The purpose of this study was to investigate the arthro-sonographic appearance of the chronic anterior talofibular ligament (ATFL) injury. Twenty-nine patient, who were identified to have partial or complete ATFL tears by conventional ultrasonography were included. Intraarticular injection of 5 mL of fluid (2.5 cc lidocaine+2.5 saline) was performed under ultrasound-guidance, which was followed by arthrosonography. Among 23 patients with partial tear which was detected by the conventional ultrasonography, 11 patients were identified to have complete tear by the arthrosonography. Among 6 patients with complete tear was detected by conventional ultrasonography, all of them identified to have complete tear by the arthrosonography. Arthrosonography is helpful in evaluation the configuration of ATFL complete tear and detecting complete tear by making them appear larger and apparent after instillation of fluid.
Humans ; Injections, Intra-Articular ; Ligaments

Bilateral trans-scaphoid perilunate fracture dislocations are uncommon and have been rarely reported in the literature. Furthermore, it is more difficult to manage in the case of Fenton's syndrome (scaphocapitate fracture syndrome, trans-scaphoid trans-capitate fracture dislocation). These injuries occur after a high-energy trauma caused by fall from height or vehicular accidents. These fracture dislocation patterns have very few reported cases in the literature and little information as to the diagnosis, management, and surgical approach for treatment. We present a case of scaphocapitate fracture syndrome on the right hand and trans-scaphoid trans-triquetral perilunate injury on the left hand at the same time.
Diagnosis ; Dislocations* ; Hand

OBJECTIVE: The objectives of this study were to clarify the short-term effects of transforaminal epidural steroid injection (TFESI) for degenerative lumbar scoliosis combined with spinal stenosis (DLSS), and to extrapolate factors relating to the prognosis of treatment. METHOD: Thirty-six patients with lumbar radicular pain from DLSS were enrolled. Subjects were randomly assigned to one of two groups (steroid or lidocaine group). We compared the effect of pain suppression at 2, 4 and 12 weeks after the procedure between the two groups. Radiographic analysis included measurement of the Cobb's angle, the upper endplate obliquities of L3 and L4, and maximal lateral olisthy between two adjacent lumbar vertebrae. Sagittal plane measurement included lumbar lordosis, and thoracolumbar kyphosis. Statistical analysis of both radiographic and clinical parameters along with treatment outcome was performed to determine any significant correlations between the two. RESULTS: There were no significant differences in the demographic data, initial visual analogue scale (VAS) or Oswestry disability index (ODI) between the steroid group (n=17) and the lidocaine group (n=19). Two, 4, and 12 weeks after injection VAS, ODI showed a significantly greater improvement in the steroid group compared to the lidocaine group (p<0.05). The radiographic and clinical parameters were not significantly correlated with treatment outcome. CONCLUSION: Our findings suggest that fluoroscopic transforaminal epidural steroid injections appear to be an effective non-surgical treatment option for patients with degenerative lumbar scoliosis combined with spinal stenosis (DLSS) and radicular pain.
Animals ; Constriction, Pathologic ; Humans ; Kyphosis ; Lidocaine ; Lordosis ; Lumbar Vertebrae ; Prognosis ; Scoliosis ; Spinal Stenosis ; Treatment Outcome

BACKGROUND AND OBJECTIVES: The majority of laryngeal tumors are known to be SCC (squamous cell carcinoma). Non-SCC (non-squamous cell cancers) of the larynx represent a diverse spectrum of diseases with different prognosis and ratio-nales of management from SCC. Therapeutic options to these tumors depend on their histopathological characteristics and clinical behaviors. The purpose of this study was to assess the unique aspects of the non-SCC and to draw diagnosis and provide management options and prognostic variables. MATERIALS AND METHOD: Eleven non-SCC of the larynx from the 212 patients who were diagnosed with larynx cancer during their 3-year visits from 1997 to 2000 were reviewed retrospectively. RESULTS: The incidence of non-SCC was 5.2%. Pathology of non-SCC revealed 3 cases of malignant lymphoma, 2 cases of verrucous cell carcinoma and neuroendocrine carcinoma one case each of basaloid squamous cell carninoma, salivary duct carcinoma, adenocarcinoma, and spindle cell carcinoma. The most common site of origin was supraglottis (6 case, 56.5%), followed by glottis (4 cases, 36.4%) and subglottis (2 cases, 17.2%). Non-Hodgkin's lymphomas and basaloid squamous cell carninoma were treated by chemotherapy. The remaining cases were treated with surgery followed by postoperative radio-therapy or postoperative chemotherapy. The mean follow-up period was 26.8 months (12-43 months). CONCLUSION: Non-SCC accounts for approximately 5.2% of all malignancies of the larynx. Tissue biopsy is the most important diagnostic tool for the non-SCC of the larynx and the tissue sample must be obtained from the deep portion of the submucosal layer. Except for malignant lymphomas, the combined therapy that includes surgery would be the best method of treatment for non-SCC.
Adenocarcinoma ; Biopsy ; Carcinoma, Neuroendocrine ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Glottis ; Humans ; Incidence ; Laryngeal Neoplasms ; Larynx* ; Lymphoma ; Lymphoma, Non-Hodgkin ; Pathology ; Prognosis ; Retrospective Studies ; Salivary Ducts

