OBJECTIVE: To investigate the effect of mirror therapy on recovery of upper limb function and strength in subacute hemiplegia after stroke. METHOD: Fourty subacute hemiplegic stroke patients (onset <6 months) were enrolled and randomly assigned to either the mirror therapy (MT, n=19), or control group (n=21). MT group received mirror therapy for 30 minutes after each treatment, additionally with the traditional rehabilitation programs, 5 days per week for 4 weeks; 2 hours or more per day, 3 days or more per week. To measure the outcome, we performed the manual muscle test (MMT), manual function test (MFT) and Jarmar grip strength test. RESULTS: MT group showed significant improvements in MMT, grasp and lateral pinch force of grip strength test (p<0.05), compared to control group. Improvement in MFT was more evident in MT group (p<0.05). CONCLUSION: Mirror therapy can be used as an adjuvant therapeutic technique for improving upper limb function and strength for subacute hemiplegia.
Hand Strength ; Hemiplegia ; Humans ; Muscle Strength ; Muscles ; Organometallic Compounds ; Stroke ; Upper Extremity

BACKGROUND AND OBJECTIVES: The repolarization abnormalities, after radiofrequency catheter ablation (RFCA) of accessory pathway (AP) in patients with Wolff-Parkinson-White (WPW) syndrome, is commonly appeared in standard 12 lead electrocardiogram (ECG) as inverted T waves. We analyzed the serial ECGs after RFCA of AP in patients with WPW syndrome, in order to understand the repolarization abnormalities after RFCA. MATERIALS AND METHOD: The study patients were consisted of ninety two patients (mean age: 35 years old, male: 56 patients) out of 157 patients whose ECGs were taken at before, immediately after, one day, one, four, eight, twelve week (s) after RFCA from December 1992 to July 1997. RESULTS: The seventy three patients (79%) out of ninety two patients showed the repolarization abnormalities and the thirteen patients (14%) showed normalization of secondary T wave changes immediately after RFCA. In contrast, six patients (7%) did not show any T wave changes after RFCA and they had left lateral AP. The lead that most frequently showed inverted T wave changes after RFCA was lateral lead (lead I, aVL) in case of left lateral AP and inferior lead (II, III, aVF) in case of other APs. The incidence of repolarization abnormalities after RFCA was significantly higher in patients whose preRFCA QRS duration is longer (> or =0.12 sec). The concordance rate of repolarization abnormalities after RFCA was 86% (63 patients of 73 patients showing repolarization abnormalities after RFCA). The normalization of repolarization abnormalities after RFCA was acquired in sixty four patients (94%) out of sixty eight patients who showed repolarization abnormalities and followed up to twelve weeks after RFCA. The mean time interval to the normalization of repolarization abnormalities after RFCA was 4.3+/-3.2 weeks. The time interval to the normalization of repolarization abnormality after RFCA was not related with age, AP or preRFCA QRS duration. CONCLUSION: The ECG lead, in which the repolarization abnormalities occurs after RFCA , is related with the location of the AP. The repolarization abnormalities after RFCA were more common in patients with longer preRFCA QRS duration. The repolarization abnormalities after RFCA could not be understood only by cardiac memory.
Adult ; Catheter Ablation* ; Electrocardiography ; Humans ; Incidence ; Male ; Memory ; Wolff-Parkinson-White Syndrome

