OBJECTIVE: While the optic nerve sheath diameter (ONSD) is measured by computed tomography and ultrasonography as an indicator of an elevation in the intracranial pressure (ICP), it is unclear which ONSD measurement is useful for predicting an increased ICP. This study examined the comparability between the ONSD measured by computed tomography and ultrasonography. METHODS: A prospective study of 150 patients in the emergency center was performed. The ONSD was measured 3 mm behind the globe of all patients by computed tomography and ultrasonography. The receiver operator characteristic (ROC) curve was analyzed to determine the diagnostic utility of detecting ICP through ONSD. RESULTS: A total of 150 patients were enrolled. Thirty-three patients (22.0%) were found to have an increased ICP. The ONSD in patients with increased ICP was significantly higher than that of normal ICP patients measured by computed tomography and ultrasonography. Moreover, computed tomography and ultrasonography revealed an area under the ROC curve value of 0.886 and 0.933, respectively. The ONSD measurement by computed tomography and ultrasonography produced similar results (P=0.256). CONCLUSION: The ONSD measured by computed tomography and ultrasonography is a valuable indicator of an ICP elevation. Therefore, either of the two diagnostic methods for monitoring the ICP can be used in patients with a critical care and resource-limited setup.
Critical Care ; Emergencies ; Humans ; Intracranial Pressure ; Optic Nerve ; Prospective Studies ; ROC Curve ; Ultrasonography

Sodium glucose cotransporter 2 (SGLT2) inhibitor has been recently reported of diabetic ketoacidosis due to accumulation of ketone bodies in patients with severe dehydration caused from such like diarrhea even though the patient had normal glucose level. This is a case of ketoacidosis in normal glucose level as production of ketone bodies is stimulated in liver with increased secretion of glucagon by stimulation of α cells in pancreas due to increase of lipolysis caused from reducing insulin and by SGLT2 inhibitor among patients who are under concurrent insulin and SGLT2 inhibitor. Thus, insulin dosage reduction requires caution in order to control blood glucose level on combined treatment of SGLT2 inhibitor in a patient who is administering insulin because the patient may be caused ketoacidosis in normal blood glucose level.
Blood Glucose ; Dehydration ; Diabetic Ketoacidosis* ; Diarrhea ; Glucagon ; Glucose* ; Humans ; Insulin* ; Ketone Bodies ; Ketosis ; Lipolysis ; Liver ; Pancreas ; Sodium*

The aim of this study was to evaluate the bone mineral density and the prevalence of osteoporosis in postmenopausal Korean women with low-energy distal radius fractures and compared with those of aged-matched normal Korean women. Two hundred and six patients with distal radius fractures between March 2006 and March 2010 were included in this study. Patients were divided into three groups by age; group 1 (50-59 years), group 2 (60-69 years), and group 3 (70-79 years). Controls were age-matched normal Korean women. The bone mineral density values at all measured sites, except for the spine, were significantly lower in group 1 than those of control. While the bone mineral density values in group 2 and 3 were lower than those of controls, these differences were not statistically significant. All groups had significantly higher prevalence of osteoporosis at the Ward's triangle; however, at the spine, femoral neck and trochanteric area it was not significantly different from those of age-matched controls. Although the prevalence of osteoporosis of the postmenopausal women with low-energy distal radius fractures may not be higher than that of the control, osteoporosis should be evaluated especially in younger postmenopausal patients to prevent other osteoporotic hip and/or spine fractures.
Aged ; Body Mass Index ; Bone Density ; Female ; Femoral Neck Fractures/diagnosis ; Humans ; Middle Aged ; Osteoporosis/*epidemiology ; Postmenopause ; Prevalence ; Radius Fractures/*diagnosis ; Republic of Korea/epidemiology ; Retrospective Studies ; Spinal Fractures/diagnosis

