Metronidazole Induced Encephalopathy with Peripheral Polyneuropathy in Patient with Spinal Cord Injury

황기훈,심영주,정호중,김기찬,신배욱,정주호 대한척추신경외과학회 2012 Neurospine Vol.9 No.1

Metronidazole may produce a number of neurologic side effects including peripheral neuropathy, seizure, encephalopathy. We experienced neurological side effects of metronidazole. The 32-year-old female patient with spinal cord injury was diagnosed as encephalophathy and peripheral polyneuropathy resulting from complication of metronidazole. It was difficult to diagnose at first glance using clinical findings because of paraplegia due to spinal cord injury. But through magnetic resonance imaging with diffusion weighted imaging and electrophysiologic study, the patient showed to have characteristic abnormalities that of a person suffering from metronidazole-induced encephalopathy and peripheral polyneuropathy. Whether the symptoms were caused by a peripheral nerve lesion or MIE, the patient’s paraplegia prevented to appear other symptoms, such as ataxic gait and seizure, from manifesting. In such case as this, an active differentiated diagnosis is crucial.

Arnold Chiari I Malformation with Tip-Toe Gait: A Case Report

황기훈,김기찬,정호중,심영주,박용석 대한척추신경외과학회 2013 Neurospine Vol.10 No.1

The Arnold-Chiari type I malformation has many symptoms such as headache, neck pain, gait impairment, abnormal movements or postures. But a few cases reported association of specific symptom including headache, neck pain, vertigo or ataxia. We report a case of 12 year-old boy presenting with tip-toe gait. Magnetic resonance imaging (MRI) study of brain and spine revealed underlying Arnold-Chiari type I malformation. This case shows that it is need for central nervous system evaluation in patients with changes of lower extremities tone.

Clinical Effectiveness of Complex Decongestive Physiotherapy for Malignant Lymphedema: A Pilot Study

황기훈,정호중,김기찬,심영주 대한재활의학회 2013 Annals of Rehabilitation Medicine Vol.37 No.3

Objective To evaluate the effect of complex decongestive physiotherapy (CDPT) on malignant lymphedema patients. Methods Patients (n=22) with malignant lymphedema of the upper or the lower limb were assigned to this study. CDPT without manual lymphatic drainage (MLD) was used five times per week for two weeks. The main outcome measurements included measurement of the circumference of the limb (proximal, distal, and total) to assess volume changes. We also employed the visual analog scale (VAS) to evaluate pain, and the short form-36 version 2 questionnaire (SF-36) to assess quality of life (QOL). All items were assessed pre and post-treatment for each patient.Results There was a statistically significant difference in the volume change of the upper limbs (3.7%, p=0.001) and the lower limbs (10.9%, p=0.001). A 1.5 point reduction on the ten-point VAS was noted after CDPT. The scores on the physical and the mental components of the SF-36 showed statistical improvement after treatment (p=0.006, p=0.001, respectively).Conclusion These results suggest that all components of the CDPT program except MLD are helpful in treating malignant lymphedema in terms of pain reduction and reduction of the volume of the affected upper or lower limb. This treatment regimen also has positive effects on QOL.

