Hirayama disease is a slowly progressing benign motor neuron disease that affects the distal upper limb. A 29-year-old man visited the hospital with a 1-year history of weakened left proximal upper limb. He was diagnosed with Hirayama disease 9 years ago, while there was no further progression of the muscle weakness afterward. Atrophy and weakness was detected in proximal upper limb muscles. Magnetic resonance imaging and somatosensory evoked potentials were normal. Needle electromyography showed abnormal findings in proximal upper limb muscles. Our patient had Hirayama disease involving the proximal portion through secondary progression. Clinical manifestation and accurate electromyography may be useful for diagnosis. Rare cases with progression patterns as described here are helpful and have clinical meaning for clinicians.
Adult ; Atrophy ; Diagnosis ; Electromyography ; Evoked Potentials, Somatosensory ; Humans ; Magnetic Resonance Imaging ; Motor Neuron Disease ; Muscle Weakness ; Muscles ; Needles ; Upper Extremity

OBJECTIVE: To obtain reference values, to suggest optimal recording and stimulation site for radial motor nerve conduction study (RmNCS), and to analyze the correlation among RmNCS parameters, demographics and ultrasonography (US) findings. METHODS: A total of 55 volunteers participated in this study. We hypothesized that ‘lateral edge of spiral groove (A)’ was the optimal stimulation site, and the ‘largest cross-sectional area (CSA) of extensor indicis proprius (EIP) muscle (B)’ was the optimal recording site. The surface distance between ‘A’ and the lateral epicondyle of the humerus divided by upper arm length, was named the spiral groove ratio. The surface distance between ‘B’ and the ulnar styloid process divided by forearm length, was named the EIP ratio. Using US, we identified these sites, and further conducted RmNCS. RESULTS: Data was collected from 100 arms of the 55 volunteers. Mean amplitude and latency were 5.7±1.1 mV and 5.7±0.5 ms, respectively, at the spiral groove, and velocity between elbow and spiral groove was 73.7±7.0 m/s. RmNCS parameters correlated significantly with height, weight, arm length, and CSA of the EIP muscle. Spiral groove ratio and EIP ratio were 0.338±0.03 and 0.201±0.03, respectively; both values were almost the same, regardless of age, sex and handedness. CONCLUSION: We established a reference value and standardized method of RmNCS using US. Optimal RmNCS can be conducted by placing the recording electrode 20% (about one-fifth) of forearm length from the ulnar styloid process, and stimulating at 34% (about one-third) of the humeral length from the lateral epicondyle.
Adult* ; Arm ; Demography ; Elbow ; Electrodes ; Electromyography ; Forearm ; Functional Laterality ; Humans ; Humerus ; Methods ; Neural Conduction* ; Radial Nerve ; Reference Values ; Ultrasonography* ; Volunteers

This study was performed to evaluate the feasibility of ultrasound-guided computed tomography (CT) cholecystography and to establish an optimal protocol. In 8 healthy beagles, CT cholecystography was conducted using four contrast formulas; two dilution ratios (1:1 vs. 1:3) and two total volumes (8 mL vs. 16 mL) of 300 mgI/kg iohexol after ultrasound-guided percutaneous contrast injection into the gallbladder. CT images were obtained at 3, 10, and 30 min after injection and assessed qualitatively and quantitatively. For all contrast formulas, CT cholecystography showed the gallbladder and the intra- and extrahepatic bile ducts. The volume of the gallbladder and size of bile duct were significantly larger when using a volume of 16 mL iohexol than an 8 mL volume regardless of the dilution ratio. The distinction between the common bile duct and duodenum, the filling of the gallbladder, and the patency of bile duct were effectively assessed using a 16 mL volume of contrast agent with either dilution ratio. Beam-hardening artifacts deteriorated CT image quality for visualizing the biliary system when using the dilution ratio of 1:1. Patency of the bile tract could be easily evaluated using a curvilinear planar reconstruction. There was no significant difference in CT scan time among the different conditions. Minor leakage of contrast agent temporarily occurred after contrast injection in 30% of 32 sets of CT cholecystography. Ultrasound-guided percutaneous cholecystography can visualize both gallbladder and biliary tract with minimal artifacts using a contrast agent volume of 16 mL with a 1:3 dilution ratio.
Animals ; Artifacts ; Bile ; Bile Ducts ; Bile Ducts, Extrahepatic ; Biliary Tract ; Cholecystography ; Common Bile Duct ; Contrast Media ; Dogs ; Duodenum ; Gallbladder ; Iohexol ; Tomography, X-Ray Computed

