No abstract available.
Diabetic Neuropathies*

Traumatic knee contracture is a common complication after an operative procedure. It occurs mainly due to an intraarticular adhesion and results in a significant knee dysfunction and disability. Patients with a contracture have different ways of recovery, however there is no reliable clinical data regarding a recovery to the full range of motion after knee injury. A proper therapeutic plan is needed to the physiatrists during a rehabilitation of the traumatic knee contracture. The purpose of this study was to obtain a clinical insight into the course of recovery to the normal range of motion after a traumatic knee contracture. One hundred and fourty-seven cases of traumatic knee contracture patients who underwent an operative treatment at the Department of Orthopedic Surgery, St. Mary's Hospital between the years of 1992 to 1996, were reviewed. Knee contractures were most frequent in the second and third decades with a traffic accident being the most common cause. A factor that influenced regaining a normal range of motion was the injury type with an earlier recovery in the order of an injury to the meniscus, cruciate ligament, collateral ligament, a complex injury, and a bone fracture. Persistent contracture groups showed a higher incidence of bone fractures around the knee and open surgeries, while there was no discrepancy in sex, age, and operation time. In conclusion, the results of this study are expected to give some insights to clinicians and to help them in treating patients with the traumatic knee contracture after operation.
Accidents, Traffic ; Collateral Ligaments ; Contracture* ; Fractures, Bone ; Humans ; Incidence ; Knee Injuries ; Knee* ; Ligaments ; Orthopedics ; Range of Motion, Articular ; Reference Values ; Rehabilitation ; Surgical Procedures, Operative

OBJECTIVE: To provide normal reference values of the sonographic diameters and cross sectional area (CSA) of the posterior tibialis tendon (PTT) in Korean adults for early diagnosis and treatment of PTT dysfunction. METHOD: 240 feet from 120 healthy volunteers (63 males; 57 females, mean age: 36.40+/-11.37) were included in this study. Those with a previous history of surgery or trauma to the lower extremities and systemic disease, such as, hypertension, diabetes, or rheumatoid arthritis were excluded. PTT was examined through ultrasonograhy with the patient placed in the prone oblique position, with the knee extended, and ankle dorsiflexed to neutral angle. We evaluated the anterioposterior (AP) and transverse diameter and CSA of the PTT along the line that connected from the posteroinferior angle of the medial malleolus to the heel. RESULTS: The AP diameter of PTT measured by sonography was 3.42+/-0.03 mm and the transverse diameter of the PTT was 9.20+/-0.08 mm. The CSA was 21.46+/-0.26 mm2. Differences in diameters and CSA related to sidedness, sex did not show statistical significance (p>0.05). There was weak linear relationship in AP and transverse diameter and CSA with weight, height, leg and foot length. CONCLUSION: The normal Korean reference values of the PTT diameter and CSA that we obtained from ultrasonography can be used as useful reference data in diagnosing early pathologic conditions of PTT dysfunction.
Adult ; Animals ; Ankle ; Arthritis, Rheumatoid ; Early Diagnosis ; Female ; Foot ; Heel ; Humans ; Hypertension ; Knee ; Leg ; Lower Extremity ; Reference Values ; Tendons

OBJECTIVE: Nowadays half body bathing (H-bath) became popular with increasing interests of health and well-being. H-bath is expected to be beneficial and safe as well as conventional whole body bathing (W-bath). However, there has been no formal report on the safety and effectiveness of H-bath. Therefore, this study tried to evaluate and compare the cardiovascular response during H-bath and W-bath in patients with or without cardiovascular disease. METHOD: 17 subjects with at least one cardiovascular risk factor and 15 subjects without any cardiovascular risk factor took H-bath while 22 healthy control group without any cardiovascular risk factor took W-bath. Changes of skin and oral temperature as well as hemodynamic responses (systolic blood pressure, diastolic blood pressure, heart rate) were measured. RESULTS: Increasing of systolic blood pressure and heart rate in H-bath was statistically lowered compared to W-bath as time goes by in bathing (p<0.05). There were no significant difference in patients with and without cardiovascular disease. CONCLUSION: Heart rate, temperature, systolic blood pressure showed a more gradual increase during H-bath than during W-bath. We propose that H-bath could be a more safe and compliant method of cardiac rehabilitation in patients with cardiovascular disease.
Baths* ; Blood Pressure ; Cardiovascular Diseases ; Heart ; Heart Rate ; Hemodynamics* ; Humans ; Rehabilitation ; Risk Factors* ; Skin

