Anatomical Basis of Pronator Teres for Electromyography Needle Placement Using Ultrasonography

OBJECTIVE: To find the optimal needle insertion site for needle electromyography of the pronator teres (PT) muscle among commonly used sites. METHODS: Fifty forearms of 25 healthy subjects were evaluated. Four expected needle insertion points were designated as follows. Point 0 was positioned at the midpoint between the medial epicondyle and medial border of biceps tendon in the elbow crease. Points 1, 2, and 3 were located 2 cm, 3.5 cm and 5 cm distal to point 0, respectively. We assumed that the thickness of PT and the distances between a vertical line from each point to the medial margin of the PT were significant parameters for finding the optimal site. Thus, we measured these parameters through ultrasonographic examination. RESULTS: In men, the PT was thickest at point 2, and in women, at point 1. The distance between the expected needle insertion line and medial margin of PT was longest at point 1 in both men and women, and was statistically significant compared to points 2 and 3. Both men and women had neurovascular bundles located lateral to the expected needle insertion line. CONCLUSION: The most appropriate and safe needle electromyographic insertional site for the PT is 2-3.5 cm distal to the mid-point between the biceps tendon and medial epicondyle in the elbow crease and the needle should be inserted upward and medial.

Correction: Extensive Intramuscular Venous Malformation in the Lower Extremity

We found that the first author name was published incorrectly. Jung Ho Chul was changed to Ho Chul Jung.

Extensive Intramuscular Venous Malformation in the Lower Extremity

Typical venous malformations are easily diagnosed by skin color changes, focal edema or pain. Venous malformation in the skeletal muscles, however, has the potential to be missed because their involved sites are invisible and the disease is rare. In addition, the symptoms of intramuscular venous malformation overlaps with myofascial pain syndrome or muscle strain. Most venous malformation cases have reported a focal lesion involved in one or adjacent muscles. In contrast, we have experienced a case of intramuscular venous malformation that involved a large number of muscles in a lower extremity extensively.

Epidural Abscess after Interventional Muscle and Nerve Stimulation Therapy (IMNS): A Case Report

Advanced procedures for pain control have recently grown and became popular Although the incidence of epidural abscess is very low, but appears to have increased due to procedures being performed more frequently in the spine region, we should devote every effort to the prevention of abscess formation. Most cases of epidural abscess in the literature are related to epidural catheterization and neuroaxial anesthesia. MRI or CT scanning should be performed to confirm the diagnosis, and early neurosurgical consultation is advisable to avoid sequelae. A 63-year-old female patient with diabetes mellitus received interventional muscular and nerve stimulation (IMNS). After IMNS, the patient began to suffer severe low back pain and local tenderness MRI showed epidural and multifocal abscess in the lumbar region, and an emergency decompressive laminectomy with drainage was performed. We recommend an aseptic technique to prevent infection during IMNS for diabetic patients.

Bronchial Rupture Following Blunt Chest Trauma: 3 cases reports

The incidence of the bronchial rupture following blunt chest trauma has increased gradually with the increases of traffic accident and mechanization. We have experienced the 3 cases of the bronchial rupture following blunt chest trauma. The first case was a 38 year old man who was compressed into a blank wall by fork-lift. He complained of severe dyspnea with air leak through the chest tube and right pneumothorax with collapsed lung was seen in his chest X-ray film after closed thoracostomy. Emergency bronchoscopy showed disruptions of the right upper lobar bronchus and the membranous portion of the intermediate bronchus. The second was 8 year old boy who was sustained a crushing chest injury by bus. He also complained of severe dyspnea with air leak through the chest tube and right pneumothorax with collapsed lung was seen in his chest X-ray film after closed thoracostomy. We performed the computed tomogram of the chest and found the bronchial rupture at the distal portion of the right main bronchus. The third case was 40 year old male who was sustained a crushing chest injury by in-car accident. He complained of mild dyspnea without air leak through the chest tube and the left lung was well expanded in his chest X-ray film after closed thoracostomy. Bronchoscopy showed disruption of the 6th cartilaginous portion of the left main bronchus. Emergency bronchoplasties were performed with interrupted end-to-end anastomosis in all cases. Postoperative air leak occurred for 7 days in the third case. Others were uneventful.

