Cerebral palsy is the most common motor disorder in childhood. In cerebral palsy, spasticity can be a very disabling feature: limited locomotor abilities, contracture and gait difficulty. We present two cases of cerebral palsy patients who had treated with oral medication and chemodenervation with the Botulinum toxin A or alcohol but could not walk independently. We performed percutaneous selective radiofrequency thermocoagulation in the tibial motor nerve branch under the general anesthesia. The degree of spasticity, which was measured with modified Ashworth scale and modified Tardieu scale, was reduced and recurrence of the spasticity wasn't seen untill 6 months. Percutaneous selective radiofrequency thermocoagulation could be a treatment option for spasticity of cerebral palsy with little adverse effect.
Anesthesia, General ; Botulinum Toxins ; Cerebral Palsy ; Contracture ; Electrocoagulation ; Gait ; Humans ; Muscle Spasticity ; Nerve Block ; Recurrence

Herpes zoster is acute viral infection characterized by the appearance of vesicles that occur on the skin and mucous membrane along the pathway of an involved sensory nerve. The incidence is increased in those who have history of trauma, malignant tumor, radiation therapy and the immuno-suppressive drug users. Although herpes zoster is usually as benign viral infection, complications may occur especially when cranial nerves are involved. So careful treatment is necessary when cranial nerves are involved. We have treated two cases. One is involved trigeminal nerve mandibular branch, another maxillary branch. We have used conservative therapy, pain control, acyclovir on this area and obtained good result. After 17 and 8 months respectively, no complications occur in our two cases. So we present two cases with review of literature.
Acyclovir ; Cranial Nerves ; Drug Users ; Herpes Zoster* ; Humans ; Incidence ; Mucous Membrane ; Skin ; Trigeminal Nerve

OBJECTIVE: To assess the clinical usefulness of ultrasonography for the diagnosis of mild and very mild carpal tunnel syndrome. METHOD: Ultrasonographic evaluation was performed in 39 hands of 29 patients with mild and very mild carpal tunnel syndrome according to Bland's neurophysiologic grading scale. Controls included 41 hands of 34 subjects without electrophysiologic evidence of carpal tunnel syndrome. Ultrasonographic findings were evaluated quantitatively with regard to the cross-sectional area, the flattening ratio, the swelling ratio of the median nerve, and palmar displacement of the flexor retinaculum. The analysis of differences between controls and patients group were done by independent t-test. Cut-off values using receiver operation characteristic, were calculated. RESULTS: Patients had significantly increased cross sectional area and flattening ratio of the median nerve at proximal carpal area, palmar displacement of the flexor retinaculum at proximal carpal area. A critical value of equal or higher to 8.5 mm(2) for cross-sectional area at the pisiform level showed a sensitivity 79.5%, a specificity of 95.1%, which had most diagnostic value compared with the value of cross-sectional area at the distal radius level, flattening ratio at the pisiform level and palmar displacement. CONCLUSION: Ultrasonography was useful in the diagnosis of mild and very mild carpal tunnel syndrome.
Carpal Tunnel Syndrome ; Displacement (Psychology) ; Hand ; Humans ; Median Nerve ; Radius ; Sensitivity and Specificity