편마비 환자의 견관절 아탈구에 대한 테이핑 신전율 차이에 따른 효과 비교

황기훈,이지형,심영주,김기찬,정호중 대한재활의학회 2010 Annals of Rehabilitation Medicine Vol.34 No.3

Objective: To investigate the effects of elasticity difference in strapping therapy for 4 weeks in the patients with hemiplegic shoulder. Method: Total sixty-two patients with hemiplegic shoulder were randomly enrolled to three groups. In group I, two parts of a Y shaped first tape, were attached from humeral insertion of deltoid muscle to clavicle midline, following anterior and mid deltoid line, respectively, with 125% elasticity. And two parts of a Y shaped second tape were attached horizontally from head of greater tubercle to medial end of scapular spinous process, following supraspinatus and infraspinatus muscles, respectively, with 125% elasticity. Group II patients were applied by the tape with 100% elasticity. Group III was control. The effects of strapping therapy were evaluated by using visual analogue scale (VAS), range of motion (ROM), vertical distance (VD), horizontal distance and joint distance on radiologic findings of plain anteroposterior view and lateral distance on shoulder ultrasonography which was examined between lateral border of acromion and greater tuberosity of humeral head, at entry, 14 and 28 days later. Results: Repeated measured ANOVA indicated that the all groups of the VD showed corrective effect (p<0.05). And for early 14 days, reductions of VAS between the study group I and the other groups were meaningful at this study (p<0.05). Conclusion: The strapping therapy is a useful therapeutic tool to decrease the degree of shoulder subluxation and to reduce pain in early rehabilitation therapy of patients with post-stroke hemiplegic subluxation (J Korean Acad Rehab Med 2010; 34: 304-309) Objective: To investigate the effects of elasticity difference in strapping therapy for 4 weeks in the patients with hemiplegic shoulder. Method: Total sixty-two patients with hemiplegic shoulder were randomly enrolled to three groups. In group I, two parts of a Y shaped first tape, were attached from humeral insertion of deltoid muscle to clavicle midline, following anterior and mid deltoid line, respectively, with 125% elasticity. And two parts of a Y shaped second tape were attached horizontally from head of greater tubercle to medial end of scapular spinous process, following supraspinatus and infraspinatus muscles, respectively, with 125% elasticity. Group II patients were applied by the tape with 100% elasticity. Group III was control. The effects of strapping therapy were evaluated by using visual analogue scale (VAS), range of motion (ROM), vertical distance (VD), horizontal distance and joint distance on radiologic findings of plain anteroposterior view and lateral distance on shoulder ultrasonography which was examined between lateral border of acromion and greater tuberosity of humeral head, at entry, 14 and 28 days later. Results: Repeated measured ANOVA indicated that the all groups of the VD showed corrective effect (p<0.05). And for early 14 days, reductions of VAS between the study group I and the other groups were meaningful at this study (p<0.05). Conclusion: The strapping therapy is a useful therapeutic tool to decrease the degree of shoulder subluxation and to reduce pain in early rehabilitation therapy of patients with post-stroke hemiplegic subluxation (J Korean Acad Rehab Med 2010; 34: 304-309)

Causes of Shoulder Pain in Women with Breast Cancer-Related Lymphedema: A Pilot Study

정호중,심영주,황기훈,김기찬 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.4

Purpose: To inform on shoulder pathology and to identify the disabilities and level of quality of life (QOL) associated with shoulder pain in patients with breast cancer-related lymphedema (BCRL). Materials and Methods: Using patient history, physical examination, and ultrasound (US), we classified patients with BCRL into the following three groups: no pain with normal ultrasound (US), pain with normal US, and pain with abnormal US. We evaluated shoulder pathology using US, pain intensity using a visual analogue scale (VAS), and functional disability using the Korean version of the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire. For assessment of QOL, we used the Korean version of the brief form of the World Health Organization Quality of Life Assessment Instrument (WHOQOL-BREF). Results: 28.9% of patients had no pain and normal US, 31.6% had pain with normal US, and 39.5% had pain with abnormal US. The US findings for those with pain and abnormal US revealed the following: 53.3% had a supraspinatus tear, 13.3% had biceps tenosynovitis, 13.3% had acromioclavicular arthritis, 13.3% had subdeltoid bursitis, and 53.3% had adhesive capsulitis. Patients with shoulder pain and abnormal US findings had significantly higher mean DASH and pain scores. Pain scores were positively correlated with DASH scores and negatively correlated with QOL. Conclusion: We found that BCRL with shoulder pain and evidence of shoulder pathology on US was associated with reduced QOL and increased disability. Proper diagnosis and treatment of shoulder pain are necessary to improve QOL and decrease disability in patients with BCRL.

