A 57-year-old man presented with weakness in both legs upon awakening after drinking. Magnetic resonance imaging (MRI) of the lumbar spine did not reveal any intraspinal abnormalities but MRI of the pelvis revealed lesions with abnormal intensities with heterogeneous contrast enhancement in both gluteal muscles. Serum creatine phosphokinase was markedly elevated. A diagnosis of lumbosacral plexopathy, complicating rhabdomyolysis was made. With supportive care he recovered well but mild weakness of the right ankle remained at 6 month-follow-up. Pelvic MRI is a helpful diagnostic tool in localizing rhabdomyolysis. Lumbosacral plexopathy should be included in the differential diagnosis of the such cases, presenting with sudden weakness of legs.
Ankle ; Creatine Kinase ; Diagnosis ; Diagnosis, Differential ; Drinking ; Humans ; Leg* ; Magnetic Resonance Imaging ; Middle Aged* ; Muscles ; Pelvis ; Rhabdomyolysis* ; Spine

OBJECTIVE: There is still debate about the diagnostic efficacy of digital infrared thermographic imaging(DITI), nevertheless, it has been used for the diagnosis of carpal tunnel syndrome(CTS). We performed comparative study between patient and control groups to investigate the diagnostic value of DITI in CTS. METHODS: We studied 27 patients with electrodiagnostically-proven CTS and 18 symptom-free volunteers as a control. We measured thermal difference on DITI in the corresponding regions of the hands and forearms. We statistically analyzed the thermal data using a t-test. RESULTS: The average thermal difference in the diagnosed patient group ranged from 0.0303 degrees C to 0.2856 degrees C, while that in control group ranged from 0.0611 degrees C to 0.2878 degrees C. In the CTS patient group, thermal difference between each 2nd finger was higher than that of other regions. However, there was no statistical significance between patient and control groups. CONCLUSION: We found that the diagnostic value of DITI in CTS was not sufficient. There should be a reconsideration of the usefulness of DITI in CTS.
Carpal Tunnel Syndrome* ; Diagnosis* ; Fingers ; Forearm ; Hand ; Humans ; Thermography* ; Volunteers

PURPOSE: This study was to compare short arm double splint allowing forearm rotation with sugar tong splint in terms of loss of reduction and incidence of shoulder stiffness after closed reduction of the distal radius factures. METHODS: From June 2012 to February 2013, we retrospectively reviewed patients with distal radius fractures applied short arm double splint or sugar tong splint after closed reduction. Patients with more than 18 years old, acceptable reduction in X-ray and followed up at least 4 weeks were enrolled. Short arm double splint (SD) group was applied in 47 cases and sugar tong splint (ST) group was 34 cases. Gender, age and fracture types were not significantly different between two groups. The radiographic parameters were measured for palmar tilt, articular step-off, radial length, radial inclination, ulnar variance. The incidence and time of the reduction loss were also evaluated. In functional outcomes, the occurence of ipsilateral shoulder stiffness and the disabilities of the arm, shoulder and hand (DASH) score were evaluated with the medical records or telephone questionnaires at 6 months after initial trauma. RESULTS: Loss of reduction was occured 16 cases in SD group (34%) and 10 cases in ST group (29.4%), which did not differ significantly between the groups (p=0.169). The DASH score and shoulder stiffness were not statistically different between two groups. CONCLUSION: There was no significant difference in loss of reduction after closed reduction of distal radius fractures and functional outcomes in both groups.
Arm* ; Forearm ; Hand ; Humans ; Incidence ; Medical Records ; Radius Fractures* ; Radius* ; Retrospective Studies ; Shoulder ; Splints* ; Telephone

BACKGROUND AND PURPOSE: Cutaneous nerve biopsies based on two-dimensional analysis have been regarded as a creditable assessment tool for diagnosing peripheral neuropathies. However, advancements in methodological imaging are required for the analysis of intact structures of peripheral nerve fibers. A tissue-clearing and labeling technique facilitates three-dimensional imaging of internal structures in unsectioned, whole biological tissues without excessive time or labor costs. We sought to establish whether a tissue-clearing and labeling technique could be used for the diagnostic evaluation of peripheral neuropathies. METHODS: Five healthy individuals and four patients with small-fiber neuropathy (SFN) and postherpetic neuralgia (PHN) were prospectively enrolled. The conventional methods of indirect immunofluorescence (IF) and bright-field immunohistochemistry (IHC) were adopted in addition to the tissue-clearing and labeling method called active clarity technique-pressure related efficient and stable transfer of macromolecules into organs (ACT-PRESTO) to quantify the intraepidermal nerve-fiber density (IENFD). RESULTS: The mean IENFD values obtained by IF, bright-field IHC, and ACT-PRESTO in the healthy control group were 6.54, 6.44, and 90.19 fibers/mm², respectively; the corresponding values in the patients with SFN were 1.99, 2.32, and 48.12 fibers/mm², respectively, and 3.06, 2.87, and 47.21 fibers/mm², respectively, in the patients with PHN. CONCLUSIONS: This study has shown that a tissue-clearing method provided not only rapid and highly reproducible three-dimensional images of cutaneous nerve fibers but also yielded reliable quantitative IENFD data. Quantification of the IENFD using a tissue-clearing and labeling technique is a promising way to improve conventional cutaneous nerve biopsies.
Biopsy ; Fluorescent Antibody Technique, Indirect ; Humans ; Imaging, Three-Dimensional ; Immunohistochemistry ; Methods ; Nerve Fibers ; Neuralgia, Postherpetic ; Peripheral Nerves ; Peripheral Nervous System Diseases ; Prospective Studies

