OBJECTIVE: To determine the possibility of a new measurement tool using electromyography and ultrasonography for quantitative spasticity assessment in post-stroke patients. METHODS: Eight hemiplegic stroke patients with ankle plantarflexor spasticity confirmed by a Modified Ashworth Scale (MAS) were enrolled. Spasticity was evaluated using the MAS and Modified Tardieu Scale (MTS). Each subject underwent surface electromyography (sEMG) using the Brain Motor Control Assessment (BMCA) protocol and was compared with a healthy control group. Using ultrasonography, muscle architecture and elasticity index were measured from the medial gastrocnemius muscle (GCM) on the affected and unaffected sides. RESULTS: MAS and MTS revealed significant correlation with sEMG activity. The fascicle length and pennation angle were significantly decreased in the medial GCM on the hemiplegic side compared with the unaffected side. The elasticity index of the spastic medial GCM was significantly increased compared with the unaffected side. The MTS X and R2–R1 values were significantly correlated with the elasticity index in the hemiplegic GCM. The relationship between clinical evaluation tools and both BMCA and sonoelastography was linear, but not statistically significant in the multiple regression analysis. CONCLUSION: The BMCA protocol and ultrasonographic evaluation provide objective assessment of post-stroke spasticity. Further studies are necessary to conduct accurate assessment and treatment of spasticity.
Ankle ; Brain ; Elasticity ; Elasticity Imaging Techniques ; Electromyography ; Evaluation Studies as Topic* ; Humans ; Muscle Spasticity* ; Muscle, Skeletal ; Muscles ; Pilot Projects* ; Stroke ; Ultrasonography

STUDY DESIGN: A literature review. OBJECTIVES: To describe the causes and clinical characteristics of cauda equina syndrome. SUMMARY OF LITERATURE REVIEW: The cauda equina syndrome, complex symptoms and signs expressed as variable clinical manifestation, has rare incidence but needs attention since it can bring about serious complications and sequales if neglected. MATERIALS AND METHODS: The Author reviewed articles reporting the causes and clinical manifestation of cauda equina syndrome. RESULTS: There are marked inconsistencies in the current evidence base surrounding the definition due to various clinical presentation of cauda equina syndrome. CONCLUSION: As there is no symptom or sign which has an absolute diagnostic value in establishing the diagnosis of cauda equina syndrome, any patient in whom a clinical suspicion of cauda equina syndrome arises must undergo urgent magnetic resonance imaging for diagnosis.
Cauda Equina* ; Diagnosis ; Humans ; Incidence ; Magnetic Resonance Imaging ; Polyradiculopathy*

Although CAPD has become firmly established as an effective mode of renal replacement therapy, it's technique survival rate is much inferior compared to hemodialysis. To date, few patients have been maintained on this therapy for more than 10 years. To gain insights into clinical features of patients who had maintained over 10 years on CAPD in Korea, we retrospectively compared 23 patients who survived more than 10 years on PD(Long-term survivors, LTS) and 63 patients who died(Short-term survivors, STS-died, 41 patients) or changed to hemodialysis(STS-HD, 22 patients) within 4 years of initiating PD. For all patients, age, sex, diabetic history, prior cardiac events, body weight and biochemical profiles were analyzed. 1) The LTS were younger(39.7+/-12.4 vs. 47.7+/-12.3 vs. 60.9+/-13.8 years) compared with STS-HD and STS-died. 2) The LTS had less cases of DM(4.3% vs. 31.8 % vs, 61%), and had less cases of prior cardiac events(4.3% vs. 4.5% vs, 34.1%) compared with STS-HD and STS-died. Sex ratio and body weight were comparable in three groups. 3) At the initiation of PD, the LTS had higher serum creatinine(16.7mg/dL vs. 12.4mg/dL vs, 8.4mg/dL), albumin(3.53g/dL vs. 3.27g/dL vs, 3.20g/dL) levels compared with STS-HD and STS-died. 4) During 10 year CAPD treatment, LTS showed relatively stable body weight except the increase of body weight for the first 2 years in female. BUN, creatinine, protein, albumin constantly increased for the first 4 years, and then started to decline by 4 th to 6 th years. In conclusion, young age, non-diabetic history, less prior cardiac events and good nutritional status can predict the long-term survival on peritoneal dialysis. The evaluation of nutritional status and nutritional support by 4 th to 6 th years may be important in maintaining long-term survival in CAPD patients.
Body Weight ; Creatinine ; Female ; Humans ; Korea ; Nutritional Status ; Nutritional Support ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Renal Dialysis ; Renal Replacement Therapy ; Retrospective Studies ; Sex Ratio ; Survival Rate ; Survivors

