No abstract available.
Evoked Potentials* ; Intercostal Nerves* ; Neural Conduction*

OBJECTIVE: To determine the relationship of the Mini-Mental State Examination (MMSE) scores to the functional improvement of the brain-injured patients with a traumatic brain injury or cerebrovascular accident. METHOD: Thirty patients who were admitted to a rehabilitation hospital for their initial brain injury were retrospectively studied. Subjects were administerd a MMSE as cognitive assessment and a Functional Independence Measure (FIM) and Modified Barthel Index (MBI) as functional assessment upon referral for the rehabilitation and at discharge. RESULTS: MMSE scores, FIM scores and MBI scores at discharge increased significantly compared to the scores at the start of rehabilitation. The changes of MMSE scores significantly correlated with the changes of FIM scores and MBI scores in 30 brain injured patients (p<0.001). Among the subitems of FIM, the social cognition, communication, self care, and sphincter control were strongly correlated with the MMSE scores. CONCLUSION: We conclude that the MMSE can be a relevant predicting factor for the changes of functional status of brain-injured patients from a inpatient stroke rehabilitation and post brain- injury rehabilitation.
Brain Injuries ; Brain* ; Cognition ; Humans ; Inpatients ; Referral and Consultation ; Rehabilitation ; Retrospective Studies ; Self Care ; Stroke

OBJECTIVE: The objective of this study is to determine the effect of unilateral brain lesion on hand strength and dexterity of ipsilateral side in hemiplegic patients and the change of strength and dexterity of ipsilateral hand after rehabilitation according to the side of brain lesion. METHOD: Sixty four hemiplegic patients with unilateral brain lesion underwent hand function tests for the ipsilateral hand to the brain lesion. Grip strength, tip pinch, lateral pinch, and palmar pinch strength were measured, and Purdue pegboard test was performed. Results were compared with a group of forty age-matched healthy volunteers. RESULTS: There was significant decrement of hand strength and dexterity of ipsilateral side except grip strength in patients with unilateral brain lesion in the begining of rehabilitation compared with the controls. Hand strength and dexterity of ipsilateral hand was significantly improved after rehabilitation. There was no significant difference in hand strength and dexterity of ipsilateral side according to the side of hemispheric lesion. CONCLUSION: Ipsilateral upper extremity function in hemiplegic patients may also be affected adversely, and therefore rehabilitation treatment for ipsilateral upper extremity function should be involved.
Brain* ; Hand ; Hand Strength ; Healthy Volunteers ; Hemiplegia* ; Humans ; Pinch Strength ; Rehabilitation ; Upper Extremity*

Total abdominal hystrectomy is the most common surgery of Gynecology. It's complication are taken very important. Although neuropathy, especially femoral nerve injury, is rare, recently we have experienced a case of femoral neuropathy after total abdominal hystrectomy. We present this case with a brief review of literature.
Femoral Nerve* ; Femoral Neuropathy ; Gynecology

BACKGROUND: Epidural narcotics are now widely used for postoperative pain relief, but their side effects are problematic. Thus, this study was undertaken to evaluate the analgesic effects and to minimize the side effects of the combination of epidural morphine and ketamine versus epidural morphine alone in pateints with postoperative pain. METHODS: The value of using a combined infusion of morphine with a variable dose of ketamine for postoperative analgesia following subtotal gastrectomy was assessed in a double-blind randomised study of 30 patients. Three groups of 10 patients received an infusion of morphine at 2 mg/day, either alone, or combined with ketamine at a rate of 0.4 or 0.6 mg/kg/day. RESULTS: Postoperative anlagesia, sedation, and side effects were not statistically significantly different between groups I and II. Postoperative sedation, and side effects were not statistically significantly different between groups I and III. VAS of group III at 1-2 h was lower than in group I. CONCLUSION: The addition of ketamine to a continuous infusion of morphine dose not significantly improve postoperative analgesia. In addition, increasing the dose of ketamine does not significantly improve postoperative analgesia, Nor does it increase sedation, or side effects.
Analgesia ; Gastrectomy* ; Humans ; Ketamine ; Morphine* ; Narcotics ; Pain, Postoperative*

