A 43 years old woman had suffered from a lower back pain for 2 months. She experienced pain aggravation after spinal manipulative therapy that was practiced by non-licentiate. Physical examination showed tenderness on L1 and L2 spinous processes. Radionuclide bone scan with 99mTc-MDP showed increased radioactivity of L1, L2 vertebral bodies. The MRI finding showed low signal intensity of L1 and L2 vertebral bodies in T1-weighted image and high signal intensity in T2-weighted image. Needle biopsy finding showed fibrosis and inflammatory cell invasion of bone marrow. We concluded that she had tuberculous spondylitis and non-detection or negligent treatment of a preexisting disease contributed to aggravation of her symptoms. We report one case of tuberculous spondylitis aggravated by spinal manipulative therapy with review of literatures.
Adult ; Biopsy, Needle ; Bone Marrow ; Female ; Fibrosis ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Musculoskeletal Manipulations* ; Physical Examination ; Preexisting Condition Coverage ; Radioactivity ; Spondylitis* ; Technetium Tc 99m Medronate

PURPOSE: We evaluated brain perfusion SPECT findings of MELAS syndrome and mitochondrial myopathy in correlation with MR imaging in search of specific imaging features. MATERIALS AND METHODS: Subjects were five patients (four females and one male; age range, 1 to 25 year) who presented with repeated stroke-like episodes, seizures or developmental delay or asymptomatic but had elevated lactic acid in CSF and serum. Conventional non-contrast MR imaging and Tc-99m-ethyl cysteinate dimer (ECD) brain perfusion SPECT were performed and imaging features were analyzed. RESULTS: MRI demonstrated increased T2 signal intensities in the affected areas of gray and white matters mainly in the parietal (4/5) and occipital lobes (4/5) and in the basal ganglia (1/5), which were not restricted to a specific vascular territory. SPECT demonstrated decreased perfusion in the corresponding regions of MRI lesions. In addition, there were perfusion defects in parietal (1 patient), temporal (2), and frontal (1) lobes and basal ganglia (1) and thalami (2). In a patient with mitochondrial myopathy who had normal MRI, decreased perfusion was noted in left parietal area and bilateral thalami. CONCLUSION: Tc-99m ECD SPECT imaging in patients with MELAS syndrome and mitochondrial myopathy showed hypoperfusion of parieto-occipital cortex, basal ganglia, thalamus and temporal cortex, which were not restricted to a specific vascular territory. There were no specific imaging features on SPECT. The significance of abnormal perfusion on SPECT without corresponding MR abnormalities needs to be evaluated further in larger number of patients.
Basal Ganglia ; Brain* ; Female ; Humans ; Lactic Acid ; Magnetic Resonance Imaging ; Male ; MELAS Syndrome* ; Mitochondrial Encephalomyopathies ; Mitochondrial Myopathies* ; Occipital Lobe ; Perfusion ; Rabeprazole ; Seizures ; Thalamus ; Tomography, Emission-Computed, Single-Photon*

The lips are essential in maintaining oral competence and assist in mastication, deglutition, and articulation. The lips are also important aesthetically, contributing to appearance and facial expression. Defects of up to one third of the lower lip can be closed primarily, but larger defects require more complex techniques. Successful lip reconstruction require careful meticulous planning to achieve the optimum functional and cosmetic result. When planning a reconstruction of a large defect of the lower lip, the following points should be taken into consideration: 1) maintain the sphincter function, 2) retain the sensation, 3) acquire a large enough opening for the mouth, 4) strive for an acceptable cosmetic appearance. It is not possible to satisfy all these criteria in every instance, and careful preoperative evaluation is essential. We describe here a successful technique to reconstruct a large lower lip defect using a depressor anguli oris musculocutaneous flap and a mucosal flap for elderly patients.

Hirayama disease is characterized by focal amyotrophy of the upper limb associated with unilateral or asymmetric bilateral muscle weakness. It occurs in young men in their late teens or early twenties. Repeated or sustained neck flexion is thought to be a cause of the disease. It is important to prevent the progression of the disease through early recognition and management. We reported a patient with Hirayama disease in order to review the typical clinical, electrodiagnostic and radiological findings of Hirayama disease.
Adolescent ; Humans ; Male ; Muscle Weakness ; Neck ; Spinal Muscular Atrophies of Childhood* ; Upper Extremity*

OBJECTIVE: The purpose of this study was to evaluate therapeutic effect of local steroid injection in carpal tunnel syndrome, and to make a comparison between therapeutic effect in patients with and without diabetic neuropathy. METHOD: 30 patients (40 hands) with carpal tunnel syndrome diagnosed clinically and electrophysiologically were injected with 40mg of methylprednisone. Patients were evaluated with the visual analogue scale after 4 weeks and 8 weeks. According to the therapeutic responses, the patients were grouped into: excellent; good; poor; failed; recurrent. RESULTS: After 4 weeks, symptom relief was noted in the 95% of all cases: 100% of the patients without diabetic neuropathy; 82% of the patients with diabetic neuropathy. After 8 weeks, symptom relief was noted in the 82.5% of all cases: 86% of the patients without diabetic neuropathy; 73% of the patients with diabetic neuropathy. There was no statistically significant difference between the patients with and without diabetic neuropathy (p>0.05). CONCLUSION: We concluded that local steroid injection in carpal tunnel syndrome was an effective therapeutic modality for a short term and local steroid injection in the carpal tunnel syndrome with diabetic neuropathy diagnosed by palmar test also had a good effect.
Carpal Tunnel Syndrome* ; Diabetic Neuropathies ; Humans

