There are some cases of myofascial pain syndrome (MPS) with chronic upper back pain that does not respond to dry needling or trigger point injection, well-known treatments for MPS. A 67-year-old female developed a stabbing upper back pain with trigger point at left T7∼8 levels 10 years ago. She complained of the pain with Numeral Rating Scale (NRS) 8 points. Myofascial release technique and trigger point injection had no effect. Under ultrasound guidance 20 ml of 1% lidocaine was injected into thoracic paravertebral space. Immediately, the pain was reduced to NRS 4 points. One week later, the second block was performed in the same way as the first, and the pain was reduced to NRS 2 points. The stabbing pain disappeared, and oral opioids were discontinued. Ultrasound guided thoracic paravertebral space block is an effective and safe treatment for refractory MPS with chronic upper back pain.

Manual therapy has been widely practiced in almost all countries worldwide. With its potential complications, there are contraindications for thrust technique. A 56-year-old woman diagnosed with athetoid cerebral palsy visited a local clinic due to a tingling sensation in right hand that lasted for a year and aggravated to both upper extremities. The patient underwent three sessions of cervical manual therapy including thrust technique. No evaluation was performed. The patient immediately felt weakness in all extremities after performing cervical thrust technique. Magnetic resonance imaging showed atlantoaxial instability and cervical myelopathy. Approximately one-third of adults with cerebral palsy reported chronic musculoskeletal pain and they often experience neck pain. Particularly in athetoid cerebral palsy, malalignment or instability of the cervical spine is prevalent and often results in myelopathy. Therefore, musculoskeletal evaluation is necessary to identify cervical instability in case of cervical thrust technique, and it should be performed by relevant medical professionals.

OBJECTIVE: Gamma Knife Stereotactic Radiosurgery (GK SRS) has become an important treatment modality for vestibular schwannomas. We evaluated the tumor control rate, patterns of tumor volume change and preservation of hearing following low-dose radiation for vestibular schwannomas in a homogeneous cohort group in which the mean marginal dose was 12 Gy. METHODS: A total of 59 patients were enrolled in this study. All enrolled patients were followed-up for at least 5 years and the radiation dose was 11-13 Gy. Regular MRI, audiometry and clinical evaluations were done and tumor volumes were obtained from MRI using the OSIRIS program. RESULTS: The tumor control rate was 97%. We were able to classify the patterns of change in tumor volume into three categories. Transient increases in tumor volume were detected in 29% of the patients and the maximum transient increase in tumor volume was identified at 6 to 30 months after GK SRS. The transient increases in tumor volume ranged from 121% to 188%. Hearing was preserved in 4 of the 12 patients who had serviceable hearing prior to treatment. There were no other complications associated with GK SRS. CONCLUSION: Low-dose GK SRS was an effective and safe mode of treatment for vestibular schwannomas in comparison to the previously used high-dose GK SRS. Transient increases in tumor volume can be identified during the follow-up period after low-dose GK SRS for vestibular schwannomas. Physicians should be aware that these increases are not always indicative of treatment failure and that close observation is required following treatments. Unfortunately, a satisfactory hearing preservation rate was not achieved by reducing the radiation dose. It is thought that hearing preservation is a more sophisticated problem and further research is required.
Audiometry ; Cohort Studies ; Follow-Up Studies ; Hearing ; Humans ; Magnetic Resonance Imaging ; Neuroma, Acoustic* ; Radiosurgery* ; Treatment Failure ; Tumor Burden

While angina pectoris is not uncommonly seen in hyperthyroidism, only rare case reports have proved that the myocardial ischemia was induced by coronary artery spasm. A 62 year-old man with a prior diagnosis of hyperthyroidism presented with repeated episodes of syncope and chest pain. The coronary angiogram showed normal coronary arteries. Severe diffuse spasm of both coronary was spontaneously induced and normalized after intracoronary nitroglycerin injection during the procedure of coronary angiography. For one year, he was on simultaneous antianginal and antithyroidal medicines with accomplishment of euthyroid state. He did not experience and anginal symptom for the last six months. The followup coronary angiogram performed 1 year later revealed a newly developed atherosclerotic lesion (about 50% stenosis in diameter) at the proximal left anterior descending artery. However provocative challenge test with intracoronary acetylcholine infusion failed to induce coronary spasm at the lesion. We report a case of coronary artery spasm associated with hyperthyroidism with a review of literatures.
Acetylcholine ; Angina Pectoris ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Diagnosis ; Follow-Up Studies ; Humans ; Hyperthyroidism* ; Middle Aged ; Myocardial Ischemia ; Nitroglycerin ; Spasm ; Syncope

