BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease. Despite of proper treatment and improving treatment regimens, HLH patients still show a fatal prognosis. Therefore the evaluation of prognostic factor is important and there are many studies about hyperbilirubinemia as a prognostic factor in HLH. So we studied the prognostic value of hyperbilirubinemia in HLH children. METHODS: A retrospective analysis was performed about 33 patients who were diagnosed with HLH at Pusan National University Hospital and Yangsan Pusan University Hospital between January 2000 to December 2012. We reviewed the clinical characteristics, laboratory findings, and results of treatment to identify hyperbilirubinemia as a prognostic factor in HLH patients. RESULTS: The median age of patients at diagnosis was 32 months. Most of patients presented with fever, pale appearance, abdominal pain and jaundice. Forty-eight point five percentage of patients showed normal serum bilirubiln level (<2.0 mg/dL) and 51.5% showed hyperbilirubinemia (> or =2.0 mg/dL). In normal serum bilirubin group, 1 patient (6.3%) was relapsed and 1 patient (5.9%) was relapsed in hyperbilirubinemia group. In the hyperbilirubinemia group, the mortality was higher than the normal bilirubin group but, there was no statistical significance. CONCLUSION: As a prognostic factor serum bilirubin at diagnosis in HLH patients, there was no significant correlation between hyperbilirubinemia and poor outcome. But, our study has a limitation that the number of patients is too small and almost showed good prognosis.
Abdominal Pain ; Bilirubin* ; Busan ; Child ; Diagnosis ; Fever ; Fibrinogen ; Gyeongsangnam-do ; Humans ; Hyperbilirubinemia ; Jaundice ; Lymphohistiocytosis, Hemophagocytic* ; Mortality ; Prognosis ; Retrospective Studies

Diffusion tensor imaging (DTI) has a diagnostic value in cervical myelopathy. The usefulness of diffusion metrics as a potential prognostic biomarker was assessed in this review. Various diffusion metrics, such as fractional anisotropy, mean diffusivity, apparent diffusion coefficient, and radial diffusivity, were significant in correlation with functional recovery after surgery. Changes in diffusion metrics not only at the compression level, but also above and below the compression level were confirmed. However, it was difficult to confirm the results owing to the diversity of studies. Further efforts to make a consensus on spinal cord DTI are needed.
Anisotropy ; Consensus ; Diffusion Tensor Imaging ; Diffusion ; Recovery of Function ; Spinal Cord ; Spinal Cord Diseases

OBJECTIVE: To evaluate the effects of extracorporeal shockwave therapy (ESWT) on pain, function, and ultrasonographic features of chronic stroke patients with knee osteoarthritis (OA). METHODS: A total of 18 chronic stroke patients (33 knee joints) with unilateral or bilateral knee OA (Kellgren-Lawrence grade ≥1) were enrolled in this study. The patients were randomly allocated to an experimental group receiving ESWT (n=9) or a control group receiving sham ESWT (n=9). For the ESWT group, patients received 1,000 pulses weekly for 3 weeks, totaling to an energy dose of 0.05 mJ/mm² on the proximal medial tibia of the affected knee. The assessments were performed before the treatment, immediately after the first treatment, and 1 week after the last treatment using the following: the visual analog scale (VAS) for pain; patient perception of the clinical severity of OA; the Korean version of Modified Barthel Index (ambulation and chair/bed transfer); the Functional Independence Measure scale (FIM; bed/chair/wheelchair transfer, toilet transfer, walking, and stairs); and ultrasonographic features (articular cartilage thickness, Doppler activity, and joint effusion height). RESULTS: The experimental group showed a significant improvement in VAS score (4.50±1.87 to 2.71±1.38) and patient perception of the clinical severity of OA (1.87±0.83 to 2.75±0.46). The bed/chair/wheelchair transfer components of the FIM score also improved significantly (4.12±1.55 to 4.62±1.30). In terms of the ultrasonographic features, increased Doppler activity was observed in the medial knee in the experimental group immediately following ESWT. CONCLUSION: It is suggested that ESWT may reduce pain and improve function in chronic stroke patients with OA, and may increase vascular activity at the target site.
Cartilage ; High-Energy Shock Waves ; Humans ; Joints ; Knee* ; Osteoarthritis, Knee* ; Pilot Projects* ; Stroke* ; Tibia ; Ultrasonography ; Visual Analog Scale ; Walking

Aphasia, result from damage of language-dominant area of the brain, usually accompanied hemiparesis due to proximity of language centers and motor control areas. So, global aphasia without hemiparesis is a rare stroke syndrome. We report a case of right handed man with language disturbance after stroke. He showed global aphasia without hemiparesis. We use diffusion tensor image tractography (DTT) for evaluation of global aphasia without hemiparesis. DTT demonstrated that preservation of the corticospinal tract. After speech therapy, he showed improvement of language profile on K-WAB.

