Many reports of changes in cervical alignment after posterior occipitocervical (O-C) fusion causing dysphagia are available. The clinical course can range from mild discomfort to severe aspiration. However, the underlying pathogenesis is not well known. We report an 80-year-old female with videofluoroscopic swallowing study evidence of aspiration that developed after occiput-C3/4 posterior fusion. Pharyngeal pressure was analyzed using high resolution manometry (HRM). Impaired upper esophageal sphincter opening along with diminished peristalsis and pharyngeal pressure gradient were revealed by HRM to be the main characteristics in such patients. The patient fully recovered after a revision operation for cervical angle correction. Distinct pressure patterns behind reversible dysphagia caused by a change in cervical alignment were confirmed using HRM analysis.
Aged, 80 and over ; Cervical Vertebrae ; Deglutition ; Deglutition Disorders* ; Esophageal Sphincter, Upper ; Female ; Humans ; Manometry* ; Neurosurgery ; Peristalsis

Clinical presentation of supplementary motor area (SMA) syndrome includes complete akinesia of the contralateral side of the body and mutism, with secondary recovery of neurologic deficit. Multi-joint coordination is frequently impaired following the development of a brain lesion and is generally restricted by abnormal patterns of muscle activation within the hemiparetic limb, clinically termed muscle synergies. However, no work to date has confirmed this observation with the aid of objective methods, such as gait analysis, and the development of reflex pattern has not been suggested as a possible cause. We describe two unusual cases of flexor synergy after tumor resection of SMA lesions.
Brain ; Brain Neoplasms ; Extremities ; Gait ; Lower Extremity* ; Motor Cortex ; Muscles ; Mutism ; Neurologic Manifestations ; Reflex

No abstract available.
Diagnosis* ; Polycystic Kidney Diseases*

Although commercialization of mobile phones has raised much concerns about the effects of radiofrequency radiation on the human body, few experimental studies have been conducted on the effects of radiofrequency radiation on physiological homeostasis, immune and inflammatory responses. Therefore, we presently investigated the effect of 835 MHz radiofrequency radiation on spontaneous wheel exercise, hormone and cytokines levels in the plasm of mice. Mice were divided into 4 groups as control, exercise, radiofrequency radiation, radiofrequency radiation & exercise group. The body weight, corticosterone and blood cytokine levels were checked for 10 weeks. Followed by the exposure to radiofrequency radiation for 6 hours a day, the more increase in body weight was observed in the radiofrequency radiation & exercise group than in the spontaneous exercise group. When the amount of spontaneous exercise was measured for 10 weeks, the amount of exercise was increased in the both control and spontaneous exercise group, while the amount of exercise was decreased in the radiofrequency radiation group. To determine whether the homeostasis, immune and inflammatory responses are indirectly affected by radiofrequency radiation exposure, IL-1β, IL-6, IL-12 (p70), TNF-α, IFNγ, and GM-CSF were measured by ELISA kit, respectively. As a result, the blood levels of IL-6, IL-12 (p70) and TNF-α in the spontaneous exercise group were higher than that of control group, and each cytokine levels in the radiofrequency radiation & exercise group were lower than that of control group. However, the corticosterone, IL-1β, IFNγ and GM-CSF didn't show statistically significant differences in all groups. It has been confirmed that exposure to high frequency electromagnetic waves for a long time can affect the amount of exercise, body weight, and some inflammatory cytokines such as IL-6, IL-12 (p70) and TNF-α.
Animals ; Body Weight ; Cell Phones ; Corticosterone* ; Cytokines* ; Electromagnetic Radiation ; Enzyme-Linked Immunosorbent Assay ; Granulocyte-Macrophage Colony-Stimulating Factor ; Homeostasis ; Human Body ; Interleukin-12 ; Interleukin-6 ; Mice* ; Radiation Exposure