The urinary tract infection(UTI) is a very common complication of rehabilitation patients with neurogenic bladder. Proper diagnosis and early treatment are very important for the long term rehabilitation outcomes. Many reports are available in the literature on the characteristics of UTI in spinal cord injury(SCI) patients, however only few reports appear on non-SCI patients. We have done comprehensive chart reviews of 1,251 patients with neurogenic bladder who were admitted to the rehabilitation medicine department, PMC from January 1982 to August 1996. Patients were divided into 4 groups: patients with stroke, spinal cord injury, traumatic brain injury and other neurologic diseases, and we have studied: incidence of UTI, commonly cultured organisms, antibiotic sensitivities, urinary pH, voiding methods, and residual urine volumes. The incidences of UTI are 50.9% for all patients, 48.1% in Stroke, 72.3% in Spinal cord injury, 38.9% in Traumatic brain injury, and 34.1% in other neurologic diseases. There has been increase of Gram(+) cocci and decrease of Gram(-) rod during study period. Commonly cultured organisms are Escherichia coli(E. coli), Pseudomonas, Klebsiella. The decreased antibiotic sensitivities are noted in almost all organisms. Positive correlations are found between the incidence of UTI, high urine pH, high residual urine volumes, and use of catheters. In conclusion, despite of many variable factors, the trends of UTI in each groups show no significant difference.
Brain Injuries ; Catheters ; Diagnosis ; Escherichia ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Klebsiella ; Pseudomonas ; Rehabilitation ; Spinal Cord ; Spinal Cord Injuries ; Stroke ; Urinary Bladder, Neurogenic* ; Urinary Tract Infections* ; Urinary Tract*

OBJECTIVE: To investigate the treatment effect of Ulmus, which has been traditionally used for the treatment of the pressure ulcers in Korea. METHOD: Thirteen cases with stage IV pressure ulcers (according to the National Pressure Ulcer Advisory Panel, 1989) were enrolled for the study. Seven cases were treated with Ulmus and 6 cases were treated with wet gauze as a control group. The sizes and stages of pressure ulcers were evaluated every 2 week for 12 weeks. RESULTS: After 12 weeks, the size of pressure ulcers decreased from 78.17+/-47.77 cm3 to 8.14+/-13.17 cm3 (mean S.D., n=7) in Ulmus treated group, whereas from 62.10+/-40.89 cm3 to 36.69+/-36.23 cm3 (mean+/-S.D., n=6)in wet gauze treated group. The size of pressure ulcers decreased more significantly (p<0.05) in Ulmus treated group than wet gauze dressed group. Among seven cases treated by Ulmus, 2 cases completely healed, 3 cases improved to stage II, and 2 cases remained to stage IV, whereas among 6 cases treated by wet gauze, 1 cases improved to stage II, 1 case to stage III, and 4 cases remained to stage IV. CONCLUSION: Ulmus was more effective in management of pressure ulcers than wet gauze. We suggest that Ulmus can be used as a useful method of conservative treatment for the stage IV pressure ulcers.
Korea ; Pressure Ulcer* ; Ulmus*

BACKGROUND AND OBJECTIVES: An experimental model of bacterial rhinosinusitis is essential to study the pathogenesis of rhinosinusitis. To our knowledge, there hasn't been an experimental model using rats for bacterial rhinosinusitis, where Staphylococcus aureus is directly inoculated to the rat nose. Staphylococcus aureus is also a predominantly isolated bacterial pathogen in the episode of acute rhinosinusitis. The aim of this study was to develop a rat model of rhinosinusitis induced by Staphylococcus aureus, ATCC 25923. SUBJECTS AND METHOD: The infected Sprague-Dawley rats (4-6 week-old male) were applied intranasally with 40 microliter of Staphylococcus aureus, ATCC 25923, which corresponds to 108 colony-forming units per milliliter, which in turn corresponds to a No. 1 McFarland turbidity by spectrophotometer (VITEK, USA). After the 2nd, 5th, and 14th day, the rats were killed respectively. RESULTS: Nasal sinuses were then observed at low power field (x40) for changes in the amount of inflammatory cell clusters in the sinus cavity. There were significant differences in the number of inflammatory cell clusters between the infected and control rats (p<0.05). The infected rats killed at the 5th day had significantly more inflammatory cell clusters within the sinus cavities (p<0.05). CONCLUSION: Staphylococcus aureus induces acute bacterial rhinosinusitis in rats as measured by increased inflammatory cell clusters. This study demonstrates the efficacy of a rat model of acute bacterial rhinosinusitis.
Animals ; Models, Animal* ; Models, Theoretical ; Nose ; Paranasal Sinuses ; Rats* ; Rats, Sprague-Dawley ; Staphylococcus aureus* ; Staphylococcus* ; Stem Cells