The posterior tibial muscle is considered a plantar flexor as well as an invertor of the foot, which acts as a key muscle to the medial longitudinal arch by locking the talar joints in normal gait. Rupture of the posterior tibial tendon can cause a valgus deformity of the hindfoot and an abduction deformity of the forefoot which produces a typical flat foot and a talar dislocation in severe cases. The tendon of posterior tibial muscle can be ruptured spontaneously after the age of 40 from chronic stress at the ankle joint, or by sports injury and trauma. Severe foot deformity which can be prevented by early diagnosis and appropriate treatment often occurs from misdiagnosis as a chronic ankle sprain or a congenital flat foot. We report two cases of foot deformities caused by spontaneous and traumatic rupture of posterior tibial tendons with their clinical manifestations and MRI findings.
Ankle Injuries ; Ankle Joint ; Athletic Injuries ; Congenital Abnormalities ; Diagnostic Errors ; Dislocations ; Early Diagnosis ; Flatfoot* ; Foot ; Foot Deformities ; Gait ; Joints ; Magnetic Resonance Imaging ; Rupture* ; Tendons*

Objective: To investigate the action observation effects of functional electrical stimulation (FES) on the communication between motor cortex and muscle through corticomuscular coherence (CMC) analysis. Methods: Electroencephalogram (EEG) and electromyogram (EMG) of 27 healthy, nonathlete subjects were measured during action observation, FES, and action observation with FES, which lasted for 7sper session for 10 times. All trials were repeated for 30 times. Simultaneously measured EEG raw data and rectified EMG signals were used to calculate CMC. Only confidence limit values above 0.0306 were used for analysis. CMC was divided into three frequency domains, andthe grand average coherence and peak coherence were computed. Repeated ANOVA was performed to analyze the coherence value difference for each condition’s frequency band. Results: CMC showed significant differences in peak coherence and average coherence between the conditions (p<0.05). Action observation application with FES in all frequency band showed the highest peak and average coherence value. Conclusions The results of this study are assumed to be the combination of increased eccentric information transfer from the sensory-motor cortex by action observation and an increased in concentric sensory input from the peripheral by the FES, suggesting that these are reflecting the sensorimotor integration process.

Objective: To investigate the action observation effects of functional electrical stimulation (FES) on the communication between motor cortex and muscle through corticomuscular coherence (CMC) analysis. Methods: Electroencephalogram (EEG) and electromyogram (EMG) of 27 healthy, nonathlete subjects were measured during action observation, FES, and action observation with FES, which lasted for 7sper session for 10 times. All trials were repeated for 30 times. Simultaneously measured EEG raw data and rectified EMG signals were used to calculate CMC. Only confidence limit values above 0.0306 were used for analysis. CMC was divided into three frequency domains, andthe grand average coherence and peak coherence were computed. Repeated ANOVA was performed to analyze the coherence value difference for each condition’s frequency band. Results: CMC showed significant differences in peak coherence and average coherence between the conditions (p<0.05). Action observation application with FES in all frequency band showed the highest peak and average coherence value. Conclusions The results of this study are assumed to be the combination of increased eccentric information transfer from the sensory-motor cortex by action observation and an increased in concentric sensory input from the peripheral by the FES, suggesting that these are reflecting the sensorimotor integration process.

BACKGROUND: Postherpetic neuralgia (PHN) is usually managed pharmacologically. It is not uncommon for patients with chronic kidney disease (CKD) to suffer from PHN. It is difficult to prescribe a sufficient dose of anticonvulsants for intractable pain because of the decreased glomerular filtration rate. If the neural blockade and pulsed radiofrequency ablation provide only short-term amelioration of pain, spinal cord stimulation (SCS) with a low level of evidence may be used only as a last resort. This study was done to evaluate the efficacy of spinal cord stimulation in the treatment of PHN in patients with CKD. METHODS: PHN patients with CKD who needed hemo-dialysis who received insufficient relief of pain over a VAS of 8 regardless of the neuropathic medications were eligible for SCS trial. The follow-up period was at least 2 years after permanent implantation. RESULTS: Eleven patients received percutaneous SCS test trial from Jan 2003 to Dec 2007. Four patients had successfully received a permanent SCS implant with their pain being tolerable at a VAS score of less than 3 along with small doses of neuropathic medications. CONCLUSIONS: SCS was helpful in managing tolerable pain levels in some PHN patients with CKD along with tolerable neuropathic medications for over 2 years.
Anticonvulsants ; Electric Stimulation Therapy ; Follow-Up Studies ; Glomerular Filtration Rate ; Health Resorts ; Humans ; Kidney ; Kidney Diseases ; Neuralgia, Postherpetic ; Pain, Intractable ; Renal Insufficiency, Chronic ; Spinal Cord ; Spinal Cord Stimulation

