OBJECTIVE : To analyze the methylenetetrahydrofolate reductase (MTHFR) mutation in recurrent spontaneous abortion associated with hyperhomocysteinemia. MATERIAL AND METHOD: The blood Sample of habitual aborter with high fasting homocysteine level was tested by PCR-RFLP method. RESULTS: The patient was found to be a homozygosity for MTHFR gene mutation that was confirmed by the finding which is consistent with the mutation at the nucleotide 677 C to T, Corresponding to Ala to Val. CONCLUSIONS: Hyperhomocysteinemia due to MTHFR mutation is a cause of recurrent spontaneous abortion. Therefore, the MTHFR mutation should be examined in the workup of recurrent spontaneous abortion showing hyperhomocysteinemia.
Abortion, Spontaneous* ; Fasting ; Female ; Homocysteine ; Humans ; Hyperhomocysteinemia* ; Methylenetetrahydrofolate Reductase (NADPH2)* ; Pregnancy

The effectiveness of several sulfhydryl compounds in the treatment of paraquat intoxication has been previously tested based on their antioxidant ability. However, practical guidelines for their clinical use remain to be determined. As a preliminary pharmacokinetic study on sulfhydryl compounds, we attempted to establish the optimal concentration of N-acetyl-L-cysteine, glutathione, superoxide dismutase, and catalase. We measured the antioxidant effect of these antioxidants in normal pooled plasma and on intracellular reactive oxygen species (ROS) induced by paraquat. N-acetyl-L-cysteine begins to suppress the production of ROS in plasma at concentrations as low as 5 mM, with the suppression being maximal at 40 mM. In the same way, glutathione increased the total antioxidant status in plasma at concentrations of 5-40 mM in a dose-dependent manner. Complete suppression of ROS in plasma induced by exposure to 500 micrometer paraquat for 40 min was observed when using 40 mM N-acetyl-L-cysteine and 5 mM glutathione. These concentrations are comparable with 50 units of catalase, which reduced ROS at concentrations of 5-100 units. Further pharmacokinetic study into the systemic administration of these antioxidants is necessary, using effective concentrations of 5-40 mM for both N-acetyl-L-cysteine and glutathione, and 1-50 units of catalase.
Acetylcysteine/*pharmacology ; Animals ; Antioxidants/pharmacokinetics/*pharmacology ; Ascorbic Acid/metabolism ; Catalase/metabolism ; Dose-Response Relationship, Drug ; Free Radical Scavengers/pharmacology ; Glutathione/metabolism/*pharmacology ; Human ; Mice ; NIH 3T3 Cells ; Paraquat/pharmacology ; Reactive Oxygen Species ; Serum/*drug effects ; Support, Non-U.S. Gov't

OBJECTIVE: To identify the prevalence of multidrug-resistant (MDR) bacteria and identify their specific risk factors in routine urine specimens of spinal cord injury (SCI) patients. METHODS: This study was designed in a retrospective manner, reviewing the medical records of SCI patients who were admitted to a specialized SCI unit between January 2001 and December 2013. Patients were investigated for age, gender, American Spinal Injury Association impairment scale, SCI level, duration after injury, bladder management method, and hospitalization history within four weeks prior to visiting our unit. The results of routine urine cultures including presence of MDR organisms were analyzed. RESULTS: Among the total 2,629 urine samples from the newly admitted SCI patients, significant bacteriuria was identified in 1,929 (73.4%), and MDR organisms were isolated in 29 (1.1%) cultures. There was an increasing trend of MDR organism prevalence from 2001 to 2013 (p<0.01). The isolation of MDR organisms in inpatients who were admitted for rehabilitation (1.3%) was significantly higher than it was among community-residing persons (0.2%) (p<0.05). By voiding method, patients who used a suprapubic indwelling catheter (3.3%) or a urethral indwelling catheter (2.6%) showed a higher rate of MDR organism isolation (p<0.05). CONCLUSION: There was an increasing trend of MDR organism isolation in SCI patients. Inpatients and persons who used indwelling catheters showed a higher risk of MDR organism isolation.
Bacteria* ; Bacteriuria ; Catheters, Indwelling ; Drug Resistance, Multiple ; Hospitalization ; Humans ; Inpatients ; Medical Records ; Prevalence* ; Rehabilitation ; Retrospective Studies ; Risk Factors* ; Spinal Cord Injuries* ; Spinal Cord* ; Spinal Injuries ; Urinary Bladder ; Urinary Tract Infections

