OBJECTIVE: The purpose of this study is to evaluate the usefulness of infrared thermography in patients with carpal tunnel syndrome by comparing with electrodiagnostic and ultrasonographic findings.METHOD: From January 2014 to October 2017, electrodiagnosis, ultrasound, and digital infrared thermal image (DITI) of unilateral carpal tunnel syndrome diagnosed in a single hospital were retrospectively analyzed. The subjects with bilateral symptoms of carpal tunnel syndrome, peripheral vascular disease, diabetes, thyroid disease, fibromyalgia, rheumatic disease, systemic infection, inflammation, malignant tumor, and other musculoskeletal disorders such as finger osteoarthritis, peripheral neuropathy, cervical radiculopathy, and the previous history of surgery were excluded.RESULTS: Of 53 patients diagnosed with carpal tunnel syndrome, 11 were male and 42 were female. The visual analogue scale was 4.9 ± 1.9, and the duration of symptom was 11.8 ± 12.5 months. There was no statistically significant difference in the body surface temperature between the unaffected and affected sides. The severity of symptoms, electrodiagnostic findings, and cross-sectional area of the median nerve significantly correlates to each other. The temperature difference between the second fingers of the affected and unaffected sides showed a weak correlation with the amplitude of sensory nerve action potential and onset latency of compound muscle action potential, when there was no significant correlation with the other parameters.CONCLUSION: The difference in temperature on the surface of the body, which can be confirmed by DITI, is little diagnostic value when DITI is performed in unilateral carpal tunnel syndrome patients, especially when compared with ultrasonography.
Action Potentials ; Carpal Tunnel Syndrome ; Electrodiagnosis ; Female ; Fibromyalgia ; Fingers ; Humans ; Inflammation ; Male ; Median Nerve ; Methods ; Osteoarthritis ; Peripheral Nervous System Diseases ; Peripheral Vascular Diseases ; Radiculopathy ; Retrospective Studies ; Rheumatic Diseases ; Thermography ; Thyroid Diseases ; Ultrasonography

BACKGROUND AND PURPOSE: An increase in brain water diffusivity as measured using magnetic resonance imaging (MRI) has been recently reported in normal-appearing white matter (NAWM) in patients affected by cognitive impairment. However, it remains to be clarified if this reflects an overt neuronal tissue disruption that leads to degenerative or microvascular lesions. This question was addressed by comparing the regional MRI apparent diffusion coefficients (ADCs) of NAWM in patients affected by Alzheimer's disease (AD) or vascular dementia (VaD). The relationships of ADCs with the white-matter hyperintensity (WMH) burden, carotid atherosclerosis, and cognitive performance were also investigated. METHODS: Forty-nine AD and 31 VaD patients underwent brain MRI to assess the WMH volume and regional NAWM ADCs, neuropsychological evaluations, and carotid ultrasound to assess the plaque severity and intima-media thickness (IMT). RESULTS: Regional ADCs in NAWM did not differ between VaD and AD patients, while the WMH volume was greater in VaD than in AD patients. The ADC in the anterior corpus callosum was related to the WMH volume, while a greater carotid IMT was positively correlated with the temporal ADC and WMH volume. The memory performance was worse in patients with higher temporal ADCs. Constructional praxis scores were related to ADCs in the frontal, and occipital lobes, in the anterior and posterior corpus callosum as well as to the WMH volume. Abstract reasoning was related to frontal, parietal, and temporal ADCs. CONCLUSIONS: Our data show that higher regional ADCs in NAWM are associated with microcirculatory impairment, as depicted by the WMH volume. Moreover, regional ADCs in NAWM are differently associated with the neuropsychological performances in memory, constructional praxia, and abstract reasoning domains.
Alzheimer Disease* ; Atherosclerosis ; Brain ; Carotid Artery Diseases ; Corpus Callosum ; Dementia, Vascular* ; Diffusion Magnetic Resonance Imaging ; Diffusion* ; Humans ; Leukoaraiosis ; Magnetic Resonance Imaging* ; Memory ; Neurons ; Occipital Lobe ; Rabeprazole ; Ultrasonography ; Water