OBJECTIVES: The purpose of this study is to evaluate the incidence of secondary T wave changes in WPW syndrome and the relation between the incidence of the secondary T wave changes and sex, age (duration of preexcitation), mean and maximal QRS duration (from the onset of delta wave to the end of S wave) of standard 12 lead electrocardiogram (ECG) and the site of accessory pathway (AP). The secondary purpose of this study is to evaluate the relation between the site of secondary T wave changes and the location of the AP. METHODS: Of the total 128 patients (pts) with WPW syndrome, standard 12 lead ECGs of 125 pts (mean age 35, male 71 pts) who were free from bundle branch block (n=2) and myocardial ischemia (n=1) were analyzed. The locations of Aps were divided into 4 categories (anterior, left lateral, posterior and right lateral) by intracardiac mapping. RESULTS: 82 (66%) pts of 125 pts showed secondary T wave changes. The incidence of secondary T wave changes was not related to sex or duration of preexcitation, but mean QRS duration (<0.12: 46%, 0.12: 88%, p<0.001), maximal QRS duration (<0.12: 32%, 0.12: 73%, p<0.001) and the site of AP (right: 80%, left: 54%, p=0.003). The most frequent lead showing secondary T wave changes in ECG was lateral (lead I, aVL) in pts with anterior (43%, 9 out of 21), posterior (50%, 25 out of 50) and right lateral (86%, 6 out of 7) AP. But, no secondary T wave change was found in most pts with left lateral (n=47) AP. CONCLUSION: The incidence of the secondary T wave changes in pts with WPW syndrome is high (66%). These changes are not related to sex and duration of preexcitation, but to the mean and maximal QRS duration during preexcitation and the location of the AP. The ECG lead showing secondary T wave changes in pts with WPW syndrome appears to be related to the location of the AP and the most frequent lead is I and aVL.
Bundle-Branch Block ; Electrocardiography ; Humans ; Incidence ; Male ; Myocardial Ischemia ; Wolff-Parkinson-White Syndrome

PURPOSE: The aim of this study is to evaluate morphological changes of the medial nerve in patients with carpal tunnel syndrome (CTS) before and after endoscopic release of the transverse carpal ligament, and to correlate the ultrasonography (US) findings with the use of high resolution US and the surgical outcome for the median nerve. MATERIALS AND METHODS: Thirty patients with CTS confirmed by a clinical and electrophysiological study underwent high resolution US. The US instrumentation was equipped with a high frequency linear transducer to measure the cross sectional area, flattening ratio and swelling ratio of the medial nerve at the distal radioulnar joint, proximal and distal carpal tunnel before and three months after surgery. RESULTS: The cross sectional area (CSA) of the median nerve at the distal radioulnar level showed a decrease from 0.13 +/- 0.03 cm2 before surgery to 0.11 +/- 0.03 cm2 after surgery, and the CSA of the proximal carpal tunnel showed a decrease from 0.17 +/- 0.07 cm2 to 0.14 +/- 0.05 cm2; these differences were statistically significant. There was no statistically significant correlation between the morphological change and symptom improvement. CONCLUSION: This study confirmed a decreasing CSA of the medial nerve at the distal radioulnar and proximal carpal tunnel in a postoperative patient with CTS, as determined by the use of high resolution US. No association was found between a change in the CSA of the median nerve and symptom improvement. A further study based on multiple measurements of the median nerve with a longer period is necessary to establish the association between a change in the CSA of the median nerve and symptom improvement.
Carpal Tunnel Syndrome ; Humans ; Joints ; Ligaments ; Median Nerve ; Transducers

Stroke in young adults is uncommon and may require extensive evaluation to elucidate an underlying cause. A 21- year-old male professional golfer experienced left side weakness, dysarthria, headache during golfing. Magnetic resonance imaging (MRI) revealed broad ischemia on right basal ganglia, frontal and temporal lobes. Magnetic resonance angiography (MRA) and 4-vessel angiography revealed beading of right intracranial internal carotid and middle cerebral arteries which suggests fibromuscular dysplasia. We report a case of intracranial fibromuscular dysplasia without renal involvement resulting in cerebral infarction in young male professional golfer.
Angiography ; Basal Ganglia ; Carotid Artery, Internal, Dissection ; Cerebral Infarction ; Dysarthria ; Fibromuscular Dysplasia ; Golf ; Headache ; Humans ; Ischemia ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male ; Middle Cerebral Artery ; Stroke ; Temporal Lobe ; Young Adult