OBJECTIVES: Mirtazapine is a newly introduced antidepressant in Korea. The purpose of this study is to evaluate effectiveness and safety of mirtazapine as an antidepressant for the first time in Korean patients with major depression. METHODS: This study is an open, non-comparative, multicenter study treated with mirtazapine for 6 weeks in patients with DSM-IV diagnosis of major depression who have 17-item HAMD score> or = 18 and who are between 18 and 65 years of age. Mirtazapine was administered 30 mg orally as an initial dose and could be increased to 45 mg from the 14th day of treatment, depending on the therapeutic responses of subjects. The clinical efficacy of mirtazapine was assessed at the baseline and at the 1st, 2nd, 4th, and 6th week of treatment. To assess the clinical efficacy of the drug, well-trained psychiatrists have evaluated subjects using 17-item HAMD and CGI on each evaluation periods. Also, for the evaluation of subjective symptoms of patients, BDI was used. Adverse experiences associated with mirtazapine were evaluated on each visit, with recordings of blood pressure, heart rate and weight. The responders were defined as patients with > or = 50% decrease from baseline in total 17-item HAMD scores and remitted patients with a total 17-item HAMD score of < or = 7. RESULTS: Out of 79 subjects enrolled, 45 were completed this study. After 6 weeks, the score of 17-item HAMD, CGI and BDI demonstrated statistically significant decrease compared with at the baseline. This decrease was observed as early as the 1st week of mirtazapine treatment. Moreover, the meaningful reduction in each total scores of these different parameters on each evaluation period could be detected, except in case of 2-4 week and 4-6 week of BDI. The responder rate was 15.6% at the first week of mirtazapine treatment, 88.9% at the 6th week. The rate of remission was 2.2% at the first week and 60.0% at the 6th week. The most frequent adverse events during 6 weeks were somnolence(31.6%), drowsiness(19%) and weight gain(17.7%). Aside from sedation and weight gain, anticholinergic, cardiovascular and stimulating side effects are less than 10%, and no one complained about sexual dysfunction. The dropouts(34 subjects, 43%) were caused by adverse events(38.2%), insufficient compliance(35.3%) and uncooperation with the study(20.6%). CONCLUSION: Mirtazapine has shown to have superior antidepressant effect in this study. Especially, this effect appeared from the early treatment phase, the 1st week of treatment. The most frequent adverse events reported were somnolence, drowsiness and weight gain. Anticholinergic, cardiovascular, stimulating adverse events as well as sexual dysfunction were rarely reported, and there was no clinical significant change on physical examinations. Therefore this study showed that mirtazapine is a superior and safe antidepressant in patients with major depression.
Blood Pressure ; Depression* ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Heart Rate ; Humans ; Korea ; Physical Examination ; Psychiatry ; Sleep Stages ; Weight Gain

OBJECTIVES: Mirtazapine is a newly introduced antidepressant in Korea. The purpose of this study is to evaluate effectiveness and safety of mirtazapine as an antidepressant for the first time in Korean patients with major depression. METHODS: This study is an open, non-comparative, multicenter study treated with mirtazapine for 6 weeks in patients with DSM-IV diagnosis of major depression who have 17-item HAMD score> or = 18 and who are between 18 and 65 years of age. Mirtazapine was administered 30 mg orally as an initial dose and could be increased to 45 mg from the 14th day of treatment, depending on the therapeutic responses of subjects. The clinical efficacy of mirtazapine was assessed at the baseline and at the 1st, 2nd, 4th, and 6th week of treatment. To assess the clinical efficacy of the drug, well-trained psychiatrists have evaluated subjects using 17-item HAMD and CGI on each evaluation periods. Also, for the evaluation of subjective symptoms of patients, BDI was used. Adverse experiences associated with mirtazapine were evaluated on each visit, with recordings of blood pressure, heart rate and weight. The responders were defined as patients with > or = 50% decrease from baseline in total 17-item HAMD scores and remitted patients with a total 17-item HAMD score of < or = 7. RESULTS: Out of 79 subjects enrolled, 45 were completed this study. After 6 weeks, the score of 17-item HAMD, CGI and BDI demonstrated statistically significant decrease compared with at the baseline. This decrease was observed as early as the 1st week of mirtazapine treatment. Moreover, the meaningful reduction in each total scores of these different parameters on each evaluation period could be detected, except in case of 2-4 week and 4-6 week of BDI. The responder rate was 15.6% at the first week of mirtazapine treatment, 88.9% at the 6th week. The rate of remission was 2.2% at the first week and 60.0% at the 6th week. The most frequent adverse events during 6 weeks were somnolence(31.6%), drowsiness(19%) and weight gain(17.7%). Aside from sedation and weight gain, anticholinergic, cardiovascular and stimulating side effects are less than 10%, and no one complained about sexual dysfunction. The dropouts(34 subjects, 43%) were caused by adverse events(38.2%), insufficient compliance(35.3%) and uncooperation with the study(20.6%). CONCLUSION: Mirtazapine has shown to have superior antidepressant effect in this study. Especially, this effect appeared from the early treatment phase, the 1st week of treatment. The most frequent adverse events reported were somnolence, drowsiness and weight gain. Anticholinergic, cardiovascular, stimulating adverse events as well as sexual dysfunction were rarely reported, and there was no clinical significant change on physical examinations. Therefore this study showed that mirtazapine is a superior and safe antidepressant in patients with major depression.
Blood Pressure ; Depression* ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Heart Rate ; Humans ; Korea ; Physical Examination ; Psychiatry ; Sleep Stages ; Weight Gain

