Winging of the scapula is characterized clinically by a prominence of the vertebral border and inferior angle of the scapula. Trauma, neuritis, neural injury during surgical procedure and many other causes may develop winging of scapula. When pain and functional impairment persist, surgical intervention may become appropriate. We report two cases of winged scapula. One case was serratus anterior palsy due to blunt trauma, which was treated by transfer of teres major and pectoralis minor elongated with a tensor fascia strip. Another case was trapezius muscle palsy due to iatrogenic spinal accessary nerve injury, which was treated by transfer of the levator scapulae, rhomboid major and rhomboid minor muscle. In the former case, there was no weakness nor deformity of affected shoulder. In the later case, there was some residual pain and limitation of motion.
Congenital Abnormalities ; Fascia ; Neuritis ; Paralysis ; Scapula* ; Shoulder ; Superficial Back Muscles

No abstract available.
Toluene* ; Xylenes*

BACKGROUND: Infectious complications frequently occur after cardiac arrest and may be even more frequent after therapeutic hypothermia. Pneumonia is the most common infectious complication associated with therapeutic hypothermia, and it is unclear whether prophylactic antibiotics administered during this intervention can decrease the development of early-onset pneumonia. We investigated the effect of antibiotic prophylaxis on the development of pneumonia in cardiac arrest patients treated with therapeutic hypothermia. METHODS: We retrospectively reviewed the medical records of patients who were admitted for therapeutic hypothermia after resuscitation for out-of-hospital cardiac arrest between January 2010 and July 2015. Patients who died within the first 72 hours or presented with pneumonia at the time of admission were excluded. Early-onset pneumonia was defined as pneumonia that developed within 5 days of admission. Prophylactic antibiotic therapy was defined as the administration of any parenteral antibiotics within the first 24 hours without any evidence of infection. RESULTS: Of the 128 patients admitted after cardiac arrest, 68 were analyzed and 48 (70.6%) were treated with prophylactic antibiotics within 24 hours. The frequency of early-onset pneumonia was not significantly different between the prophylactic antibiotic group and the control group (29.2% vs 30.0%, respectively, p = 0.945). The most commonly used antibiotic was third-generation cephalosporin, and the class of prophylactic antibiotics did not influence early-onset pneumonia. CONCLUSION: Antibiotic prophylaxis in cardiac arrest patients treated with therapeutic hypothermia did not reduce the frequency of pneumonia.
Anti-Bacterial Agents ; Antibiotic Prophylaxis* ; Heart Arrest* ; Humans ; Hypothermia* ; Medical Records ; Out-of-Hospital Cardiac Arrest ; Pneumonia* ; Resuscitation ; Retrospective Studies

BACKGROUND: As Korea red ginseng has been reported to show a significant protective effect against H. pylori-induced cytotoxicity and DNA damage in vitro, we designed a study to assess the efficacy of red ginseng treatment in patients with H. pylori-associated chronic gastritis. METHODS: A total of 84 patients with H. pylori-associated chronic gastritis were recruited and randomly divided into two groups. During the trial, 34 patients out of 42 patients in the placebo control group and 36 patients out of 42 patients in the red ginseng group completed the protocol. The patients received a one week triple therapy for the eradication of H. pylori and then received either placebo capsules that were composed of flour for the placebo group or red ginseng capsules for the treatment group, which were administered for 10 weeks. An endoscopic examination of gastritis with a visual analogue scale, a test for detection of H. pylori, immunohistochemistry of 8-OHdG, the 8-OHdG immunohistochemical staining for assessing oxidative DNA damage and TUNEL staining for apoptosis were performed, respectively. RESULTS: H. pylori eradication rates were augmented in the red ginseng group as compared to the placebo group (91.7% in the red ginseng group and 79.4% in the placebo group), but there was no statistical significance (p=0.147). For an analysis of gastritis based on Updated Sydney System, the red ginseng group showed significant improvement in neutrophil infiltrations (p=0.008) and intestinal metaplasia (p=0.005). An attenuation of 8-OHdG immunohistostaining after treatment was seen more frequently in the red ginseng group (p<0.001). An attenuation of DNA damage and apoptosis was seen for the red ginseng group as compared to the placebo group (p<0.001). CONCLUSIONS: Supplementary administration of red ginseng augmented eradication rates of H. pylori, attenuated gastric inflammation, and reduced oxidative DNA damage and apoptosis, suggesting the clinical usefulness of red ginseng.
Apoptosis ; Capsules ; DNA Damage ; Flour ; Gastritis* ; Helicobacter pylori ; Helicobacter* ; Humans ; Immunohistochemistry ; In Situ Nick-End Labeling ; Inflammation ; Korea* ; Metaplasia ; Neutrophils ; Panax*

No abstract available.
Female ; Herpes Zoster* ; Humans ; Immunoglobulin G* ; Recurrence*

A pontine intracranial hemorrhage (ICH) evokes several neurological symptoms, due to the various nuclei and nerve fibers; however, hearing loss from a pontine ICH is rare. We have experienced a non-traumatic pontine ICH patient, with hearing loss. A 43-year-old male patient had a massive pontine hemorrhage; his brain magnetic resonance imaging revealed the hemorrhage on the bilateral dorsal pons, with the involvement of the trapezoid body. Also, profound hearing loss on the pure-tone audiogram and abnormal brainstem auditory evoked potential were noticed. Fifty-two months of long-term follow-up did not reveal any definite improvement on the patient's hearing ability.
Adult ; Brain ; Evoked Potentials, Auditory, Brain Stem ; Follow-Up Studies* ; Hearing Loss* ; Hearing* ; Hemorrhage* ; Humans ; Intracranial Hemorrhages ; Magnetic Resonance Imaging ; Male ; Nerve Fibers ; Pons

