OBJECTIVE: Carpal tunnel syndrome (CTS), a common entrapment neuropathy of the median nerve at the wrist, can be diagnosed clinically and electrophysiologically and treated successfully. The purpose of this study was to determine an association between clinical findings and the electrodiagnostic severity of this syndrome. METHOD: Medical records of 313 patients with CTS which was confirmed based on clinical and electrophysiological findings were reviewed. Clinical symptoms and signs (thenar atrophy, sensory change, positive Tinel sign and Phalen test) and electrodiagnostic values were recorded. CTS severity was determined according to the modified Stevens' criteria. The relationship between electrodiagnostic severity and clinical findings was investigated and statistically analyzed using the ANOVA and chi square tests. RESULTS: The median motor and sensory latencies became prolonged and amplitudes decreased with worsening electrophysiological severity of CTS, and the differences between severity groups were statistically significant. The frequency of symptoms and signs obtained was significantly greater in the more severe CTS groups. CONCLUSION: A positive correlation exists between the frequency of clinical findings and electrophysiological severity of CTS.
Atrophy ; Carpal Tunnel Syndrome* ; Electrodiagnosis ; Humans ; Median Nerve ; Medical Records ; Wrist

OBJECTIVE: To demonstrate a conduction block of the median nerve at the flexor retinaculum (FR) in carpal tunnel syndrome (CTS), comparison of potentials obtained with stimulation of median nerve at the wrist and the palm may be required. METHOD: To determine the severity and incidence of conduction block in patients with CTS, seventy hands of neurologically healthy adults (mean age, 48 years) as control, and seventy hands of patients with CTS (mean age, 51 years) were tested. We performed median motor and middle finger recorded antidromic sensory conduction study with stimulation of the wrist and palm of a distance of 5 cm. The negative peak spike duration and baseline to peak amplitude of the compound muscle action potential (CMAP), and sensory nerve action potential (SNAP) with wrist and palm stimulations were measured. From these values, the wrist to palm duration ratio and amplitude ratio were obtained. RESULTS: The criteria of median motor nerve conduction block were a wrist to palm amplitude ratio of less than 0.7 and a wrist to palm duration ratio of less than 1.13. The criteria of median sensory conduction block were a wrist to palm amplitude ratio of less than 0.61 and a wrist to palm duration ratio of less than 1.33. In the patient group, 10 hands (14.3%) showed motor conduction block and 12 hands (17.1%) showed sensory conduction block and 3 hands (4.3%) showed both. The wrist to palm amplitude ratios of CMAP and SNAP in the patient showing conduction block were 0.6+/-0.1, and 0.4+/-0.2, respectively. There was no correlation between palm CMAP or SNAP amplitude and respective wrist to palm ratios. CONCLUSION: Comparison of the amplitude and duration of CMAP or SNAP obtained with stimulation of both wrist and palm may be able to differentiate between conduction block and axonal degeneration. These values may be useful in planning treatment and predicting outcome.
Action Potentials ; Adult ; Axons ; Carpal Tunnel Syndrome* ; Fingers ; Hand ; Humans ; Incidence ; Median Nerve ; Neural Conduction ; Wrist

OBJECTIVE: To evaluate the anatomic course of the lateral antebrachial cutaneous nerve (LABCN) and medial antebrachial cutaneous nerve (MABCN) in the forearm. METHOD: We dissected 29 upper extremities of 16 cadavers for LABCN and 20 upper extremities of 15 cadavers for the MABCN. We measured the distance (BT_L) between the biceps tendon (BT) and LABCN on the intercondylar line. The BT is the point at which biceps tendon crosses intercondylar line. The distance (L12) between LABCN and the point of 12 cm distal to BT on the line between BT and radial artery at wrist was measured. The distance (ME_M) between MABCN and medial epicondyle on the intercondylar line was measured. M8 and M10 are the distances between MABCN and the points 8 cm and 10 cm distal to BT on the line from BT to mid-point of flexor carpi radialis and palmaris longus at the wrist respectively. RESULTS: BT_L and L12 were 1.4+/-3.7 mm and 4.4+/-3.7 mm respectively. ME_M, M8 and M10 were 28.6+/-6.9 mm, 18.9+/-8.9 mm and 18.3+/-8.2 mm respectively. The thickness of LABCN and MABCN was 19.1+/-4.9 mm and 13.2+/-4.2 mm respectively. CONCLUSION: The LABCN was emerge just lateral to biceps tendon at the elbow and ran down to radial artery. The anatomic course of MABCN was variable at the elbow and forearm.
Cadaver ; Elbow ; Forearm ; Radial Artery ; Tendons ; Upper Extremity ; Wrist

