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Ethics*

The Osler-Rendu-Weber syndrome is characterized by multiple telangiectasic lesions usually involving the mucous membranes, face and distal extremities. It is a congenital malformation inherited as an autosomal dominant trait and the lesions usually appear during adulthood. The major symptoms are recurrent epistaxis and gastrointestinal bleeding, but they may cause intracranial hemorrhage at the white matter of the brain stem, cerebellum and diencephalon. We report a case of typical autosomal dominant trait Osler-Rendu-Weber syndrome associated with intracranial hemorrhage at the right basal ganglia.
Basal Ganglia ; Brain Stem ; Cerebellum ; Diencephalon ; Epistaxis ; Extremities ; Hemorrhage ; Intracranial Hemorrhages ; Mucous Membrane ; Stroke ; Telangiectasia, Hereditary Hemorrhagic

OBJECTIVE: To compare the effects and side effects of chemodenervation according to the neurolytic agents, injection techniques and treatment indications. METHOD: One hundred and seventy three cases of chmodenervation were reviewed. They were classified into three groups(phenol, b otulinum toxin, mixed) according to the neurolytic agents and into three groups(nerve trunk block, motor point block, both) according to the injection technique and nine gruoups(cervical dystonia, elbow flexor spasticity, wrist and hand spasticity, hip adductor spasticity, stiff knee gait, ankle plantar flexor spasticity, sustained ankle clonus, rear foot varus, toe clawing) according to the treatment indications. The rate of suboptimal results and side effects was descriptively measured. RESULTS: 1) The suboptimal results were observed in 19% of phenol blocks and 17% of Botulinum toxin injections. But the side effects were more frequently observed in phenol blocks(25%) than Botulinum toxin injections(2%). 2) In terms of phenol injection techniques, a nerve trunk injection was more successful(88%) than a motor point injection(69%). In case of simultaneous injections into the nerve trunk and motor point, the effects were very promising(100%). But the side effects were more frequently observed in the nerve trunk injections(26%) than the motor point injections(12%). 3) In terms of treatment indications, suboptimal results were observed in 44% of stiff knee gaits, 38% of cervical dystonias and 27% of toe clawing cases. Side effects were observed in 33% of toe clawing cases, 25% of sustained ankle clonus cases and 21% of elbow flexor spasticity cases. CONCLUSION: The suboptimal results were slightly higher in botolinum toxin injections than in phenol blocks. The side effects were more frequently observed in phenol blocks than in botulinum toxin injections.
Animals ; Ankle ; Botulinum Toxins ; Dystonia ; Elbow ; Foot ; Gait ; Hand ; Hip ; Hoof and Claw ; Knee ; Muscle Spasticity ; Nerve Block* ; Phenol ; Toes ; Torticollis ; Wrist

Variations in the distribution and the magnitude of the forces in the foot may reflect painful conditions and abnormalities of structure or function. By tracking the path of the instantaneous COP(center of pressure) during stance phase, the balance and pattern of progression can be determined, but parameters on COP have not been standardized nor widely applied to clinical settings yet. To quantify the COP parameters and to evaluate the clinical applicability of COP, within subject experimental design was used. Twenty six subjects with age of sixties who had no history of foot problems were recruited. Foot contact and COP parameters were measured and compared between flat foot, low heel and high heel shod walking. 1) Gait cycle parameters, 2) foot contact parameters such as total contact area, contact length, contact width, and 3) COP parameters such as initial contact COP, mean COP, anteroposterior and mediolateral displacement of COP, slope of COP, velocity of COP during each functional rocker were measured with F-scan pressure sensitive insole system. In normal flat foot walking, COP of initial contact and mean COP were anatomically correspond to the center of the heel and to the center of the sole respectively. COP displacements corresponded to 83% of foot contact length anteroposteriorly and 18% of forefoot contact width mediolaterally. Slope of COP was about 6 degrees inwardly directed. Velocities of the COP during each functional rocker action were even and about 22-27 cm/sec around. In high heel shod walking, COP of initial contact was displaced 1.73 cm anteriorly and mean COP was displaced 0.31 cm medially and 1.89 cm anteriorly. Anteroposterior displacement of COP was also reduced. Velocity of the COP during heel rocker was faster and velocity during ankle rocker was slower compared to flat foot walking, which suggests excessive heel rocker and reduced ankle rocker action in high heel shod walking. In conclusion, COP parameters measured by pressure sensitive insole system may reflect the biomechanical alteration of the foot quantitatively and may be useful in assessing the biomechanical function of the foot.
Ankle ; Flatfoot ; Foot* ; Gait ; Heel ; Research Design ; Walking*