Self-Knotting of Nasogastric Tube in a Stroke Patient with Dysphagia: A Case Report

강인현,배민준,Yangrok Hur,황기훈 대한연하장애학회 2020 대한연하장애학회지 Vol.10 No.2

In cases of inadequate nutrition among individuals with dysphagia, nasogastric tube insertion is considered for nutritional supplementation. Typically, the complications of nasogastric tube insertion are not severe. In rare cases, however, nasal or nasopharyngeal injury caused by the self-knotting of nasogastric tubes can occur. This paper presents a case of spontaneous knotting of a nasogastric tube and its removal in a patient with aspiration pneumonia caused by dysphagia. This case shows that self-knotting must be considered when there is strong resistance during the removal of a nasogastric tube.

부인암 관련 하지 림프부종의 유병률 및 위험인자

강승훈 ( Seung Hoon Kang ),황기훈 ( Ki Hun Hwang ),심영주 ( Young Joo Sim ),정호중 ( Ho Joong Jeong ),이태화 ( Tae Hwa Lee ),김성한 ( Sung Han Kim ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.8

목적: 한국에서 부인과 관련 암 치료를 받은 환자에서 하지부종의 유병률과 위험 인자의 확인하기 위하여 시행되었다. 연구 방법: 2003년 1월부터 2006년 12월까지 4년 동안 수술적 치료 및 비수술적 치료를 받은 242명의 부인과 암 환자의 의무기록과 면담을 후향적으로 분석하였다. 의무기록 혹은 면담에 의한 기록을 통해 하지부종이 있는 환자를 확인하였고, 그 후 통계학적인 특징, 다른 의학적 병력, 암의 유형과 병기, 림프절의 절제, 수술방법, 항암치료, 방사선치료, 호르몬치료와 혈액검사 결과를 확인하였다. 그리고 이 결과로부터 다중 다변량 회귀분석을 통하여 하지의 림프부종에 대한 위험 요인을 평가하였다. 결과: 242명의 환자 중 48명 (19.8%)에서 하지 림프부종이 있었다. 하지부종이 있는 환자들은 체질량 지수가 더 높았고, 방사선치료, 항암 치료의 병력이 있었으며, 림프절절제와 근치적 자궁절제술을 받았던 경우가 많았다. 다변량 분석을 통해 체질량 지수, 방사선 치료 병력과 림프절절제는 부인과 암치료 후 하지부종에 대한 독립적 위험 인자임을 보였다. 결론: 방사선 치료를 받았거나, 체질량 지수가 25 이상인 경우 그리고 림프절 절제를 시행한 환자는 부인과 암치료 후 하지부종이 발생할 가능성이 있다. 그래서 이들 환자들은 추적관찰 기간 동안 질병의 발생률과 예방법과 치료에 대하여 교육을 받아야 한다. Objective: To identify the prevalence and risk factors for lower limb lymphedema in the patients after gynecologic neoplasms treatment in Korea. Methods: We retrospectively reviewed the medical records and interviewed 242 gynecologic neoplasms patients who have managed surgically and medically over a 4 year period between January 2003 and December 2006. We identified the patients with lower limb lymphedema as described by the medical records or reported by the interviews. We obtained demographic characteristics, other medical history, cancer type, stage of cancer, lymph node dissection, chemotherapy, radiotherapy, hormone therapy and laboratory findings. Multiple logistic regression analysis was done to evaluate the risk factors for lower limb lymphedema. Results: Forty eight (19.8%) patients out of two hundred forty two had lower limb lymphedema. Those patients with lower limb lymphedema had a higher body mass index, radiotherapy history, chemotherapy history and lymph node dissection history, radical hysterectomy. Multivariate analysis revealed that body mass index, radiotherapy and lymph node dissection were independently risk factors for lower limb lymphedema after gynecologic neoplasms treatment. Conclusion: The patients who had radiotherapy, body mass index greater than 25 or lymph node dissection must be considered as potential candidates to have lower limb lymphedema in the patients after gynecologic neoplasms treatment. Therefore, these patients should be informed during the follow-up period about this morbidity, the preventive measures, and the treatments.