BACKGROUND: A reliable, well-validated home blood pressure(BP) self measurement device could have an important role in the management of hypertension. Rigorous assessment of such a device have not performed well, particularly in the hypertensive range. METHODS: We assessed the National EW274W device(oscillometric) for home messurem of BP according to the standards set out by the British Hypertension Society protocol and American Association for the Advancement of Medical Instrumentation(AAMI). The device was compared with sequential measurements using a standard mercury sphygmomanometer in the same arm in 105 patients aged 16-79 years. The BP of subjects was measured three times at least a week apart. These data were analysed using Pearson's correlation and paired t-test. RESULTS: The device was highly correlated to mercury sphygmomanometer in mean systolic BP(SBP) and mean diastolic BP(DBP) (r=0.93, r=0.93, P<0.05). The device was satisfactory over the whole BP range(SBP 106-182mmHg, DBP 56-116mmHg), with a B grade for SBP and a A grade for DBP(British Hypertension Society protocol) and a PASS for both SBP and DBP(AAMI). Sensitivity and specificity are 84.2%, 93.0%(mean SBP) and 100%, 96.9% (mean DBP). CONCLUSIONS: We concluded the wrist blood pressure meter(National EW274W) for home BP measurement is highly satisfactory and is suitable for clinical use.
Arm ; Blood Pressure* ; Humans ; Hypertension ; Sensitivity and Specificity ; Sphygmomanometers ; Wrist*

PURPOSE: To evaluate the results of vitrectomy-assisted intravitreal tissue plasminogen activator (tPA) and SF6 gas injection in the treatment of submacular hemorrhage. METHODS: Thirty-one eyes of 30 consecutive patients with submacular hemorrhages undergoing vitrectomy with intravitreal tPA (50 microg/0.1 ml) and SF6 gas injection and completed 12 months of follow-up were evaluated. RESULTS: The mean duration of visual symptoms was 4.1 days. Submacular blood was completely displaced in all 31 eyes after surgery. The best corrected visual acuity (logMAR) improved to 0.56 +/- 0.46 at 12 months from 1.15 +/- 0.51 at baseline (P = 0.002). The most important factors related to visual acuity at the 12-month follow-up were the underlying etiology for the submacular hemorrhage and visual acuity 3 months after surgery (P = 0.003 and P = 0.000, respectively). The 12-month visual acuity was independent of age, gender, presence of vitreous hemorrhage, sub-ILM hemorrhage, baseline visual acuity, duration of symptoms, and the diameter of the submacular hemorrhage. No retinal detachment or re-submacular hemorrhage developed during the follow-up period. CONCLUSIONS: This surgical technique can effectively displace submacular hemorrhage without complications. The 3-month visual acuity appears to predict the 12-month visual acuity. The final visual acuity was associated with the primary etiology for the submacular hemorrhage.
Eye ; Follow-Up Studies ; Hemorrhage ; Humans ; Retinal Detachment ; Tissue Plasminogen Activator ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage

BACKGROUND: Flow interruption technique has been used to measure respiratory system mechanics, and its prominent advantage is to partitionate the respiratory system resistance into airway and tissue component. In this study, we investigated the effects of varing concentrations of enflurane on respiratory system mechanics using flow interruption technique. METHODS: Six cats, weighing 3.0~3.6 kg were used. Pentobarbital sodium was injected intraperitonially and endotracheal intubation was followed. Intermittent mandatory ventilation was applied with Siemens Servo 900C ventilator. The inspiratory flow rate, tidal volume, and respiratory rate were fixed, and normocarbia (PaCO2; 30~35 mmHg) was maintained throughout the experiment. The changes in the pressure and volume were recorded with Bicore CP100 pulmonary monitor at control, 0.5, 1, 1.5, and 2 MAC of enflurane. The data were transfered to a PC and analyzed by Anadat processing software. Respiratory system, airway and tissue viscoelastic resistances, and dynamic and static compliances were calculated. RESULTS: Respiratory system resistances decreased up to 1 MAC of enflurane compared to the control value (p<0.05), but there were no significant differences in the values of resistance among 1, 1.5, 2 MAC of enflurane. There were no significant differences in tissue viscoelastic resistances, and dynamic and static compliances with varying concentrations of enflurane. CONCLUSIONS: Enflurane significantly reduces the respiratory system resistance mainly by decreasing airway resistance. Tissue viscoelastic resistance and respiratory system compliances are not influenced by changes in concentration of enflurane.
Airway Resistance ; Animals ; Cats* ; Enflurane* ; Intubation, Intratracheal ; Mechanics* ; Pentobarbital ; Respiratory Rate ; Respiratory System* ; Tidal Volume ; Ventilation ; Ventilators, Mechanical