Solitary fibrous tumors (SFTs) are spindle-cell tumors that rarely arise within extrathoracic area. Massive SFTs involving the pterygopalatine fossa are extremely rare and surgical excision represents a multidisciplinary surgical challenge. We present a case of 64-year-old female with a huge mass originating from the pterygopalatine fossa invading the skull base. Distinct microscopic findings and a positive nuclear staining of signal transducer and activator of transcription 6 (STAT-6) pathologically confirmed SFT. The right internal maxillary artery branch was embolized preoperatively and a surgical excision was performed through a combined technique of transpalatal, mid-facial degloving and endoscopic approach. Postoperative radiotherapy successfully removed the remnant tumor adjacent to the carvenous sinus. Follow- up MR images showed no evidence of recurrence for two years. To our knowledge, there has been no previous report of the successful treatment of this vast extent of SFT in the pterygopalatine region via endoscopic-external-combined approach and radiotherapy.

BACKGROUND: The aim of surgical treatment for atrial septal defect is correction of anatomical and physiologic anomaly. Incidence of heart failure, cerebrovascular accident, atrial fibrillation and late mortality depend on the timing of surgery. Echocardiographic cardiac functional alteration after surgery is not surveyed sufficiently. So we intended to observe the alteration and function of cardiac anatomy after surgery. METHODS: We studied 22 patients who were undergone correction surgery of atrial septal defect at Keimyung university medical center. We devided patients into two groups according to age. Group I consists of patients who undergone surgery before 41 year old(mean age 32.25 year old, male 3, total 12). Group II comprises patients who undergone surgery after 41 year old(mean age 53.4 year old, male 1, total 10). We compared chief complaint, preoperative cardiac catheterization finding, pre- and post-operative echocardiographic finding(ejection fraction, end diastolic right and left ventricular dimension, grade of tricuspid regurgitation, paradoxical septal motion) between 2 groups. RESULTS: Preoperatively 6 patients(50%) of group I patients were diagnosed as mild congestive heart failure(according to NYHA functional class) and 2 patients(20%) of group II patients were in mild congestive heart failure. The Qp/Qs of both group were 3.5+/-1.7, 2.9+/-1.3, systolic right ventricular pressure were 42.1+/-10.5, 44.5+/-9.5mmHg, systolic pulmonary arterial pressure were 31.3+/-4.3, 36.6+/-7.3mmHg. 1 of group I patients and 2 of group II patients showed ejection fraction below 55% on postoperative echocardiography. The others showed normal ejection on echocardiography. Mean end diastolic right ventricular dimension was 3.84cm preopratively and 2.53cm postoperatively on group II patients. Mean end diastolic right ventricular dimension of group I patients was 3.94cm preoperatively and 2.81cm postoperatively. 3 of group I patients showed mild TR(tricuspid regurgitation), 5 showed moderate TR, and 4 showed severe TR preoperatively. 3 of group I patients showed loss of TR, 1 showed moderate TR, 8 showed mild TR. 3 of group II patients showed mild TR, 2 showed moderate TR, 5 showed severe TR preoperatively. 6 of group II patients showed mild TR, 3 showed moderate TR, 1 showed severe TR postoperatively. Paradoxical septal motion reflects right ventricular pressure overloading and was observed on both groups preoperatively. But after correction surgery, paradoxical septal motion persists at 6(50%) of group I patients, 6(60%) of group II patients. CONCLUSION: Conclusively, surgical correction for atrial septal defect before age of 41 is effective to prevent or slow down the manifestation of congestive heart failure, persistence of TR. Ejection fraction was improved significantly on echocardiography on both groups. But paradoxical septal motion persist after surgery, so more survey is needed.
Academic Medical Centers ; Adult* ; Arterial Pressure ; Atrial Fibrillation ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography* ; Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Heart Septal Defects, Atrial* ; Humans ; Incidence ; Male ; Mortality ; Stroke ; Tricuspid Valve Insufficiency ; Ventricular Pressure