OBJECTIVE: We evaluated the relationship between transcranial Doppler sonography (TCD) and three-dimensional computerized tomography angiography (3D-CTA) under delayed ischemic neurologic deficit (DIND) with angioplasty following vasospasm. MATERIALS & METHODS: Twenty consecutive patients with DIND following vasospasm who received sequential TCD and CTA were analyzed. On TCD, vasospasm was defined as anterior circulation peak mean velocity>120 cm/s, daily increases of 50cm/s, and a Lindegaard ratio (LR)degrees root 3. On 3D-CTA data were subdivided into local and combined types according to the position where vasospasm occurred, and into mild, moderate, and severe by the blood vessel diameter. RESULTS: Among the 20 consecutive patients with DIND, 13 of them received angioplasty. On TCD, the angioplasty group had more frequent vasospasm and tended to have an LR higher than 3. The mean blood flow velocity of MCA in the angioplasty group was 40 cm/sec higher than the group without angioplasty. On CTA, the angioplasty group showed combined, moderate types more frequently. After 3D-CTA evaluation, TCD sensitivity, specificity, positive predictive value and negative predictive value, analyzed with the index of diminished vessel diameter that was more than moderate, were 92.6%, 83.3%, 72.2% and 50.0%, respectively. CONCLUSION: TCD and 3D-CTA could be useful tools for evaluation and management planning of critical patients suspected of having DIND by vasospasm.
Angiography ; Angioplasty ; Blood Flow Velocity ; Blood Vessels ; Glycosaminoglycans ; Humans ; Neurologic Manifestations ; Sensitivity and Specificity ; Subarachnoid Hemorrhage ; Ultrasonography, Doppler, Transcranial

OBJECTIVE: The purpose of this study is to characterize the distribution of posterior inferior cerebellar artery (PICA) aneurysm, the computed tomography (CT) patterns of hemorrhage, and the clinical presentation thereof. METHODS: We reviewed the records 1050 patients with intracranial aneurysms treated at our institution between January 1999 and November 2003. Upon clinical review of radiological data and postoperative reports, we found 20 patients with PICA aneurysms. RESULTS: The incidence of PICA aneurysms was 1.9% of all intracranial aneurysms. The location of PICA aneurysms varied. Of the 20 PICA aneurysm cases, ruptured aneurysms accounted for 18 cases. Review of only these ruptured cases resulted in the following observations : Subarachnoid hemorrhage (SAH) was presented in 94.4% of cases. Isolated infratentorial and supratentorial SAH was present in 7 cases (38.9%) and 2 cases (11.1%), respectively. SAH involving the infratentorial and supratentorial region was present in 8 cases (44.5%). Intraventricular hemorrhage (IVH) with or without associated SAH was seen in 77.8% of cases, whereas isolated IVH was seen in only one case. Perimedullary large hematoma was present in 50% of cases, while the hematoma was consistently thicker on the aneurysm side. Hydrochephalus was present in 16 cases (88.9%). Although patients' postoperative outcomes were excellent or good in 70% of the above cases, initial angiograms failed to reveal ruptured PICA aneurysms in 3 cases. CONCLUSION: PICA aneurysm is rare in most aneurysm cases. However, awareness of a possibility of PICA aneurysm and its features are still nonetheless important. IVH and hydrocephalus are commonly presented with a ruptured PICA aneurysm and complete vertebral angiography is a required to recognize this condition.
Aneurysm* ; Aneurysm, Ruptured ; Angiography ; Arteries* ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Intracranial Aneurysm ; Pica ; Subarachnoid Hemorrhage