OBJECTIVE: To quantify the activation of the paraspinalis muscles (multifidus and erector spinae) at different walking velocities and slope with surface electromyography. METHODS: This study was a prospective experimental study involving ten healthy male participants. Surface electrodes were placed over the multifidus and erector spinae muscles at the L5 and L3 level. After the electrode was placed at the lumbar paraspinalis muscles, electromyography signals were recorded over 20 seconds. Data were collected three times during the walking exercise at a 0degrees gradient with the speed from 3 to 6 km/hr. At 7degrees gradient and 15degrees gradient, data were also collected three times but a walking speed of 4 km/hr. The area under the curve was calculated for quantitative measurement of muscle activation. RESULTS: While the muscle activation was increased at higher walking velocities at the L5 and L3 levels of the multifidus, the erector spinae muscle activation did not show any change at higher walking velocities. At L3 level of the multifidus and erector spine muscles, the muscle activation was significantly increased in 15degrees gradient compared to those seen in at 0degrees gradient. At L5 level, the multifidus and erector spinae muscle activation in 0degrees gradient was not significantly different from that those seen in 7degrees or 15degrees gradient. CONCLUSION: Fast walking exercise activates lumbar multifidus muscles more than the slow walking exercise. Also, the mid lumbar muscles are comparatively more activated than low lumbar muscles when the walking slope increases.
Electrodes ; Electromyography ; Humans ; Low Back Pain ; Male ; Muscles ; Paraspinal Muscles* ; Prospective Studies ; Spine ; Walking*

The July issue of Clinical Endoscopy deals with selected articles covering the state-of-the-art lectures delivered during the 50th seminar of the Korean Society of Gastrointestinal Endoscopy (KSGE) on March 30, 2014, highlighting educational contents pertaining to either diagnostic or therapeutic gastrointestinal (GI) endoscopy, which contain fundamental and essential points in GI endoscopy. KSGE is very proud of its seminar, which has been presented twice a year for the last 25 years, and hosted more than 3,500 participants at the current meeting. KSGE seminar is positioned as one of premier state-of-the-art seminars for endoscopy, covering topics for novice endoscopists and advanced experts, as well as diagnostic and therapeutic endoscopy. The 50th KSGE seminar consists of more than 20 sessions, including a single special lecture, concurrent sessions for GI endoscopy nurses, and sessions exploring new technologies. Nine articles were selected from these prestigious lectures, and invited for publication in this special issue. This introductory review, prepared by the editors of Clinical Endoscopy, highlights core contents divided into four sessions: upper GI tract, lower GI tract, pancreatobiliary system, and other specialized topic sessions, including live demonstrations and hands-on courses.
Endoscopy ; Endoscopy, Gastrointestinal* ; Lectures ; Lower Gastrointestinal Tract ; Publications ; Upper Gastrointestinal Tract

Blue nevus may rarely appear in a plaque form. Because of its rarity and unusual appearance, this nevus may present a diagnostic problem and gives no definite prognosis. We report a case of plaque -type blue nevus in a 25-year-old man. He presented an irregularly demarcated plaque, measuring 1.5 x 3 cm, composed of multiple grouped slate gray to blue papules of varying size with intervening faint gray-blue discoloration on the back, which had existed for 10 years. Histopathological examination showed clumps of numerous heavily melanin-laden dendritic melanocytes in the reticular dermis with intervening stromal fibrosis. Numerous melanophages were intermingled with the melanocytes. There were no islands of pale cells seen in the cellular blue nevus and no malignant changes such as nuclear and cytoplasmic pleomorphism, mitotic figures and so on. The diagnosis of plaque-type blue nevus was made and its histopathological features were consistent with a common blue nevus.
Adult ; Cytoplasm ; Dermis ; Diagnosis ; Fibrosis ; Humans ; Islands ; Melanocytes ; Nevus ; Nevus, Blue* ; Prognosis

OBJECTIVE: To characterize neuropathic pain in patients with spinal cord injury (SCI) according to classification used in the study by Baron et al. (Baron classification), a classification of neuropathic pain based on the mechanism. To also compare the patterns of neuropathic pain in SCI patients with those in patients with other etiologies and to determine the differences in patterns of neuropathic pain between the etiologies. METHODS: This was a descriptive cross-sectional study. We used the Baron classification to investigate the characteristics of neuropathic pain in SCI. Sixty-one SCI patients with neuropathic pain (The Leeds assessment of neuropathic symptoms and signs score > or =12) were enrolled in this study between November 2012 and August 2013, after excluding patients <20 of age, patients with visual analog scale (VAS) score <3, pregnant patients, and patients with systemic disease or pain other than neuropathic pain. RESULTS: The most common pain characteristic was pricking pain followed by electrical pain and numbness. The mean VAS score of at-level neuropathic pain was 7.51 and that of below-level neuropathic pain was 6.83. All of the patients suffered from rest pain, but 18 (54.6%) patients with at-level neuropathic pain and 20 (50.0%) patients with below-level neuropathic pain suffered from evoked pain. There was no significant difference in between at-level and below-level neuropathic pains. CONCLUSION: The result was quite different from the characteristics of post-herpetic neuralgia, but it was similar to the characteristics of diabetic neuropathy as shown in the study by Baron et al., which means that sensory nerve deafferentation may be the most common pathophysiologic mechanism of neuropathic pain after SCI. Since in our study, we included short and discrete symptoms and signs based on diverse mechanisms, our results could be helpful for determining further evaluation and treatment.
Classification ; Cross-Sectional Studies ; Diabetic Neuropathies ; Humans ; Hypesthesia ; Neuralgia* ; Spinal Cord Injuries* ; Visual Analog Scale