Clinical Analysis of Traumtic Diaphragmatic Injuries

Authors reviewed the records of sixteen patients with traumatic diaphragmatic injuries from May 1992 through December 1996. Thirteen patients were male and three were female(M:F=4.3:1). The age distribution ranged from 2 to 46 years with the mean age of 30.2 years. The sixteen patients included thirteen who had blunt trauma and three with penetrating trauma. Of those thirteen blunt trauma, twelve patients(92.3%) were left sided and one(7.7%) involved the right diaphragm. Three patients with penetrating trauma had left sided diaphragmatic injuries. The diagnosis was made preoperatively in thirteen patients(81.3%) and during surgery in three patients(18.8%). Thoracotomy was performed in eleven patients and thoracoabdominal incision in five. There was one death and the mortality rate was 6.3%.

Three Cases of Cardiac Injury due to Penetrationg and Blunt Trauma

Three cases who were successfully treated for cardiac injuries by open thoracotomy were reported. The range of the ages of the patients was 3rd decade. Two of the 3 were males with blunt injuries by motor vehicle accident and one was male with stab wound by knife. In the case of blunt injuries, the right atrium was involved in one case and the right and left atrium were involved in the other. The site of stab wound was the right atrium. There were two cases with the pre-operative diagnosis of cardiac injuries and they were blunt injuries. The case of stab wound was not diagnosed pre-operatively. All cases were treated with open thoracotomy-one posterolateral thoracotomy, one median sternotomy and one Clam shell incision. All of them had an uneventfull post-operative course.

CONGENITAL CYSTIC ADENOMATOID MALFORMATION TREATED WITH EMERGENCY OPERATION

Congenital cystic adenomatoid malformation is rare form of disease causing in the lung. The main symptoms and signs are cyanosis, tachypnea, and other form of respiratory distress at or shortly after birth. In auscultation, decreased breath sound is audible and in chest X-ray, shifting of mediastinum, pulmonary herniation and depression of diaphragm are visualized with cystic shadow. We have experienced a case of cystic adenomatoid malformation of lung. After emergency operation, patients were recovered uneventfully.

A Study of management for Splenic Injuries

Due to its anatomical position and histological characteristics of thin capsule and low abundance of connective tissue, the spleen is a prime target for damage from blunt injury or during operation. Until recently, total splenectomy has been considered as safe operation for splenic injuries. But now, splenic salvage procedure or non operative treatment have become the standard care with knowledge for immunologic function of spleen, development of radiologic examination such as ultrasonography and abdominal CT, and report about high risk of mortality after splenectomy. Authors have experienced 27 patients with splenic injury admitted to the emergency department during 5 years 4 months period from 1991 to 1996. Among them, 10 patients were received total splenectomy, 2 patients partial splenectomy, 8 patients splenorrhaphy, one patients hemostasis, and 6 patients underwent nonoperative management.

A Case of Nonischemic Central Retinal Vein Occlusion Developed in the course of Ulcerative Colits / 대한소화기내시경학회지

Ulcerative colitis is a chronic, inflammatory disease of colon which is rare in Korea. In the course of ulcerative colitis numerous extraintestinal complication may develop on the joints, skin, liver, kidney, vessel, oral cavity and eyes. The most common ocular lesions complicated in patients with ulcerative colitis are episcleritis and iritis. And the cases of retinal vascular disease in associated with ulcerative colitis are extremely rare. We experienced nonischemic central retinal vein occlusion complicated in a patient with ulcerative colitis, who is 32-year-old male and complained decreased visual acuity and metamorphosis.