OBJECTIVE: To evaluate effects of subacromial bursa injection with steroid according to dosage and to investigate whether hyaluronidase can reduce steroid dosage. METHODS: Thirty patients with periarticular shoulder disorder were assigned to receive subacromial bursa injection once a week for two consecutive weeks. Ten patients (group A) underwent subacromial bursa injection with triamcinolone 20 mg; another group of ten patients (group B) with hyaluronidase 1,500 IU and triamcinolone 20 mg; and the other ten patients (group C) with triamcinolone 40 mg. We examined the active range of motion (AROM) of the shoulder joint, visual analogue scale (VAS), and shoulder disability questionnaire (SDQ) at study entry and every week until 1 week after the 2nd injection. RESULTS: All groups showed statistically significant improvements in VAS after 1st and 2nd injections. When comparing the degree of improvement in VAS, there were statistically significant differences between groups C and A or B, but not between groups A and B. SDQ was statistically significantly improved only in groups B and C, as compared to pre-injection. There were statistically significant differences in improvement of SDQ after the 2nd injection between groups C and A or B. Statistically significant improvements in AROM were shown in abduction (groups B and C) and in flexion (group C only). CONCLUSION: Repeated high-dose (40 mg) steroid injection was more effective in terms of pain relief and functional improvements of shoulder joint than medium-dose (20 mg) steroid injection in periarticular disorder. Hyaluronidase seems to have little additive effect on subacromial bursa injection for reducing the dosage of steroid.
Humans ; Hyaluronoglucosaminidase* ; Range of Motion, Articular ; Shoulder ; Shoulder Impingement Syndrome ; Shoulder Joint ; Triamcinolone ; Surveys and Questionnaires

OBJECTIVE: To investigate the additive effect of sono-guided subacromial bursa injection of hyaluronate with steroid in patients with peri-articular shoulder disorders. METHOD: This prospective randomized controlled trial involved 26 patients who had shoulder pain. Group A, consisting of 13 patients, was treated with a sono-guided subacromial bursa injection containing a mixture of 0.5% lidocaine (5 ml) and triamcinolone 40 mg (1 ml), followed by injection with sodium hyaluronate (2 ml) once a week for 3 weeks. The other 13 patients (Group B) were treated with a sono-guided subacromial bursa injection containing a mixture of 0.5% lidocaine (5 ml) and triamcinolone 40 mg (1 ml) once a week for 3 weeks. The effects were assessed using a visual analogue scale (VAS) of shoulder pain, active range of motion (AROM), shoulder function assessment scale (SFA), shoulder disability questionnaire (SDQ) at study entry and every week from first injection until 4 weeks after the 1st injection (= 2 weeks after 3rd injection). RESULTS: (1) Demographic features and all parameters measured before injection did not show a significant difference between the 2 groups. (2) Statistically significant improvements were shown in VAS, SFA, SDQ during the 1st, 2nd, and 4th week after the first injection in both groups (p<0.05). (3) SFA showed significant improvement at 1 week after injection only in group A (p<0.05). (4) AROM of internal rotation showed significant improvement at week 4 after the 1st injection only in group A (p<0.05). CONCLUSION: Subacromial bursa injection of hyaluronate with steroid in patients with peri-articular shoulder disorders has additive effects on functional improvement of the affected shoulder, including the AROM of internal rotation.
Humans ; Hyaluronic Acid ; Lidocaine ; Prospective Studies ; Range of Motion, Articular ; Shoulder ; Shoulder Pain ; Triamcinolone ; Surveys and Questionnaires

OBJECTIVE: To investigate the effect of botulinum toxin type A (BTXA) on drooling and the morphologic change of the salivary gland in patients with cerebral palsy. METHOD: Eight cerebral palsy patients suffering from severe drooling participated in this study. BTXA was injected into both submandibular and parotid glands under intravenous sedation and with ultrasound guidance (1 unit/gland/kg: maximum 100 units) in an outpatient or inpatient procedure. The severity of drooling was measured before injection and 3 weeks after injection using the Teacher Drooling Scale, the Drooling Score-severity, frequency and the Visual Analog Scale. To investigate the morphologic change of the salivary glands, the size of salivary glands were measured before injection and 3 weeks after injection using computed tomography of the neck. The measurement values were analyzed by Wilcoxon signed rank test. RESULTS: Statistically significant improvements were shown in all three parameters for assessing the severity of drooling after BTXA injections (p<0.05). Size of the salivary glands were significantly decreased at 3 weeks after BTXA injection (p<0.05). CONCLUSION: Salivary gland injection with BTXA could be a useful treatment method to reduce drooling in patients with cerebral palsy and decreased size of salivary glands may partially explain the mechanism.
Botulinum Toxins ; Botulinum Toxins, Type A ; Cerebral Palsy ; Humans ; Inpatients ; Neck ; Outpatients ; Parotid Gland ; Salivary Glands ; Sialorrhea ; Stress, Psychological