OBJECTIVE: To analyze the relationship between brain lesion location and type of chronic dysphagia in patients with supratentorial stroke. METHODS: Data from 82 chronic stroke patients who underwent videofluoroscopic swallowing studies at >6 months after an initial stroke event were retrospectively analyzed. Delayed oral transit time, delayed pharyngeal transit time, and the presence of aspiration were extracted. A voxel-based lesion symptom mapping (VLSM) analysis was used to correlate types of dysphagia with specific brain lesions. RESULTS: VLSM identified several clusters of voxels that significantly correlated with type of dysphagia. Delayed oral transit time mainly correlated with lesions in the left inferior frontal lobe and precentral gyrus; delayed pharyngeal time mainly correlated with lesions in the right basal ganglia and corona radiate; and aspiration was mainly correlated with lesions in the putamen. CONCLUSION: Understanding the association between lesion location and dysphagia in chronic stroke patients is an important first step towards predicting permanent dysphagia after stroke. Improved understanding of the neural correlates of dysphagia will inform the utility of interventions for its treatment and prevention after stroke.
Basal Ganglia ; Brain ; Deglutition ; Deglutition Disorders* ; Frontal Lobe ; Humans ; Neuroimaging ; Putamen ; Retrospective Studies ; Stroke*

OBJECTIVE: This study aimed to investigate the difference in micronutrient levels between oral feeding and enteral feeding in chronic stroke patients to assess the risks of enteral feeding. METHODS: Patients with chronic stroke who were admitted to the Department of Rehabilitation Medicine between January 2011 and June 2012 were enrolled. The serum concentrations of iron, copper, zinc, folate, and vitamin B12, as well as the absolute CD4 and CD8 lymphocyte counts, were assessed. RESULTS: Of the 73 patients enrolled in this study, 50 were fed orally, while the other 23 were fed through a percutaneous endoscopic gastrostomy (PEG) or nasogastric (NG) tube. The serum concentrations of vitamin B12 and folate were significantly higher in the enteral feeding group than in the oral feeding group. However, the serum concentration of zinc was significantly lower in the enteral feeding group. CONCLUSION: There is little difference between enteral feeding and oral feeding in terms of micronutrient provision except that the serum concentration of zinc in the enteral feeding group was significantly lower than that in the oral feeding group. Clinicians should recognize that chronic stroke patients who require tube feeding have a risk of micronutrient deficiency. Early detection of malnutrition and micronutrient deficiency is important for providing the necessary nutrients.
Copper ; Enteral Nutrition* ; Folic Acid ; Gastrostomy ; Humans ; Iron ; Lymphocyte Count ; Malnutrition ; Micronutrients* ; Rehabilitation ; Stroke* ; Vitamin B 12 ; Zinc

PURPOSE: This study attempted to understand health behaviors and analyze the association of the health behaviors with musculoskeletal diseases in adults. METHOD: The subjects of this study were 6,946 adults aged between 20 and 65 who had participated in the 2001 National Health Nutrition Survey. The instrument was composed of Health Interview Survey (HIS), Health Behavior Survey (HBS) and Health Examination Survey (HES), which were used in the 2001 National Health Nutrition Survey. Data were analyzed using SPSS 10.1 by applying chi2 and multivariate logistic regression. RESULTS: 1. The present smoking rate was 46.5% and the present drinking rate was 81.2%. 2. Of the subjects, 22.7% were overweight (BMI> or =25), and 28.1% were exercising regularly. 3. Major factors affecting musculoskeletal diseases were low education, poor economic state, smoking, and BMI. Middle school graduates were 2.54 times more likely to have musculoskeletal diseases than college graduates. The risk was 1.83 times higher in indigent respondents than in affluent ones, and 1.43 times higher in smokers than in non-smokers. CONCLUSION: Therefore, in order to reduce musculoskeletal diseases in adults, other various factors should be looked into, and public education about appropriate posture and exercise should be carried out in community. Additionally, concentrated intervention programs for patients with musculoskeletal diseases should be performed.
Adult* ; Surveys and Questionnaires ; Drinking ; Education ; Health Behavior* ; Humans ; Logistic Models ; Musculoskeletal Diseases* ; Nutrition Surveys ; Overweight ; Posture ; Poverty ; Smoke ; Smoking