Over the past four decades after Korean War, a great deal of data and clinical experiences have been accumulated relating to the diagnosis and surgical treatment of cardiovascular diseases. Among many institutes, Seoul National University Hospital Including Children's Hospital has played a leading role up to date. Clinical data following the first open heart surgery on August 7,1959 up to December 1993 revealed that the total number of open heart surgery was cises in Seoul National University Hospital and overall mortality was 6.8%. Since 1977, the cases of open heart surgery has rapidly increased due to two main reasons : Accumulation of untreated cardiac patients and widening coverage by national medical insurance. The number of cases exceeded 100 in 1978, 400 in 1980, 600 in 1982 and 700 in 1986. In the second half of 1980's and 1990's the number of cases were over 700 per year. The ratio of congenital to acquired heat disease was 1.5:1 , and that of acyanotic to cyanotic congenital cardiac anomaly was 2.0: 1. The order of frequency of acyanotic group was Ventricular Septal Defect(56.4%), Atrial Septal Defect(28.6%), Endocardial Cushion Defect(4.6%), Pulmonary Stenosis(2.9%) and Patent Ductus Arteriosus(1.0%). Whereas the incidence of cyanotic group was Tetralogy of Fallot(57.5%), Transpotion of Great Arteries(9.5%),Double Outlet Right Ventricle(8.7%) and Pulmonary Atresia(5.7%). The overall mortality of acyanotic congenital heart disease was 2.9% and that of cyanotic congenital heart disease was 16.7%. Transposition of Great Arteries, Pulmonary Atresia and Truncus Arteriosus especially resulted in very high mortality,25-30%. The causes of high mortality in these group were inadequate patient selection for operation, inexperienced perioperative neonatal care and unskiled operative technique, but the figure was remarkebly improved since 1990, and now operative mortality reached under 10%. In 2019 cased of valvular heart disease, single mitral valve disease was most common (1139 cases) and double valvular disease was 534 cases and triple valvular disease was 41 cases. According to the order of frequency in redo valvular disease was 6,0%. The frequency of ischemic heart disease and aortic disease were not so frequency previously but these figures rapidly increase in recent days. The first CABG was performed at this hospital in 1981 and 240 cases have been performed by 1993.Overall mortality was 7.1%. The number of cases in 1993 was increased two times compared to 1992, but the mortality was decreased to 2.4%. Acute aortic dissection (57 cases) was most common among 127 cases of aortic disease which was operative mortality was 26.3% which was very high. Mortality gradually decreased recently down to zero because of appropriate brain protection technique including deep hypothemia, circulatory arrest and selective cerebral perfusion. In Korea, brain death is not accepted by law as well as traditional concept. However in 1993 and up to now, five cases of heart transplantation were performed by voluntary consent of familly of the donor and recipient.
Academies and Institutes ; Aortic Diseases ; Brain ; Brain Death ; Cardiovascular Diseases ; Diagnosis ; Endocardial Cushions ; Heart Defects, Congenital ; Heart Transplantation ; Heart Valve Diseases ; Heart* ; Hot Temperature ; Humans ; Incidence ; Insurance ; Jurisprudence ; Korea ; Korean War ; Mitral Valve ; Mortality ; Myocardial Ischemia ; Patient Selection ; Perfusion ; Pulmonary Atresia ; Seoul ; Thoracic Surgery* ; Tissue Donors ; Transposition of Great Vessels ; Truncus Arteriosus

