Effect of Low Frequency Cerebellar Repetitive Transcranial Magnetic Stimulation on Balance Impairment in Patients With Cerebral Infarction

Objective@#To investigate the effect of low frequency cerebellar repetitive transcranial magnetic stimulation (rTMS) on balance impairment in patients with cerebral infarction. @*Methods@#Thirty-two patients were randomly divided into two groups: rTMS group (n=16) and control (n=16). In the rTMS group, treatment was performed five times per week for 2 weeks (10 sessions), and in the control group, a sham coil was used with the sound and sensation of scalp similar to the rTMS coil. Patients in both groups underwent a conventional rehabilitation program. Berg Balance Scale (BBS) was used as the primary outcome measurement. Timed Up and Go test (TUG), 10-m walk test (10mWT), and Activity-specific Balance Confidence scale (ABC) were used as the secondary outcome measurement. All scales were measured at baseline (T0), after 10 sessions of rTMS (T1), and at 4 weeks after treatment completion (T2) by therapists with over 5 years of clinical experience. @*Results@#There were significant improvements between T0 and T1, and between T0 and T2, for all assessed items in the rTMS group. Whereas there were significant improvements between T0 and T1, and between T0 and T2, for the BBS and 10mWT in the control group. TUG (-4.87±5.05 vs. -0.50±2.97 seconds) and ABC score (8.10±8.33 vs. 0.16±0.97) were observed significant differences in comparison of the changes from T0 to T1 between the two group. BBS score (4.40±3.66 vs. 1.88±3.14), TUG (-4.87±4.56 vs. -0.62±2.96 seconds) and ABC score (8.22±7.70 vs. -0.09±0.86) differed significantly from T0 to T2 between the two groups. @*Conclusion@#Our findings suggest that low-frequency cerebellar rTMS is helpful for improving balance in patients with cerebral infarction, and maybe a beneficial treatment for these patients.

Therapeutic effect of acupuncture point injection with placental extract in knee osteoarthritis / 中西医结合学报

<p><b>OBJECTIVE</b>This study evaluated the effectiveness of acupuncture point injection (API) with placental extract on pain reduction and joint function in patients with knee osteoarthritis (OA).</p><p><b>METHODS</b>Fifty-two patients with knee OA, with an average age of 64, and having a symptom duration of more than 3 months were studied in this report. Placental extract was injected weekly into acupuncture point ST35, BL23, BL24 and BL25 for 5 weeks; 8 mL of placental extract into ST35 on the affected side, and 1 mL of placental extract to BL23, BL24 and BL25 bilaterally.</p><p><b>RESULTS</b>After a five-week treatment of API with placental extract, pain was substantially decreased in patients of all Kellgren-Lawrence (KL) grades. Improvement of knee joint swelling was also apparent. Decrease of pain and joint swelling improved daily working productive time among patients of all KL grades.</p><p><b>CONCLUSION</b>Study results imply that API with placental extract is a potentially useful therapy to control pain and maintain joint functions in knee OA patients.</p>

Predictive Value of Serum Procalcitonin in Urinary Tract Infection Patients with Bacteremia

PURPOSE: Urinary tract infection (UTI) is a common disease in the emergency department (ED). In general, UTI could be treated easily without complication. However, UTI with bacteremia can progress to sepsis or severe sepsis and delay of appropriate treatment can result in worse prognosis. Increased serum procalcitonin level in the bacterial infection of ED patients has been proven. The purpose of this study is to examine the clinical utility of procalcitonin as a predictor for bacteremia in UTI patients in the ED setting. METHODS: This is a retrospective cohort study. UTI Patients admitted through the ED of three academic teaching hospitals from January 2010 to December 2012 were enrolled. We investigated demographic characteristics, hemodynamic variables, and laboratory results including serum procalcitonin level at presentation to the ED according to the presence of bacteremia. ROC curve was obtained and multivariate regression analysis was performed to test the predictive value of serum procalcitonin level for bacteremia in UTI patients. RESULTS: A total of 334 patients were enrolled. Bacteremia was proven in 135 UTI patients. UTI patients with bacteremia had significantly higher serum level of procalcitonin (0.830 vs. 6.860, p<0.0001). In multivariable logistic regression analysis, level of procalcitonin and platelet count showed statistical significance (Odds Ratio=1.018, (1.007-1.028), 0.995, (0.992-0.998), 95% CI). Area under the curve for procalcitonin was 0.729, and cut off value was 2.52 ng/ml. CONCLUSION: Serum procalcitonin level could be used as a valuable predictor for the presence of bacteremia in UTI patients visiting the ED.