The use of epidural injection of local anesthetics with steroid for the treatment of back pain and sciatica is a widely used procedure. There have been several reports about spinal cord compression by granuloma or fibrous mass related to intrathecal or epidural morphine injection. There have been also some reports about arachnoiditis after epidural injection of steroid. However, there have been no reports regarding dural sac or nerve root compression by fibrous mass after epidural steroid injections. We would report a case of dural sac and nerve root compression secondary to the formation of fibrous mass in the lumbar epidural space after epidural steroid and local anesthetic injections. In this case, the characteristic radiologic findings before and after epidural injection therapy and clinical progress were documented.
Anesthetics, Local ; Arachnoid ; Arachnoiditis ; Back Pain ; Epidural Space ; Granuloma ; Injections, Epidural ; Morphine ; Radiculopathy ; Sciatica ; Spinal Cord Compression

BACKGROUND: Arterial hypoxemia has been noted in patients with liver cirrhosis because of bronchial vessel dilatation. Cabenes et al. reported that bronchial hyperresponsiveness to the metacholine inhalation was observed in patients of left side heart failure, he suggested that one of the mechanism was bronchial vessel dilatation. We hypothesized that patients of liver cirrhosis might have bronchial hyperresponsiveness to metacholine inhalation due to portal hypertension. We evaluate the relationship between bronchial responsiveness and severity of liver cirrhosirs, severity of portal hypertension. METHODS: In the 22 patients of the liver cirrhosis with clinical portal hypertension metacholine provocation test was done and determined PC20 FEV1. We classified lifter cirrhosis according to Pugh- Child classification Esophagogastroscopies were performed for the evaluation of the relationship between bronchial hyperresponsiveness and severity of esophageal varix. RESULTS: In the 22 cases of the liver cirrhosis with clinical portal hypertension. The causes of liver cirrhosis, alcoholic hepatitis was 9 cases. hepatitis B virus was 12 cases, hepatitis C virus was 1 case. and 151 cases (68.18%) of total 22 cases were positive in metacholine provocation test. In positive cases There was no significant relationship between PC20FEV1 and severity of liver cirrhosis which were classified by Pugh-Child classification or severity of esophageal varix(p<0.05). CONCLUSION: we observed that bronchial responsiveness to metacholine increased in the patients of liver cirrhosis and there was no significant relationship between the severity of liver cirrhosis and the severity of esophageal varix.
Anoxia ; Child ; Classification ; Dilatation ; Esophageal and Gastric Varices ; Fibrosis ; Heart Failure ; Hepacivirus ; Hepatitis ; Hepatitis B virus ; Humans ; Hypertension, Portal ; Inhalation ; Liver Cirrhosis* ; Liver Cirrhosis, Alcoholic ; Liver*

OBJECTIVE: The aim of this meta-analysis was to investigate the effects of ankle foot orthosis on adult post-stroke hemiplegic patients' walking ability and pattern. METHOD: We searched for the case controlled clinical trials about the effects of ankle foot orthosis (AFO) for walking ability and pattern using quantitative gait analysis in adult post-stroke patients, which published between January 1950 and July 2012 in PubMed, and searching engine of Journal of Korean Academy of Rehabilitation Medicine. The mean standardized difference (MSD) and a 95% confidence interval (CI) were estimated for gait ability and pattern using fixed effect models. RESULTS: Sixteen of the 56 articles were included in this analysis. The selected studies involved a total of 274 patients. The walking speed, cadence, the portion of double limb supporting, stride length on affected side, the portion of swing period on unaffected side, and symmetry of swing period were improved by AFO. The oxygen cost was decreased by AFO. The AFO did improve ankle dorsiflexion at initial contact, maximal ankle dorsiflexion at swing phase, but the ankle plantar flexion at push-off did not. CONCLUSION: The ankle foot orthosis has some evidence to improve the walking ability and gait pattern in post-stroke hemiplegic patients.
Adult ; Animals ; Ankle ; Case-Control Studies ; Extremities ; Foot ; Foot Orthoses ; Gait ; Gait Disorders, Neurologic ; Hemiplegia ; Humans ; Orthotic Devices ; Oxygen ; Stroke ; Walking

Background: This retrospective study investigated the incidence rate of accidental foreign body aspiration and ingestion according to patient sex, age, and dental department. This study aimed to verify whether the incidence rate is higher in geriatric than in younger patients and whether it is different among dental departments. Methods: Accidental foreign body aspiration and ingestion cases were collected from electronic health records and the safety report system of Yonsei University Dental Hospital from January 2011 to December 2017. The collected data included patients’ age, sex, medical conditions, treatment procedures, and foreign objects that were accidentally aspirated or ingested. The incidence rate was calculated as the number of accidental foreign body aspirations and ingestions relative to the total number of patient visits. Differences depending on the patients’ sex, age, and dental department were statistically identified. Results: There were 2 aspiration and 37 ingestion cases during the 7-year analysis period. The male to female incidence ratio was 2.8:1. The incidence rate increased with age and increased rapidly among those aged 80 years or older. Seven of the 37 patients with accidental foreign body ingestion had intellectual disability, Lou Gehrig’s disease, dystonia, or oral and maxillofacial cancer. The incidence rate was highest in the Predoctoral Student Clinic and the Department of Prosthodontics. The most frequently swallowed objects were fixed dental prostheses and dental implant components. Conclusion The incidence rate of accidental foreign body aspiration and ingestion differed according to patient sex, age, and dental department. Dental practitioners must identify high-risk patients and apply various methods to prevent accidental foreign body aspiration and ingestion in dental clinics. Inexperienced practitioners should be particularly careful.