Neurocutaneous melanosis is a rare congenital syndrome characterized by the presence of large or multiple congenital melanocytic nevi and benign pigment cell tumors of the leptomeninges. Neurocutaneous melanosis is thought to represent an error in the morphogenesis of embryonal neuroectoderm. We experienced a neonate who presented with giant, dark colored pigmented nevi covering chest, abdomen, neck and arms, with satellite lesions. Magnetic resonance image showed a nodular hyperintense lesion in the amygdala of the right temporal lobe, and T1-weighted images showed hyperintensities in the adjacent leptomeninges. We report a rare case of neurocutaneous melanosis with a brief review of related literature.
Abdomen ; Amygdala ; Arm ; Humans ; Infant, Newborn ; Melanosis* ; Morphogenesis ; Neck ; Neural Plate ; Nevus, Pigmented ; Temporal Lobe ; Thorax

OBJECTIVE: To evaluate the usefulness of the sural/superficial radial sensory nerve action potential amplitude ratio (SRAR) in the electrodiagnosis of diabetic polyneuropathy. METHOD: Nerve conduction study was performed in 80 diabetic patients and 31 normal adults. Standard nerve conduction studies were performed. Sural nerve response was recorded with the active electrode on the posterosuperior margin of the lateral malleolus and stimulation 14 cm proximally. Superficial radial nerve response was recorded with the active on the snuffbox and stimulation 10 cm proximally. Baseline-to-peak sensory nerve action potential(SNAP) amplitudes were measured, and SRAR were obtained. The diabetic group was subdivided into an electro physiologically normal group (DMNL, n=32) and neuro pathy group (DMPN, n=48). SRAR was compared among the control (NORM, n=31), DMNL and DMPN groups. RESULTS: SRAR was 0.344 in NORM, 0.314 in DMNL and 0.145 in DMPN, respectively. SRAR showed 77.1% sensitivity and 93.8% specificity. Sural SNAP amplitude sensitivity was 85.4% and specificity, 88.7%. CONCLUSION: The relatively high specificity of SRAR indicates its usefulness in the diagnosis of diabetic polyneu ropathy. However, as the superficial radial sensory SNAP amplitude decreased significantly in the diabetic groups compared to control, the SRAR is not superior to the sural SNAP amplitude in the diagnosis of diabetic polyneuropathy.
Action Potentials ; Adult ; Diabetic Neuropathies* ; Diagnosis ; Electrodes ; Electrodiagnosis* ; Humans ; Neural Conduction ; Radial Nerve ; Sensitivity and Specificity ; Sural Nerve*

OBJECTIVE: To compare the latency difference of median and ulnar sensory nerves through the wrist-palm short segment in patients with carpal tunnel syndrome (CTS). METHOD: Subjects included 68 hands of 36 carpal tunnel syndrome patients and 97 hands of 53 healthy adults with no electrophysiologic evidence of CTS. The median and the ulnar sensory responses were recorded on the third and the fifth digit using bar recording electrode, respectively. Both nerves were stimulated just proximal to the distal wrist crease and 5 cm distal to the proximal stimulation point. The latency differences between the 2 stimulation points were obtained. RESULTS: The transcarpal short segment conduction times in the control group were 1.0+/-0.1 msec and 0.9+/-0.1 msec for the median and ulnar nerves, respectively. The transcarpal short segment conduction times in the patients with CTS were 1.9+/-0.5 msec and 1.0+/-0.3 msec for the median and ulnar nerves, respectively. The transcarpal short segment conduction time difference between the median and ulnar nerves were 0.13+/-0.12 msec in the control group and 0.88+/-0.50 msec in the CTS group. The difference of transcarpal conduction of two nerves was statistically significant in comparison with the two groups. CONCLUSION: Wrist-palm short segment study of median and ulnar sensory nerve may be used adjunctively in diagnosis of mild CTS.
Adult ; Carpal Tunnel Syndrome* ; Diagnosis* ; Electrodes ; Hand ; Humans ; Ulnar Nerve* ; Wrist

OBJECTIVE: The purpose of this study is to translate the Berg Balance Scale (BBS) to the Korean version (K-BBS) and to evaluate its reliability. METHOD: With the agreement of Katherine Berg, the original editor of the BBS, two physiatrists and three physical therapists had translated the English version of BBS into Korean (K-BBS). This was back-translated into English by a Korean-American physiatrist fluent in English. After a 2- hour K-BBS education course, the video recorded K-BBS of 18 stroke patients were reviewed by nine examiners (four physiatrists and five physical therapists) to assess the inter- rater and the intra-rater reliability. Kendall's correlation coefficient and Pearson's correlation coefficient were computed to assess the intra-rater and test-retest reliability, respectively. RESULTS: The inter-rater reliability was 0.97 at 2 separate evaluations with an interval of 10 days (p<0.05). The intra- rater reliability was 0.95 (p<0.05) in the physiatrist group and 0.97 (p<0.05) in the physical therapist group. CONCLUSION: We recommend that the Korean version of the Berg balance scale is a reliable instrument to be used in balance assessment of stroke patients.
Education ; Humans ; Physical Therapists ; Rehabilitation ; Stroke