The Effects of Essential Aroma Oils on Brain Activation: Olfactory Functional MRI and c-Fos Expression / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For centuries, fragrance had beneficial psychological and physiological effects on humans. Aromatherapy, the use of concentrated essential oils extracted from herbs, flowers, and other parts of plants to treat various diseases, is becoming more commonly accepted within the health service. However, there are very few published articles, which provide a sound rationale for the use of aromatherapy as a medical intervention. The purpose of this study was to find a scientific explanation for the effect of aromatherapy by investigating 1. whether or not essential aroma oils caused increased brain activity and 2. which areas of the brain were activated by the essential aroma oils. MATERIALS AND METHODS: Olfactory fMRI (functional magnetic resonance imaging), which is capable of monitoring and recording regional pathophysiological fluctuations in living brains, was performed on 11 healthy adult humans during exposure to essential aroma oils (lavender and lemon oils) and buthanol. The c-fos immunohistochemical staining was also performed on brain tissues of 24 Mongolian gerbils after exposure to the essential aroma oils. RESULTS: In the human fMRI study, the olfactory cortex was activated in all subjects by the essential aroma oils and buthanol. Additionally, lavender oil also activated the hearing and language-related regions of brain. In the animal study, similar results were observed: immunoreactive cells were detected in the hearing and language related regions of gerbil brains that had been exposed to lavender oil. CONCLUSION: The lavender oil activated not only the olfactory region but also the hearing and language-related regions of the brain. These results imply that the essential aroma oil introduced through the olfactory pathway has effects on other regions of the brain.

The Classification and Clinical Importance of the Anterior Attic Bony Plate on Temporal Bone CT / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Anterior attic bony plate (cog) is a coronally oriented bony septum which is suspended from the anterior petrosal tegmen, and the anterior epitympanic recess is partitioned from epitympanum by this bony plate. It is an important pathway for anterior drainage which can cause inflammation in obstructed conditions; therefore, it needs appropriate procedure to eradicate the lesions without recurrence. We aimed to classify types of the anterior attic bony plates on the temporal bone CT and to find correlation between the types of the anterior attic bony plates and the development of chronic otitis media and cholesteatoma. MATERIALS AND METHODS: We reviewed 264 cases of the temporal bone CT of the normal and the chronic otitis media patients, of which 64 cases were excluded as lesions could not be identified due to severe destruction and obscurity of the figure. RESULTS: In normal ears, the incidence of the anterior attic bony plate was 67% in the plate type, 28% in the pyramid type, and 5% in the anterior type. In the diseased ear, the incidences were 40%, 44%, 16%, in the plate type, pyramid type, and anterior type, respectively and in the cholesteatoma ear, 30%, 43%, 27%, respectively. The difference of incidence was statistically significant. CONCLUSION: We assumed that the development of the chronic otitis media is related to the type of the anterior attic bony plate in some degree. Especially, the anterior type was more prominent in cholesteatoma than in noncholesteatoma with a statistical significance. Further studies are needed to figure out the correlation between the type of the anterior attic bony plate and it's clinical importance.

Clinical Analysis of Intact Bridge Mastoidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: Open cavity and closed cavity tympanomastoidectomy each has both advantages and disadvantages. In order to optimize advantages while reducing or eliminating disadvantages, intact bridge mastoidectomy was developed. The intact bridge mastoidectomy operation can similarly be thought of as a modified radical mastoidectomy. MATERIALS AND METHODS: Intact bridge mastoidectomy was performed in 48 ears from 1987 to 1998. To evaluate the results of intact bridge mastoidectomy, 48 cases were reviewed retrospectively. RESULTS: Among 48 patients, 24 (50%) were chronic otitis media and 12 (25%) were cholesteatomatous chronic otitis media. The methods of tympanoplasty were as follows : 11 cases of type I tympanoplasty (23%), two cases of type II tympanoplasty(4%), 21 cases of type III tympanoplasty (44%), and 14 cases of type IV tympanoplasty (29%). Postoperative air-bone gaps were improved by 12 dB in non-cholesteatoma group, and 0 dB in cholesteatoma group. The average healing period was 13.6 weeks, with 80% being healed within a period of 4 months. Postopertative complications were as follows : one case of cholesteatoma, two cases of tympanic membrane perforation, one case of wound infection, and two cases of pocket retraction. CONCLUSIONS: Although the hearing gain was not impressive, intact bridge mastoidectomy allowed adequate visualization for eradication of pathologic tissue, and desirable anatomic configurations for ossiculoplasty and tympanoplasty.

