Diagnostic Usefulness of Digital Infrared Thermal Image in Carpal Tunnel Syndrome

OBJECTIVE: The purpose of this study is to evaluate the usefulness of infrared thermography in patients with carpal tunnel syndrome by comparing with electrodiagnostic and ultrasonographic findings.METHOD: From January 2014 to October 2017, electrodiagnosis, ultrasound, and digital infrared thermal image (DITI) of unilateral carpal tunnel syndrome diagnosed in a single hospital were retrospectively analyzed. The subjects with bilateral symptoms of carpal tunnel syndrome, peripheral vascular disease, diabetes, thyroid disease, fibromyalgia, rheumatic disease, systemic infection, inflammation, malignant tumor, and other musculoskeletal disorders such as finger osteoarthritis, peripheral neuropathy, cervical radiculopathy, and the previous history of surgery were excluded.RESULTS: Of 53 patients diagnosed with carpal tunnel syndrome, 11 were male and 42 were female. The visual analogue scale was 4.9 ± 1.9, and the duration of symptom was 11.8 ± 12.5 months. There was no statistically significant difference in the body surface temperature between the unaffected and affected sides. The severity of symptoms, electrodiagnostic findings, and cross-sectional area of the median nerve significantly correlates to each other. The temperature difference between the second fingers of the affected and unaffected sides showed a weak correlation with the amplitude of sensory nerve action potential and onset latency of compound muscle action potential, when there was no significant correlation with the other parameters.CONCLUSION: The difference in temperature on the surface of the body, which can be confirmed by DITI, is little diagnostic value when DITI is performed in unilateral carpal tunnel syndrome patients, especially when compared with ultrasonography.

Combination Technique with Ultrasonography and Electromyography for Botulinum Injection in the Cricopharyngeal Muscle: A Case Report / 대한연하장애학회지

Cricopharygeal dysfunction (CPD) may lead to a range of symptoms including dysphagia and aspiration. Treatments for CPD have included mechanical dilation, myotomy and botulinum injection. Recently, the use of botulinum toxin injection has been reported to be safe and effective for the treatment of CPD. Ultrasonography guided technique, however, is not well established. A 55-year-old woman visited the hospital with a left cerebellar, lateral medullary, and pons infarct 4 years ago. A three-year conventional dysphagia therapy had not improved the patient's condition. Nutrition had been provided via a percutaneous endoscopic gastrostomy (PEG) tube. Videofluoroscopic swallowing study (VFSS) showed CPD. Ultrasonography and elelctromyography-guided injection of 20 units of botulinum (Meditoxin®) in left cricopharyngeal muscle. One month after injection, the VFSS showed improvement in relaxation of the upper esophageal sphincter. The patient could eat semisolid food and a soft diet at 1,200 kcal/day orally; the treatment was a success.

Relationship between handwashing practices and infectious diseases in Korean students / 農村醫學 地域保健

OBJECTIVES: The purpose of this study was to investigate the association between practice and infectious diseases in elementary, middle and high school students. METHODS: In 16 metropolitan cities and province of the Korea, the students who from fourth grade of elementary school to third grade of high school were surveyed by personal interviews and an web-based online survey from 5 to 25 September, 2014. We analyzed data with chi-square test and logistic regression analysis. RESULTS: Common cold, diarrhea, and eye infections were more prevalent among students in higher grade than lower grade. In particular, common cold was more prevalent among girls than boys, using hand sanitizer than washing with soaps, and students who wash the dorsal side of hand than not wash the dorsal side of hand. CONCLUSIONS: Higher-grade students showed low status of hand washing practice. Hand washing was determined as the fact which influences to increase the prevention of communicable disease such as common cold. Considering the fact that youth groups have higher risk of being infected due to their group life, schools are recommended to provide adequate educations regarding proper hand washing practice with soap.

Prevalence and allergens of allergic rhinitis in children and adolescents in Gwangju

