The Usefulness of Ultrasonographic Evaluation in the Tendinitis

OBJECTIVE: The purpose of this study is to investigate the usefulness of ultrasonographic evaluation in the tendinitis. METHOD: 52 tendinitis cases were evaluated by physical examination, Cyriax selective tension technique, simple X-ray and the high-resolution realtime ultrasonography. And clinical diagnosis of tendinitis was confirmed when symptom was relieved after the local lidocain injection to suspected site of tendinitis. The ultasonographic results were compared to clinical diagnosis and ultrasonographic findings were investigated. RESULT: The distribution of clinical tendinitis was as follows;15 extensor carpi radialis tendinitis, 12 supraspinatus tendinitis, 9 subscapular tendinitis and etc. Clinical diagnosis was matched with ultrasonographic results in 38 cases out of 52 (73.1%). The ultrasonographic findings of tendinitis were as follows; 31 hypoechogenicity, 14 thickening, 13 hypervascularity, 12 irregular margin and etc. CONCLUSION: The ultrasonography is useful in diagnosis of tendinitis and can provide the exact lesion site of tendinitis. Also it can be used for differential diagnosis of acute or chronic tendinitis.

Neurophysiological Changes after Botulinum Toxin A Injection in Normal Adults

OBJECTIVE: To evaluate the neurophysiological changes after intramuscular botulinum toxin A (BTX-A) injection in normal adults. METHOD: Nine subjects were studied by electrophysiological measurements before and after the injections. BTX-A (5 IU, Botox , Allergen, USA) was injected in the extensor digitorum brevis (EDB) muscles. Thereafter, electrophysiological measurement was followed up during 6 months. RESULTS: The compound muscle action potential (CMAP) amplitude of injected EDB muscle decreased significantly for 8 weeks, a maximal decrement at 4 weeks after injection. CMAP peak area changes over time were nearly identical to those of CMAP peak amplitudes. The first/fourth amplitude change of CMAP with 3-Hz repetitive nerve stimulation decreased significantly for 8 weeks and the amplitude following post-exercise activation increased significantly after injection. There were no significant changes in F-wave amplitude and latency. CONCLUSION: Serial electrophysiological measurements after intramuscular BTX-A injection into EDB provide useful information for the neurophysiological change after injection.

The Clinical Profiles and Risk Factors and Outcome of CAPD Peritonitis : A Single Center Study / 대한신장학회잡지

Peritonitis remains the leading cause of the patient dropout in CAPD in many developing countries. In Korea, 71% of CAPD patients dropout is caused by peritonitis. To elucidate an adequate guideline for treating peritonitis in our country, we analyzed clinical and bacteriologic profiles of peritonitis(1995. 1. 1- 1999. 12. 31). Two hundred and twenty eight episodes of peritonitis were developed in 127/247 patients. The incidence of peritonitis was 0.41/patient-year in general, which was decreased to 0.24/patient-year in 1999. The incidence of causative organisms were as follows; 82(36.0%) by Gram positive organisms, 38 (16.2%) by gram negative organisms, 16 cases(7.0%) by mixed organsisms, and 5 cases(2.2%) by fungus. During study period, the incidence of peritonitis by gram positive organsism was decreased while the incidence of peritonitis by gram negative organism was not changed. Recurrent infection/relapse was noted in 58 patients(45%). Peritonitis were eradicated only in 66% of the cases by initial antibiotics(cefazolin+aminoglycoside); and another 17% responded by second line antibiotics. Peritoneal catheters were removed in 38 episodes(16.7%). Patients with exit infection were more frequent in removal of catheter. Risk factor analysis was performed in 146 patients, who were newly started CAPD. There were 60 initial episodes of peritonitis(mean duration of follow up was 16.7 patient months). Sixty-five percent were free of peritonitis at the end of first year, 54% at the end of second year and 45% at the end of third year (Kaplan-Meier). Factors such as age, sex, underlying DM, were not risk factor for CAPD peritonitis. In conclusion, we observed that the incidence of peritonitis decreased every year. It was revealed however that only 66% of peritonitis can be successfully treated by first line antibiotics. Second line antibiotics such as ceftazidime may need to be introduced in early phase of CAPD peritonitis. Up to one third of patients had recurrent infection/relapse, which raised the incidence of peritonitis. Continuing education as well as better exit care is needed to improve technical survival of CAPD patients in Korea.