The importance of anaplastic lymphoma kinase (ALK) as an oncogene in non-small cell lung cancer (NSCLC) has emerged as a major concern due to a dramatic clinical effect of targeted therapy. As compared with the research for targeted therapy, the study about clinicopathological characteristics for ALK positive NSCLC hasn't been worked enough. Here, we describe a 35-year-old woman diagnosed with stage IVb NSCLC with ALK rearrangement. During evaluating her disease, a metastatic lesion to uterine cervix was found. Although lung cancer metastasis to female genital tract is rare, we also present case series that show a metastasis to the female genital tract in NSCLC with ALK rearrangement. These case series could suggest that ALK positive NSCLC has distinct metastatic pattern.
Adenocarcinoma* ; Adult ; Carcinoma, Non-Small-Cell Lung ; Cervix Uteri* ; Female ; Glycogen Storage Disease Type VI ; Humans ; Lung Neoplasms ; Lung* ; Lymphoma* ; Neoplasm Metastasis* ; Oncogenes ; Phosphotransferases*

Magnetic Resonance Image (MRI) has been used as a safe, conventional and harmless diagnostic tool. However, thermal injuries have frequently been reported during MRI scanning due to the heat generated by the reaction with the magnetic field. It is recommended that metal-containing monitoring devices such as pulse oximetry and ECG monitoring leads should be removed prior to the start of the MRI scan, but these monitoring devices are inevitably placed in children or patients in the intensive care unit who have low compliance with the scan. Since the interaction between the metal probe or wire loop of pulse oximetry and the magnetic field can result in high thermal conduction, full-thickness burn can occur over the entire body surface during the MRI examination. Several cases of thermal burns from pulse oximetry on the fingers have been reported. However, we present a case of a full-thickness burn arising left earlobe in a 2-month-old child caused by the high conduction heat from pulse oximetry metal probe.

Infections are a major complication in burn patients. In particular, in immunocompromised patients, burn wounds are prone to infections due to destroyed cutaneous barriers and a weakened immune response. It is critical for physicians to monitor infections during burn treatment, since infections can disturb the healing process. It can be challenging to identify the causative microorganism and implement proper treatment for infected burn wounds. Bacterial infections such as impetigo are the most commonly reported, followed by fungal and viral infections. Human herpes virus is one of the most frequent viral infections that complicate burn patients’ recovery. Cases of varicella-zoster virus (HHV-3) infection among pediatric burn patients or reactivation in major burn patients in intensive care units have been reported in the literature. Herein, we present a case where HHV-3 reactivation was promptly detected during the treatment of a facial scald burn.

Purpose: Electric scooters have recently entered into wide use in South Korea because of their eco-friendliness and convenience. Associated accidents resulting in friction burns are also increasing, due to a lack of recognition of the regulations regarding drivable roads and speed limits. We present the clinical characteristics of friction burns induced by electric scooters.M ethods: We retrospectively evaluated the clinical records of 48 patients who visited our institution after accidents involving electric scooters from January 2018 to February 2022. Demographic data, including age, sex, time of the accident, the type and location of the friction burn, and associated injuries, were reviewed. Results: The age of the patients ranged from 15 to 51 years. The most common injuries were superficial partial-thickness dermal burns, while 14 cases involved deep partial-thickness dermal burns. Multifocal injuries were present in a single patient in most cases. The face was the most commonly affected region, followed by the knees. The average treatment period was 13.0 days, but the follow-up period was longer in patients with facial bone fractures or other comorbidities. Conclusion Friction burns from electric scooters are increasing, but their clinical presentation and related statistics have not been reported yet. Since most patients were not injured or had only mild epidermal burns in regions with enough clothing, appropriate safety equipment can prevent burns from electric scooters. However, once accidents occur, patients often present with multiple other injuries in the extremities, so proper injury evaluation and management should be emphasized for shorter hospitalization and optimal outcomes.