DNA barcoding has been widely used in species identification and biodiversity research. A short fragment of the mitochondrial cytochrome c oxidase subunit I (COI) sequence serves as a DNA bio-barcode. We collected DNA barcodes, based on COI sequences from 156 species (529 sequences) of fish, insects, and shellfish. We present results on phylogenetic relationships to assess biodiversity the in the Korean peninsula. Average GC% contents of the 68 fish species (46.9%), the 59 shellfish species (38.0%), and the 29 insect species (33.2%) are reported. Using the Kimura 2 parameter in all possible pairwise comparisons, the average interspecific distances were compared with the average intraspecific distances in fish (3.22 vs. 0.41), insects (2.06 vs. 0.25), and shellfish (3.58 vs. 0.14). Our results confirm that distance-based DNA barcoding provides sufficient information to identify and delineate fish, insect, and shellfish species by means of all possible pairwise comparisons. These results also confirm that the development of an effective molecular barcode identification system is possible. All DNA barcode sequences collected from our study will be useful for the interpretation of species-level identification and community-level patterns in fish, insects, and shellfish in Korea, although at the species level, the rate of correct identification in a diversified environment might be low.
Biodiversity ; DNA ; DNA Barcoding, Taxonomic ; DNA, Mitochondrial ; Electron Transport Complex IV ; Insects ; Korea ; Shellfish

OBJECTIVES: To investigate the causative agents for the dermatological problems associated with the polypropylene manufacturing process. METHODS: The study subjects consisted of 44 male workers involved in the polypropylene manufacturing process. Twenty-seven of them had been exposed to additives, and the remaining 17 had not. Among the 27 exposed, 10 had been exposed previously, and 17 are currently being exposed through their duties. Patch test were performed with three different concentrations, 0.1%, 1% and 10% of 10 different additives that was diluted with Vaseline. RESULTS: 18 subjects (41%) had positive reactions to the patch tests. Exposed group had a higher reaction rate (51.9%) than the control group (23.5%). When the positive reactions were further classified, 7, 6 and 5 were compatible with probably irritant, probably allergic, and multiple hypersensitivity reactions respectively. The most frequent reactions were from Ultranox-626 followed by Millad 3988, Armoslip-E and Songstab Sc-100. CONCLUSIONS: When considering the significantly higher probability of an allergic reaction rate among the currently exposed group compared to non- or previously-exposed groups, the nature of dermatological problems in a polypropylene plant is probably allergic. Ultranox-626, Millad3988, Armoslip-E and Songstab Sc-100 were the main causatives agents found in the process.
Humans ; Hypersensitivity ; Irritants ; Male ; Patch Tests ; Petrolatum ; Plants ; Polypropylenes*

Neoplastic meningitis occurs in approximately 5% of patients with cancer. Primary diffuse leptomeningeal gliomatosis is a rare condition whereby a glioma arises from heterotopic cell nests in the leptomeninges. We report here a case presenting with clinical features similar to those of chronic infectious meningitis without positive cerebrospinal fluid cytology. Neurological signs in our patient deteriorated progressively without responding to antitubercular, antiviral, or antibiotic therapy. Leptomeningeal biopsy sampling revealed the condition to be primary diffuse leptomeningeal gliomatosis.
Biopsy ; Cerebrospinal Fluid ; Glioma ; Humans ; Meningitis*

