Thoracoscopic sympathectomy is a common technique used to treat plamar hyperhiodrosis. The complications of thoracoscopic sympathectomy are rare. Recently, we experienced a complex regional pain syndrome(CRPS) after thoracoscopic sympathecotomy in a patient with hyperhidrosis. The treatment of this complication was chemical epidural sympathetic block and conservative pain control. The result of this treatment was good. The patient was recovered after one month.
Humans ; Hyperhidrosis* ; Pain, Postoperative ; Sympathectomy* ; Thoracoscopy

Infants with Sandhoff disease typically appear normal until 3–6 months of age. As the disease progresses, they present with symptoms such as loss of motor skills, exaggerated startle response to loud noise, seizures, visual loss, and paralysis. We encountered a rare case of a 22-month-old girl with Sandhoff disease characterized by progressive motor weakness and dysphagia, who initially showed signs of aspiration at 20 months of age. The major problems related to dysphagia were oromotor dysfunction and abnormal feeding posture. Within 3 months of identification of difficulty in swallowing, the patient showed a significant decrease in food intake, with rapid deterioration of nutritional status. We report our case with a review of the literature.
Deglutition Disorders ; Deglutition* ; Eating ; Female ; Humans ; Infant ; Motor Skills ; Noise ; Nutritional Status ; Paralysis ; Posture ; Reflex, Startle ; Sandhoff Disease* ; Seizures

Sjogren's syndrome is a chronic autoimmune disorder characterized by lymphocytic infiltration of the lacrimal and salivary glands, leading to dryness of eyes (kerato-conjunctivitis sicca) and mouth (xerostomia). The skin lesions in Sjogren's syndrome are usually manifested as xeroderma, but sometimes appear as annular erythema or vasculitis. Central nervous system symptoms may be presented as one of extraglandular manifestations, though rare in incidence, and need differential diagnosis from multiple sclerosis. We report a case of a 45-year-old woman diagnosed as multiple sclerosis at first but later as neurologic manifestation of primary Sjogren's syndrome, showing signs of multiple sclerosis and cutaneous erythematous lesions.
Case Report ; Diagnosis, Differential ; Erythema/pathology ; Erythema/diagnosis* ; Female ; Human ; Middle Age ; Multiple Sclerosis/pathology ; Multiple Sclerosis/diagnosis* ; Sjogren's Syndrome/pathology ; Sjogren's Syndrome/diagnosis*

PURPOSE: We report a case of idiopathic orbital myositis with sudden onset of unilateral visual loss and hypertrophy of the lateral rectus muscle at the apex of the orbit that was diagnosed using orbital biopsy and treated with intravenous corticosteroids. CASE SUMMARY: We examined a 20-year-old woman who complained of decreased visual acuity and binocular diplopia for 2 weeks. She showed 40-prism diopter left esotropia at the primary position. Her visual acuity with eyeglasses was 0.7 and 0.2 in the right and left eyes, respectively. Brain magnetic resonance imaging (MRI) revealed a round mass on the left lateral rectus muscle at the apex of the orbit with optic nerve compression. We planned orbital biopsy to exclude orbital lymphoma and other biopsy-requiring diseases. After 3 weeks, the visual acuity of her left eye decreased to 0.02. Repeated MRI revealed enlargement of all extraocular muscles on the left orbit. With biopsy showing several lymphocytes infiltrating muscle fibers, we made a diagnosis of idiopathic orbital myositis. Intravenous injection of corticosteroids was administered during hospitalization. After 2 weeks of corticosteroid therapy, the visual acuity of her left eye was improved to 0.63, the esotropia disappeared, and the enlargement of the left lateral rectus muscle was improved on orbital MRI. CONCLUSIONS: For non-specific idiopathic orbital myositis located at the apex of the orbit and enlargement of the extraocular muscle in a short period with decreased visual acuity, administration of intravenous injection of corticosteroids before orbital biopsy could help restore vision.
Adrenal Cortex Hormones ; Biopsy ; Brain ; Diagnosis* ; Diplopia ; Esotropia ; Eyeglasses ; Female ; Hospitalization ; Humans ; Hypertrophy ; Injections, Intravenous ; Lymphocytes ; Lymphoma ; Magnetic Resonance Imaging ; Muscles ; Optic Nerve ; Orbit* ; Orbital Myositis* ; Telescopes ; Visual Acuity ; Young Adult