Diabetes mellitus (DM) can accompany many musculoskeletal (MSK) diseases. It is difficult to distinguish the DM-related MSK diseases based on clinical symptoms alone. Sonography is frequently used as a first imaging study for these MSK symptoms and is helpful to differentiate the various DM-related MSK diseases. This pictorial essay focuses on sonographic findings of various MSK diseases that can occur in diabetic patients.
Adult ; Cellulitis/ultrasonography ; Diabetes Mellitus, Type 2/*complications ; Diabetic Neuropathies/ultrasonography ; Female ; Humans ; Male ; Musculoskeletal Diseases/complications/*diagnosis/ultrasonography ; Pyomyositis/microbiology/ultrasonography ; Tenosynovitis/microbiology/ultrasonography ; Vascular Diseases/ultrasonography

Neck mass can be frequently encountered in pediatric patients. Most neck mass in pediatric patients are either inflammatory lesions or benign tumors but their differential diagnoses are not always easy. We must not forget the study results that a considerable portion of pediatric neck mass constitutes malignant tumors. Generally neck mass can be divided into inflammatory, developmental (congenital), and tumorous lesions. Developmental neck mass are generally thyroglossal duct cyst, branchial cleft cyst, dermoid cyst, vascular malformation, or hemangioma. Manifestations of inflammatory neck mass are reactive cervical lymphadenopathy, infectious lymphadenitis (viral or bacterial), mycobacterial cervical lymphadenopathy, or Kawasaki disease. The more uncommonly found pediatric malignant neck mass are lymphoma, rhabdomyosarcoma, or thyroid carcinoma. For the diagnosis of pediatric neck mass complete blood count, purified protein derivative test for tuberculosis, and measurement of titers for Epstein-Barr virus are required and in special cases, infectious diagnostic panels for cat-scratch disease, cytomegalovirus, human immunodeficiency virus, or toxoplasmosis may be needed. Ultrasonography is the most convenient and feasible diagnostic method in differentiating various neck mass. Computed tomography is performed when identifying the anatomical aspects of the neck mass or where deep neck infection or retropharyngeal abscess is suspected. Surgical management for congenital neck mass is recommended to prevent secondary infection or various complications following size increase. Most pediatric neck mass originate from bacterial lymphadenitis and antibacterial therapy is considered first line of conservative treatment. However if the neck mass is either over 2 cm in size without any evidence of inflammation, firm or fixed to surrounding tissue, accompanied by B symptoms, unresponsive to initial antibacterial therapy or over 4 weeks of conservative management, or considered keep growing for over 2 weeks, one must suspect the possibility of malignancy and must consult a head and neck specialist for further detailed evaluation.
Blood Cell Count ; Branchioma ; Cat-Scratch Disease ; Coinfection ; Cytomegalovirus ; Dermoid Cyst ; Diagnosis ; Diagnosis, Differential ; Head ; Hemangioma ; Herpesvirus 4, Human ; HIV ; Humans ; Inflammation ; Lymphadenitis ; Lymphatic Diseases ; Lymphoma ; Mucocutaneous Lymph Node Syndrome ; Neck* ; Retropharyngeal Abscess ; Rhabdomyosarcoma ; Specialization ; Thyroglossal Cyst ; Thyroid Neoplasms ; Toxoplasmosis ; Tuberculosis ; Ultrasonography ; Vascular Malformations

OBJECTIVETo investigate the role of quantitative three-dimensional (3D) power Doppler ultrasound in differentiating malignant and benign thyroid nodule.

METHODSA total of 92 lesions in 86 patients were preoperatively examined using 3D power Doppler ultrasound. The Virtual Organ Computer-aided Analysis(VOCAL)-imaging program was used to analyze the stored volume ultrasound. The differences in the mean gray value (MG), vascularization index (VI), flow index(FI), and vascularization flow index (VFI) were compared between benign and malignant lesions.

