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

PURPOSE: To evaluate the result of arthroscopic modified Brostrom procedure with suture anchor for chronic lateral ankle instability. MATERIALS AND METHODS: Fifty-two patients with chronic lateral ankle instability were analyzed, who underwent arthroscopic modified Brostrom procedure between December 2010 and May 2012. Clinical evaluation was performed using AOFAS scroring and Sefton grading system. RESULTS: The average AOFAS hind foot score increased from preoperative 61.9 to 88.8 at the last follow up. There were 35 excellent, 9 good, 4 fair, 4 poor results according to Sefton grading system. For one patient, lateral ankle instability recurred. CONCLUSION: Arthroscopic modified Brostrom procedure is considered to be an effective and satisfactory technique.
Ankle* ; Arthroscopy ; Follow-Up Studies ; Foot ; Humans ; Suture Anchors

PURPOSE: The present study investigated the outcomes of nonsurgical treatment of abnormal eyelid position using hyaluronic acid gel. METHODS: Abnormal eyelid position including 18 eyes with lid retraction, 10 eyes with lagophthalmos, and 18 eyes with ectropion were treated with hyaluronic acid gel. The mean age was 50 +/- 17.8 years and the mean observation period was 11 +/- 2.4 months. The photographs of patients were taken before injection, 1 month, 4 months, and at the last follow-up after injection. The marginal reflex distance 1 (MRD1) and marginal reflex distance 2 (MRD2) of patients were measured and analyzed by the Image J Program. The severity of ectropion was graded by a scoring system. RESULTS: Ten eyes with lagopthalmos improved 1.9 +/- 1.2 mm after injection. The 16 eyes with lid retraction improved 1.3 +/- 0.9 mm. Twenty-three eyes with ectropion improved and 17 eyes (81%) were completely corrected. The average frequency of injection was 1.1 and the average dose of injection was 0.4 +/- 0.12 cc. No significant complications were observed in any patient. CONCLUSIONS: Hyaluronic acid gel injections can be used safely and effectively as a nonsurgical treatment for patients with abnormal eyelid position without any significant complications.
Ectropion ; Eye ; Eyelids ; Follow-Up Studies ; Humans ; Hyaluronic Acid ; Reflex

Purpose: The goal of this study was to evaluate the efficacy of suction drains following total hip arthroplasties, by comparing the post-operative results between the group with suction drains and the group without suction drains. Materials and Methods: Eighty-six patients, who underwent primary total hip arthroplasties from June 2001 to June 2004, were divided into two groups: group 1 (48 patients), with suction drains; and group 2 (38 patients), without suction drains. We assessed the perioperative hemoglobin and platelet levels, the amount of total blood loss, the amount of post-operative blood transfusions, post-operative ranges of motion (ROMs, at 6 weeks), wound problems, and general conditions. Results: Although the postoperative hemoglobin level was greater in group 2 than in group 1, there was no statistically significant difference. The amount of total blood loss and blood transfusions in group 1 were statistically greater than in group 2 (p<0.05). There were no statistically significant differences in the post-operative ROMs and wound complications between groups 1 and 2. Conclusion: There were no limitations of hip motion and no wound complications in the patients without suction drains after total hip arthroplasties. However, they required fewer post-operative blood transfusions than did the patients with suction drains, due to less post-operative blood loss; and the absence of a suction drain might prevent retrograde tube infections. In addition, patients without suction drains after total hip arthroplasties seemed to recover better did than those with suction drains. Therefore, suction drains might provide no benefit in total hip arthroplasties.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Blood Platelets ; Blood Transfusion ; Hip ; Humans ; Suction* ; Wounds and Injuries

Paget's disease of bone (osteitis deformans), a chronic osseous disease of unknown etiology, is extremely rarein Asia although well known in western countries. This disease is characterized by the simultaneous absorption ofbone and the new bone formation of abnormal character affecting middle and later age groups. The authorsexperienced a case of monostotic Paget's disease involving left pelvic bone in 56-years old female. To ourknowledge, this is the first cas report of monostotic Paget's in Korea.
Absorption ; Asia ; Female ; Humans ; Korea ; Osteitis Deformans ; Osteogenesis ; Pelvic Bones

OBJECTIVE: To evaluate and compare the rate and etiologies of second trimester pregnancy loss in monochorionic (MC) or dichorionic (DC) twins, and natural or assisted reproductive technology (ART) twins. METHODS: Between January 1997 and December 2008, there were 146 cases of second trimester twin pregnancy losses (between 12 and 24 weeks gestation) from 2,467 twin pregnancies. They were divided into four groups according to chorionicity and fertilization. Chorionicity was established by ultrasound at early gestation and confirmed by histologic examination after delivery. From a total of 2,467 twin deliveries, 392 MC, 2058 DC, and 17 unknown chorionicity were observed. Fertilization methods were classified as 736 natural, 1,590 ART, and 141 unknown conceptions. The pregnancy loss rate and possible mechanisms were compared in each group. RESULTS: During the study period, there were 43 MC, 86 DC, and 17 unknown chorionicities and 45 natural, 78 ART, and 23 unknown fertilizations. Total twin pregnancy loss rate was 5.9% (146/2,467), with 11.0% (43/392) and 4.2% (86/2,058) for MC twin group and DC twin group, respectively. Likewise, it was 6.1% (45/736) and 4.9% (78/1,590) for natural twin group and ART twin group. The most common cause was intrauterine fetal death (IUFD) in 22 (51.2%) in MC twin group and preterm premature rupture of membranes (PPROM) in 40 (46.5%) in DC twin group, followed by preterm labor (PTL) in 37 (43%). In natural pregnancy, IUFD was the most common etiology in 20 (44.5%) and for ART twin group, it was PTL in 35 (44.9%). CONCLUSION: Twin pregnancy loss rate was higher in MC twin group compared with DC twin group in the second trimester. MC twin group had a higher incidence of IUFD as a cause of second trimester pregnancy loss. The etiologies in DC twin group were PPROM and PTL. It is suggested that antenatal care in twin pregnancy should be explored for preventing fetal loss and promoting neonatal well-being.
Chorion ; Female ; Fertilization ; Fetal Death ; Humans ; Incidence ; Membranes ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy, Twin ; Reproductive Techniques, Assisted ; Rupture ; Twins