BACKGROUND: Production of nitric oxide (NO) radicals may contribute to neuronal injury. We examined that the inhibition of NO synthase (NOS) could improve postischemic neurologic outcome after spinal cord ischemia in rabbits. Also, we measured cGMP as a marker of NOS activation in control and experimental groups. METHODS: Spinal cord ischemia in rabbits was induced by aortic occlusion with aneurysm clip at the level just below branching of left renal artery. Five minutes before aortic occlusion, saline (control group, n=10) or a NOS inhibitor NG-nitro-L-arginine methyl ester (10 mg/kg, L-NAME group, n=10) was injected intravenously. After 15 min ischemia and 1 hour reperfusion, animals were sacrified and the spinal cords were extruded for the measurement of cGMP by enzymeimmunoassay. For neurologic examination, the same procedures of ischemia/reperfusion and drug injection were done, except that rabbits were perfused for 4 hours (control-4 and L-NAME-4, n=8 at each group) or 48 hours (control-48 and L-NAME-48, n=8 at each group) after aortic occlusion. RESULTS: L-NAME (10 mg/kg) increased mean systemic arterial pressure accompanied by bradycardia, and reduced cGMP significantly. Control-4 animals showed better neurologic function than L-NAME-4 animals (p<0.05), however, there was no significant difference of neurologic outcome between control-48 and L-NAME-48 groups. CONCLUSION: Intravenous administration of L-NAME prior to spinal cord ischemia/reperfusion diminishes the extent of postischemic neuronal spinal cord damage at the early postreperfusion period.
Administration, Intravenous ; Aneurysm ; Animals ; Arterial Pressure ; Bradycardia ; Ischemia ; Neurologic Examination ; Neurons ; NG-Nitroarginine Methyl Ester* ; Nitric Oxide ; Nitric Oxide Synthase ; Nitroarginine* ; Rabbits* ; Renal Artery ; Reperfusion ; Spinal Cord Ischemia ; Spinal Cord*

BACKGROUND: Production of nitric oxide (NO) radicals may contribute to neuronal injury. We examined that the inhibition of NO synthase (NOS) could improve postischemic neurologic outcome after spinal cord ischemia in rabbits. Also, we measured cGMP as a marker of NOS activation in control and experimental groups. METHODS: Spinal cord ischemia in rabbits was induced by aortic occlusion with aneurysm clip at the level just below branching of left renal artery. Five minutes before aortic occlusion, saline (control group, n=10) or a NOS inhibitor NG-nitro-L-arginine methyl ester (10 mg/kg, L-NAME group, n=10) was injected intravenously. After 15 min ischemia and 1 hour reperfusion, animals were sacrified and the spinal cords were extruded for the measurement of cGMP by enzymeimmunoassay. For neurologic examination, the same procedures of ischemia/reperfusion and drug injection were done, except that rabbits were perfused for 4 hours (control-4 and L-NAME-4, n=8 at each group) or 48 hours (control-48 and L-NAME-48, n=8 at each group) after aortic occlusion. RESULTS: L-NAME (10 mg/kg) increased mean systemic arterial pressure accompanied by bradycardia, and reduced cGMP significantly. Control-4 animals showed better neurologic function than L-NAME-4 animals (p<0.05), however, there was no significant difference of neurologic outcome between control-48 and L-NAME-48 groups. CONCLUSION: Intravenous administration of L-NAME prior to spinal cord ischemia/reperfusion diminishes the extent of postischemic neuronal spinal cord damage at the early postreperfusion period.
Administration, Intravenous ; Aneurysm ; Animals ; Arterial Pressure ; Bradycardia ; Ischemia ; Neurologic Examination ; Neurons ; NG-Nitroarginine Methyl Ester* ; Nitric Oxide ; Nitric Oxide Synthase ; Nitroarginine* ; Rabbits* ; Renal Artery ; Reperfusion ; Spinal Cord Ischemia ; Spinal Cord*

The mesenchymal chondrosarcoma of the orbit is so rare that only a few cases have been reported in Korea and world-wide. We experienced that a patient whose complaints were proptosis and diplopia caused by orbital tumor. After tumor removal, it was histologically diagnosed as mesenchymal chondrosarcoma. So we report a case of mesenchymal chonrosarcoma of the orbit with a review of the literature.
Chondrosarcoma, Mesenchymal* ; Diplopia ; Exophthalmos ; Humans ; Korea ; Orbit*