OBJECTIVE: To compare the therapeutic effects between radiofrequency thermocoagulation and phenol motor branch block in treatment of spasticity of child with cerebral palsy. METHOD: Thirteen patients with spastic cerebral palsy were randomly divided into two groups. One group received percutaneous selective radiofrequency thermocoagulation on tibial nerve motor branch and the other group received phenol motor branch block to the gastrocnemius muscle. Therapeutic effects were assessed before and after treatment for 6 months in each group. The severity of ankle spasticity was assessed with the modified Ashworth scale (MAS), the modified Tardieu scale (MTS), and the passive range of motion (PROM) of ankle joint. RESULTS: In both groups, the MAS and MTS decreased, and radiofrequency thermocoagulation group showed more significant reduction of the spasticity (p<0.05). There was a significant increase in PROM on knee flexion and extension in a radiofrequency thermocoagulation group (p<0.05). CONCLUSION: Percutaneous selective radiofrequency thermocoagulation could be a treatment option for relieving the localized spasticity of ankle in spastic cerebral palsy with little adverse effect.
Animals ; Ankle ; Ankle Joint ; Cerebral Palsy ; Child ; Electrocoagulation ; Humans ; Knee ; Muscle Spasticity ; Muscle, Skeletal ; Phenol ; Range of Motion, Articular ; Tibial Nerve

An ultrasonographic examination revealed increased fetal bladder size and decreased AFI as well as fetal bilateral hydronephrosis at 173weeks' gestation. Diagnosis of the fetal posterior urethral valve syndrome was made. Percutaneous fetal bladder puncture with aspiration and amniocentesis was performed. The fetus was normal male karyotype and with a predicted good renal function(sodium concentration, chloride concentration, and osmolarity at 74 mEq/L, 60 mEq/L, and 148 mOsm, respectively). So, the fetus underwent amnioinfusion and vesico-amniotic shunting procedure (VASP) using a double-basket catheter at 194weeks' gestation in order to prevent development of dysplastic kidneys and hypoplastic lungs. The healthy male baby was delivered at 384weeks' gestation and had normally functioning kidney. Cutaneous vesicostomy was performed for the newborn since the urethral orifice was small. The one year old infant is now well and waiting for urethroscopic valve ablation procedure.
Amniocentesis ; Catheters ; Cystostomy ; Diagnosis ; Fetus ; Humans ; Hydronephrosis ; Infant ; Infant, Newborn ; Karyotype ; Kidney ; Lung ; Male ; Osmolar Concentration ; Pregnancy* ; Punctures ; Urinary Bladder

Abscess ; Anti-Bacterial Agents ; Cavernous Sinus Thrombosis ; Disseminated Intravascular Coagulation ; Drainage ; Humans ; Mediastinitis ; Middle Aged ; Multiple Organ Failure ; Resuscitation ; Sepsis

We compared genetic variations in virulence mega plasmids pXO1 and pXO2 of twenty-seven Bacillus anthracis strains from Korean patients and environmental samples together with those of Bacillus anthracis Sterne, Pasteur and A2012 standard strains. Genetic variations were analyzed in twenty-three variable regions (ten and thirteen variablenumber tandem repeats and insertion/deletions in pXO1 and pXO2, respectively). The pXO1 plasmids were classified into 7 groups and pXO2 plasmids to 12 groups. Discrete phylogenic lineages could be differentiated between environmental and clinical strains by UPGMA (unweighted pair group method with average) method. In addition, clinical strains showed more variations than environmental isolates. The pXO2 plasmid appeared genetically more unstable than pXO1. A general plasmid genotype could be suggested for Korean soil isolates since they mostly clustered into a representative group.
Bacillus anthracis* ; Bacillus* ; Genetic Variation* ; Genotype ; Humans ; Korea* ; Plasmids* ; Soil ; Tandem Repeat Sequences ; Virulence

The authors dersibe two cases of moyamoya-like disease associated with intracranial aneurysm. Moyamoya like disease, rare variant of moyamoya disease, has a normal unilateral caroted system. There are only few cases reported in the world literature of moyamoya-like disease associated with intracranial aneurysm. The radiological fearures and the management of these cases are discussed.
Intracranial Aneurysm* ; Moyamoya Disease ; Rare Diseases