OBJECTIVE: To evaluate the radiographic and clinical outcomes of percutaneous vertebroplasty (PVP) in patients with Kümmell's disease. METHODS: A retrospective review was conducted for 19 vertebrae in 18 patients, between January 2012 and June 2016. A visual analogue scale (VAS) score was used to determine each patient's subjective level of pain (0=no pain to 10=severe pain) preoperative, immediately postoperative and at the last follow-up (at least 12 months after PVP). Radiographic parameters such as regional and global kyphotic angle, lumbar lordosis (LL), thoracolumbar junction (TLJ) angle, vertebral height, cement leakage, refracture, and adjacent level fracture were evaluated by the clinician preoperative, immediate postoperative and at the last follow-up. RESULTS: The mean VAS score significantly decreased after PVP and the decrease was maintained through to the final follow-up (p<0.05). However, the regional and global kyphotic angle, LL, and TLJ angle were not improved. Cement leakage was observed in 5 cases (26.3%): however, there were no cases of cement leakage into the spinal canal. No neurological deterioration was observed, even among patients with cement leakage. Adjacent level fractures were detected in 3 cases (15.8%). CONCLUSION: PVP can be considered as an effective treatment option for pain relief and maintenance of sagittal balance in patients with Kümmell's disease.
Animals ; Follow-Up Studies* ; Humans ; Lordosis ; Retrospective Studies ; Spinal Canal ; Spine ; Vertebroplasty*

Occupational exposure to trichloroethylene (TCE) can occasionally induce severe cutaneous disorders, including hypersensitivity syndrome and Stevens-Johnson syndrome. The clinical manifestation of TCE hypersensitivity syndrome is quite similar to that of drug-induced hypersensitivity syndrome and includes skin lesions, hepatitis, fever, and lymphadenopathy. Almost all cases of TCE hypersensitivity syndrome developed within 2–8 weeks after the first exposure to TCE in an occupational setting. This typical course and clinical feature of hypersensitivity syndrome together with occupational history of TCE contact may lead to prompt diagnosis and treatment of this potentially fatal disease. This report describes a 32-year-old man who has been intermittently engaged in cleaning work using TCE for about 3 years, and then developed TCE hypersensitivity syndrome. To the best of our knowledge, this is the first case of TCE hypersensitivity syndrome with a long duration of symptom onset due to intermittent exposure to TCE. Thus, physicians should take thorough occupational history when seeing a patient with hypersensitivity syndrome has neither history of drug intake nor regular exposure to TCE.
Adult ; Diagnosis ; Fever ; Hepatitis ; Humans ; Hypersensitivity* ; Lymphatic Diseases ; Occupational Exposure ; Skin ; Stevens-Johnson Syndrome ; Trichloroethylene*

A 33-year-old man was admitted to our hospital with chest pain and exertional dyspnea. Two-dimensional echocardiography showed prominent trabeculations and deep intertrabecular recesses, findings consistent with noncompaction of the ventricular myocardium. Thoracoabdominal CT and cardiac magnetic resonance imaging (CMR) revealed situs ambiguous with polysplenia and noncompaction of the left ventricular myocardium. CMR also demonstrated delayed enhancement of the trabeculations located at the apical portion of the left ventricle. The coronary angiogram was normal. This is the first case of noncompaction of the ventricular myocardium associated with situs ambiguous with polysplenia.
Abnormalities, Multiple/*pathology ; Adult ; Echocardiography ; Heart Ventricles/abnormalities ; Humans ; Magnetic Resonance Imaging ; Male ; Myocardium/*pathology ; Spleen/*abnormalities ; Syndrome ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: We sought to determine whether an elevated homocysteine (Hcy) level is associated with a worse prognosis in Korean patients with coronary artery disease (CAD). SUBJECTS AND METHODS: A total of 5839 patients (60.4% male, mean age 61.3±11.2 years) with CAD were enrolled from 2000 to 2010 at Gangnam Severance Hospital. CAD was diagnosed by invasive coronary angiography. Laboratory values including Hcy level were obtained on the day of coronary angiography and analyses were performed shortly after sampling. Patients were divided into two groups according to their Hcy levels. Baseline risk factors, coronary angiographic findings, length of follow-up, and composite endpoints including cardiac death (CD) and non-fatal myocardial infarction (NFMI) were recorded. 1:1 propensity score matched analysis was also performed. RESULTS: Over a mean follow-up period of 4.4±2.5 years, there were 132 composite endpoints (75 CD and 57 NFMI) with an event rate of 2.3%. Mean Hcy level was 9.9±4.3 µmol/L (normal Hcy 7.9±1.5 µmol/L and elevated Hcy 13.9±5.1 µmol/L). Kaplan-Meier survival analysis showed an association of elevated Hcy level with worse prognosis (p<0.0001). In addition, a multivariate Cox regression analysis showed an association of elevated Hcy level with worse prognosis for both the entire cohort (hazard ratio [HR] 2.077, 95% confidence interval [CI] 1.467-2.941, p<0.0001) and the propensity score matched cohort (HR 1.982, 95% CI 1.305-3.009, p=0.001). CONCLUSION: Elevated Hcy level is associated with worse outcomes in Korean patients with CAD.
Cohort Studies ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Death ; Follow-Up Studies ; Homocysteine* ; Humans ; Male ; Myocardial Infarction ; Prognosis ; Propensity Score* ; Risk Factors