Klippel-Trenaunnay syndrome is characterized by three typical clinical manifestations; 1) Capillary malformations (port-wine stains), 2) bony and soft tissue hypertrophy, 3) varicosities or venous malforamation, but many other clinical manifestations can be presented. Although many associated clinical manifestations were reported in Klippel-Trenaunay syndrome, peripheral polyneuropathy or any other results of electrodiagonostic study were not reported previously. We experienced a 22 year old male who was transfered in rehabiliation program after surgical management of intra cerebral hemorrhage. During rehabilitation program we diagnosed him as Klippel-Trenaunay syndrome by three typical clinical manifestations associated with dilated cardiomyopathy. He also presented sensory impairment in distal part of all extremites. Electrodiagonostic study revealed peripheral polyneuropathy. We concluded that the possibility of peripheral polyneuropathy should be considered in Klippel-Trenaunnay syndrome.
Capillaries ; Cardiomyopathy, Dilated ; Cerebral Hemorrhage ; Humans ; Hypertrophy ; Klippel-Trenaunay-Weber Syndrome* ; Male ; Polyneuropathies* ; Rehabilitation ; Young Adult

This article provides an update on tinnitus for audiologists and other clinicians who provide tinnitus-specific services. Tinnitus can be attributable to hearing loss, somatosensory system dysfunction, or auditory cortex dysfunction, with hearing loss being the most common cause and serious underlying pathologies being rare. Hearing loss does not always lead to tinnitus, and patients with tinnitus do not always suffer from hearing loss. The first scenario is explained by a so-called inhibitory gating mechanism, whereas the second assumes that all tinnitus sufferers have some degree of hearing impairment, which might not be detected in standard audiological examinations. The treatments should aim at symptomatic relief and management of associated distress. Current treatment options include pharmacotherapy, education, counseling, cognitive behavioral therapy, and sound therapy.

OBJECTIVE: To help adjusting the proper timing of replacement of the percutaneous endoscopic gastrostomy (PEG) Foley catheter in brain injured patients. METHOD: Twenty one brain injured patients with PEG Foley catheter were studied and divided into three groups by indwelling duration. The balloon of Foley catheter was inflated with 5 ml of normal saline. We calculated the deflating velocity of the balloon by estimating remained amount of normal saline and indwelling duration at the time of replacement. RESULTS: In 6 patients, the PEG Foley catheter was pulled out easily before aspiration of remained normal saline. In all of these cases, remained amount of normal saline was less than 2 ml. The deflating velocities of the balloons were 0.057 +/- 0.024 ml/day in cases with 3 to 4weeks of indwelling duration, 0.066 +/- 0.005 ml/day with 4 to 5 weeks, 0.067 +/- 0.012 ml/day with above 5weeks. The mean deflating velocity was 0.063 +/- 0.016 ml/day in human. The deflating velocity was slower than that of the previous study in vitro. CONCLUSION: The mean days of deflation of the balloon of total PEG Foley catheter down to 2.5 ml were 42.1 days. We suggest that the PEG Foley catheter would be replaced within 42 days after exchange.
Brain* ; Catheters* ; Gastrostomy* ; Humans

Most of axillary nerve injury develops after dislocation of glenohumeral joint, proximal humeral fracture and direct blow to the deltoid muscle. Some cases in volleyball players and athletes playing contact sports like hockey, football have been reported. But axillary nerve injury after swimming with butterfly stroke has not been reported previously. We experienced a 34 year old female who had weakness in abduction and sensory impairment in lateral aspect of right arm after butterfly stroke. She was transferred from local clinic to our Rehabilitation Department because symptoms were not improved despite conservative treatment. We diagnosed her as axillary nerve injury by typical clinical manifestations and electrodiagnostic study. Additionally, we detected type II superior laburum anterior posterior lesion combined with axillary nerve injury in shoulder magnetic resonance image. We should consider possibility of axillary nerve injury in a patient with shoulder pain and weakness after swimming like butterfly stroke.
Adult ; Arm ; Athletes ; Butterflies* ; Deltoid Muscle ; Dislocations ; Female ; Football ; Hockey ; Humans ; Rehabilitation ; Shoulder ; Shoulder Fractures ; Shoulder Joint ; Shoulder Pain ; Sports ; Stroke* ; Swimming* ; Volleyball