The sensitivity and specificity of ST segment change on ECG for detection of coronary artery disease(CAD) by pacing stress test were assessed. Among 28 cases with chest pain(mean age 52, M/F : 21/7), 10 patients had normal coronary angiographic finding(Group I), and 18 had coronary artery disease(Group II). Pacing stress test showed high specificity(100%), but low sensitivity(61%) for the diagnosis of CAD. Especially in patients with 1 vessel disease, the sensitivity was only 50%, and positive results were not attained unless there was at least 90% or more stenosis in any of the major branches(LAD, RCA or LCX). But in patients with multivessel disease, the sensitivity was much higher(83%). Lateral(V4-6) or inferior leads(2, 3, aVF) showed ischemic ST segment depression most commonly. Therefore one of the inferior lead and V5 may be a minimum requirement for monitoring pacing-induced ST segment changes. Time constant during isovolumic relaxation showed statistically significant prolongation after pacing only in CAD patient group, suggesting pacing-induced impairment of early left ventricular relaxation.
Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Depression ; Diagnosis* ; Electrocardiography ; Exercise Test ; Humans ; Relaxation ; Sensitivity and Specificity ; Thorax

Recurrent peritonitis is the major complication of continuous ambulatory peritoneal dialysis (CAPD) and a common reason for discontinuation of this form of therapy. Polymicrobial peritonitis by gram- negative organisms suggests intraabdominal pathology not directly associated with CAPD, necessitating early removal of catheter and/or abdominal exploration. The source of infection may still be gastrointestinal, especially in light of the polymicrobial gram-negative peritonitis and rarely be gastrointestinal malignancy. We recently experienced a case of 64-year-old woman with recurrent CAPD peritonitis by polymicrobial gram-negative organisms, originated from colon cancer. Colon cancer was confirmed by barium enema, abdominal CT and colonoscopic biopsy. She underwent right hemicolectomy and removal of catheter simultaneously. The biopsy revealed a moderately to poorly differentiated adenocarcinoma with abundant mucin production.
Adenocarcinoma ; Barium ; Biopsy ; Catheters ; Colon* ; Colonic Neoplasms* ; Enema ; Female ; Humans ; Middle Aged ; Mucins ; Pathology ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Tomography, X-Ray Computed

BACKGROUND: Subacromial erosion remains a major concern after surgical fixation of acromioclavicular (AC) joint using a clavicular hook plate. To minimize postoperative subacromial erosion, we investigated the structural relationship between distal clavicle and acromion around the AC joint by considering the surgical fixation of the joint using the hook plate technique. METHODS: Computed tomography scans of 101 AC joints without any inherent pathology were analyzed. The angle between the distal clavicle and acromion around the AC joint (AC angle), depth of the acromion, differences in height between distal clavicle and acromion (AC height difference), and thickness of distal clavicle and acromion at the AC joint were measured. Descriptive statistics were calculated for each anatomical parameter, and all results were compared between gender groups. RESULTS: The mean AC angle was 17.1°(range, −8.0° to 39.0°), and the mean AC height difference was 3.5 mm (range, −0.7 to 8.7 mm). Both factors showed very high variability (coefficients of variation=62.6% and 46.6%, respectively). The mean AC angle was significantly higher in the female gender than in the male gender (19.8° vs. 13.8°, p=0.048). The mean acromion thickness and distal clavicular thickness were both significantly thinner in the female group than in the male group (p < 0.001) CONCLUSIONS: Taken together, we believe our results might be helpful in minimizing postoperative subacromial erosion when performing surgical fixation of the AC joint using the hook plate, and be valuable in improving future design of the hook plate.
Acromioclavicular Joint ; Acromion ; Clavicle ; Female ; Humans ; Joints ; Male ; Pathology ; Shoulder Fractures