Slipped capital femoral epiphysis is a rare hip disorder that mainly occurs in pubertal children. Although the exact cause of this disorder is unknown, it is known to be associated with obesity, trauma, delayed sexual development, delayed bone maturation, chronic renal failure, genetic diseases, endocrine disorders (growth hormone deficiency, hypothyroidism, hypogonadism), growth hormone therapy, and gonadotropin releasing hormone agonist (GnRH agonist) therapy. We report 2 cases of slipped capital femoral epiphysis in adolescent females who were receiving growth hormone therapy. The first case is of a 16 year-old-girl with chronic renal failure and renal osteodystrophy. The second case is of an 11 year-old-girl with idiopathic precocious puberty who had received GnRH agonist and growth hormone therapy. Unilateral or bilateral slipped capital femoral epiphysis developed at 1 year 3 months after treatment in both the cases. The chief complaints were pain in the hip joint and lower extremities. Growth hormone and/or GnRH agonist therapy was stopped, and in situ screw fixations of the involved hip epiphyses were performed.
Adolescent ; Child ; Endocrine System Diseases ; Epiphyses ; Female ; Gonadotropin-Releasing Hormone ; Growth Hormone ; Hip ; Hip Joint ; Humans ; Hypothyroidism ; Kidney Failure, Chronic ; Lower Extremity ; Obesity ; Puberty, Precocious ; Renal Osteodystrophy ; Sexual Development ; Slipped Capital Femoral Epiphyses

Achalasia is rare disorder with an estimated prevalence of 0.5~1 per 100,000 per year and secondary achalasia due to trauma is rarer. The following case report describes a patient who developed achalasia after chest trauma. This report presents a 22 year-old male with chest trauma who had hoarseness and postprandial reflux. We suggested the achalasia through video-fluoroscopic swallowing study (VFSS), and confirmed superior and recurrent laryngeal neuropathies through laryngeal electromyography (EMG). VFSS and laryngeal EMG are helpful to diagnose the achalasia due to vagus nerve injury after chest trauma.
Deglutition ; Electromyography ; Esophageal Achalasia ; Hoarseness ; Humans ; Male ; Prevalence ; Thorax ; Vagus Nerve ; Vagus Nerve Injuries

PURPOSE: To evaluate the difference between the midvastus and median parapatellar approach in total knee arthroplasty (TKA) in terms of clinical and radiologic results. MATERIALS AND METHODS: From January to December 2003, 49 patients having bilateral TKA were randomized prospectivity-one knee having a vastus splitting approach and the other knee having a median parapatellar approach- to compare operation time, postoperative ROM and drain amount, knee society knee score and function score, return to SLR, patellar tilting and displacement. The data was collected during 2 years of follow-up period, and analyzed using paired t-test. RESULTS: The patients with the midvastus splitting approach performed active straight-leg raise sooner (mean, 1.8 day) than the patients operated on using median parapatellar approach (mean, 2.2 days). But, there was no statistically difference. Knee flexion was better at post-operative 4 weeks in midvastus splitting approach group (mean, 125.5 degrees) than the median parapatellar approach group (mean, 123.9 degree)(p=0.028). However, patellar displacement was more severe in midvastus splitting approach group (mean, 3.4 mm) than the median parapatellar group (mean, 1.6 mm) (p=0.035). There was 1 postoperative hematoma and avulsion fracture of patellar tendon in midvastus splitting approach group. CONCLUSION: Even though midvastus splitting approach could provides the advantage of early postoperative rehabilitation, The midvastus splitting surgical approach dose not consider as being superioir to median parapatellar approach due to severe injury of midvastus and limitation of surgical indication.
Arthroplasty* ; Follow-Up Studies ; Hematoma ; Humans ; Knee* ; Patellar Ligament ; Rehabilitation

Objectives: ：Maltreatment is one of representative risk factor for psychiatric illnesses. While several studies indicate the relationship between physical activity and maltreatment, there was lack of study using objective measurements. This study was conducted to find the biomarkers of physical activity related to maltreatment experiences in healthy adults using wearable device. Methods: ：A total of 60 healthy adults were recruited; 15 subjects reported maltreatment experiences. Physical activity and sleep data were collected using Fitbit for 2 weeks. Child maltreatment experiences were assessed by Adverse Childhood Experiences (ACE). Symptoms were measured using the Insomnia Severity Index (ISI), Morningness-Eveningness Questionnaire (MEQ), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Results: ：The child maltreatment group showed lower movement distance (p=0.025) and number of walks (p=0.010) compared to the control group. After controlling for anxiety and depressive symptoms in women, maltreatment group represented significant reduction in light activities (p=0.021) as well as movement distance (p=0.024) and number of walks (p=0.011). There was no significant difference in sleep variables between the two groups. Conclusions ：Even in healthy participants, maltreatment experiences can negatively affect daily light physical activity.