OBJECTIVE: The aim of this study is to evaluate the change of esophageal acidity when feeding via nasogastric tube is replaced by via percutaneous endoscopic gastrostomy (PEG) tube. METHOD: Fourteen patients with brain injury participated in the study. 24-hour pH monitoring was performed during nasogastric tubal feeding. After PEG tube insertion, 24-hour pH monitoring was followed up. There was no difference in medication affecting to esophageal acidity in same patient at both pH monitorings. The results of pH monitorings analyzed with Wilcoxon signed rank test. RESULTS: The total time below pH 4.00 was 135.43+/-190.69 minutes for the patients with nasogastric tube and 25+/-42.74 minutes for PEG tube (p=0.013). The numbers of acid reflux was 42.07+/-47.03 and 21.93+/-22.77 respectively (p=0.074). Of the 14 patients, 9 had acid reflux in nasogastric tubal feeding, which was improved in all 9 patients after PEG. Of the 14 patients, 5 had no acid reflux in nasogastric tubal feeding but 3 of the 5 developed new acid reflux in PEG tubal feeding. CONCLUSION: Percutaneous endoscopic gastrostmy tube feeding was better for acid reflex control. But careful observation is needed after PEG because PEG can develop new acid reflux.
Brain Injuries ; Brain* ; Enteral Nutrition* ; Gastrostomy* ; Humans ; Hydrogen-Ion Concentration ; Reflex

Background: This study aimed to analyze the life expectancy and cause of death in osteoarthritis (OA) patients who underwent total knee arthroplasty (TKA) and to identify risk factors that affect long-term mortality rate after TKA. Methods: Among 601 patients, who underwent primary TKA due to OA by a single surgeon from July 2005 to December 2011, we identified patients who died after the operation using data obtained from the National Statistical Office of Korea. We calculated 5-, 10-, and 15-year survival rates of the patients and age-specific standardized mortality ratios (SMRs) compared to general population of South Korea according to the causes of death. We also identified risk factors for death. Results: The 5-year, 10-year, and 15-year survival rates were 94%, 84%, and 75%, respectively.The overall age-specific SMR of the TKA cohort was lower than that of the general population (0.69; P < 0.001). Cause-specific SMRs for circulatory diseases, neoplasms, and digestive diseases after TKA were significantly lower than those of the general population (0.65, 0.58, and 0.16, respectively; all P < 0.05). Male gender, older age, lower body mass index (BMI), anemia, and higher Charlson comorbidity index (CCI) were significant factors associated with higher mortality after TKA. Conclusion TKA is a worthwhile surgery that can improve life expectancy, especially from diseases of the circulatory system, neoplasms, and digestive system, in patients with OA compared to the general population. However, careful follow-up is needed for patients with male gender, older age, lower BMI, anemia, and higher CCI, as these factors may increase long-term mortality risk after TKA.

Objectives: The purpose was to identify the ingredients that are usually surveyed for assessing real prices and to present the demand for such surveys by nutrition teachers and dietitians for ingredients used by school foodservice. Methods: A survey was conducted online from December 2019 to January 2020. The survey questionnaire was distributed to 1,158 nutrition teachers and dietitians from elementary, middle, and high schools nationwide, and 439 (37.9% return rate) of the 1,158 were collected and used for data analysis. Results: The ingredients which were investigated for price realities directly by schools were industrial products in 228 schools (51.8%), fruits in 169 schools (38.4%), and specialty crops in 166 schools (37.7%). Moreover, nutrition teachers and dietitians in elementary, middle, and high schools searched in different ways for the real prices of ingredients. In elementary schools, there was a high demand for price information about grains, vegetables or root and tuber crops, special crops, fruits, eggs, fishes, and organic and locally grown ingredients by the School Foodservice Support Centers. Real price information about meats, industrial products, and pickled processed products were sought from the external specialized institutions. In addition, nutrition teachers and dietitians in middle and high schools wanted to obtain prices of all of the ingredients from the Offices of Education or the District Office of Education. Conclusions Schools want to efficiently use the time or money spent on research for the real prices of ingredients through reputable organizations or to co-work with other nutrition teachers and dietitians. The results of this study will be useful in understanding the current status of the surveys carried out to determine the real price information for ingredients used by the school foodservice.