OBJECTIVE: To investigate the predictive value of the sympathetic skin response (SSR) in diagnosing complex regional pain syndrome (CRPS) by comparing three diagnostic modalities-SSR, three-phasic bone scans (TPBS), and thermography. METHODS: Thirteen patients with severe limb pain were recruited. Among them, 6 were diagnosed with CRPS according to the proposed revised CRPS clinical diagnostic criteria described by the International Association for the Study of Pain. SSR was measured in either the hands or feet bilaterally and was considered abnormal when the latency was prolonged. A positive TPBS finding was defined as diffuse increased tracer uptake on the delayed image. Thermographic findings were considered positive if a temperature asymmetry greater than 1.00degrees C was detected between the extremities. RESULTS: Five of 6 CRPS patients showed prolonged latency on SSR (83% sensitivity). TPBS was positive in the 5 CRPS patients who underwent TPBS (100% sensitivity). Thermography was positive in 4 of 5 CRPS patients who underwent the procedure (80% sensitivity). The remaining 7 non-CRPS patients differed on examination. SSR latencies within normal limit were noted in 4 of 7 non-CRPS patients (57% specificity). Results were negative in 4 of 5 non-CRPS patients who underwent TPBS (80% specificity), and negative in 3 of 5 non-CRPS patients who underwent thermography (60% specificity). CONCLUSION: SSR may be helpful in detecting CRPS.
Case-Control Studies* ; Complex Regional Pain Syndromes ; Extremities ; Foot ; Galvanic Skin Response ; Hand ; Humans ; Radionuclide Imaging ; Skin* ; Thermography

OBJECTIVE: To evaluate the epidemiologic change of patients with spinal cord injury who were admitted to a Rehabilitation Hospital, Yonsei University College of Medicine, during 1987-1996 and 2004-2008. METHODS: Medical records of 629 patients with spinal cord injury admitted to the Rehabilitation Hospital, Yonsei University College of Medicine, from 2004 to 2008 were collected and reviewed retrospectively. RESULTS: The male-to-female ratio decreased to 2.86:1, the mean age at injury increased, nontraumatic etiology increased, traffic accident remained to be the most common in traumatic spinal cord injury, and falling increased significantly. Tumor was the most common etiology in nontraumatic spinal cord injury, tetraplegia and incomplete injuries occurred more than paraplegia and complete injuries, indwelling catheter was the most common voiding method, and the duration of hospitalization decreased. CONCLUSION: Many trends changed in epidemiology of spinal cord injury.
Accidents, Traffic ; Catheters, Indwelling ; Hospitalization ; Humans ; Medical Records ; Paraplegia ; Quadriplegia ; Spinal Cord ; Spinal Cord Injuries

This study was carried out to investigate the nutritional education status and the recognition of the importance of elementary school dietitians (N=183) in the Gyeongnam area. The results are summarized as follows. All subjects took part in nutritional education program, but the educational methods were passive, as in the case of "home correspondence" (80.8%) and "bulletin board poster" (16.4%), and the education frequency was very low as in "one time/month" (90.2%). The subjects thought "as an independent subject" (41.5%) and "as a related subjects" (35.1%) were suitable teaching venues for the nutritional education. They were very low in individual counseling (4.5%) for school children because of "lack of opportunity" (42.2%) and "heavy work load" (24.1%). However, most of the subjects wished that nutritional counseling could offered in the future (95.5%). The parents' experience of nutritional education was also low (34.3%). Information sources for nutritional education were mainly the "internet" (53.1%) and "re-educational materials" (25.0%). The available instructional materials included "printed materials" (96.7%), "exhibition bulletin materials" (70.3%) and "electronic materials" (46.4%). The preferred education materials were "exhibition bulletin materials" (32.2%), "printed materials" (29.2%), and "electronic materiaThis study was carried ls" (27.7%). However, materials they wished to purchase were "electronic materials" (54.5%) and "cubic materials" (26.0%). These results show a difference between the preferred materials and the possessed materials. Most school dietitians (98.4%) recognized the necessity of nutritional education with respect to "good table manners" (42.0%), "correction of food prejudices" (30.3%), and "proper nutrition for growth" (21.0%). Although they had a great interest in nutritional education, they had difficulty in cutting their learning into practice because of "heavy work load" (30.9%), "lack of a systematic curriculum" (25.2%), and "lack of a educational opportunity" (22.8%). Ninety five percent of subjects wished to have nutrition education taught as an independent subject. They pointed out "kindergarten" (60.0%) and "lower grades in elementary school" (33.9%) as the optimal starting times for nutritional education and "school dietitians" (91.3%) as suitable teachers for these programs. The required topics chosen by the subjects for nutritional education for children were "proper eating habits" (54.2%) and "nutritional problem" (31.5%). The dietitians thought "food prejudices" (44.7%), "eat too much processed and instant foods" (36.5%), and "obesity" (11.8%) were the most common nutritional problems among elementary school children. These results suggest the necessity of solving the nutritional problems in children by developing a nutritional education program. Along with this program, if dietitian assisted programs for parents were developed, the effects of nutritional education could definitely be increased.
Child ; Counseling ; Eating ; Education* ; Humans ; Learning ; Nutritionists* ; Parents