Incidence of Congenital External Ear Anomalies in Taegu City and Kyungpook Province / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Congenital anomalies of the external ear occurs rarely, and has negative effects on children due to its unaesthetic appearance and hearing impairment. Thus surgical management is needed to correct the deformity and to gain hearing. Authors report the incidence of congenital anomalies of the external ear because there is no available data in Korea. MATERIALS AND METHODS: We conducted a hospital based survey and analyzed data from 9 hospitals in Taegu city and Kyungpook Province for the year of 1996. RESULTS: 1) Of the total of 33,898 births, 63 new borns were affected, and the incidence of anomaly was 18.5 per 10,000 births. 2) Incidence of male and female was 43 (68%) and 20 (32%). 3) Incidence of abnormalities is as follows: preauricular sinus was 7.0 per 10,000 births, polyotia was 4.4 per 10,000 births, lop ear was 2.1 per 10,000 births, bifid lobule was 0.9 per 10,000 births, macrotia was 0.9 per 10,000 births, Satyr ear was 0.6 per 10,000 births, microtia was 9.2 per 10,000 births, aural atresia was 3.2 per 10,000 births. 4) According to Marx's classification of the microtia, Grade I was 20, Grade II was 4, and Grade III was 8 cases.

Index for the Diagnosis of Cholesteatoma on the Temporal Bone CT / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Diagnosis of cholesteatoma on temporal bone CT relies on secondary factors such as bony destructions and ossicular erosions combined with abnormal soft tissue density. But some non-cholesteatomatous otitis media have such findings and some cholestatoma do not have such findings, so its diagnosis is a difficult problem. We tried to find an index for accurate diagnosis of cholesteatoma on the CT findings. MATERIALS AND METHOD: Sixty-five patients with chronic otitis media (COM) with cholesteatoma and 55 patients with COM without cholesteatoma underwent preoperative CT scan followed by surgical exploration. Operative notes and radiographs were reviewed and data were collected regarding the nature of soft tissue density, state of ossicles, presence or absence of bone destructions. We defined the cholesteatoma factor as that which has significantly higher incidence in cholesteatoma group than non-cholesteatoma group among the data, and defined the cholesteatoma index as the number of cholesteatoma factors on temporal bone CT of one patient. RESULTS: The cholesteatoma factors were scutum destrucion, tegmen destruction, lateral semicircular canal destruction, external auditory canal destruction, sigmoid plate destruction, attic wall destruction, aditus ad antrum widening, antral wall destruction, ossicular superstructure destruction, and ossicular medial displacement. The probability of presence of cholesteatoma was 15.9%, 41.7%, 75.0%, 88.9%, 100% when the cholesteatoma index was 0, 1, 2, 3, >or= 4, respectively. CONCLUSIONS: We suggest the cholesteatoma index as a useful tool of diagnosis of cholesteatoma on the basis of temporal CT findings.

Intraoperative HistoacrylR Injection of Glomus Tympanicum Tumor / 대한이비인후과학회지

The therapeutic options for glomus tumor management are either palliative (ie, radiation, embolization or a combination) or definitive (ie, surgery or combinations of surgery-radiation, radiation-surgery or embolization-surgery). Of these, surgical excision is the standard treatment modality for glomus tympanicum tumors. As glomus tympanicum tumor has highly vascular nature, profuse hemorrhage may be intermittently induced during its removal. Preoperative embolization is used frequently to reduce intraoperative bleeding. We report a case of glomus tympanicum tumor which was removed completely with the help of direct inject of HistoacrylR into the mass during the operation. This method allows almost bloodless ablation of the entire tumor.