PURPOSE: The purpose of this study was to present a systematic treatment method for nontuberculous mycobacteria (NTM) infection of the hand and wrist to gain better clinical outcomes. METHODS: 10 patients of deep NTM infection of the hand and wrist were reviewed. Extensive debridement was performed in all cases. When biopsy result suggested mycobacterial infection such as granulomatous inflammation, empirical tuberculosis medication was started. After culture confirmed NTM growth, the species was identified and in vitro sensitivity test was performed. Then medication was switched according to the results. Functional outcomes of the hand and wrist were measured by total active motion of the fingers and by range of motion of the wrist respectively. RESULTS: Diagnosis was tenosynovitis in seven patients, infective arthritis and osteomyelitis combined with tenosynovitis of the wrist in three patients. Two patients had recurred skin ulcer during follow-up period and undergone second debridement. After second operation, no patient had a persistent discharging sinus and all patient were completely healed during follow-up period. Functional outcome of the eight patients who had NTM infection of their hand was excellent in two, good in four, fair in one, poor in one. Mean range of motion of the two patients who had osteomyelitis of their wrist was dorsiflexion 20degrees, volar flexion 15degrees, radial deviation 0degrees, ulnar deviation 15degrees. CONCLUSION: Our standardized treatment protocol can be helpful for treatment of deep NTM infection of the hand and wrist.
Arthritis ; Biopsy ; Clinical Protocols ; Debridement ; Diagnosis* ; Fingers ; Follow-Up Studies ; Hand* ; Humans ; Inflammation ; Nontuberculous Mycobacteria* ; Osteomyelitis ; Range of Motion, Articular ; Skin Ulcer ; Tenosynovitis ; Tuberculosis ; Wrist*

There is increasing attention to medical problems of musicians. Many studies find a high prevalence of work-related musculoskeletal disorders in musicians, ranging from 73.4% to 87.7%, and string players have the highest prevalence of musculoskeletal problems. This paper examines the various positions and movements of the upper extremities in string players: 1) basic postures for holding instruments, 2) movements of left upper extremity: fingering, forearm posture, high position and vibrato, 3) movements of right upper extremity: bowing, bow angles, pizzicato and other bowing techniques. These isotonic and isometric movements can lead to musculoskeletal problems in musicians. We reviewed orthopedic disorders that are specific to string players: overuse syndrome, muscle-tendon syndrome, focal dystonia, hypermobility syndrome, and compressive neuropathy. Symptoms, interrelationships with musical performances, diagnosis and treatment of these problems were then discussed.
Cumulative Trauma Disorders/*etiology ; Humans ; Musculoskeletal Diseases/*etiology ; *Music ; Neuromuscular Diseases ; Occupational Diseases/*etiology

PURPOSE: We reported clinical results of autologous tricorticocancellous bone grafting and plate-screw fixation for nonunion of the forearm bones. MATERIALS AND METHODS: Ten patients with nonunion of the forearm bones that underwent surgical treatment were evaluated. Tricorticocancellous bone grafting which was harvested from the iliac crest and plate-screw fixation were performed. Radiologic bone union was evaluated based on the simple radiographs. At the final follow-up, range of motion was measured and the Anderson scale was used for functional evaluation. RESULTS: Radiologic bone union was achieved in all cases. The mean range of motion was 139degrees of elbow flexion, 3degrees of flexion contracture, 73degrees of forearm pronation, 72degrees of supination, 70degrees of wrist flexion, and 70degrees of wrist extension. Anderson scale was excellent in 6 patients, satisfactory in three, and unsatisfactory in one. CONCLUSION: Autologous tricorticocancellous bone grafting and rigid plate-screw fixation is a reliable method to achieve successful healing of forearm bone nonunions.
Bone Transplantation ; Contracture ; Elbow ; Follow-Up Studies ; Forearm ; Humans ; Pronation ; Range of Motion, Articular ; Supination ; Wrist

Intrahepatic sarcomatoid cholangiocarcinomais is a very rare disease with a poor prognosis due to its biologically aggressive tumor behavior. We report a patient who presented with subcapsular hemorrhage and a rapidly growing liver mass. A 57 year-old man was admitted with severe abdominal pain. CT and MRI images showed the presence of a 10 cm-sized subcapsular hemorrhage connected with a multi-lobulated mass with hemorrhage and necrotic foci in the right liver. The patients underwent right hemihepatectomy with caudate lobectomy and lymphadenectomy. The operation findings revealed metastatic nodules to the diaphragm and omentum. Detailed histopathological analysis through immunohistochemistry confirmed the diagnosis of sarcomatoid cholangiocarcinoma with a poorly undifferentiated sarcomatous component. The patient underwent chemotherapy. To date, the patient is doing well for 8 months after initial diagnosis.
Abdominal Pain ; Benzeneacetamides ; Cholangiocarcinoma ; Diaphragm ; Hematoma ; Hemorrhage ; Humans ; Immunohistochemistry ; Liver ; Lymph Node Excision ; Omentum ; Piperidones ; Prognosis ; Rare Diseases