Objective: This study is to measure the high sensitivity C-reactive protein (hs-CRP) value in acute myocardial infarction (AMI) patients who arrive within 6 hours of the symptom manifestation and see how the resulting value affects the short term prognosis in AMI patients. Methods: This study was conducted on 118 patients who had less than 6 hours of onset-to-door time among 149 patients who were diagnosed with myocardial infarction in emergency room and undergo percutaneous coronary intervention (PCI) for 2 years from September 2017. The group including main adverse cardiovascular outcomes were compared in the patients according to the blood test figures (hs-CRP on admission [CRP1], CRP velocity [CRPv], post-PCI hs-CRP [CRP2], and CRP difference values [CRP2-1]). Results: In this study, the average of the hs-CRP values of AMI patients arriving within 6 hours of the symptom manifestation was 2.2±2.3 mg/L. CRP velocity that corrected the CRP value to the elapsed time after the onset of symptoms and N-terminal probrain natriuretic peptide (NT-proBNP) appeared to be significantly correlated with the occurrence of main adverse cardiovascular outcomes (P=0.03). Conclusion The hs-CRP values of AMI patients arrived within 6 hours of the symptom manifestation showed the mean risk group. CRPv and NT-proBNP showed a significant casual relationship with main adverse cardiovascular outcomes.

BACKGROUND: The surgical treatment of pectus carinatum is usually a modified Ravitch operation that consists of complete costal cartilage resection and sternal wedge osteotomy. We tried a simple and easy technique that is resection of only deformed, protruded costal cartilage and pre-sternal compression with using a stainless steel bar and this is done without sternal osteotomy. Therefore, we performed partial cartilage resection and pre-sternal compression with a stainless steel bar and we observed the effects and the efficiency of treatment. MATERIAL AND METHOD: From July, 2006 to June, 2008, 10 patients with pectus carinatum underwent our modified technique of pectus carinatum surgery. The effects of surgery and the complications were reviewed. RESULT: 5 patients with only pectus carinatum underwent our modified technique of pectus carinatum surgery. 5 patients with pectus carinatum and pectus excavatum underwent our modified technique of pectus carinatum surgery and Nuss surgery. The mean patient age was 13.4+3.3 years old. The mean operation time was 137.6+22.9 minutes for the pectus carinatum patients and 234.0+36.5 minutes for the pectus carinatum and pectus excavatum patients. The mean length of hospitalization was 11.8+1.0 days. The Haller pectus index of pectus carinatum was 2.10+/-0.21 preoperatively and this was increased to 2.53+/-0.07 postoperatively. The only complication was simple partial wound disruption in 1 patient. CONCLUSION: We performed partial cartilage resection and pre-sternal compression with a stainless steel bar in 10 patients with pectus carinatum and its effects were good. Our modified technique of pectus carinatum is easy and simple as compared with the Ravitch operation. But removal of the stainless steel bar has not yet been performed for these patients and long-term follow up is needed to accurately evaluate the effects of this surgery in many surgical cases.
Cartilage ; Follow-Up Studies ; Funnel Chest ; Hospitalization ; Humans ; Osteotomy ; Stainless Steel ; Thoracic Wall