Cognitive Ability in Total Deafness with K-WISC / 대한이비인후과학회지

The criteria of suitability for a cochlear implant has been extended postlingual deaf adult including prelingual deaf children in their difficulty with speech and vocabulary development. The cognitve ability of deaf students has been investigated in a deaf school using Kedi-WISC. The results are as follows; 1) The deaf students were not inferior in intelligence when compared with normal hearers, but the intelligence between deaf students and normal hearers was different in quality. 2) In subtest they made higher scores at object assembly, block design and coding in senior group 3) It is supposed for deaf student that performance under vision and memory is relatively excellent although concrete and abstract tasks is retarded. No emotional disordered cases is found in this study.

The discharge patterns and the caloric response of the primary afferent vestibular neurons / 대한이비인후과학회지

No abstract available.

Infratemporal Fossa Approach to Lesions in the Base of the Skull

The technique and results of infratemporal fossa approach of jugular formamen meuroma and clivus chordoma are presented. The infratemporal fossa approach allowed radical removal of jugualr foramen neuroma and effective palliative removal of clivus chordoma. The basic features of infratemporal fossa approach are permanent anterior displacement of the facial nerve, subtotal petrosectomy and obliteration of the middle ear cleft.

The Treatment of Recurrent Anterior Dislocation of the Shoulder by Modified Bristow Operation / 대한정형외과학회잡지

A review of sixteen cases of the modified Bristow operation for recurrent anterior dislocation of the shoulder from Feb. 1987 to Feb. 1989 was presented and the following results were obtained. 1. The age of initial dislocation varied from 12 years to 27 years of age with the average of 17.3 years. 2. The age at operation varied from 21 years to 30 years of age with the average of 23.3 years. 3. The times of dislocation vaaried form 7 to 40 times with the average 23.8 times. 4. The average loss of abduction and external rotation were 5.9 and 12.5 degree respectively. 5. The complications and recurrence were not observed in this period

A Clinical Study of the Treatment of Ruptures of Deltoid Ligament Associated with Fracture of Distal Part of Fibula / 대한정형외과학회잡지

A survey of the literature on the treatment of ruptures of deltoid ligament associated with fracture of distal part of fibula is controversial. Some authors advocated surgical repair of the ruptured deltoid ligament based on the theoretical consideration, while others advocated non-operative treatment based on the clinical consideration. We studied the results in forty-five patients who were treated for disruption of the deltoid ligament and a distal fibular fracture. The length of follow-up in our series was twelve to twenty-four months, with an average of fifteen months. When the fibular fracture was adequately reduced and medial clear space was returned to its normal width, the 91 percents both of patients of being treated with repair of deltoid ligament and patients of being treated without repair had a good or excellent results.

A Clinical Study of the Ankle Fracture / 대한정형외과학회잡지

The ankle is a complex structure supporting the entire musculoskeletal system during standing and walking. The injuries to the ankle joint result in a severe functional disturbance because of complex anatomical characteristics around the ankle joint. 284 patients of the ankle fracture that were treated in orthopedic Dept. Capital Armed Forced General Hospital from march 1985. to march 1988. were analized in clinical and radiological aspects. The following results were obtained: 1. The main cause of the injuries was falling from a height and the other were sports injury and slipping down in order. 2. The most common type by Lauge-Hansen classification was supination-external rotation type(122 case, 42.9%). 3. 211 case(74.3%) were treated with open reduction and internal fixation, and 73 case(25.7%) were treated with closed reduction. Poor outcome seemed closely related to the severity of the injury and degree of fracture displacement. 4. Accurate reduction and rigid internal fixation of the lateral malleolus with shortening was important factor. 5. Classification of Lauge-Hansen was useful in the diagnosis and treatment of the ankle fractures.