Association of Brain Lesions and Videofluoroscopic Dysphagia Scale Parameters on Patients With Acute Cerebral Infarctions

모상준,정호중,한용현,황기훈,최종경 대한재활의학회 2018 Annals of Rehabilitation Medicine Vol.42 No.4

Objective To investigate the characteristics and risk factors of dysphagia using the videofluoroscopic dysphagia scale (VDS) with a videofluoroscopic swallowing study (VFSS) in patients with acute cerebral infarctions. Methods In this retrospective study, the baseline VFSS in 275 stroke patients was analyzed. We divided patients into 8 groups according to lesion areas commonly observed on brain magnetic resonance imaging. Dysphagia characteristics and severity were evaluated using the VDS. We also analyzed the relationship between clinical and functional parameters based on medical records and VDS scores. Results In comparison studies of lesions associated with swallowing dysfunction, several groups with significant differences were identified. Apraxia was more closely associated with cortical middle cerebral artery territory lesions. Vallecular and pyriform sinus residue was more common with lesions in the medulla or pons. In addition, the results for the Korean version of the Modified Barthel Index (K-MBI), a functional assessment tool, corresponded to those in the quantitative evaluation of swallowing dysfunctions. Conclusion A large cohort of patients with cerebral infarction was evaluated to determine the association between brain lesions and swallowing dysfunction. The results can be used to establish a specific treatment plan. In addition, the characteristic factors associated with swallowing dysfunctions were also confirmed.

대칭적인 사지의 근력약화와 감각장애를 보인 비전신성 혈관염성 신경병 -증례보고-

이지형,김기찬,정호중,심영주,황기훈,김병훈 대한근전도전기진단의학회 2009 대한근전도 전기진단의학회지 Vol.11 No.2

Non-systemic vasculitic neuropathy is an arteriolar necrotizing vasculitis, histologically restricted to the peripheral nervous system. We report a case of a patient who had non-systemic vasculitic peripheral neuropathy that were presented muscle weakness, hypesthesia and peripheral edema. A 24 years old patient was admitted for sensory change and muscle weakness gradually aggravated and accompanied with painful edema of hand and foot, bilaterally. Physical examination revealed glove-stocking type hypesthesia in upper and lower limbs and the motor power of hands and feet was decreased to fair and good grade on manual muscle test. Apart from slight elevation of ESR and CRP, others were non-specific in hematologic test. Motor-sensory axonal loss type of peripheral polyneuropathy was detected in electrodiagnostic test. In neurohistologic test, chronic inflammatory neuropathy was found along with vasculitic change in arteriole, so patient was diagnosed as non-systemic vasculitic peripheral neuropathy.

Dysphagia due to Physiological Constriction after Stroke: A Case Report

배민준,강인현,Yangrok Hur,황기훈 대한연하장애학회 2021 대한연하장애학회지 Vol.11 No.2

The aortic arch normally causes no symptomatic physiological constriction of the esophagus. Symptoms of dysphagia are generally observed in the presence of specific conditions, such as an aortic aneurysm. In the present case, during a videofluoroscopic swallowing study (VFSS), the authors incidentally found that despite the absence of an aortic lesion, the dysphagia observed in a stroke patient was caused by compression from the aortic arch. The patient complained of discomfort when swallowing, similar to a bolus lodged in the chest, which was consistent with compression by the aortic arch found on the VFSS and chest computed tomography (CT). After undergoing dysphagia therapy, the VFSS after 52 days revealed improved swallowing function; however, the sensation of food lodging in the chest due to compression by the aortic arch persisted. We conclude that although the physiological constriction of the esophagus by the aortic arch is usually asymptomatic, the constriction can be a factor that exacerbates the swallowing function in patients with dysphagia, and should therefore be considered during the differential diagnosis.