RESULTSThe MG of the malignant thyroid nodules was significantly lower than that of the benign ones (28.27±7.21 vs. 32.89±8.73,P=0.007). The benign nodules had significantly higher VI,FI,and VFI than the malignant nodules [VI:(40.43±26.55)% vs. (26.87±23.06)%,P=0.011;FI:41.03±7.19 vs. 37.51±7.17,P=0.022;VFI:18.23±14.60 vs. 11.47±12.47, P=0.009]. Also,76.5% (39/51) of the malignant nodules and 92.7% (38/41) of the benign nodules had higher VIs in the shell of the lesion than that of the whole lesion,and 80.4%(41/51) of the malignant nodules and 95.1% (39/41) of the benign nodules had higher FIs in the shell of the lesion than that of the whole lesion.

CONCLUSIONSQuantitative 3D power Doppler ultrasound provides a useful tool in distinguishing benign and malignant thyroid nodules. The malignant thyroid nodules have lower echoes than the benign nodules, wherese the benign nodules have larger blood flow than the malignant nodules.

Metabolic syndrome, a constellation of cardiovascular disease risk factors, is a global pandemic. Over 30% of the adult population in both South Korea and the United States are currently classified as having metabolic syndrome. Vascular endothelial function is a precursor of future atherosclerotic cardiovascular disease. Conduit artery flow-mediated dilation using ultrasonography is considered the non-invasive, gold standard for assessing nitric oxide-mediated vascular endothelial function. Patients with metabolic syndrome commonly exhibit increased insulin resistance and hyperglycemia, which are thought to impair vascular endothelial function by increasing oxidative stress and reducing nitric oxide bioavailability in the vascular endothelium and in smooth muscle cells. Previous findings have indicated that long-term aerobic exercise has a positive effect on impaired vascular endothelial function in metabolic syndrome patients, but the underlying mechanisms have not been fully elucidated. Therefore, further studies are needed that will apply different exercise modalities and intensities with the goal of improving vascular endothelial function in patients with metabolic syndrome, as well as investigation of the associated mechanisms. Ultimately, well-designed future studies will help to establish and develop exercise prescription and/or exercise therapy programs that can reduce cardiovascular disease risk and improve cardiovascular health in metabolic syndrome patients.
Adult ; Arteries ; Biological Availability ; Cardiovascular Diseases ; Endothelium, Vascular ; Exercise ; Exercise Therapy ; Humans ; Hyperglycemia ; Insulin Resistance ; Korea ; Myocytes, Smooth Muscle ; Nitric Oxide ; Oxidative Stress ; Pandemics ; Prescriptions ; Risk Factors ; Ultrasonography ; United States

PURPOSE: To evaluate the findings of carotid ultrasonography performed on patients with retinal vascular disease and to determine the risk of cardiovascular disease and association of retinal vascular disease and cardiovascular disease. METHODS: From December 2009 to May 2012, patients diagnosed with central retinal artery occlusion (CRAO, n = 18), central retinal vein occlusion (CRVO, n = 23), and branch retinal vein occlusion (BRVO, n = 68) underwent carotid ultrasonography. We evaluated the intima-media thickness (IMT) of the common carotid artery (CCA) and the internal carotid artery (ICA), stenosis and the number of plaques, and then compared these results with those of a healthy control group (n = 221). RESULTS: The mean CCA-IMT and ICA-IMT were significantly higher in the CRAO and BRVO groups compared with the control group. On the contralateral side, CCA-IMT was increased in the CRAO, BRVO, and CRVO groups and ICA-IMT was increased in the CRAO and BRVO groups compared with the control group. Contralateral CCA stenosis was higher in the CRVO group (9.1%) and ipsilateral ICA stenosis in CRAO group (21.7%) was significantly higher than that of the control group. Plaque was observed better in all groups compared with the control group. The proportion of patients risk for cardiovascular disease, i.e. those who had IMT thickenesses more than 1.0 mm, was higher in the CRAO and BRVO groups compared with the control group. CONCLUSIONS: The carotid ultrasound findings of patients with retinal vascular diseases showed increased IMT and plaque. The group of patient at risk for cardiovascular disease, which was defined with carotid artery IMT, was higher in patients with retinal vascular disease. Therefore, in patients with retinal vascular disease, carotid artery ultrasonography and the overall management and treatment of cardiovascular disease are necessary.
Cardiovascular Diseases ; Carotid Arteries ; Carotid Artery, Common ; Carotid Artery, Internal ; Constriction, Pathologic ; Ultrasonography ; Humans ; Retinal Artery Occlusion ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde* ; Ultrasonography* ; Vascular Diseases*