PURPOSE: Allergic rhinitis (AR) is one of the most common childhood diseases in Korea. In this study, we aimed to investigate the prevalence and allergens of childhood AR in Gwangju. METHODS: From April 2013 to September 2013 in Gwangju, skin prick test and questionnaire survey were performed targeting 2,330 children in total (350 kindergartners, 930 elementary school students, 589 middle school students, and 461 high school students). RESULTS: The overall prevalence of AR was 23.5% (female 21.3%, male 26.1%). According to age groups, prevalence of AR was 14.9% (female 10.7%, male 19.8%) in kindergartners, 24.5% (female 18.8%, male 29.4%) in elementary school students, 23.3% (female 18.1%, male 27.6%) in middle school students, 26.2% (female 27.7%, male 23.2%) in high school students. The most common allergen was Dermatophagoides pteronyssinus (79.7%), followed by Dermatophagoides farina (72.2%), birch (14.0%), alder (12.0%), Japanese hop (9.2%), Alternaria (8.9%), cat fur (7.2%), Japanese cedar (6.9%), ryegrass (6.6%), willow (6.0%), pine (5.4%), oak (4.9%), mugwort (4.3%), orchard grass (4.0%), sheep fescue (3.7%), fat hen (3.4%), ragweed (3.4%), and maple (3.4%). CONCLUSION: This research figures out the prevalence and the detailed allergens of AR in Gwangju children. We suggest that more vegetation data of Japanese cedar should be surveyed in recent future.

The Additional Effect of Hyaluronidase in Lumbar Interlaminar Epidural Injection

OBJECTIVE: To evaluate the effect of hyaluronidase in lumbar interlaminar epidural injection (LIEI) for low back pain and sciatica. METHOD: Sixty-one patients suffering from severe low back pain and sciatica were randomly allocated into three groups. Group T (n=18, mean duration of illness: 2.12+/-1.16 months) received lumbar interlaminar epidural injection (LIEI) with 2 ml triamcinolone (40 mg/ml) and 5 ml bupivacaine (0.25%). Group H (n=16, mean duration of illness: 2.05+/-1.12 months) received LIEI with 1,500 IU hyaluronidase and 5 ml bupivacaine (0.25%). Group TH (n=27, mean duration of illness: 2.16+/-1.65 months) received LIEI with 1,500 IU hyaluronidase, 2 ml triamcinolone (40 mg/ml), and 5 ml bupivacaine (0.25%). The effects were evaluated using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) at preinjection and 2 weeks, 4 weeks, and 8 weeks after LIEI. RESULTS: Pain improved in all groups after 2 weeks (p<0.05). After 8 weeks, there was no significant difference in VAS improvement among the 3 groups. However, pain improved in 70.4% of Group TH compared with preinjection, in contrast to 44.4% of Group T and 31.3% of Group H. The ODI improved significantly only in Group TH after 8 weeks (p<0.05). CONCLUSION: LIEI with triamcinolone and hyaluronidase is more effective for reducing pain after 8 weeks than injection with triamcinolone or hyaluronidase alone.

Characteristics and Prognosis of Pusher Syndrome in Stroke Patients

OBJECTIVE: To evaluate the incidence, associated neuropsychological symptoms, imaging feature and prognosis of pusher syndrome (PS). METHOD: One hundred-ninety-seven patients with unilateral acute stroke were enrolled. Patients were evaluated for the presence and severity of PS using a standardized scale for contraversive pushing, neurological examination, assessment of neuropsychological symptoms (neglect, anosognosia, aphasia, apraxia), activities of daily living (ADL) and neuroimaging studies (CT or MRI). ADL was measured with Korean version of modified Barthel index (K-MBI). RESULTS: PS was found in 10.7% (n=21) of the included patients. No significant differences were found between patients with and without PS in age, sex, handedness, initial K-MBI score, neuropsychologic symptoms, lesion size and cortical involvement. Thalamic lesion was strongly correlated with PS (p<0.05). PS had no independent influence on gain in ADL, but spent 4.8+/-1.7 weeks (p<0.05) more to reach the same final outcome level than did patients without PS. Average symptom duration of PS was 14.6+/-3.6 weeks. Initial severity of PS did not influence on gain in ADL and recovery period. CONCLUSION: PS did not affect final functional outcome, but slowed the process of recovery considerably. And thalamus seems to be fundamentally involved in control of upright body posture. Presence of PS is more important than severity of initial PS for prognosis.