The Usefulness of Ultrasonographic Evaluation in the Musculoskeletal Disease

OBJECTIVE: The aim of this study is to know the usefulness of ultrasonographic evaluation in the musculoskeletal disease. METHOD: Thirty-nine cases with musculoskeletal pain were evaluated by physical examination, Cyriax selective tension technique, simple X-ray, electromyography, arthrography, Computed tomography, Magnetic resonance image and the high-resolution realtime ultrasonography to define the location of pain. The ultasonographic results were compared to other diagnostic methods. RESULTS: The ultrasonographic findings are as follow; 22 tendinitis, 7 entrapment neuropathies, 6 bursitis, 2 ligament injuries, and 2 rotator cuff injuries. Clinical diagnosis were matched with ultrasonographic findings in 30 cases out of 39. The most common ultrasonographic findings in 22 tendinitis cases were hypoechogenicity in affected tendon. Ultrasonographic findings in 7 entrapment neuropathies were 6 nerve swellings and 1 nerve flattening. CONCLUSION: The ultrasonography can provide detailed images of musculoskeletal system, including tendons, nerves and subcutaneous tissue. Therefore the ultrasonography is very useful in diagnosis and treatment of some musculoskeletal diseases such as tendinitis and entrapment neuropathy.

Defect of Acid-base Transporters in Distal Renal Tubular Acidosis / 대한신장학회잡지

The purpose of this study was to elucidate whether the molecular defect of acid-base transporters in renal tubules is related to the functional defect of urinary acidification in distal renal tubular acidosis(RTA). We performed NH4Cl, furosemide, or bicarbonate loading test to evaluate renal acidification function, and immunohistochemistry using antibodies to H+- ATPase, Cl-/HCO3- exchanger(band-3 protein), and Na+/K+-ATPase in kidney tissue in 6 patients with RTA and renal cell carcinoma patients as normal controls. Kidney tissue was obtained either by percutaneous needle biopsy(RTA) or nephrectomy(NC). The results were as follows; 1) In all six RTA patients, proton secretory defect of distal acidification was shown by a failure to lower the urine pH after NH4Cl loading or furosemide test or abnormally low urine-blood pCO2 difference during bicarbonate loading. In two patients with RTA, proximal acidification defect was combined, which was demonstrated by increased fractional excretion of bicarbonate. 2) In normal control, intense H+-ATPase and band-3 protein staining was observed in collecting ducts. 3) In distal RTA patients, H+-ATPase and band- 3 protein staining was not demonstrable or markedly decreased in the intercalated cells of distal nephron. 4) In two patients who had both proximal and distal RTA, H+-ATPase staining was markedly decreased in the brush border of proximal tubules as well as the distal nephron. In conclusion, the defect of acid-base transporters in renal tubule was related with the functional defect of urinary acidification in distal RTA.

Congenital Kyphosis Due to Dorsal Hemivertebra in Adult: A case report

Kyphotic deformity arising from the failure in formation of a vertebral body is an uncommon condition showing late complications of gross spinal angulation, paraplegia, impaired bladder function and cardiopulmonary deficiencies. Congenital hemivertebra constitute approximately 6% of anomalies associated with congenital spinal deformities. The natural course of this disease remains unpredictable, especially regarding the development of neurological impairment. Only a few numbers of patients with severe kyphosis due to congenital dorsal hemivertebra have been reported. We present a 40-year-old man with severe thoracic kyphosis. Gait difficulty due to paraplegia occurred at the age of fifteen with progressive development of the right lower limb pain and later impairment of bladder function. He had no cardiopulmonary deficiencies. Radiological findings showed a wedge shaped dorsal hemivertebra and cord compression at the eleventh level of thoracic vertebra. In view of the poor prognosis of surgical intervention he was fitted with an Jewett brace so that further neurological impairment was avoided. We report a rare case of congenital kyphosis due to dorsal hemivertebra in adult with progressive neurological impairment.