PURPOSE: Malignant bowel obstruction causes gastrointestinal symptoms and leads to diminished quality of life in patients with advanced cancer. Several studies have shown the efficacy of octreotide for the relief of malignant bowel obstruction-related symptoms. The aim of this study is to assess the efficacy and safety of octreotide in patients with malignant bowel obstruction. METHODS: We retrospectively reviewed medical records of twenty nine patients who had suffered from malignant bowel obstruction without clinical improvement of conservative care and subsequently, received octreotide treatment. Initial dosage of octreotide was 0.1 mg/day, and dose was escalated depending on the clinical effect. For each patient, we assessed visual analogue scale (VAS) of pain, number of vomiting episode, and amount of nasogastric tube drainage. RESULTS: Median dosage of octreotide was 0.2 mg/day (range 0.1~0.6), and median duration from initial medication to death was 20 days (range 2~103). VAS before and after octreotide treatment were 5.6+/-1.24, and 2.7+/-0.96, respectively. The numbers of vomiting episode before and after octreotide treatment were 3.6/day+/-2.5, and 0.4/day+/-0.8, respectively. The mean amounts of nasogastric tube drainage before and after octreotide treatment were 975+/-1,083 cc/day and 115+/-196 cc/day, respectively. Statistically significant reduction in VAS, the number of vomiting episode and the amount of nasogastric tube drainage were observed after octreotide treatment (P<0.05). CONCLUSION: Administration of octreotide in patients with malignant bowel obstruction, which is uncontrolled by other medication, was effective and safe. In such clinical situations, physicians should consider to add of octreotide for symptomatic control.
Drainage ; Humans ; Intestinal Obstruction ; Medical Records ; Octreotide ; Quality of Life ; Retrospective Studies ; Vomiting

We report here on an unusual case of mucinous cystic tumor that was associated with endometriosis in the cecum. A 45-year-old woman was admitted to the hospital due to her 5 day history of right lower quadrant abdominal pain with a mild fever. A laparotomy was performed under the clinical impression of the tubo-ovarian abscess. A relatively well defined a multi-locular cystic mass (8.0x8.0x7.0 cm) filled with white-to-yellow thick mucoid material was found in the wall of the cecum. The right ovary and fallopian tube showed marked fibrous adhesion to the external surface of the cecal mass. A right hemicolectomy and salpingo-oophorectomy were performed. Histologically, the tumor was similar to those of ovarian borderline mucinous tumor, the intestinal type, and the mucinous epithelium of the tumor was merged with the endometriotic epithelium and stroma. On immunostaining, the CK20 positive mucinous epithelium was well demarcated from the CK7 endometriotic epithelium. This is the first case of low-grade mucinous cystic tumor intimately associated with intestinal endometriosis in the cecum.
Abdominal Pain ; Abscess ; Cecum* ; Endometriosis ; Epithelium ; Fallopian Tubes ; Female ; Fever ; Humans ; Laparotomy ; Middle Aged ; Mucins* ; Ovary

OBJECTIVES: Bioterrorism (BT) preparedness and response plans are particularly important among healthcare workers who will be among the first involved in the outbreak situations. This study was conducted to evaluate the current status of education for BT preparedness and response in healthcare-related colleges/junior colleges and to develop learning objectives for use in their regular curricula. METHODS: We surveyed all medical colleges/schools, colleges/junior colleges that train nurses, emergency medical technicians or clinical pathologists, and 10% (randomly selected) of them that train general hygienists in Korea. The survey was conducted via mail from March to July of 2007. We surveyed 35 experts to determine if there was a consensus of learning objectives among healthcare workers. RESULTS: Only 31.3% of medical colleges/schools and 13.3% of nursing colleges/junior colleges had education programs that included BT preparedness and responses in their curricula. The most common reason given for the lack of BT educational programs was 'There is not much need for education regarding BT preparedness and response in Korea'. None of the colleges/junior colleges that train clinical pathologists, or general hygienists had an education program for BT response. After evaluating the expert opinions, we developed individual learning objectives designed specifically for educational institutions. CONCLUSIONS: There were only a few colleges/junior colleges that enforce the requirement to provide education for BT preparedness and response in curricula. It is necessary to raise the perception of BT preparedness and response to induce the schools to provide such programs.
*Bioterrorism ; Curriculum ; Disaster Planning/*organization & administration ; Humans ; Korea ; Schools, Health Occupations/*organization & administration