BACKGROUND: Gastric cancer remains the main cause of cancer-related death in Korea. Accurate preoperative staging of gastric cancer is essential to predict prognosis and to plan optimal treatment. Although there are many reports dealing with the diagnostic values of conventional methods, controversies are still present especially in the field of preoperative staging. In this study, we evaluated the accuracy of gastroscopy and upper gastrointestinal series(UGI) for diagnosis of gastric cancer, and determined the usefulness of ultrasonography and computed tomography for preoperative staging. METHODS: One hundred twenty-three patients, who underwent operation from Aug. 1991 to Mar. 1995 under the diagnosis of gastric cancer were analyzed. We excluded 15 patients because their postoperative definitive stagings were undetemined. RESULTS: 1) Among 123 patients, the proportion of early gastric cancer was 26.0%(32/123) and that of the advanced gastric cancer was 74.0%(91/123). 2) The sensitivity of endoscopic diagnosis of gastric cancer was 96.7%(119/123), and the accuracy to determine the depth of invasion was 82.9% (102/123). 3) The sensitivity of UGI study for gastric cancer was 89.9%(98/109), and the accuracy to determine the depth of invasion was 61.5%(61/109). 4) The sensitivity of abdominal ultrasonography to detect the tumor was 11.3%(8/71), the accuracy to determine the T stage was 29.2%(28/96), and the sensitivity and specificity to detect lymph node metastasis was 13.6%(8/59), 100%(37/37), respectively. 5) The sensitivity of abdominal CT to detect the tumor was 74.3%(26/35), the accuracy to determine the T stage was 32.5%(13/40), and the sensitivity and specificity to detect lymph node metastasis were 34.5%(9/29), 72.7%(8/11), respectively. 6) The accuracy of preoperative staging was 45.5%(56/123). The 49.6%(62/123) of gastric cancer was downstaged, whereas only 4.1%(5/123) was overstaged. CONCLUSION: Our results show that high accuracy for diagnosis of gastrie cancer with the gastroscopy and UGI. However preoperative staging with ultrasonography and computed tomograpy was often underestimated, which could be concluded that the usefulness of the radiologic methods was limited.
Diagnosis* ; Gastroscopy ; Humans ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Sensitivity and Specificity ; Stomach Neoplasms* ; Tomography, X-Ray Computed ; Ultrasonography

Popliteal artery entrapment syndrome is a rare disorder and lead to claudication and disturbance of blood flow from the results of an abnormal relationship of the popliteal artery to the gastrocnemius muscle, a fibrous band or the popliteus muscle in a young male population. The specific diagnosis is difficult. In most cases, surgical treatment provides a definitive diagnosis of the lesion and is necessary for the patient's recovery. A 34-years-old male was admitted complaining of claudication and pain on left leg. Ankle-brachial index, vascular sonography, CT-angiogram and MRI revealed an occlusion of proximal popliteal artery of left leg. The patient was confirmed as a popliteal artery entrapment syndrome (type IV) that the popliteal artery was entrapped by a fibrous band around the popliteus muscle in the operative field. Completely occluded fibrotic popliteal artery was removed, and interposition with ipsilateral greater saphenous vein graft was done. After surgery, symptoms of the patient have improved.
Ankle Brachial Index ; Arteries ; Diagnosis ; Humans ; Leg ; Magnetic Resonance Imaging ; Male ; Muscle, Skeletal ; Peripheral Vascular Diseases ; Popliteal Artery* ; Saphenous Vein ; Transplants

Background: s/Aims: The enhancing capsule (EC) in hepatocellular carcinoma (HCC) diagnosis has received varying degrees of recognition across major guidelines. This study aimed to assess the diagnostic utility of EC in HCC detection. Methods: We retrospectively analyzed patients who underwent pre-surgical computed tomography (CT) and hepatobiliary agent-enhanced magnetic resonance imaging (HBA-MRI) between January 2016 and December 2019. A single hepatic tumor was confirmed based on the pathology of each patient. Three radiologists independently reviewed the images according to the Liver Imaging Reporting and Data System (LI-RADS) v2018 criteria and reached a consensus. Interobserver agreement for EC before reaching a consensus was quantified using Fleiss κ statistics. The impact of EC on the LI-RADS classification was assessed by comparing the positive predictive values for HCC detection in the presence and absence of EC. Results: In total, 237 patients (median age, 60 years; 184 men) with 237 observations were included. The interobserver agreement for EC detection was notably low for CT (κ=0.169) and HBA-MRI (κ=0.138). The presence of EC did not significantly alter the positive predictive value for HCC detection in LI-RADS category 5 observations on CT (94.1% [80/85] vs. 94.6% [88/93], P=0.886) or HBAMRI (95.7% [88/92] vs. 90.6% [77/85], P=0.178). Conclusions The diagnostic value of EC in HCC diagnosis remains questionable, given its poor interobserver agreement and negligible impact on positive predictive values for HCC detection. This study challenges the emphasis on EC in certain diagnostic guidelines and suggests the need to re-evaluate its role in HCC imaging.