BACKGROUND: Periampullary cancer is a relatively common malignancy, and its incidence is increasing. A pancreaticoduodenectomy is the procedure of choice in patients with periampullary cancer. However, leakage of the pancreaticojejunal anastomosis has been a major complication after a pancreaticoduodenectomy, with a frequently reported incidence of 5 percent to 25 percent. The ideal management of the pancreatic stump has not yet been determined. Thus we tried to find a safe and effective pancreatic stump management technique and to monitor the security of the pancreatic stump anastomosis by using the body fluid amylase level. PATIENTS AND METHODS: Forty six (46) consecutive patients who had undergone a pancreaticoduodenectomy, between January 1990 and January 1998, were evaluated retrospectively. Before June 1997, we did 36 pancreaticojejunostomies without long stent insertion into the pancreatic duct (group 2). After that, we did 10 P-Jstomies with long stent insertion (group 1). A long silicone stent was used for intubation of the anastomosis. Also the amount of pancreatic juice drainage from the long pancreatic duct tube was checked daily. We placed two Penrose drains and one Jackson-Pratt drain near the anastomosis. Patients were monitored for clinical evidence of a pancreatic fistula by evaluation of the amylase concentration in serum and the peritoneal drainage at postoperative day 7. The normal range of body fluid amylase was defined to be within five times of the normal serum amylase level. Cholangiography, which was obtained through a T-tube or a percutaneous transhepatic catheter, was performed on postoperative day 7 and was used to assess to leakage from or the obstruction at any of the three reconstructive anastomoses. RESULTS: In group 1, there was no leakage from the P-Jstomy site. The daily mean pancreatic juice amount and body fluid amylase level were 76.6 ml/day (range, 0.4-137.4 ml/day) and 147.4 U/L (range,44-323 U/L). In group 2, there were 4 cases of leakage at the P-Jstomy site (11.1%). CONCLUSION: An external long pancreatic duct stent insertion is an effective and safe method for management of a pancreatic remnant. We could check the amount of the daily pancreatic juice precisely. Effective decompression of the P-Jstomy was achieved by long stent insertion. We could monitor the security of the pancreatic stump anastomosis by the body fluid amylase level. We suggest that our method, which monitors the body fluid amylase level, is effective in early detection and treatment of P-Jstomy site leakage. The effort to find the best method for management of the pancreatic remnant should be continued.
Amylases ; Body Fluids ; Catheters ; Cholangiography ; Decompression ; Drainage ; Humans ; Incidence ; Intubation ; Pancreatic Ducts* ; Pancreatic Fistula ; Pancreatic Juice ; Pancreaticoduodenectomy ; Pancreaticojejunostomy* ; Reference Values ; Retrospective Studies ; Silicones ; Stents*

Neurogenic bladder is common in most spinal cord injury patients. Voiding cystourethrography (VCUG) is recommended in these patients to detect urinary tract complications. However, rare but serious complications may occur during VCUG, although VCUG is generally safe. There are several case reports of bladder rupture occurring in pediatric patients. Here, we report the first case of iatrogenic bladder rupture in an adult spinal cord injury patient in Korea. Particularly, extravasation of contrast without manual instillation has hardly ever been reported. To the best of our knowledge, this is the first reported case of bladder rupture without manual instillation during VCUG. We report a case of a 59-year-old female with paraplegia due to tuberculous spondylitis who underwent VCUG as a part of routine evaluation of neurogenic bladder. Extravasation of the contrast media during VCUG developed as a complication and the patient recovered spontaneously without any intervention. Therefore, VCUG should be performed properly in chronic spinal cord injury patients.
Adult ; Contrast Media ; Female ; Humans ; Korea ; Middle Aged ; Paraplegia ; Rupture ; Spinal Cord Injuries* ; Spinal Cord* ; Spondylitis ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Tract