OBJECTIVE: The purpose of this study is to evaluate the effect of functional electrical stimulation (FES) on hemiplegic shoulder subluxation in post-acute stroke patients. METHOD: Forty-four patients who had shoulder subluxation as a consequence of their first stroke were included and randomly assigned to either a control group (22 subjects) or a study group (22 subjects). Patients in both groups received physiotherapy and used an arm sling. The study group received, FES therapy to shoulder muscles (supraspinatus and posterior deltoid) for 30 minutes, five days a week for 6 weeks. The effect of FES therapy was evaluated by assessment of the severity of subluxation using radiologic measurements before and after treatment. RESULTS: 1) The severity of subluxation was significantly increased after 6 weeks (p<0.05) in the control group. In the study group, it was reduced but the difference was not statistically significant (p>0.05). 2) In the group of patients with early treatment (onset duration, less than 6 months), the control group showed a significant increase in subluxation (p<0.05), but the study group showed significantly reduced (p<0.05) shoulder subluxation after treatment period. 3) In the group of patients with mild shoulder subluxation before treatment (less than 1 finger breadth), the control group showed a significant increase in subluxation (p<0.05), but the study group showed significantly reduced (p<0.05) shoulder subluxation after treatment period. CONCLUSION: The FES therapy is effective in preventing and reducing the severity of hemiplegic shoulder subluxation in post-acute stroke patients, especially if duration since stroke onset was less than six months and the severity of subluxation before treatment was mild.
Arm ; Electric Stimulation* ; Fingers ; Humans ; Muscles ; Shoulder* ; Stroke

The purpose of this study was to investigate learners' opinion about the experience of online continuing medical education, and the effectiveness of it. The study was conducted on online continuing medical education courses conducted as a model case by Konggi-do Medical Association and VirtualMD Co., Ltd with the approval of Korean Medical Association, from July through December, 2002. Fifteen online multimedia courses, supported by learning management system and e-test(electronic assessment) system, were opened. Learners' internet log data, and answers to a questionnaire were collected. And a pre-test post-test design experiment was implemented to measure the effectiveness of learning. The results showed that doctors are already technically and environmentally ready to take online continuing medical education and have correct understanding about the necessity and benefits of online continuing medical education. The difference between the pre-test score and the post-test score was statistically significant(t=3.24, p<.01), and practically significant(Effect Size=.89).
Education, Medical, Continuing* ; Internet ; Learning ; Multimedia ; Surveys and Questionnaires

The autoinfective filariform larva of Strongyloides stercoralis causes hyperinfection in immunosuppressed hosts. Here we report on the case of a male patient who was admitted to the emergency room at Gwangju Veterans Hospital with a complaint of dyspnea, and who was receiving corticosteroid therapy for asthma. Many slender larvae of S. stercoralis with a notched tail were detected in Papanicolaou stained sputum. They measured 269 +/- 21.2 micrometer in length and 11 +/- 0.6 micrometer in width. The esophagus extended nearly half of the body length. The larvae were identified putatively as autoinfective third-stage filariform larvae, and their presence was fatal. The autoinfective filariform larva of S. stercoralis has not been previously reported in Korea.
Aged ; Animals ; Fatal Outcome ; Humans ; Immunocompromised Host ; Larva ; Male ; Sputum ; Strongyloides/growth & development/*isolation & purification ; Strongyloidiasis/*etiology ; Superinfection/*parasitology