BACKGROUND: Recently, an elevated serum homocysteine level has been reported to be associated with increased fracture risk and reduced bone mineral density (BMD). So far, little research has been done to evaluate such association in Korean population. Therefore, we investigated the association between serum homocysteine levels and BMD in Korean adults. METHODS: The subjects consisted of 2,750 adults who visited a health promotion center at a university hospital from January 2005 to March 2006. Self-administered questionnaires provided information about lifestyle and medical history. Fasting plasma samples were collected and BMD of the lumbar spine and femoral neck were obtained by dual energy X-ray absorptiometry. To adjust for menopausal state, the female subjects were divided into three groups according to age (< or =45 yrs, 46~55 yrs, 55 yrs <). Multiple linear regression analysis was used to evaluate the association between serum homocysteine levels and BMD in each gender and age group. RESULTS: The results adjusted for alcohol and smoking history showed significant association between serum homocysteine levels and BMD in women (Lumbar spine: beta=-0.006, P=0.015, Femoral neck: beta=-0.065, P=0.012) but not in men (Lumbar spine: beta=0.001, P=0.240, Femoral neck: beta=0.001, P=0.242). With analyses by three age groups, plasma homocysteine level was associated with both lumbar and femoral BMD in age 46~55 women (Lumbar spine: beta=-0.014, P=0.024, Femoral neck: beta= -0.007, P=0.019). CONCLUSION: Our study suggests that increased serum homocysteine level is an independent risk factor for low BMD among women, especially perimenopausal women. Further studies about the sexual differences and the mechanisms linking serum homocysteine level to BMD are needed.
Absorptiometry, Photon ; Adult ; Bone Density ; Fasting ; Female ; Femur Neck ; Health Promotion ; Homocysteine ; Humans ; Life Style ; Linear Models ; Male ; Osteoporosis ; Plasma ; Risk Factors ; Smoke ; Smoking ; Spine ; Surveys and Questionnaires

BACKGROUND: Smoking is a major risk factor of cardiovascular morbidity and mortality. Arterial stiffness has been identified as an important determinant of cardiovascular risk. Augmentation index is an indicator of arterial stiffness, which can be quantified noninvasively. The goal of this study was to assess the effect of current smoking status on augmentation index (AIx) in Korean male subjects. METHODS: A total of 70 males without clinical cardiovascular diseases were studied in this cross sectional study. AIx was measured in 35 current smokers and 35 nonsmokers by recording pressure waveforms using radial applanation tonometry in a SphygmoCor device. RESULTS: Augmentation index was significantly higher in the current smokers (19.4+/-12.9% vs. 9.7+/-12.8%; P<0.05). A multiple regression model confirmed that smoking status was independently associated with arterial stiffness (beta=0.350, P<0.001). CONCLUSION: Current smoking is associated with increased augmentation index, which is a marker of cardiovascular disease. Further studies are required to investigate clinical applications of arterial stiffness.
Cardiovascular Diseases ; Humans ; Male* ; Manometry ; Mortality ; Risk Factors ; Smoke* ; Smoking* ; Vascular Stiffness

BACKGROUND: Obesity has been proposed as a risk factor for cardiovascular diseases. CRP has been proposed as an independent risk factor for cardiovascular diseases, and has been associated with body weight and body fatness. It has been known that weight reduction reduces CRP. We examined the hypothesis that weight loss can reduce plasma CRP levels in Korean, obese premenopausal women. METHODS: In a sample of 36 Korean obese (BMI 25.00~47.02 kg/m2), premenopausal (22~48 years) women, we measured hsCRP, plasma lipid profiles, blood glucose, body weight, body mass indexes, body fatness and intra abdominal body fat area. A 12-week weight reduction program was conducted in 36 obese women. When the program was finished, fat distribution, hsCRP and lipid profile test was repeated. The effects of weight loss on CRP levels were tested by means of paired t-test and nonparametric Wilcoxon signed rank test. RESULTS: We found that plasma CRP level was positively associated with body weight, body mass index, body fatness, CT-measured abdominal visceral and subcutaneous fat area. After a 12-week weight loss protocol, the average weight loss was 7.97+/-3.46 kg (P<0.0001) with loss of fat mass 5.29+/-0.59 kg, and 1.98+/-1.20 kg lean body mass. Plasma CRP levels were both positively associated with plasma CRP level reductions (P=0.0437). CONCLUSION: Obesity and adiposity influenced significantly on plasma CRP in Korean premenopausal women on cross sectional basis. Moreover, 12-week caloric restriction induced weight loss decreased plasma CRP levels. Weight loss represents an intervention to reduce plasma CRP and can mediate to reduce cardiovascular disease risk in Korean obese premenopausal women.
Adipose Tissue ; Adiposity ; Blood Glucose ; Body Mass Index ; Body Weight ; Caloric Restriction ; Cardiovascular Diseases ; Female ; Humans ; Obesity ; Plasma ; Prospective Studies ; Risk Factors ; Subcutaneous Fat ; Weight Loss* ; Weight Reduction Programs