No abstract available.
Muscle, Skeletal* ; Tibial Nerve*

PURPOSE: To investigate the therapeutic effectiveness of ultrasound (US)-guided trigger point injection for myofascial trigger points (MTrPs) in the internal rotator muscles of the shoulder in post-mastectomy patients. MATERIALS AND METHODS: This pilot study was a non-controlled, prospective, clinical trial. Nineteen post-mastectomy patients with a diagnosis of at least one active MTrP in the subscapularis and/or pectoralis muscles were included. We performed trigger point injections into the subscapularis muscle deep behind the scapula as well as the pectoralis muscle for diagnostic and therapeutic purpose by the newly developed US-guided method. RESULTS: Visual analogue scale and range of motion of the shoulder for external rotation and of abduction showed significant improvement immediately after the first injection and 3 months after the last injection compared with baseline (p<0.05 for both). Duration from onset to surgery and duration of myofascial pain syndrome in the good responder group were significantly shorter than in the bad responder group (p<0.05). Patients did not report any complications related to the procedure or serious adverse events attributable to the treatment. CONCLUSION: In post-mastectomy patients with shoulder pain, US-guided trigger point injections of the subscapularis and/or pectoralis muscles are effective for both diagnosis and treatment when the cause of shoulder pain is suspected to originate from active MTrPs in these muscles, particularly, the subscapularis.
Adult ; Aged ; Anesthetics, Local/administration & dosage/therapeutic use ; Female ; Humans ; Injections, Intramuscular/methods ; Lidocaine/administration & dosage/therapeutic use ; Mastectomy ; Middle Aged ; Muscle, Skeletal/drug effects/ultrasonography ; Myofascial Pain Syndromes/drug therapy ; Pectoralis Muscles/drug effects/*ultrasonography ; Trigger Points/*ultrasonography

Paroxysmal positional nystagmus is a common finding in patients with vertigo and can occur in typical and atypical forms. Atypical forms of paroxismal positional nystagmus are thought to represent conditions which are in fact not "benign". This patient was diagnosed as right posterior semicircular canal BPPV at first. After modified Epley maneuver, the type of nystagmus was changed to atypical forms. After left cupulolith reposition maneuver (CRmM), the nystagmus and dizziness were disappeared finally.
Dizziness ; Humans ; Nystagmus, Physiologic ; Semicircular Canals ; Vertigo*

A 66-year-old man presented with typical trigeminal neuralgia (TN). Magnetic resonance angiography (MRA) revealed a primitive trigeminal artery (PTA) that came into contact with the trigeminal nerve. Based on MRA, we performed microvascular decompression (MVD). In the operational field, we confirmed the PTA location and performed MVD successfully. Postoperatively, the patient's pain subsided without any complications.
Aged ; Arteries* ; Humans ; Magnetic Resonance Angiography ; Microvascular Decompression Surgery ; Trigeminal Nerve ; Trigeminal Neuralgia*

A 66-year-old man presented with typical trigeminal neuralgia (TN). Magnetic resonance angiography (MRA) revealed a primitive trigeminal artery (PTA) that came into contact with the trigeminal nerve. Based on MRA, we performed microvascular decompression (MVD). In the operational field, we confirmed the PTA location and performed MVD successfully. Postoperatively, the patient's pain subsided without any complications.
Aged ; Arteries* ; Humans ; Magnetic Resonance Angiography ; Microvascular Decompression Surgery ; Trigeminal Nerve ; Trigeminal Neuralgia*

BACKGROUND AND OBJECTIVES: Canal paresis in patients with BPPV has been variously reported to present in 13% to 57%. Should disorders affecting the peripheral vestibular system, such as vestibular neuronitis, head trauma precede or coexist the onset of BPPV, then particle repositioning maneuver (PRM) may be less effective or ineffective and need further vestibular rehabilitation after the particle repositioning maneuver. The purpose of this study is to investigate the clinical feature and importance of vestibular rehabilitation in patients with BPPV associated with canal paresis. MATERIALS AND METHODS: A retrospective review was made of 212 patients who visited and diagnosed as BPPV at Hallym university medical center from March 2004 to September 2006. We evaluated the coexistence of canal paresis, methods of treatment and outcome of 128 patients who performed bithermal caloric test. RESULTS: The vestibular assessment by bithermal caloric test showed the canal paresis in 28 patients. In 21 patients, the canal paresis was ipsilateral, in 2 patients, it was contralateral to the BPPV, and in 5 patients, canal paresis was bilateral. Among 28 patients with canal paresis, 12 patients demonstrated as primary BPPV, 16 patients as secondary BPPV. 28 patients with canal paresis were performed PRM. Vestibular rehabilitation was performed in 18 patients who had ongoing symptoms such as nonspecific continuous dizziness after PRM. Among 18 patients, 14 patients were improved, 4 patients were treatment resistant. CONCLUSION: This study shows the importance of detailed vestibular testing such as bithermal caloric test in BPPV patients. Patients with evidence of concomitant vestibular pathology would be expected to require further vestibular rehabilitation.
Academic Medical Centers ; Caloric Tests ; Craniocerebral Trauma ; Dizziness ; Humans ; Paresis* ; Pathology ; Rehabilitation ; Retrospective Studies ; Vertigo* ; Vestibular Neuronitis