Over the past four decades after Korean War, a great deal of data and clinical experiences have been accumulated relating to the diagnosis and surgical treatment of cardiovascular diseases. Among many institutes, Seoul National University Hospital Including Children's Hospital has played a leading role up to date. Clinical data following the first open heart surgery on August 7,1959 up to December 1993 revealed that the total number of open heart surgery was cises in Seoul National University Hospital and overall mortality was 6.8%. Since 1977, the cases of open heart surgery has rapidly increased due to two main reasons : Accumulation of untreated cardiac patients and widening coverage by national medical insurance. The number of cases exceeded 100 in 1978, 400 in 1980, 600 in 1982 and 700 in 1986. In the second half of 1980's and 1990's the number of cases were over 700 per year. The ratio of congenital to acquired heat disease was 1.5:1 , and that of acyanotic to cyanotic congenital cardiac anomaly was 2.0: 1. The order of frequency of acyanotic group was Ventricular Septal Defect(56.4%), Atrial Septal Defect(28.6%), Endocardial Cushion Defect(4.6%), Pulmonary Stenosis(2.9%) and Patent Ductus Arteriosus(1.0%). Whereas the incidence of cyanotic group was Tetralogy of Fallot(57.5%), Transpotion of Great Arteries(9.5%),Double Outlet Right Ventricle(8.7%) and Pulmonary Atresia(5.7%). The overall mortality of acyanotic congenital heart disease was 2.9% and that of cyanotic congenital heart disease was 16.7%. Transposition of Great Arteries, Pulmonary Atresia and Truncus Arteriosus especially resulted in very high mortality,25-30%. The causes of high mortality in these group were inadequate patient selection for operation, inexperienced perioperative neonatal care and unskiled operative technique, but the figure was remarkebly improved since 1990, and now operative mortality reached under 10%. In 2019 cased of valvular heart disease, single mitral valve disease was most common (1139 cases) and double valvular disease was 534 cases and triple valvular disease was 41 cases. According to the order of frequency in redo valvular disease was 6,0%. The frequency of ischemic heart disease and aortic disease were not so frequency previously but these figures rapidly increase in recent days. The first CABG was performed at this hospital in 1981 and 240 cases have been performed by 1993.Overall mortality was 7.1%. The number of cases in 1993 was increased two times compared to 1992, but the mortality was decreased to 2.4%. Acute aortic dissection (57 cases) was most common among 127 cases of aortic disease which was operative mortality was 26.3% which was very high. Mortality gradually decreased recently down to zero because of appropriate brain protection technique including deep hypothemia, circulatory arrest and selective cerebral perfusion. In Korea, brain death is not accepted by law as well as traditional concept. However in 1993 and up to now, five cases of heart transplantation were performed by voluntary consent of familly of the donor and recipient.
Academies and Institutes ; Aortic Diseases ; Brain ; Brain Death ; Cardiovascular Diseases ; Diagnosis ; Endocardial Cushions ; Heart Defects, Congenital ; Heart Transplantation ; Heart Valve Diseases ; Heart* ; Hot Temperature ; Humans ; Incidence ; Insurance ; Jurisprudence ; Korea ; Korean War ; Mitral Valve ; Mortality ; Myocardial Ischemia ; Patient Selection ; Perfusion ; Pulmonary Atresia ; Seoul ; Thoracic Surgery* ; Tissue Donors ; Transposition of Great Vessels ; Truncus Arteriosus

No abstract available.

No abstract available.
Fontan Procedure*

No abstract available.
Diagnosis* ; Thrombosis*

No abstract available.
Thoracic Surgery*

Heart failure unresponsive to bed rest, low sodium diet, digitalis, diuretics, vasodilators and cardiac inotropic agents is a difficult therapeutic problem. Although remission was achieved with such treatment, its duration was short and easily recurred. We present a report of severe refractory congestive heart failure in three patients successfully treated with Continuous Ambulatory Peritoneal Dialysis (CAPD). These patients were admitted to the hospital many times and treated by conventional methods but cannon maintain their condition for a long time. In all three patients, edema, pulmonary congestion, electrolyte abnormalities, decreased ejection fraction and fractional shortening of myocardioum were eliminated or improved by CAPD. All three patients improved from Class IV congestive heart to Class II, as defined by the New York Heart Association, and experienced a define improvement in their sense of well being We conclude CAPD as an effective and the useful treatment for servere congestive heart failure refractory to conventional medical treatments.
Bed Rest ; Diet ; Digitalis ; Diuretics ; Estrogens, Conjugated (USP)* ; Heart ; Heart Failure* ; Humans ; Peritoneal Dialysis, Continuous Ambulatory ; Pulmonary Edema ; Sodium ; Vasodilator Agents