No abstract available.
Anemia, Aplastic* ; Discitis* ; Humans ; Low Back Pain*

Videofluoroscopic swallowing study (VFSS) used for the diagnosis of dysphagia has limitations in objectively assessing the contractility of the pharyngeal muscle or the degree of the upper esophageal sphincter relaxation. With a manometer, however, it is possible to objectively assess the pressure changes in the pharynx caused by pharyngeal muscle contraction during swallowing or upper esophageal sphincter relaxation, hence remedying the limitations of VFSS. The following case report describes a patient diagnosed with lateral medullar infarction presenting a 52-year-old male who had dysphagia. We suggested that the manometer could be used to assess the specific site of dysfunction in patients with dysphagia complementing the limitations of VFSS. We also found that repetitive transcranial magnetic stimulation was effective in treating patients refractory to traditional dysphagia rehabilitation.
Complement System Proteins ; Deglutition ; Deglutition Disorders* ; Diagnosis* ; Esophageal Sphincter, Upper ; Humans ; Infarction ; Male ; Manometry* ; Middle Aged ; Pharyngeal Muscles ; Pharynx ; Rehabilitation ; Relaxation ; Transcranial Magnetic Stimulation*

OBJECTIVE: To evaluate the feasibility of ultrasound guided atlanto-occipital joint injection. METHOD: Six atlanto-occipital joints of three cadavers were examined. Cadavers were placed in prone position with their head slightly rotated towards the contra-lateral side. The atlanto-occipital joint was initially identified with a longitudinal ultrasound scan at the midline between occipital protuberance and mastoid process. Contrast media 0.5cc was injected into the atlanto-occipital joint using an in-plane needle approach under ultrasound guide. The location of the needle tip and spreading pattern of the contrast was confirmed by fluoroscopic evaluation. RESULTS: After ultrasound guided atlanto-occipital joint injection, spreading of the contrast media into the joint was seen in all the injected joints in the anterior-posterior fluoroscopic view. CONCLUSION: The ultrasound guided atlanto-occipital injection is feasible. The ultrasound guided injection by Doppler examination can provide a safer approach to the atlanto-occipital joint.
Atlanto-Occipital Joint ; Cadaver ; Contrast Media ; Head ; Joints ; Mastoid ; Needles ; Prone Position

BACKGROUND: There is no standardized tool and parameter that can accurately assess the sympathetic function before and after performing sympathectomy in patients with primary palmar hyperhidrosis. We examined the effectiveness of the sympathetic skin response (SSR) study for documenting the change of sympathetic denervation before and after performing selective thoracic sympathicotomy. MATERIAL AND METHOD: We prospectively investigated the SSR from 12 healthy subjects who were diagnosed with primary hyperhidrosis. Each SSR was recorded on the right palm or sole with electrical stimuli applied to the skin at the left wrist and foot and vice versa for the controlateral side. This test was performed before, 2 weeks and 1 year after selective thoracic sympathicotomy. The data was corrected for the onset latency and the amplitude of the SSR (n=24). RESULT: The mean age of the 12 patients was 24.6+/-0.4 years (range: 19~36) and the gender ratio was 1:0.7. The mean values of the preoperative, postoperative 2 weeks and postoperative 1 year onset latency and amplitude of the palmar side (n=24) were 1.46+/-0.24 msec and 6,043+/-2,339micronV, 1.63+/-0.42 msec and 823+/-638micronV, and 1.44+/-0.39 msec and 2,412+/-1,546micronV, respectively. The mean values of the plantar side (n=38) were 1.83+/-0.42 msec and 2,816+/-1,694micronV, 2.16+/-0.39 msec and 1,445+/-1,281micronV and 1.95+/-0.25 msec and 1,622+/-865micronV, respectively. Among the documented parameters, only the palmar amplitude (p=0.002) showed statistical significance in recording the change of the sympathetic system within the same individual for the pre and postoperative period. CONCLUSION: The SSR amplitude ratio may be a useful parameter for documenting the efficacy of sympathetic denervation after selective sympathicotomy.
Foot ; Humans ; Hyperhidrosis ; Postoperative Period ; Prospective Studies ; Skin ; Sympathectomy ; Sympathetic Nervous System ; Wrist