Objectives: The purpose was to identify the ingredients that are usually surveyed for assessing real prices and to present the demand for such surveys by nutrition teachers and dietitians for ingredients used by school foodservice. Methods: A survey was conducted online from December 2019 to January 2020. The survey questionnaire was distributed to 1,158 nutrition teachers and dietitians from elementary, middle, and high schools nationwide, and 439 (37.9% return rate) of the 1,158 were collected and used for data analysis. Results: The ingredients which were investigated for price realities directly by schools were industrial products in 228 schools (51.8%), fruits in 169 schools (38.4%), and specialty crops in 166 schools (37.7%). Moreover, nutrition teachers and dietitians in elementary, middle, and high schools searched in different ways for the real prices of ingredients. In elementary schools, there was a high demand for price information about grains, vegetables or root and tuber crops, special crops, fruits, eggs, fishes, and organic and locally grown ingredients by the School Foodservice Support Centers. Real price information about meats, industrial products, and pickled processed products were sought from the external specialized institutions. In addition, nutrition teachers and dietitians in middle and high schools wanted to obtain prices of all of the ingredients from the Offices of Education or the District Office of Education. Conclusions Schools want to efficiently use the time or money spent on research for the real prices of ingredients through reputable organizations or to co-work with other nutrition teachers and dietitians. The results of this study will be useful in understanding the current status of the surveys carried out to determine the real price information for ingredients used by the school foodservice.

OBJECTIVES: This study was conducted to investigate the job stress factors, psychosocial stress and their associations in workers engaged in the research and development of vehicles, and according to job role. METHODS: We recruited 4,066 subjects from workers at a research and development center of an automobile company. A total of 2,764 workers answered the questionnaire about socio-demographic factors, health behaviors, work-related factors, subjective labor intensity, KOSS, and SF-PWI. The final analysis included 2,282 male manufacturing and research workers. Univariate analyses and multiple logistic analyses were conducted on the complete questionnaire data to compare the job stress factors, psychosocial stress and their associations between research and manufacturing workers. RESULTS: The adjusted Odds ratios comparing the high risk group to the low risk group regarding PWI group were 2.23(95%CI=1.63-3.04) in "Lack of rewards", 1.64(95%CI=1.20-2.24) in "Interpersonal conflict", 1.59(95%CI=1.15- 2.20) in "Organizational injustice", 1.58(95%CI=1.17-2.14) in "Occupational climate" and 1.43(95%CI=1.05-1.94) in "Job insecurity" among research workers, and 2.46(95%CI=1.59 -3.80) in "Lack of rewards" and 1.94(95%CI=1.17-3.22) in "Organizational injustice" among manufacturing workers. CONCLUSIONS: There are differences in job stress factors between research and manufacturing workers. Further studies and discussions based on quantitative methodology for seeking more fundamental causes of these differences are required to establish job stress intervention plans and policies.
Automobiles ; Health Behavior ; Humans ; Male ; Odds Ratio ; Questionnaires

OBJECTIVES: The effect of chronic exposure to low levels of n-hexane on peripheral nervous system and the relationship between duration of employment and impairment of peripheral nervous system was studied. METHODS: In 21 workers at two shoe - maker factories and 21 unexposed controls, measurement of exposure of solvents, symptom Questionnaire, physical examination and electrophysiological study were conducted. RESULTS: Mean ages of study subjects in the exposed and the unexposed were 39.9 and 40.1 years old. Mean durations of employment were 15.1 and 10.0 years, respectively. Mean concentraions of urinary 2,5-HD were 2.23 mg/kg creatinine, 0.23 mg/kg creatinine, respectively. Mean concentration of solvents in air were 21.1 ppm of n-hexane, 72.2 rpm of toluene and 0.5 ppm of MEK. There were no differences in the prevalence of subjective symptoms and abnormal neurological signs between the exposed and the unexposed. But vibration extinction time(VAT) of the exposed(8.8 second) was shorter than that of the unexposed(11.9 second)(p < 0.05). Mean values of electrophysiological studies(EPS) of the two groups were within normal limit. However, mean conduction velocity of median motor nerve and median F wave(MMNCV and MFCV), mean amplitude of median sensory action potential(MSAP) were decreased in the exposed(p < 0.05). Moreover, the rate of abnormal finding more than one in sensory nerves wart increased in the exposed than those in the unexposed(p,0.05). Correlation coefficients between duration of employment and mean conduction velocity of median sensory nerve (MSNCV) and between duration of employment and MFCV were -0.57 -0.43, respectively(p < 0.05). CONCLUSIONS: These results showed that chronic (mean 15 years) low level(mean 23 ppm) exposure to n-hexane cause subclinical impairment of peripheral nervous system. These results also suggest that the longer duration of employment, the shorter values of EPB and VAT.
Creatinine ; Employment ; Peripheral Nervous System* ; Physical Examination ; Prevalence ; Questionnaires ; Shoes ; Solvents ; Toluene ; Vibration ; Warts