Ultrasonography of Morton's Neuroma Accompanied with Interdigital Bursitis

OBJECTIVE: To investigate clinical and ultrasonographic findings of Morton's neuroma with or without interdigital bursitis. METHOD: Eighty patients who were diagnosed as Morton's neuroma were included. The diagnostic criterion of Morton's neuroma at ultrasonography was hypoechoic mass was 5 mm in sagittal view. When the hypoechoic mass was molded by compression of the probe, Morton's neuroma accompanied with interdigital bursitis was diagnosed. The mean difference of symptom duration from onset to the hospital visit and the size of Morton's neuroma was evaluated. RESULTS: In eigthy patients, total 117 feet, 210 Morton's neuromas were detected. Of the 117 feet, 66% revealed more than one Morton's neuroma per one foot. Mostly Morton's neuroma was at the second (46.7%) and the third interdigital space (43.8%). Mean duration was 19.1+/-16.9 months. Comorbidity of interdigital bursitis was 23.3% of all Morton's neuroma. Mean size of Morton's neuroma with interdigital bursitis was significantly larger (10.3+/-3.0 mm) than single neuroma (8.5+/-2.5 mm). The symptom duration from onset to the hospital visit was significantly shorter in neuroma with interdigital bursitis (14.1+/-16.8 months) than single Morton's neuroma (21.2+/-16.6 months). CONCLUSION: Morton's neuroma had multiple propensity, mostly at the second and the third web space with comparable rate. Comorbidity of interdigital bursitis with Morton's neuroma was 23.3%. When interdigital bursitis was accompanied, the size of hypoechoic mass was larger and symptom duration from onset to the hospital visit was shorter than single Morton's neuroma.

Effect of the Tibia Counter Rotator Orthosis for Tibial Internal Torsion Children: A Preliminary Study

OBJECTIVE: To evaluate the therapeutic effect of the tibia counter rotator orthosis for tibial internal torsion children. METHOD: The 16 limbs included in this study were both lower extremities of 6 subjects and unilateral ones of 4 subjects (7 female and 3 male), ranging in age from less than 3 year to 11 years. These subjects were diagnosed as in-toeing gait with tibial internal torsion and had no history of forefoot adductus or other musculoskeletal abnormality. Tibial torsion was evaluated by thigh-foot angle and computed tomography before and after applying the Tibia Internal Brace(R) (TIB(R)). RESULTS: Thigh-foot angle and computed tomography showed significant improvement of tibial internal torsion before and after applying the TIB(R) (p0.05). And there was no significant correlation between age and improvement of tibial internal torsion (p>0.05). CONCLUSION: TIB(R) was effective for in-toeing gait children with tibial internal torsion.

The Effect of Percutaneous Selective Radiofrequency Thermocoagulation in the Treatment of Spasticity with Cerebral Palsy

OBJECTIVE: To compare the therapeutic effects between radiofrequency thermocoagulation and phenol motor branch block in treatment of spasticity of child with cerebral palsy. METHOD: Thirteen patients with spastic cerebral palsy were randomly divided into two groups. One group received percutaneous selective radiofrequency thermocoagulation on tibial nerve motor branch and the other group received phenol motor branch block to the gastrocnemius muscle. Therapeutic effects were assessed before and after treatment for 6 months in each group. The severity of ankle spasticity was assessed with the modified Ashworth scale (MAS), the modified Tardieu scale (MTS), and the passive range of motion (PROM) of ankle joint. RESULTS: In both groups, the MAS and MTS decreased, and radiofrequency thermocoagulation group showed more significant reduction of the spasticity (p<0.05). There was a significant increase in PROM on knee flexion and extension in a radiofrequency thermocoagulation group (p<0.05). CONCLUSION: Percutaneous selective radiofrequency thermocoagulation could be a treatment option for relieving the localized spasticity of ankle in spastic cerebral palsy with little adverse effect.

Percutaneous Selective Radiofrequency Thermocoagulation in the Treatment of Spastic Cerebral Palsy: A case report

Cerebral palsy is the most common motor disorder in childhood. In cerebral palsy, spasticity can be a very disabling feature: limited locomotor abilities, contracture and gait difficulty. We present two cases of cerebral palsy patients who had treated with oral medication and chemodenervation with the Botulinum toxin A or alcohol but could not walk independently. We performed percutaneous selective radiofrequency thermocoagulation in the tibial motor nerve branch under the general anesthesia. The degree of spasticity, which was measured with modified Ashworth scale and modified Tardieu scale, was reduced and recurrence of the spasticity wasn't seen untill 6 months. Percutaneous selective radiofrequency thermocoagulation could be a treatment option for spasticity of cerebral palsy with little adverse effect.

A Case of Acute Renal Failure Due to Ingestion of Silicon Compound / 대한신장학회잡지

Excessive exposure to several metallic elements is known to produce a variety of nephrotoxic syndromes such as glomerulonephritis, nephrotic syndrome, interstitial nephritis, structural and functional abnormalities of proximal tubule resembling the Fanconi's syndrome and acute tubular necrosis. Although the pulmonary toxicities of silicon are relatively well documented as a cause of silicoproteinosis and lung fibrosis after acute and chronic exposure to free silica(SiO2), but is little known about the nephrotoxicity of this trace element. Clinical manifestations of silicon nephropathy are similar to other heavy metal nephropathy as proteinuria, hematuria, active urinary sediments and renal failure. Diagnosis of silicon nephropathy is based on distinct exposure history to silica, variable degree of renal dysfunction and characteristic histologic findings such as cytoplasmic vacuoles and dense membrane-enclosed cytoplasmic bodies which is resembling lysosomes in proximal tubular cells. A 26-year-old man with ingestion of silicon compound(SiO2-NaOCO3) developed acute renal failure due to acute tubular necrosis. And he was recovered with conservative management to acute renal failure. So we report this case with a brief review of literature.