PURPOSE: We conducted this retrospective epidemiological study to assess the incidence and severity of lower extremity injuries in Korea METHODS: For this study, we retrospectively reviewed nationwide lower-extremity injury data compiled from 2001 to 2003 based on the National Injury Database, what included National Health Insurance Corporation (NHIC), Car Insurance, and Industry Insurance data. Data were standardized in terms of demographic characteristics, region, and socioeconomic status by using NHIC data. To assess the degree of the injuries, we used the Modified Abbreviated Injury Scale (MoAIS), what has been changed from the International Classification of Disease-10 (ICD-10) code. By using the Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS), we classified the degree of severity into four categories: mild, moderate, severe and critical. RESULTS: From 2001 to 2003, lower extremity injuries increased slightly, with a yearly average of 2,437,335. Insurance data should that lower-extremity injuries were the most common, followed by upper-extremity injuries. Significant difference were seen in the numbers of lower extremity injuries based on gender and age. As for provinces, Seoul and Gyeongi provinces had the highest numbers of cases. Junlabukdo had the highest rate of 55,282 cases per 1 million people for standardized gender and population. The annual incidence of the insured patients with lower extrimity injuries was higher than the employer's medical insurance contributions to the medical insurance program. Daily cases occur most often in May and June, with the lowest occurrences being in January and February. CONCLUSION: The result of this study shows that lower extremity injuries comprised common cause of all injuries. In addition, differences associated with gender, location and socioeconomic status were observed. Further studies are needed to find reasons and then this knowledge will allow strategies to prevent the lower extremity injuries.
Abbreviated Injury Scale ; Epidemiologic Studies ; Humans ; Incidence ; Injury Severity Score ; Insurance ; Korea ; Lower Extremity ; National Health Programs ; Retrospective Studies ; Social Class

Bezoars are conglomerates of nondigestible matter in the gastrointestinal tract that may or may not be accompanied by gastrointestinal manifestations. Bezoars develop in patients with previous gastric surgery or in those patients with delayed gastric emptying that is due to gastroparesis caused by hypothyroidism or diabetes mellitus. Small bowel obstruction due to a gastric bezoar is rare, but it can lead to severe complications such as intestinal perforation, compression necrosis etc. A female patient came to our department complaining of upper abdominal pain and she was diagnosed as having a bezoar that was causing afferent loop syndrome and pancreatitis. We attempted to manage the patient by inserting a nasogastric tube, performing gastrofibroscopy and implementing percutaneous transhepatic biliary drainage, but the patient's condition worsened and deteriorated into a septic condition. An operation was planned, but the patient showed improvement owing to the migration of the bezoar. Herein, we report on a case of afferent loop syndrome due to bezoar and this was complicated by acute pancreatitis.
Abdominal Pain ; Afferent Loop Syndrome ; Bezoars ; Diabetes Mellitus ; Drainage ; Female ; Gastric Emptying ; Gastrointestinal Tract ; Gastroparesis ; Humans ; Hypothyroidism ; Intestinal Perforation ; Necrosis ; Pancreatitis ; Porphyrins

PURPOSE: Telomerase activity is generally absent in primary cell cultures and normal tissues. Telomerase is known to be induced upon immortalization or malignant transformation of human cells. Telomerase activity can be increased in immature lymphocytes and activated lymphocytes, but it is not detected in the peripheral blood of normal persons. The authors analyzed peripheral blood telomerase from patients of gastric cancer to evaluate the possibility of using it for diagnosis and as a prognostic factor. MATENRIALS AND METHODS: We obtained blood samples from 11 inflammatory patients and 64 gastric cancer patients. The telomerase activity was measured using the [PCR-ELISA] method. The results were correlated with the T, N, M stage, cell differentiation, vascular, neural, and lymphatic invasion, tumor size, and tumor location. RESULTS: In the 11 inflammatory patients, telomerase activity was not detected while in the gastric cancer patients, a positive rate of 28.1% was noted. The peripheral telomerase activity was not related with tumor size, tumor site, lymphatic and vascular invasion, stage, or histologic differentiation. CONCLUSION: The peripheral blood telomerase activity for patients of gastric cancer can be utilized as a marker for the diagnosis of not only advanced gastric cancer, but also relatively early stage gastric cancer, but not as a prognostic factor.
Cell Differentiation ; Diagnosis ; Humans ; Lymphocytes ; Primary Cell Culture ; Stomach Neoplasms* ; Telomerase*

Aortoenteric fistula is one of the most challenging problems that confront the vascular surgeons. Controversy remains over the optimal treatment because of the continued publication of series with high mortality, amputation, and aortic disruption rates. A positive preoperative blood culture is the best predictor of mortality with increased amputation rates due to infection of the extra-anatomic bypass. Therefore, in selected cases with sepsis, a prudent management protocol is required. We report a 68-yr-old male presenting with a chronic primary aortoduodenal fistula extensively involving the duodenum and Gram-negative sepsis. We planned a staged operation. Initially, an emergency laparotomy and control of the aorta allowed stabilization of the patient, identification of the fistula, and direct in situ placement of the prosthetic graft followed by an en bloc resection of the aneurysm and the surrounding structures. After he recovered from sepsis and had been stabilized, a staged extra-anatomic bypass followed by transabdominal removal of the temporarily placed graft was done. This management plan will allow the highest success rate and may be a prudent management protocol for these difficult cases.
Aged ; Aortic Aneurysm, Abdominal/complications/*pathology/*surgery ; Chronic Disease ; Digestive System Surgical Procedures ; Duodenum/pathology ; Human ; Intestinal Fistula/complications/*pathology/*surgery ; Male ; Sepsis/*complications ; Tomography, X-Ray Computed