Migraine is a common neurologic disorder with recurrent headache and variable accompanying symptoms. Patients with migraine have suffered by an enormous burden on daily life and impairment of quality of life (QoL), but migraine is still underdiagnosed and undertreated. For early and better diagnosis and treatment of migraine, headache education and instruments for evaluation of headache outcomes including QoL and disability are essential. Nonpharmachological treatment like cognitive-behavior therapy, mindfulness-based stress reduction, lifestyle modification and trigger avoidance, biofeedback, relaxation training can reduce frequency of pain, disability, so headache education might be helpful. Headache diary and instruments for evaluation of QoL, disability and comorbidity like Migraine Disability Assessment Scale (MIDAS), Headache Impact Test-6 (HIT-6), Migraine-Specific Quality of Life Questionnaire (MSQ) are useful tools to decide plans of treatment. When nonpharmachological treatment and headache education are well applied and evaluation of the QoL and disability are reflected, it will help improve the quality of life for migraine patients.
J Korean Neurol Assoc 38(3):169-174, 2020

OBJECTIVE: To assess the efficacy and safety of ultrasound-guided intragestational injection of methotrexate (MTX) and systemic intramuscular MTX in the management of cesarean scar pregnancies. METHODS: This was a retrospective case-control study that included women diagnosed with cesarean scar pregnancy at CHA Bundang Medical Center unit between 2009 and 2015. The 26 cases were managed with local injection of MTX under ultrasound guidance and 15 cases were treated with systemic intramuscular of MTX. After the procedure, serial follow-up sonographic examination and serum beta-human chorionic gonadotropin (β-hCG) measurement were performed. RESULTS: The mean initial β-hCG level was 20,610.73 mIU/mL and ranged from 263.00–71,316.50 mIU/mL. Mean gestational age was 6.3 weeks and ranged from 4.8 to 8.5 weeks. The majority of ectopic cases were treated successfully and follow-up β-hCG level declined abruptly following the first dose of MTX. The rate of success of local MTX treatment was significantly higher than that of systemic MTX treatment. It was 93.75% vs. 73.33%, respectively (P < 0.05). CONCLUSION: Ultrasound-guided intragestational injection of MTX is an effective method for the management of cesarean scar pregnancies and is associated with minimal side effects and high treatment success.
Case-Control Studies ; Chorionic Gonadotropin ; Cicatrix ; Female ; Follow-Up Studies ; Gestational Age ; Humans ; Methods ; Methotrexate ; Pregnancy ; Retrospective Studies ; Ultrasonography

No abstract available.
Microsurgery

No abstract available.
Humans ; Infant, Newborn* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma*

Purpose: Incontinence-associated dermatitis (IAD) is widespread and a common problem in healthcare settings, It is defined as irritation of the perineal skin due to contact with urine, feces, or both. It is one of the major risk factors for the development of pressure injuries are regarded as a quality indicator of nursing care.It is important to understand the knowledge and attitudes of nurses who are primarily responsible for providing appropriate nursing care that includes differentiation of IAD from other skin breakdowns, and appropriate management. Therefore, the purpose of this study was to determine the knowledge, attitudes, and performance of IAD among clinical nurses in Korea. Methods: Data about IAD knowledge, attitudes, and performance were collected from August to November 2022. 656 nurses from six hospitals participated in the study. Results: The mean scores of nurses’ knowledge, attitudes, and performance were 17.98±2.91, 76.34±7.85, and 91.53±16.18, respectively. Nurses' knowledge showed a positive correlation in both attitudes (r=0.27, p<.001) and performance (r=0.09, p=.02), and attitudes and performance (r=0.34, p<.001) also showed a positive correlation. Conclusion To improve the knowledge and performance of nurses, an educational program consisting only of incontinence-related dermatitis is needed, and case-based education and clinical skills education are needed to enhance the ability to differentiate from pressure injury.

PURPOSE: To evaluate the clinical and radiologic outcomes of the perilunate dislocation and the lunate dislocation which were managed surgically through a dorsal approach. MATERIALS AND METHODS: Retrospective reviews of the 13 patients who had minimum 1-year follow-up after surgical treatment through isolated dorsal approach for their perilunate dislocations or the lunate dislocations were performed. The case that dislocated lunate migrated proximally through the wrist was excluded in this series. We evaluated the DASH score in questionnaire method and Mayo wrist score to analyze the clinical outcomes. Radiologic results were investigated by measurement of the scapho-lunate angle, and fracture union was also evaluated in the case of trans-scaphoid dislocation. RESULTS: The mean DASH Score was 16.3 points (range, 10.8~26.7 points) and the mean Mayo wrist score was 79 points (range, 65~90 points) at the final follow-up. There were 2 cases of excellent, 7 cases of good and 4 cases of fair in the Mayo wrist score. On the radiologic analysis, the mean scapho-lunate angle was 49.0degrees (range, 35~55degrees) and all cases were within the normal range. All cases of the trans-scaphoid perilunate dislocation achieved bone union. CONCLUSION: Author's cases showed satisfactory outcomes in clinically and radiologically. Isolated dorsal approach could give anatomical reduction and appropriate internal fixation in treatment of the perilunate dislocations and the lunate dislocations except the rare case of proximal migration of the lunate through the wrist.
Dislocations ; Follow-Up Studies ; Humans ; Surveys and Questionnaires ; Reference Values ; Retrospective Studies ; Wrist