BACKGROUND: Pigmented purpuric dermatoses (PPD) are chronic, recurrent group of disorders characterized by petechial and pigmentary macules usually localized on the lower limbs. Its etiopathogenesis is unknown. There are very few clinical and etiological studies on PPD in the literature. OBJECTIVE: We aim to examine the etiopathogenetic factors of PPD retrospectively. METHODS: Demographic characteristics, history of co-morbid disorders and drug usage, hepatitis markers, levels of serum lipids, findings of Doppler ultrasonography in lower extremities, and patch test results of the 24 patients of PPD were examined retrospectively. The patch test results, history of drug use, and co-morbid disorders of the patients were compared with those of the control groups. RESULTS: The male-to-female ratio was 1 : 2, and 83.3% of the patients had Schamberg disease. Seventeen patients had co-morbid disorders and 16 used various drugs, but there was no statistically significant difference between the controls and patients. One patient was positive for hepatitis B surface antigen and 1, for anti-hepatitis C virus antibody. Nine had elevated total cholesterol levels, and 5 had elevated triglyceride levels. Further, 30% of them were positive for at least 1 allergen, while 16% of the control subjects were positive for at least 1 allergen, but statistically significant difference was not found between the 2 groups. Variable degrees of venous insufficiency were detected in 75% of the patients on Doppler ultrasonography of the lower extremities. CONCLUSION: Venous insufficiency and hypercholesterolemia might be the basic predisposing factors for PPD. Further studies are needed to show if diabetes mellitus and hypertension may cause perivascular inflammation in PPD.
Causality ; Cholesterol ; Diabetes Mellitus ; Hepatitis ; Hepatitis B Surface Antigens ; Humans ; Hypercholesterolemia ; Hypertension ; Inflammation ; Lower Extremity ; Patch Tests ; Pigmentation Disorders ; Retrospective Studies ; Skin Diseases* ; Triglycerides ; Ultrasonography, Doppler ; Vascular Diseases ; Venous Insufficiency

OBJECTIVE: The link among carotid intima-media thickness (IMT), vascular elastic property and the disease activity of systemic lupus erythematosus (SLE) is not well defined. We investigated the association between carotid atherosclerosis, elastic properties of the carotid arterial wall and clinical parameters of SLE. METHODS: Fifty-one SLE patients and fifty healthy controls were included. Peak systolic global circumferential and posterior radial strains of carotid artery were measured to assess the elastic properties. Beta stiffness index was used as conventional method for the distensibility of the carotid artery. Information concerning SLE duration, cumulative dose of steroids and/or immunosuppressive drug intake was recorded, and SLE activity was assessed by SLE disease activity index (SLEDAI) score. RESULTS: Carotid plaques were more common in SLE patients. SLE patients with plaques were older and showed the increased mean IMT, high sensitivity C-reactive protein (hs CRP), IgG anti-cardiolipin antibody (aCL), and longer disease duration compared with those without plaques. Peak systolic global circumferential and posterior radial strain as well beta stiffness index were significantly lower in SLE group. Age, disease duration, hsCRP, IgG aCL showed significant correlations with mean IMT and parameters of carotid elastic property (all P's<0.05). CONCLUSIONS: Carotid atherosclerosis was more common in SLE patients, and carotid arterial stiffness had significant correlation with disease duration, hsCRP and IgG aCL level. Speckle tracking strain imaging is a comparative method for the assessment of elastic properties of carotid artery of SLE patients.
C-Reactive Protein ; Carotid Arteries* ; Carotid Artery Diseases* ; Carotid Intima-Media Thickness ; Humans ; Immunoglobulin G ; Lupus Erythematosus, Systemic* ; Steroids ; Ultrasonography ; Vascular Stiffness

No abstract available.
Aged ; Coronary Vessel Anomalies/radiography/*ultrasonography ; Female ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Ultrasonography, Interventional ; Vascular Diseases/*congenital/radiography/ultrasonography