PURPOSE: The purpose of this study was to evaluate the results of surgical treatment in patients with chronic flexor carpi ulnaris tendinopathy. MATERIALS AND METHODS: Five patients with 7 wrists underwent surgical treatment for chronic flexor carpi ulnaris tendinopathy. The degenerative tissue inside the tendon over the pisiform was debrided and partial release of the tendon was performed. The clinical outcome was evaluated using pre and postoperative visual analogue scale (VAS) pain score and modified Mayo wrist score at the final follow-up. RESULTS: The mean VAS score was 7.3 preoperatively, which was significantly improved to 3.6 at postoperative 2 weeks, 1.9 at 6 weeks, 1.1 at 3 months, 0.7 at 6 months, and 0.7 at the final visit. Modified Mayo wrist score showed 3 excellent, 3 good, and one fair result. Biopsy showed degenerative tissue findings in all cases. CONCLUSION: Chronic flexor carpi ulnaris tendinopathy is a degenerative disease and surgical treatment of refractory cases can decrease clinical symptoms in the early postoperative period and enable patients to return to activities of daily-living.
Biopsy ; Debridement ; Humans ; Postoperative Period ; Tendinopathy ; Tendons ; Wrist

PURPOSE: We evaluated the clinical outcomes of the autologous platelet rich plasma injection for the treatment of recalcitrant medial and lateral epicondylitis. MATERIALS AND METHODS: Nineteen cases with recalcitrant medial and lateral epicondylitis despite of conservative treatment for 1 year were enrolled in this study. Each patient underwent autologous platelet rich plasma injection and followed up minimally of 40 weeks. The assessment included a preoperative and postoperative Visual Analogue Scale (VAS) (0~10) at 4, 8, 12, 24 and 36 weeks and overall satisfaction was evaluated with Roles & Maudsley score at 36 weeks after injection. We also compared the clinical outcomes between medial and lateral epicondylitis group. RESULTS: Mean preoperative VAS was 8.7 points and improved to 5.1, 5.2 and 4.7 at 12, 24 and 36 weeks follow up, respectively. Roles & Maudsley score was excellent in 5 cases(26%), good in 7 cases(37%), acceptable in 4 cases(21%) and poor in 3 cases(16%). On the comparison of medial and lateral epicondylitis group, there was no statistical significant difference (p=0.38). CONCLUSION: The autologous platelet rich plasma injection for recalcitrant medial & lateral epicondylitis is thought to be a alternative treatment option.
Blood Platelets ; Elbow ; Follow-Up Studies ; Humans ; Platelet-Rich Plasma

BACKGROUND/AIMS: The most common type of syncope in young adults is neurocardiogenic in origin, which is not related to organic problems and has a benign nature. Therefore, there have been few reports regarding syncope in young Korean adults. Here, we examined the causes of syncope and its clinical characteristics in young combat and auxiliary police in Korea. METHODS: We performed a retrospective study of the medical records of 193 combat and auxiliary police in Korea admitted to the National Police Hospital for syncope or presyncope between January 2004 and December 2007. RESULTS: The subjects' mean age was 21+/-1.2 years, and there were 2.8+/-2.9 episodes of syncope (mean+/-SEM). The first syncope occurred after enlistment in the police in 102 patients (52.8%). Basic diagnostic studies showed two cases of elevated creatine phosphokinase and one case of anemia to be related to syncope. Syncope-related traumatic injuries occurred in 38 patients (19.7%), and syncope was more prevalent in the summer. Head-up tilt test was performed in 175 of the 193 patients, and 123 showed a positive response. Other evaluations, including brain magnetic resonance imaging, electroencephalography, and echocardiography, were not helpful for diagnosis. Syncope was neurocardiogenic in origin in the majority of cases. Other causes of syncope were exhaustion (n=2), hyperventilation syndrome (n=2), Meniere's disease (n=1), anemia (n=1), and psychiatric problems (n=5). The causes of syncope could not be identified in 59 patients (30.5%). CONCLUSIONS: Neurocardiogenic syncope was the most common type in our study population. More than half of our patients experienced their first episode after enlisting with the police. Further studies in these groups are necessary.
Adult ; Anemia ; Brain ; Creatine Kinase ; Echocardiography ; Electroencephalography ; Humans ; Hyperventilation ; Korea ; Magnetic Resonance Imaging ; Medical Records ; Meniere Disease ; Police ; Retrospective Studies ; Syncope ; Syncope, Vasovagal ; Young Adult