A Clinical Study on Ligamentous Injuries of the Knee / 대한정형외과학회잡지

The knee joint is one of the most susceptable joint to ligamentous injury. For good results, it is very important to make an early diagnosis and to give prompt management. The aim of treatment is to restore the ligaments to their previous anatomic position and tension. The authors reviewed 420 cases of ligamentous injuries in 400 patients who were admitted and managed for 6 years from March, 1981 to February, 1987. The results were as follows : 1. The athletic injury was the most commcn cause of injury(55%), and fall-down was next(26%). 2. The most common ruptured individual ligament was the medial collateral ligament. Combined ligament rupture was more common in medial collateral ligament and anterior cruciate ligament. 3. The ruptured sites of the individual ligament were found to be the following ; a) the medial collateral ligament was ruptured most frequently at the femoral attachment(43%), with the superficial layer ruptured in the midsubstance and the deep layer at the femoral attachment; b) the lateral collateral ligament torn at the fibular attachment(51%); c) the anterior cruciate ligament torn at the femoral attachment(39%); d) the posterior cruciate ligament torn at the femoral attachment(64%). 4. Many ligamentous injuries were associated with fracture(44%) and tear of meniscus- (42%). 5. In stress-radiogram, the significance of ligament injuries was present in more than 10 and 10 mm. 6. Excellent and good results were obtained in 94% by non-surgical treatment and in 92% by surgical treatment. 7. Early surgical repair of the ligament within 2 weeks after injury, gave much better result than later repairs.

A Clinical Study on Intracompartmental Pressure of Leg Using Slit Catheter / 대한정형외과학회잡지

Intracompartmental pressure of leg was measured by the slit catheter technique in one hundred fifty compartments of one hundred cases; fifty were from healthy young male adults, the others were from tibial fractured patients during three years from March 1983 to Fobruary 1986. The results were as follows; 1. Slit-catheter technique was found as a accurate method for continuous pressure monitoring. 2. The range of normal pressure was from zero to six millimeters of mercury(1.45mmHg±0.85). 3. Tissue pressure was 0–15mmHg(4.03mmHg±1.83) in unaffected side of fractured patients, 4–35mmHg(14.65mmHg±2.05) in affected side of fractured patients.

Computerized Tomography after Closed Reduction of Traumatic Hip Dislocations / 대한정형외과학회잡지

Computerized tomography has been used in the evaluation of the intracranial lesions. Recently the usage of computerized tomography has progressively widened in many fields of clinical practice. In orthopedics computerized tomography has been tried in the diagnosis and the determination of treatment of tumors, spinal disorders, hip disorders and knee problem. Four problem cases in which concentric reduction could not be obtained after closed reduction of hip dislocations were evaluated by computerized tomography from Apr, 1, 1983 to Mar. 31, 1984 in the Capital Armed Forces General Hospital and following conclusiions were obtained: 1. Open reduction revealed that muscles(adductor and pyriformis muscles), joint capsule and osteocartilaginous loose bodies (femoral and acetabular) were interposed to hinder concentric reduction. Large posterior acetabular fragment induced instability and redislocation of the hip. 2. When there were 2-3 mm lack of symmetry of the two femoral heads or any abnormal findings(breakage of Shenton's line etc.) in plain roentgenography, computerized tomography was recommanded, and muscles, osteocartilaginous loose bodies and instability were found. 3. Computerized tomography is an easy simple method and has a great diagnostic value in the evaluation of asymmetry and instability after closed reduction of traumatic hip dislocations.

A Study on Measurement of Intracompartmental Pressure About Measuring Method and Normal Value / 대한정형외과학회잡지

No abstract available in English.

A Clinical Study of Calcification of the Tibial Collateral Ligament (Pellegrini-Stieda's Disease) / 대한정형외과학회잡지

Pellegrini-Stieda's disease is a post-traumatic disorder of the knee. It is characterized by a crescentric-like bony formation in the region of the medial condyle of the femur, which usually makes its appearance upon roentgenographic examination three or more weeks after injury to the knee. During the three and a half years from January 1979 to July 1982, eleven patients were treated by conservative method and only one patient was treated by operation. The results were as follows; l. All give a history of trauma. 2. The major findings in this disease were pain in motion, local tenderness, and limitation of motion. 3. In roentgenographic findings of these cases, we noted the followings: 1) The most common site of the calcification was the proximal area of the tibial collateral ligament. 2) In seven cases (58%), the evidence of calcification was noted in 4 weeks to 12 weeks following original trauma. 3) Eight cases (67%) showed a radiolucent area from 0.5 to 3mm in thickness between the bony shadow and the femur. 4) Eight cases (67%) showed a crescentric shape of calcified area. 5) In seven cases (58%), the size of calcified mass was 1.5 to 3.5cm in length and 1 to 3mm in width. The mean size of calcified mass about 3cm in length and about 2.5mm in width. 4. Eleven cases were treated conservatively and one case was treated operatively. The results were satisfactory, and all patients were able to return to their works.