OBJECTIVE: The aim of the study was to evaluate the effectiveness of ultrasouond-guided salivary gland injection of botulinum toxin A (BTX-A) for posterior drooling. METHOD: 11 patients with brain lesion (9 cerebral palsy, 1 hypoxic ischemic encephalopathy and 1 mental retardation) with posterior drooling (an initial PDAS score greater than 2) and related pulmonary problems were recruited. Drooling severity was measured at baseline, 4 weeks, 3 months and 6 months after botulinum toxin A injection, by using Teacher Drooling Scale (TDS), Visual Analogue Scales (VAS), Drooling Score System (DSS)-severity, frequency and Posterior Drooling/Aspiration System (PDAS). RESULTS: The TDS, DSS-severity, DSS-frequency, VAS, PDAS were significantly reduced at 4 weeks and 3 months after BTX-A injection into salivary glands compared to pre-injection (p<0.05). However, there were no significant changes at 6 months compared to pre-injection level. CONCLUSION: BTX-A injection into salivary glands may improve anterior drooling in patients with brain lesions. Furthermore BTX-A injection into salivary glands may also decrease the posterior drooling which might related to respiratory symptoms in aspiration pneumonia.
Botulinum Toxins ; Botulinum Toxins, Type A ; Brain ; Cerebral Palsy ; Humans ; Hypoxia-Ischemia, Brain ; Pneumonia, Aspiration ; Salivary Glands ; Sialorrhea ; Sorbitol ; Stress, Psychological ; Tyramine ; Weights and Measures

OBJECTIVE: To investigate the effects of obturator nerve blocks with ultrasound guided intraneural alcohol injection. METHOD: Nine quadriplegic patients suffering hip adductor spasticity were included in this study. The obturator nerve was identified at just below inguinal ligament area on anteromedial surface of upper leg at supine position. An 23 G needle was inserted into anterior branch of obturator nerve under real time ultrasonography. The 50% alcohol solution was injected 3~5 ml at a time within the epineurium of the anterior branch of obturator nerve until the expanding nerve was visualized. We examed modified Ashworth scale (MAS) of hip adductor and passive range of movement of hip abduction at supine position at study entry, 1, 4, and 12 weeks after ultrasound guided intraneural injection. RESULTS: There were statistically significant improvement was seen in MAS of hip adductors and hip abduction angle at 1, 4, and 12 weeks after ultrasound guided intraneural injection, compared with parameters measured at previous injection (p<0.05). CONCLUSION: Ultrasound guided intraneural alcohol injection into anterior branch of obturator nerve for treatment of hip adductor spasticity in patients with quadriplegia is an effective and safe procedure for relieving localized spasticity of the hip adductors.
Hip ; Humans ; Leg ; Ligaments ; Muscle Spasticity ; Needles ; Obturator Nerve ; Peripheral Nerves ; Quadriplegia ; Stress, Psychological ; Supine Position

OBJECTIVE: To evaluate the clinical usefulness of sonoelastography in infants with congenital muscular torticollis (CMT). METHODS: The medical records of 215 infants clinically diagnosed with CMT were retrospectively reviewed. Fifty-three infants met the inclusion criteria as follows: 1) infants diagnosed as CMT with a palpable neck mass before 3 months of age, 2) infants who were evaluated initially by both B-mode ultrasonography and sonoelastography, and 3) infants who had received physical therapy after being diagnosed with CMT. We checked the thickness of the sternocleidomastoid (SCM) muscles in B-mode ultrasonography, strain ratio of the SCM muscles in sonoelastography, and treatment duration. We evaluated the correlation between the treatment duration and the following factors: SCM muscle thickness, ratio of SCM muscle thickness on the affected to unaffected side (A/U ratio), and strain ratio. RESULTS: Both the thickness of the affected SCM muscle and the A/U ratio did not show significant correlation with the treatment duration (p=0.66, p=0.90). The strain ratio of the affected SCM muscle was significantly greater than that of the unaffected SCM muscle (p<0.001), and the strain ratio showed significant correlation with the treatment duration (p=0.001). CONCLUSION: Sonoelastography may be a useful adjunctive tool to B-mode ultrasonography for evaluating infants with CMT, especially when predicting their rehabilitation outcomes.
Elasticity Imaging Techniques* ; Humans ; Infant* ; Medical Records ; Muscles ; Neck ; Prognosis ; Rehabilitation ; Retrospective Studies ; Torticollis* ; Ultrasonography

OBJECTIVE: To investigate the intra- and inter-rater reliability of the Korean version of the ABILOCO questionnaire (K-ABILOCO). METHODS: The original ABILOCO questionnaire was translated into Korean and back-translated into English. Stroke patients (n=30) with hemiplegia were evaluated using the K-ABILOCO at one week interval. At each visit, the physiatrist also evaluated patient performance of the activities described in the K-ABILOCO, and the total logit scores were recorded. The total scores were used to evaluate intraclass correlation (ICC). Test-retest scores and each test scores were compared to obtain the intra- and inter-rater reliability. RESULTS: The K-ABILOCO showed good intra-rater correlation at one week interval in both patient and physiatrist evaluations (ICC=0.81, 0.91), respectively. It also showed a high inter-rater correlation between the patient and physiatrist at both the first and second visits (ICC=0.76, 0.84), respectively. CONCLUSION: The K-ABILOCO is a useful tool that may reliably evaluate the locomotion ability in hemiplegic stroke patients.
Hemiplegia ; Humans ; Locomotion ; Stroke ; Surveys and Questionnaires