Mitochondrial functions are essential for the survival and function of neurons. Recently, it has been demonstrated that mitochondrial functions are highly associated with mitochondrial morphology, which is dynamically changed by the balance between fusion and fission. Mitochondrial morphology is primarily controlled by the activation of dynamin-related proteins including dynamin-related protein 1 (Drp1), which promotes mitochondrial fission. Drp1 activity is regulated by several post-translational modifications, thereby modifying mitochondrial morphology. Here, we found that phosphorylation of Drp1 at serine 616 (S616) is mediated by cyclin-dependent kinase 5 (CDK5) in post-mitotic rat neurons. Perturbation of CDK5 activity modified the level of Drp1S616 phosphorylation and mitochondrial morphology in neurons. In addition, phosphorylated Drp1S616 preferentially localized as a cytosolic monomer compared with total Drp1. Furthermore, roscovitine, a chemical inhibitor of CDKs, increased oligomerization and mitochondrial translocation of Drp1, suggesting that CDK5-dependent phosphorylation of Drp1 serves to reduce Drp1's fission-promoting activity. Taken together, we propose that CDK5 has a significant role in the regulation of mitochondrial morphology via inhibitory phosphorylation of Drp1S616 in post-mitotic neurons.
Animals ; Cells, Cultured ; Cyclin-Dependent Kinase 5/*metabolism ; Dynamins/analysis/*metabolism ; HeLa Cells ; Humans ; Mitochondria/metabolism ; Mitosis ; Neurons/*cytology/*metabolism ; Phosphorylation ; Rats

A non-steroidal anti-inflammatory drug (NSAID) has many adverse effects including cardiovascular (CV) risk. Diclofenac among the nonselective NSAIDs has the highest CV risk such as congestive heart failure, which resulted commonly from the impaired cardiac pumping due to a disrupted excitation-contraction (E-C) coupling. We investigated the effects of diclofenac on the L-type calcium channels which are essential to the E-C coupling at the level of single ventricular myocytes isolated from neonatal rat heart, using the whole-cell voltage-clamp technique. Only diclofenac of three NSAIDs, including naproxen and ibuprofen, significantly reduced inward whole cell currents. At concentrations higher than 3 micrometer, diclofenac inhibited reversibly the Na+ current and did irreversibly the L-type Ca2+ channels-mediated inward current (IC50=12.89+/-0.43 micrometer) in a dose-dependent manner. However, nifedipine, a well-known L-type channel blocker, effectively inhibited the L-type Ca2+ currents but not the Na+ current. Our finding may explain that diclofenac causes the CV risk by the inhibition of L-type Ca2+ channel, leading to the impairment of E-C coupling in cardiac myocytes.
Animals ; Anti-Inflammatory Agents, Non-Steroidal ; Calcium Channels, L-Type ; Diclofenac ; Heart ; Heart Failure ; Ibuprofen ; Muscle Cells ; Myocytes, Cardiac ; Naproxen ; Nifedipine ; Patch-Clamp Techniques ; Rats

PURPOSE: Due to the availability of serum prostate specific antigen (PSA) testing, the detection rate of insignificant prostate cancer (IPC) is increasing. To ensure better treatment decisions, we developed a nomogram to predict the probability of IPC. MATERIALS AND METHODS: The study population consisted of 1,471 patients who were treated at multiple institutions by radical prostatectomy without neoadjuvant therapy from 1995 to 2008. We obtained nonrandom samples of n = 1,031 for nomogram development, leaving n = 440 for nomogram validation. IPC was defined as pathologic organ-confined disease and a tumor volume of 0.5 cc or less without Gleason grade 4 or 5. Multivariate logistic regression model (MLRM) coefficients were used to construct a nomogram to predict IPC from five variables, including serum prostate specific antigen, clinical stage, biopsy Gleason score, positive cores ratio and maximum % of tumor in any core. The performance characteristics were internally validated from 200 bootstrap resamples to reduce overfit bias. External validation was also performed in another cohort. RESULTS: Overall, 67 (6.5%) patients had a so-called "insignificant" tumor in nomogram development cohort. PSA, clinical stage, biopsy Gleason score, positive core ratio and maximum % of biopsy tumor represented significant predictors of the presence of IPC. The resulting nomogram had excellent discrimination accuracy, with a bootstrapped concordance index of 0.827. CONCLUSION: Our current nomogram provides sufficiently accurate information in clinical practice that may be useful to patients and clinicians when various treatment options for screen-detected prostate cancer are considered.
Aged ; Asian Continental Ancestry Group ; Humans ; Logistic Models ; Male ; Middle Aged ; *Nomograms ; Prostatectomy ; Prostatic Neoplasms/*diagnosis/surgery