The most common fractures of the spine are associated with the thoracolumbar junction. The goals of treatment of thoracolumbar fracture are leading to early mobilization and rehabilitation by restoring mechanical stability of fracture and inducing neurologic recovery, thereby enabling patients to return to the workplace. However, it is still debatable about the treatment methods. Neurologic injury should be identified by thorough physical examination for motor and sensory nerve system in order to determine the appropriate treatment. The mechanical stability of fracture also should be evaluated by plain radiographs and computed tomography. In some cases, magnetic resonance imaging is required to evaluate soft tissue injury involving neurologic structure or posterior ligament complex. Based on these physical examinations and imaging studies, fracture stability is evaluated and it is determined whether to use the conservative or operative treatment. The development of instruments have led to more interests on the operative treatment which saves mobile segments without fusion and on instrumentation through minimal invasive approach in recent years. It is still controversial for the use of these treatments because there have not been verified evidences yet. However, the morbidity of patients can be decreased and good clinical and radiologic outcomes can be achieved if the recent operative treatments are used carefully considering the fracture pattern and the injury severity.
Early Ambulation ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Physical Examination ; Rehabilitation ; Soft Tissue Injuries ; Spine ; Surgical Procedures, Minimally Invasive

PURPOSE: To assess the value of first-trimester pregnancy-associated plasma protein-A (PAPP-A), nuchal translucency (NT) and second-trimester alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin-A in predicting pregnancy complications other than fetal aneuploidy. MATERIALS AND METHODS: A retrospective study in 3,121 singleton pregnancies with integrated testing was performed at Kangnam CHA hospital between January 2005 and December 2006. Baseline characteristics, pregnancy outcomes, and serum marker levels were obtained by review of the medical records. We analyzed the data to identify associations between the integrated screening markers and adverse pregnancy outcomes. Statistical analyses were performed with the SPSS program. RESULTS: In preterm labor and preeclampsia, high AFP, hCG, and inhibin-A levels and low PAPP-A and NT levels were found to be significantly correlated (P<0.05). Elevated second-trimester inhibin- A levels were associated with preeclampsia (odds ratio 2.843), low birth weight (odds ratio 1.446), and preterm labor (odds ratio 1.287), and while decreased first-trimester PAPP-A levels were associated with preeclampsia (odds ratio 0.51) and preterm labor (odds ratio 0.75). CONCLUSION: First- and second-trimester maternal serum markers screening can be used for predicting high-risk pregnancies.
alpha-Fetoproteins ; Biomarkers ; Chorionic Gonadotropin ; Down Syndrome ; Estriol ; Female ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Mass Screening ; Medical Records ; Nuchal Translucency Measurement ; Obstetric Labor, Premature ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Pregnancy, High-Risk ; Pregnancy-Associated Plasma Protein-A ; Prenatal Diagnosis ; Retrospective Studies

Subclavian steal syndrome caused by an acute thrombus is very rare. We present a case of cerebellar infarction with proximal subclavian artery thrombosis. A 56-year-old woman was admitted for sudden vertigo. One day prior to admission, she received a shoulder massage comprised of chiropractic manipulation. On examination, her left hand was pale and radial pulses were absent. Blood pressure was weak in the left arm. Downbeat nystagmus and a right falling tendency were observed. Brain MRI showed multiple acute infarctions in the left cerebellum. The findings of Doppler ultrasonography in the left vertebral artery were compatible with a partial subclavian artery steal phenomenon. Digital subtraction angiography demonstrated a large thrombus in the left subclavian artery. After heparin infusion, thrombus size markedly decreased. Cerebellar infarction caused by acute subclavian thrombosis following minor trauma is rare, but the thrombus can be successfully resolved with anticoagulation.
Brain Infarction/*diagnosis/etiology/pathology ; Cerebellar Diseases/diagnosis/etiology ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Thrombosis/*complications

This case report describes a patient with semipedunclated granuylar cell tumor(granular cell myoblastoma) of the proximal ascending colon removed by endoscopic polypectomy. A 39-year old femalie was visited to our hospital for intermittent abdominal pain and loose stool. Colonoscopic examination showed a semipedunclated lesion covered with yellowish white smooth mucosa in the proximal ascending colon. The tumor was removed by endoscopic polypectomy. The collected specimen was 0.9x0.8 cm in size. The cut surface of the specimen showed a white round firm tumor covered with mormal epithelium of the colon. Using immunohistochemical study, the tumor cells were to be positively stained by S-100 protein and negatively stained by desmin, which supports the concept of the Schwann cell origin of granular cell tumor. In Korea, 2 cases of granular cell tumor of the colon and rectum, which were treated by surgical removal, have been reported. This case in the first endoscopic polypectomy of granular cell tumor of the colon and retum in Korea. The endoscopic polypectomy is thought to be useful for the therapy of small pedunclated or semipedunclated granular cell tumor, intracolonic type.
Abdominal Pain ; Adult ; Colon ; Colon, Ascending* ; Desmin ; Epithelium ; Granular Cell Tumor* ; Humans ; Korea ; Mucous Membrane ; Rectum ; S100 Proteins