It is not common that formation of retrobulbar abscess by inflammatory spreading of chronic frontal sinusitis and even rare that the abscess cause acute exophthalmos and ocular pain. But, if the acute exophthalmos with ocular pain arise from the patient associated with chronic rhinitis or paranasal sinusitis, it should be suspected that peri bulbar abscess was formed by spreading of these disease and otorhinologic examination should be taken. The authors experienced a case of acute exophthalmos with ocular pain in a 27-years old woman and founded that abscess arising from the chronic frontal sinusitis disrupted the superomedial wall of orbit and spread to the retrobulbar area by computed tomography and other radiologic evaluation. We had good result by performing incision and drainage and some otorhinologic therapy.
Abscess ; Adult ; Drainage ; Exophthalmos* ; Female ; Frontal Sinus* ; Frontal Sinusitis* ; Humans ; Orbit ; Rhinitis ; Sinusitis

The free functional muscle transfer (FFMT) is the surgical procedure aimed at reconstructing defective or deteriorated muscle function by grafting free muscles including blood vessels and nerves. Since the free gracilis transfer in the facial paralysis was introduced in 1976, there have been many studies and clinical applications of the FFMT in various donor and recipient sites in brachial plexus injury, muscle ischemic contracture, muscle defect after tumor resection, congenital muscular deficit, multiple trauma. When the reconstruction of the nerve is delayed for 9 months to 1 year after the brachial plexus injury, voluntary muscle contracture is impossible even after the nerve regeneration by the irreversible degeneration of the muscles. And it is difficult to obtain adequate function even if nerve transfer or nerve transplantation is performed because the distance to be regenerated is too long. In these cases, the FFMT has been improved the functions of the upper limb in flexion or extension of the elbow, fingers. Many good clinical results of the FFMT have been reported, so the FFMT gets much interests and attentions. The essential things for the successful outcome of the surgery are the anatomical knowledge, the skilled surgical technique and the choice of patients who can meet the indications and receive long-term rehabilitation. Recent advances in surgical techniques will result in improved results of the FFMT.
Attention ; Blood Vessels ; Brachial Plexus* ; Contracture ; Elbow ; Facial Paralysis ; Fingers ; Humans ; Ischemic Contracture ; Multiple Trauma ; Muscle, Skeletal ; Muscles ; Nerve Regeneration ; Nerve Transfer ; Rehabilitation ; Tissue Donors ; Transplants ; Upper Extremity

OBJECTIVES: To determine the effect of facilitation on H reflex side-to-side amplitude ratio and to determine the effect of averaging under the assumption that an averaging could further stabilize the amplitude ratio in a facilitated condition. METHOD: FCR H reflex amplitude ratios of direct and averaged potentials were measured in fifty asymptomatic subjects under three conditions, during rest, during a constant 5 pound isometric contraction under the hand-dynamometer monitoring, and during a moderate constant isometric contraction under the electromyographer's verbal guidance. RESULTS: The lower limits of the amplitude ratios that encompass 97.5% of subjects by the percentile method under three conditions were as follows; (1) during the rest (n=37); 0.47 (direct) and 0.50 (average), (2) during the constant 5 pound isometric contraction under the hand- dynamometer monitoring; 0.47 (direct) and 0.48 (average), and (3) during the moderate constant isometric contraction under the electromyographer's verbal guidance; 0.48 (direct) and 0.46 (average), respectively. CONCLUSION: There seems to be no definite effect of facilitation and averaging on H reflex amplitude ratio. H reflex amplitude ratio measured in facilitated condition without averaging is still useful for the diagnosis of unilateral radiculopathy.
Diagnosis ; H-Reflex* ; Isometric Contraction ; Radiculopathy ; Upper Extremity