OBJECTIVE: To obtain the sensory thresholds of the feet from healthy adult using Semmes-Weinstein monofilaments. METHOD: Twenty male and twenty female volunteers aging from 24 to 38 years old were selected. There were no known medical conditions associated with decreased foot sensation and history of previous injury to the foot. The subjects were blindfolded with the leg resting on a chair as 14 plantar and 5 dorsal locations were tested on each foot. Each site on the foot had the Semmes-Weinstein monofilaments applied to it first, in an order of increasing stiffness, then repeated in decreasing order. A positive threshold response was recorded when the subject could feel the filament and could accurately locate where on the foot the stimulus had been applied. RESULTS: The mean sensitivity for all sites was 3.41+/-0.17. Sensation in the plantar surface of greater toe, 5th toe, arch, and dorsal surface of 1st web space, 3rd toe at the metatarsophalangeal joint level, 5th metatarsal head were the most sensitive. The least sensitive regions were the heel pad, lateral plantar midfoot, and medial and lateral heel. CONCLUSION: Normal data of sensory threshold using Semmes-Weinstein monofilament could be used for the early detection of peripheral neuropathy or loss of protective sensation.
Adult ; Aging ; Female ; Foot* ; Head ; Heel ; Humans* ; Leg ; Male ; Metatarsal Bones ; Metatarsophalangeal Joint ; Peripheral Nervous System Diseases ; Sensation ; Sensory Thresholds* ; Toes ; Volunteers

Isotonic exercise occurs when the tension or torque generated by a muscle is constant throughout the movement. In practice it is very difficult to maintain the tension constant. Evaluation of isotonic exercise should include the works of concentric and eccentric contraction and the changes in tension and torque during joint motion. However, optimal evaluation tools for isotonic exercise has yet to be developed. We authors, used virtual reality motion analysis system(VRMAS) which was codeveloped by us and EMG system(Cardwell Excel). Healthy male adult subjects(n=10) were recruited from hospital personnel. After dominant upper arm and trunk of each subject was fixed with velcro, he was instructed to repeat flexion and extension of his dominant elbow grasping dumbell (9 kg) in hand with maximal velocity as possible as can until the point of exhaustion. We measured the elbow angle, the angular velocity, torque, power, total work and the work of concentric and eccentric contraction during exercise. The results were as follows: there were four distinct elbow flexor muscle contractions during flexion and extension of the elbow with the first and the second contractions during concentric contraction and the third and the fourth contractions during eccentric contraction. Between the peaks of contraction, motion was maintained due to the momentum that was generated. Of the ten subjects, seven had higher concentric work than eccentric work with the eccentric work being higher in the remaining three. But there was no statistic significance between the works of concentric contraction and eccentric contraction(p>0.05). The biggest work was observed in the fourth contraction, while the third contraction showed the least work(p<.05). In conclusion, there were four distinct muscle contractions during elbow isotonic exercise and the works of each muscle contraction were different. This result is contrary to the definition of isotonic exercise. This study also shows that the VRMAS could be a very useful evaluation tool for several types of isotonic exercise.
Adult ; Arm ; Elbow ; Hand ; Hand Strength ; Humans ; Joints ; Male ; Muscle Contraction ; Personnel, Hospital ; Torque