OBJECTIVE: This study was undertaken to characterize the nutritional status, the status of growth and the relation to various factors in cerebral palsy. METHOD: Forty patients with cerebral palsy (20 quadriplegia, 20 diplegia) were investigated. Information was obtained from medical record, clinical measure and anthropometric measure (weight for height, triceps skinfolds thickness per age, height for age). Values of weight for height or triceps skinfold below the 2.5 percentile were defined as "undernutrition", values of height for age below the 2.5 percentile were defined as "growth retardation". Denver Developmental Screening Test (DDST) at the 12 months old and at the examined time, oromotor score, pattern of defecation, duration of gait per day of patients were interviewed from caregivers. Spasticity was measured by using Modified Ashworth's scale. RESULTS: Eleven children (27.5%) were in undernutrition state and 9 (22.5%) growth retardation. Oromotor dysfunction was positive in 62.5% and constipation in 30%. Less gait time, more severe oromotor dysfunction and fine motor delay in DDST and more quadriplegic type (p<0.05) were found in undernutrition group and no significant difference of spasticity and constipation. With logistic regression, quadriplegic type is the only significant factor to undernutrition. CONCLUSION: Undernutrition is common in cerebral palsy and quadriplegic type is significantly related to undernutrition.
Caregivers ; Cerebral Palsy* ; Child ; Constipation ; Defecation ; Gait ; Humans ; Infant ; Logistic Models ; Malnutrition* ; Mass Screening ; Medical Records ; Muscle Spasticity ; Nutritional Status ; Quadriplegia

OBJECTIVE: Clinical application of Functional Electrical Stimulation (FES) was limited due to the muscle fatigue phenomenon. This study was undertaken to find an electrical stimulation frequency, which optimally improves muscle endurance in spinal cord injured rabbit. METHOD: Fifteen rabbits were experimentally spinal cord injured at the T10 or T11 spinal cord level. Three kinds of stimulation frequency (10, 20, 40 Hz) and sham control stimulation were applied to the tibialis anterior muscle of each four group for 1 hour per day, for 2 weeks. Muscle fatigue index and peak torque were measured during electrical stimulation, and proportion of the type I musclefiber was measured at ATPase (pH 9.4) staining. RESULTS: Complete paraplegia was obtained in all 12 rabbits. Muscle fatigue index and peak torque were not changed after 2 weeks of electrical stimulation in all four groups. The proportion of the type I muscle fiber was reduced in all four groups after 2 weeks. However, 40 Hz stimulation group showed less decline in proportion of type I muscle fiber than control or 10 Hz group. CONCLUSION: High frequency electrical stimulation applied at an early stage of spinal cord injury is more effective in preserving muscle endurance than low frequency stimulation.
Adenosine Triphosphatases ; Electric Stimulation* ; Muscle Fatigue ; Paraplegia ; Rabbits ; Spinal Cord Injuries ; Spinal Cord* ; Torque

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of pre- and postoperative initiation of enoxaparin in treatment of hip fracture. MATERIALS AND METHODS: In this study, we enrolled 629 consecutive patients with hip fracture who Pusan National University Hospital between March 2009 and March 2014. Of these patients, 414 patients (65.8%) met the final inclusion criteria. Enoxaparin was administered subcutaneously at 40 mg once daily starting 48 hours after surgery in 156 patients (group A), and immediately after admission in 258 patients (group B). The incidence of symptomatic venous thromboembolism (VTE) and risk of bleeding during hospitalization period were compared between groups. RESULTS: The incidence of symptomatic VTE during the hospitalization period was 7.1% (11 patients) in group A and 5.4% (14 patients) in group B. No significant difference in the rate of symptomatic VTE was found between the groups (unadjusted odds ratio [OR], 0.756; 95% confidence interval [CI], 0.334–1.710; adjusted OR, 0.554; 95% CI, 0.212–1.449). The incidence of symptomatic deep-vein thrombosis and pulmonary embolism (including fatal and non-fatal) did not significantly differ between groups. However, fatal pulmonary thromboembolism developed in two cases in group A and one patient expired postoperatively due to pulmonary hemorrhage in group B. Major bleeding and all-cause death did not differ between groups. CONCLUSION: Preoperative starting chemical thromboprophylaxis may be considered in the elderly patients with hip fracture who have risk factors for venous thromboembolism.
Aged ; Busan ; Enoxaparin* ; Hemorrhage ; Heparin, Low-Molecular-Weight ; Hip Fractures ; Hip* ; Hospitalization ; Humans ; Incidence ; Odds Ratio ; Pulmonary Embolism ; Risk Factors ; Venous Thromboembolism ; Venous Thrombosis