Clinical Validity of Gugging Swallowing Screen for Acute Stroke Patients

OBJECTIVE: To assess the validity of Gugging Swallowing Screen (GUSS) that allows separate evaluations for non-fluid and fluid textures for aspiration risk of acute stroke patients. METHOD: Fifty-five acute stroke patients were assessed prospectively. For interrater reliability, 2 independent physicians evaluated 40 patients in two hours. For external validity, another group of 15 patients were tested by dysphagia therapist. The validity of the GUSS was established by videofluoroscopic swallowing study (VFSS). After GUSS, all patients were investigated by VFSS within 1 hour. To compare the results of VFSS, they were graded according to the Penetration Aspiration Scale (PAS). RESULTS: The cut-off value of GUSS was 14 points and 5 stage of PAS. GUSS reached 100% sensitivity, 61.1% specificity, and 100% negative predictive value when compared with VFSS by physician A (p<0.001). By physician B, GUSS (p<0.001) reached 100% sensitivity and 60.0% specificity, and 100% negative predictive value and 100%, 85.7%, 88.9%, 100%, in the 15 patient group (p<0.05). The kappa-value was 0.916 between physician A and B (p<0.05). CONCLUSION: This study proposes that GUSS is a reliable method in identifying stroke patients with aspiration risk. Such a graded assessment can provide less discomfort for those patients who can continue with their oral feeding for semisolid food while refraining from drinking fluids.

Effect of Low Power Laser Irradiation on the Proliferation and Differentiation of PC12 Nerve Cells

OBJECTIVE: We examined the effect of low power laser irradiation (LPLI) on the proliferation and differentiation of PC12 nerve cells. METHOD: After seeding 4x10(5) PC12 nerve cells each in the 24 well-culture dishes, we cultured them for 6 days with RPMI1640 media. LPLI (650 nm, 5 mW, 5 sec) was applied for 1 day, 2 days and 3 days (1, 2 and 3-day-LPLI groups) consecutively. For the degree of proliferation of PC12 nerve cells, we compared the total cell number at 6th day after LPLI by MTT cell proliferation assay. For the degree of differentiation, we compared the length of neurite out-growth and the expression of RT97 at 6th day after adding nerve growth factor on each group. RESULTS: The total cell numbers were increased significantly after LPLI, but those increments were not significant among 1, 2, and 3-day-LPLI groups. The numbers of the differentiated PC12 nerve cells and the expressions of RT97 were diminished serially according to the number of days of LPLI. CONCLUSION: We conclude that LPLI increased the proliferation and decreased the differentiation of PC12 nerve cells. We could suggest that single or short-term use of LPLI on the injured nerve should be helpful for enhancing the neural regeneration in vivo.

Anatomical Factors Influencing the Stimulation Intensity of the Functional Electrical Stimulation of the Supraspinatus Muscle

OBJECTIVE: This study was designed to evaluate the contribution of anatomical factors to the stimulation intensity needed for functional electrical stimulation (FES) of shoulder girdle muscles, especially the supraspinatus. METHOD: Anatomical dimensions, including the length of the arm and scapular spine, were measured in twenty three normal subjects. Depth and thickness of the supraspinatus and trapezius muscle were measured ultrasonographically. FES was applied for supraspinatus muscles, and the minimal intensity required to induce contraction was recorded. Correlations of intensity with the anatomical dimensions were investigated statistically. RESULTS: The thickness of the supraspinatus muscle and the length of the scapular spine showed statistically significant correlations with the minimal intensity for FES of supraspinatus muscles. No other anatomical measurements showed significant correlation. CONCLUSION: The intensity required for FES was affected by the thickness and length of muscles, rather than other anatomical variables. The results of this study suggest that one of the major factors contributing to the determination of the intensity of FES is the size of muscles. If the intensity could be estimated before stimulation, based on the size of muscle, unnecessary discomfort of the patients would be avoided.

A Case of Langerhans Cell Histiocytosis Preceding with Central Diabetes Insipidus / 대한소아내분비학회지

A 3-year-old girl presented with polydipsia and polyuria for last 2 years. Her fluid intake was 7~8 L/day, and urinalysis showed low osmolality and specific gravity. Central diabetes insipidus (DI) was diagnosed by a water deprivation test. Intranasal 1-desamino-8-D-arginine vasopressin relieved her symptoms and normalized urinary concentrations. A T1-weighted MRI scan revealed a symmetrical thickening of the central part of the pituitary stalk. Six months after the diagnosis of central DI, she developed papular skin lesions on her forehead. The lesions were surgically removed, and histologically classified as Langerhans cell histiocytosis (LCH). We concluded that thickening of the central part of the pituitary stalk might represent the first manifestation of LCH clinically presenting with central DI. In children with central DI, special attention should be paid to the appearance of the pituitary stalk using MRI for the various manifestations of LCH in the central nervous system.