Sjogren syndrome is a chronic autoimmune disease characterized by lymphocytic infiltration of exocrine glands resulting in dry mouth and eyes. Approximately one-third of patients present with systemic manifestations, but respiratory muscle involvements have been rarely reported. We report a case of acute respiratory failure complicated by primary Sjogren syndrome. Muscle biopsy revealed perivascular lymphocytic infiltrations. Corticosteroid therapy improved respiratory muscle weakness. Sjogren syndrome should be considered as one of the underlying diseases causing acute respiratory failure.
Autoimmune Diseases ; Biopsy ; Exocrine Glands ; Humans ; Mouth ; Muscular Diseases ; Respiratory Insufficiency ; Respiratory Muscles* ; Respiratory Paralysis ; Sjogren's Syndrome*

Surgical revascularization is very effective for the relief of chest pain, improvement of exercise tolerance and ventricular performance in certain ischemic heart diseases. Bypass graft angiography and native coronary angiography after coronary artery bypass graft(CABG) were required for the evaluation of graft patency, progression of the native coronary artery disease and to predict the prognosis of the patients after CABG. The cases included in this study involved 15 patients who underwent selective bypass graft angiography among 102 CABG cases. Thirty eight sites were bypassed by saphenous vein and two sites by internal mammary artery. The results were as follows: 1) The overall patency rate of the saphenous vein bypass graft was 76.3% and the two sites of the internal mammary artery bypass graft were both patent. 2) The patency rate of direct anastomosis was 86.2% and of sequential anastomosis, 44.4%. 3) In eight patients who underwent native coronary angiography, five patients showed progression of grafted coronary artery disease. Among them, two patients had accompanying progression of coronary artery disease in non-grafted vessels. 4) Follow up treadmill test performed in six patients showed improvement of exercise tolerance in all patients. 5) There was some increase in the ejection fraction of the left ventricle after CABG in six patients who received follow up left ventriculography.
Angiography* ; Chest Pain ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Exercise Test ; Exercise Tolerance ; Follow-Up Studies ; Heart Ventricles ; Humans ; Mammary Arteries ; Myocardial Ischemia ; Prognosis ; Saphenous Vein ; Transplants*

BACKGROUND: The repetitive nerve stimulation (RNS) test is a useful tool in the evaluation of neuromuscular transmission disorders. In our laboratory, we frequently use Oh's method, which tests 5 kinds of muscles (flexor carpi ulnaris (FCU), abductor digiti quinti (ADQ), orbicularis oculi, nasalis and trapezius) with 3 kinds of low rate stimulation (LRS) and high rate stimulation (HRS). This method has the advantage of high sensitivity, but is time consuming and painful to patients. So, we tried to reestablish the stage of RNS to overcome this problem and to create a useful test. METHODS: We analyzed RNS data from 369 patients, retrospectively. The number of patients with myasthenia gravis (MG) was 357 and the number with myasthenic syndrome was 12. We compared the sensitivity of individual muscle as well as individual stimulation rate. And we analyzed the results of MG and myasthenic syndrome to verify the usefulness of HRS. RESULTS: The sensitivity of RNS (LRS) was 69.7% in MG (generalized symptom 86.4%, only ocular symptom 40.3%). The sensitivity was higher with 3 pps and 5 pps than with 2 pps, while the exclusion of 2 pps did not affect the sensitivity. We found only 3 cases (1.0%) with post-tetanic exhaustion (PTE) in MG patients with negative results on LRS. The distributions of resting CMAP and post-exercise CMAP were different between MG and myasthenic syndrome. In most cases of myasthenic syndrome, the resting CMAP of ADQ and FCU was below 4.0 mV and post-exercise CMAP of ADQ and FCU was above 50%. CONCLUSIONS: LRS may be done with only 3 and 5 pps, and HRS of the ulnar nerve was helpful only if there was a suspicion of myasthenic syndrome (resting CMAP<4.0 mV or post-exercise CMAP>50%, in ADQ & FCU) or a borderline decremental response in LRS.
Humans ; Muscles ; Myasthenia Gravis* ; Neuromuscular Junction Diseases ; Retrospective Studies ; Ulnar Nerve

