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

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

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: 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

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*

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

Chest trauma can lead to various cardiac complications ranging from simple arrhythmias to myocardial rupture. An acute myocardial infarction (AMI) is a rare complication that can occur after chest trauma. We report a case of 66-year-old male who suffered a blunt chest trauma from a traffic accident resulting in an AMI. The coronary angiography revealed an eccentric 50% narrowing of the ostium of left anterior descending artery (LAD) by a dissection flap with calcification. Intravascular ultrasonography (IVUS) revealed eccentric calcified plaque (minimal luminal diameter [MLD]=3.5 mm) with a dissection flap. Intervention was not performed considering the MLD and calcified flap, and he has been conservatively managed with aspirin and losartan for 2 years. The follow-up coronary angiography showed an insignificant luminal narrowing of the proximal LAD from the ostium without evidence of a dissection. An early coronary evaluation including an IVUS study should be considered for managing patients who complain of ongoing, deep-seated chest pain with elevated cardiac enzyme levels and an abnormal electrocardiogram (ECG) after a blunt chest trauma. Based on this case, some limited cases of traumatic coronary artery dissections can be healed with conservative management and result in a good prognosis.
Aged ; Aneurysm, Dissecting/diagnosis/*etiology ; Coronary Aneurysm/diagnosis/*etiology ; Coronary Angiography ; Human ; Male ; Myocardial Infarction/diagnosis/*etiology ; Radiography, Thoracic ; Thoracic Injuries/*complications ; Ultrasonography, Interventional ; Wounds, Nonpenetrating/*complications

OBJECTIVE: To investigate a diagnostic value of ultrasonography in carpal tunnel syndrome (CTS) patients and to evaluate a correlation of sonographic measurements with the degree of electrodiagnostic abnormalities and clinical severity. METHODS: Two-hundred-forty-six symptomatic hands in 135 patients and 30 asymptomatic hands in 19 healthy individuals as control group were included. In ultrasonographic study, we measured the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve at the pisiform as well as palmar bowing (PB) of the flexor retinaculum. Sensitivity and specificity of ultrasonographic measurements were evaluated and ultrasonographic data from the symptomatic and control hands were compared to the grade of electrodiagnostic and clinical severity. RESULTS: The mean CSA was 13.7+/-4.2 mm2 in symptomatic hands and 7.9+/-1.3 mm2 in asymptomatic hands. The mean FR was 4.2+/-1.0 in symptomatic hands and 3.4+/-0.4 in asymptomatic hands. The mean PB was 3.5+/-0.5 mm in symptomatic hands and 2.6+/-0.3 mm in asymptomatic hands. Statistical analysis showed differences of the mean CSA, FR and PB between groups were significant. A cut-off value of 10 mm2 for the mean CSA was found to be the upper limit for normal value. Both the mean CSA and PB are correlated with the grade of electrophysiological abnormalities and clinical severity, respectively. CONCLUSION: Ultrasographic measurement of the CSA and PB is helpful to diagnose CTS as a non-invasive and an alternative modality for the evaluation of CTS. In addition, ultrasonography also provides a reliable correlation with the grade of electrodiagnostic abnormalities and clinical severity.
Carpal Tunnel Syndrome* ; Diagnosis* ; Hand ; Humans ; Median Nerve ; Reference Values ; Sensitivity and Specificity ; Ultrasonography*

OBJECTIVE: Neuralgic amyotrophy (NA) is a distinct clinical syndrome that is characterized by the acute onset of shoulder and arm pain, weakness, and sensory loss. The purpose of this study was to assess the clinical characteristics of NA and to determine appropriate diagnostic modalities. METHODS: We reviewed the medical and radiologic records of 10 patients diagnosed with NA retrospectively. Neurophysiologic studies were performed in all patients and magnetic resonance neurography was performed in the last three patients. RESULTS: A total of 10 patients were enrolled in our study. All patients had clinical findings compatible with NA. The most common clinical presentation was severe shoulder pain and weakness in seven patients (70%). Neurophysiologic study results were abnormal in all patients. Brachial plexus magnetic resonance neurography showed that the affected brachial plexus showed a thickened and hyper-intense trunk. All patients were managed conservatively with analgesics and physical therapy. The pain and paralysis of all patients improved clinically within 6 months of the initiation of treatment. CONCLUSION: NA is a rare disease but the symptoms of NA can mimic those of other diseases. Neurophysiologic studies and magnetic resonance neurography are extremely useful tools for the diagnosis of NA.
Analgesics ; Arm ; Brachial Plexus ; Brachial Plexus Neuritis ; Humans ; Hydrazines ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Neurophysiology ; Paralysis ; Rare Diseases ; Retrospective Studies ; Shoulder ; Shoulder Pain