A Case of Acute Poststreptococcal Glomerulonephritis Accompanied with Acute Pyelonephritis

Acute poststreptococcal glomerulonephritis(APSGN) is the most common form of postinfectious glomerulonephritis, and acute pyelonephritis(APN) is the most severe form of urinary tract infection in childhood. However, the concurrence of two diseases is uncommon in the literature. We describe a case of APSGN accompanied with APN in a 5-year-old female who presented with fever, left flank pain, headache and facial edema. Urinalysis showed pyuria, microscopic hematuria, and mild proteinuira. Serial urine cultures grew Escherichia coli. (99m)Tc-DMSA renal scan revealed a cortical defect in the upper pole of left kidney. She had a history of preceding pharyngitis, in addition, showed high blood pressure, high anti-streptolysin O titer, and low serum complement levels. The patient improved completely with supportive treatment, including antibiotic and antihypertensive therapy. These findings suggested that APSGN and APN could be manifested simultaneously or be superimposed on each other.

Expression of Caveolin-3 in the Muscle Cell and Tissue

OBJECTIVE: Caveolae are the microdomain of the plasma membrane that have been implicated in signal transduction and caveolin is a principal component of the caveolae. Caveolin-3, a family of caveolin related protein, is expressed only in muscle tissue. Here we examined the expression of caveolin-3 in the course of myobalst differentiation and within the muscle tissue. METHOD: L6 cell, rat skeletal myoblast, was cultured in the low mitogen medium and caveolin-3 expression was observed both by immunocytochemistry and western blot analysis. Localization of caveolin-3 within the muscle tissue was investigated and compared to that of dystrophin. RESULTS: While caveolin-3 was not expressed in the proliferating myolast, caveolin-3 was expressed in the differentiated myoblast. Caveolin-3 and dystrophin were co-expressed in the membrane of muscle tissue and integrated density of caveolin-3 was elevated in the area of muscle injury. In the Duchenne muscular dystrophy, caveolin-3 was expressed in the membrane of muscle tissue, but dystrophin was not. CONCLUSION: Caveolin-3 was induced during the myobalst differentiation and its expression was increased during the muscle regeneration. Caveolin-3 was physically associated with dystrophin as a complex, but not absolutely required for the biogenesis of dystrophin complex.

Acute myocardial infarction accompanying occlusion of left anterior descending and right coronary arteries / 대한내과학회지

Acute myocardial infarction (AMI) with simultaneous occlusion of two or three coronary arteries is extremely rare, but may cause devastating events unless immediate revascularization strategies are undertaken. We report an unusual case of AMI with ST-segment elevation in precordial leads. Thrombolysis was achieved successfully 2 hours after the onset of chest pain. Coronary angiography revealed residual heavy fresh thrombi at right coronary artery (RCA) as well as patent residual stenosis at left anterior descending coronary artery (LAD). Akinesia was demonstrated at anterolateral, apical, diaphragmatic, and posterobasal segments on left ventriculography. Large perfusion defects were proven at LAD and RCA territories on myocardial SPECT.

Comparison of Tissue Perfusion Measured by ST Segment Resolution between Thrombolysis and Primary Stenting in Acute ST Elevation Myocardial Infarction

BACKGROUND AND OBJECTIVES: The primary objective of reperfusion therapy in the acute ST elevation myocardial infarction (STEMI) is the recovery of myocardial perfusion in infarct tissue, as well as the restoration of epicardial blood flow. ST segment resolution on the ECG is an index, which represents adequate myocardial tissue perfusion following treatment. SUBJECTS AND METHODS: Patients with acute STEMI, arriving within 12 hours of the onset of symptom underwent either thrombolysis (n=40) or primary stenting (n=51) were used for this study. ST segments on the ECG were measured with hand-held electronic callipers and the results were analysed by a single observer. RESULTS: Thrombolysis therapy was started earlier than primary stenting, although this was not statistically significant (311+/-171 minutes vs 399+/-251 minutes, p=0.61). After treatment, thrombolysis achieved a higher rate of complete ST segment resolution (>or=70%) compared to primary stenting (20/40;50.0% vs 13/51;25.4%, p=0.016). However, when the data was corrected for time, the difference between the two modalities was not significant (p=0.119). ST segment resolution varied significantly (p=0.026) according to treatment time, regardless of treatment modality. At the 6 month follow up, patients with complete ST segment resolution had a lower rate of major cardiac event (2.1% vs 13.8% p=0.094). CONCLUSION: In this study, thrombolysis achieved a higher rate of complete ST resolution compared with primary stenting in acute STEMI. By ad hoc analysis, this result was attributed to the difference in treatment time between the two groups, suggesting successful tissue reperfusion in acute STEMI is determined primarily by the rapidity, rather than the type, of treatment.