BACKGROUND: Hereditary neuropathy with liability to pressure palsies (HNPP) is a peripheral nerve disorder characterized by autosomal dominant inheritance, recurrent pressure palsies, reduced motor and sensory conduction velocities and sausage-like swellings (tomacula) of myelin sheaths in nerve biopsy. A 1.5-Mb deletion in chromosome 17p11.2- p12 is present in the majority but not all cases of HNPP. The aim of the present study was to evaluate the clinical, electrophysiological and morphological aspects of HNPP patients associated with chromosome 17p11.2-p12 deletion. METHODS: To detect the presence of the deletion, the DNA of the patients was analyzed with pVAW409R3 (D17S122). An electrophysiological study was done in all patients. Sural nerve biopsy with teasing was done in three patients. RESULTS: DNA analysis and electrophysiological tests revealed the deletion in 8 families and 16 patients. Nerve conduction studies demonstrated diffuse mild to moderate slowing of nerve conduction velocities especially worse over the common entrapment sites, regardless of clinical manifestations. The long duration of compound muscle and nerve action potentials without conduction blocks or dispersion is characteristic of patients with HNPP. The tomacula of myelin sheaths was found on sural nerve teasing. CONCLUSIONS: We report the clinical, electrophysiological and morphological aspects of the Korean HNPP patients associated with chromosome 17p11.2-p12 deletion. (J Korean Neurol Assoc 19(3):251~259, 2001)
Action Potentials ; Biopsy ; DNA ; Humans ; Myelin Sheath ; Neural Conduction ; Paralysis* ; Peripheral Nerves ; Sural Nerve ; Wills

BACKGROUND: Moisturizers with anti-inflammatory or anti-itch activity should be developed for the safe and effective management of atopic dermatitis (AD). OBJECTIVE: This study evaluated the efficacy of a newly developed moisturizer, CSP0510 lotion (Twolines Inc., Korea), containing citric acid (CA) and trisodium phosphate (TSP) as active ingredients, in mild to moderate AD. METHODS AND RESULTS: CSP0510 lotion applied twice daily for 4 weeks to eczematous lesions improved objective and subjective (itch) symptoms of AD. The physician's global assessment (PGA) score for objective symptoms decreased from 2.5±0.6 before application to 1.3±0.5 after application in the CSP0510-treated group (n=42, p<0.001). Also, the PGA score decreased from 2.3±0.6 to 1.9±0.5 by vehicle-treated (without CA and TSP) control group (p=0.001), but there was no statistical difference between CSP0510-treated and vehicle-treated groups (p=0.089). The visual analogue scale score for itch decreased from 4.8±1.3 to 2.0±0.9 in the CSP0510-treated group (p<0.001), and from 4.6±1.1 to 3.5±0.9 in the control group (p=0.075), showing a statistical significance between two groups (p=0.002). Our results in humans were further supported by in vitro and animal experiments. In HaCaT cells treated with compound 48/80 (7.5 µg/ml), CA:TSP (1:1, vol:vol) synergistically suppressed the compound 48/80-induced upregulation of thymic stromal lymphopoietin, nerve grow factor, and calcitonin gene-related peptide. Application of CSP0510 to the dorsal skin of hairless mice for 3 weeks suppressed the oxazolone-induced allergic skin inflammation. CONCLUSION: In conclusion, CSP0510 lotion has anti-itch and anti-inflammatory activity in the skin, which improves both objective and subjective symptoms of AD.
Animal Experimentation ; Animals ; Anti-Inflammatory Agents ; Calcitonin Gene-Related Peptide ; Citric Acid* ; Dermatitis, Atopic* ; Humans ; In Vitro Techniques ; Inflammation ; Mice ; Mice, Hairless ; Skin ; Up-Regulation

Primary intestinal lymphangiectasia is a congenital lymphatic disorder characterized by dilated intestinal lacteals resulting in lymph leakage into the small bowel lumen and responsible for protein losing enteropathy. As a result, generalized edema, hypoalbuminemia, and lymphocytopenia are clinically manifested. We could not find the reason by several examinations. Therefore, we performed double balloon enteroscopy (DBE), and intestnal lymphangiectasia was diagnosed histologically by a biopsy. DBE is a safe and effective method to diagnose small bowel lymphangiectasia. We report a case of primary intestinal lymphangiectasia, which occurred in a 54-year-old male patient with generalized edema and ascites.
Ascites ; Biopsy ; Double-Balloon Enteroscopy ; Edema ; Humans ; Hypoalbuminemia ; Lymphopenia ; Male ; Protein-Losing Enteropathies