI 5000 in Spinal Cord Injury Patients

A portable ultrasound scanner has been developed to provide a noninvasive technique of measuring the bladder urine volume. This study was undertaken to determine if bladder volumes could be accurately measured in a group of spinal cord injury patients on a clean intermittent catheterization program, using a portable ultrasound scanner(BladderManager PCI 5000). We assessed the effects of different patient positions, presence of central obesity and bladder types by the urodynamic study on the accuracy of measurements as well as the inter-tester difference. Ultrasound measurements of urine volume performed by two physicians were compared to the volumes obtained by catheterization in 17 spinal cord injury patients. Subjects were tested in the seated and supine positions. The results showed a good correlation between the catheterized volumes and ultrasound measurements (Pearson correlation coefficient=0.97, r2=0.88). The mean % error was 18% for the catheterized volumes within the ranges of 45ml-640ml. But the ultrasound measurements revealed a significantly higher % error for the bladder volumes less than 200ml. Ultrasound measurements were more accurate in a supine position and among the non-obese subjects(p<0.05). There was no significant difference in the ultrasound measurements between areflexic type bladder and hyperreflexic type bladder neither in the inter-tester measurements. We conclude that the Bladder Manager PCI 5000 is not an accurate tool for the assesssment of post-void residual urine volumes, however it can be a useful tool for the patients with neurogenic bladder who are performing volume-directed clean intermittent catheterization, in reducing the unnecessary catheterization or preventing the bladder overdistensions.