A Case of Chronic Myelogenous Leukemia Associated with Rheumatoid Arthritis / 대한류마티스학회지

Rheumatoid arthritis (RA) is though to be a collagen disease induced by auto-immune mechanism of unknown etiology. Chronic myelogenous leukemia (CML) is a disease characterized by overproduction of cells of the granulocytic, especially the neutrophilic series and occasionally the monocytic series, leading to marked splenomegaly and very high white blood cell counts. There's no consensus on the risk of leukemia in RA. There are some reports ragarding the relationship between low dose of methotrexate (<20 mg weekly) and the development of leukemia in RA. Although RA is a complex process, it can be considered initially as a stem cell disorder requiring treatment similar to that administered to transplant patient. We experienced a case of CML associated with RA. A 60-year-old woman with RA was treated with low dose methotrexate (7.5 mg weekly), hydroxychloroquine (HCQ), non-steroidal anti- inflammatory drug (NSAID) and low dose steroid. This therapy was continued for 3 years. She was diagnosed CML after 3 years of therapy. CML was confirmed by bone marrow biopsy and the presence of the Philadelphia chromosome.

Asymptomatic Cor Triatriatum in an Adult Incidentally Revealed by Echocardiography

We report an unusual case of asymptomatic cor triatriatum found in a 30-year-old female suffering form Bechect's syndrome. Cor triatriatum was suspected from a routine echocardiography. The left atrium was divided into a posterior superior chamber and an anterior inferior chamber (true left atrium) by an echo-dense membrane. Two turbulent jet flows were demonstrated on transesophageal echocardiography. Catheterization and angiography demonstrated a mild increase in the pulmonary artery, and capillary wedge, pressures no associated anomalies, and with four pulmonary veins draining into the posterior chamber. The membrane was successfully resected by surgery.

Emergence of YMDD motif mutant hepatitis B virus during long-term lamivudine therapy / 대한내과학회지

BACKGROUND: The emergence of YIDD or YVDD mutant hepatitis B virus (HBV), with point mutation in the YMDD motif of DNA polymerase gene, has been reported in patients with lamivudine treatment group. The aims of this study was to investigate the emergence of mutant HBV during long-term lamivudine therapy using nested polymerase chain reaction (PCR) method and direct DNA sequencing. METHODS: Twenty-one chronic hepatitis B patients with HBeAg and HBV DNA positive were evaluated. During lamivudine therapy, there were reported breakthroughs of HBV DNA (over 50 pg/mL) when investigated the emergence of YMDD mutants by nested PCR method using restriction fragment length polymorphism (RFLP) in all patients. Direct DNA sequencing of HBV DNA polymerase gene including YMDD motif was also performed. RESULTS: There were 13 patients (61.9%) with YIDD mutant and 8 patients (38.1%) with YVDD mutant. The results of direct DNA sequencing were consistent with those of nested PCR data based on RFLP. The breakthrough was occurred at 15 to 106 weeks (57.9+/-23.6). At the point of breakthrough, the level of ALT was 74.8+/-117.7 (14-546) IU/L, and it was lower than the level of ALT before the therapy. CONCLUSION: In the long-term therapy of lamivudine, the emergence of YMDD motif mutant HBV was related to the breakthrough of HBV DNA and YIDD mutant was frequent. The nested PCR method using RFLP may be simple and sensitive to detect the YMDD motif mutant HBV.

Quadricuspid Aortic Valve: Report of Two Cases

Quadricuspid aortic valve is an uncommon congenital anomaly and cause of aortic regurgitation. We report two cases of quadricuspid aortic valve with aortic regurgitation. Case 1, a 51-year-old woman was admitted to our hospital for fatigue and chest tightness. She had to and fro murmur along the left sternal border. Transthoracic echocardiography and transeso- phageal echocardiography showed grade 2-3 aortic regurgitation with quadricuspid aortic valve. The aortic valve consisted of four cusps of equivalent size(Hurwitz type a). Case 2, a 35-year-old man was admitted to our hospital for exertional dyspnea and chest tightness. He had grade 4/6 to and fro murmur along the left sternal border. Transthoracic echocardiography showed grade 4 aortic regurgitation with suggested quadricuspid aortic valve. The aortic valve consisted of two equal larger cusps and two equal smaller cusps and a supernumerary cusp located between the right and noncoronary cusps(Hurwitz type c). He was performed aortic valve replacement with a 21 mm On-X valve.

Three cases of Lyphodystophia Centrifugalis Abdominalis Juvenilis

No abstract available.

Posterior Nasal Swab Culture in Normal Newborns by Feeding Method

No abstract available.