BACKGROUND: The term solitary fibrous tumor (SFT) is preferred over meningeal hemangiopericytoma (HPC), because NAB2-STAT6 gene fusion has been observed in both intracranial and extracranial HPCs. HPCs are now considered cellular variants of SFTs. METHODS: This study analyzes 19 patients with STAT6-confirmed SFTs, who were followed for over 11 years in a single institution. Ten patients (10/19, 56.2%) had extracranial metastases (metastatic group), while the remainder (9/19) did not (non-metastatic group). These two groups were compared clinicopathologically. RESULTS: In the metastatic group, the primary metastatic sites were the lungs (n = 6), bone (n = 4), and liver (n = 3). There was a mean lag time of 14.2 years between the diagnosis of the initial meningeal tumor to that of systemic metastasis. The median age at initial tumor onset was 37.1 years in the metastatic group and 52.5 in the non-metastatic group. The 10-year survival rates of the metastatic- and non-metastatic groups were 100% and 33%, respectively. The significant prognostic factors for poor outcomes on univariate analysis included advanced age (≥45 years) and large initial tumor size (≥5 cm). In contrast, the patients with higher tumor grade, high mitotic rate (≥5/10 high-power fields), high Ki-67 index (≥5%), and the presence of necrosis or CD34 positivity showed tendency of poor prognosis but these parameters were not statistically significant poor prognostic markers. CONCLUSIONS: Among patients with SFTs, younger patients (<45 years) experienced longer survival times and paradoxically had more frequent extracranial metastases after long latent periods than did older patients. Therefore, young patients with SFTs require careful surveillance and follow-up for early detection of systemic metastases.
Central Nervous System ; Diagnosis ; Follow-Up Studies ; Gene Fusion ; Hemangiopericytoma ; Humans ; Liver ; Lung ; Meningeal Neoplasms ; Necrosis ; Neoplasm Metastasis* ; Prognosis ; Solitary Fibrous Tumors* ; Survival Rate

Dermatomyositis is a clinical entity characterized by a distinctive cutaneous rash and inflammatory myopathy. In this disorder, the pneumomediastinum is quite a rare complication and is assumed to result from air leakage due to vasculitis, lung fibrosis or rarely after bronchoscopic lung biopsy and pulmonary function test. We describe patient with dermatomyositis who developed pneumomediastinum, pneumothorax and massive subcutaneous emphysema after pulmonary function test. She died due to respiratory failure. We think that careful observation is required in performing PFT in dermatomyositis patients with presumed interstitial lung diseases.
Biopsy ; Dermatomyositis* ; Exanthema ; Fibrosis ; Humans ; Lung ; Lung Diseases, Interstitial ; Mediastinal Emphysema* ; Myositis ; Pneumothorax ; Respiratory Function Tests ; Respiratory Insufficiency ; Subcutaneous Emphysema* ; Vasculitis

BACKGROUND AND OBJECTIVES: Glucose-insulin-potassium (GIK) fluid infusion may improve the myocardial energy metabolism in the ischemic condition. A prospective randomized clinical trial was designed to determine whether a GIK fluid infusion can reduce the ventricular remodeling in acute myocardial infarction. SUBJECTS AND METHODS: For the patients with acute myocardial infarction, during thrombolytic therapy with urokinase, GIK fluid (26% glucose 1000 mL, 50 IU insulin, and 80 mmol KCl) was administered for 24 hours. The ventricular volumes and function were evaluated by echocardiography during the admission period, at 6 months and at 12 months following discharge. RESULTS: This trial was done prospectively for 2 years in 73 patients; the GIK group included 41 patients and the control group included 32 patients. The median value of "the pain to door time" was 195 minutes in the GIK group and it was 120 minutes in the control group (p=NS). The wall motion score was 1.52+/-0.39 in the GIK group and it was 1.39+/-0.35 in the control group. The left ventricular volumes, ejection fractions, cardiac indices and the globular indices showed no significant difference between the two groups. The side effects of the GIK fluid were mild phlebitis in 6 patients (14.6%) and congestive heart failure in 5 patients (12.2%). CONCLUSION: This trial could not verify the beneficial effects of administering GIK fluid on the ventricular remodeling after acute myocardial infarction. The limitations of this trial were as follows: "the pain to door time" was too long and the severity of the myocardial infarction was mild. Low rates for the echocardiogrphy follow-up and the randomization failure in a few patients were also noted.
Echocardiography ; Energy Metabolism ; Follow-Up Studies ; Glucose ; Heart Failure ; Humans ; Insulin ; Myocardial Infarction* ; Phlebitis ; Prospective Studies ; Random Allocation ; Thrombolytic Therapy ; Urokinase-Type Plasminogen Activator ; Ventricular Remodeling