Comparison of Lumbar Lordosis according to Heel Height in Normal Adults and Patients with Spondylolisthesis

OBJECTIVE: To evaluate how to influence static lumbar lordosis by different heel heights in normal adults and patients with spondylolisthesis. METHOD: The lumbolumbar angles, lumbosacral angles and slip angles were examined while standing on barefoot, on heel support with 5 cm heel, and with 10 cm heel in 14 normal adults and 10 patients with first grade of spondylolisthesis. Standing lumbar spine lateral view was performed by one half hour adaptation with corresponding shoe types. RESULT: The lumbolumbar angles (angles between upper margin of 2nd lumbar body and low margin of 5th lumbar body) and the lumbosacral angles (between upper margin of 2nd lumbar body and low margin of 1st sacral body) in normal are 36.8+/-6.5degrees, 50.1+/-9.5degrees on barefoot, 36.0+/-7.3degrees, 49.6+/-7.4degrees on heel support with 5 cm heel, and 36.1+/-7.6degrees, 49.7+/-8.3degrees with 10 cm heel. Lumbolumbar angles and lumbosacral angles in 10 patients with spondylolisthesis 38.8 8.3degrees on barefoot, 47.2+/-10.4degrees on heel support with 5 cm heel, 38.3+/-7.0degrees, 47.7+/-9.2degrees with 10 cm heel. The slip angles in 10 patients with spondylolisthesis are 29.8+/-1.2degrees on barefoot, 30.2+/-1.8degrees on heel support with 5 cm heel, and with 10 cm heel. CONCLUSION: The changes of heel height did not significantly influence the lumbar lordosis in normal adults and patients with spondylolisthesis. There were no significant differences in average slip angle according to heel height in patients with spondylolisthesis were found.

The Associated Factors of Osteoporosis in Bone Mineral Density

OBJECTIVE: To determine the correlation between osteoporosis and the related factors through retrospective study. METHOD: Data from 1002 patients (834 women and 168 men) were analyzed through medical records [bone mineral density (BMD), age, height (Ht), body weight (BW), body mass index (BMI), and the accompanying conditions]. BMD of lumbar spine (L1-4) and femur (neck, Ward's triangle, trochanter, and shaft) were measured using dual energy x-ray absorptiometry (DEXA) and were correlated with age, Ht, BW, BMI, and accompanying diseases, and fracture incidence. RESULTS: 1) BMD of lumbar spine and femur neck in women significantly correlated with age and that of lumbar spine in men significantly correlated with BMI, Ht, BW. 2) The accompanying conditions in osteoporosis were diabetes mellitus (5.9%), Cushing syndrome (3.7%), oophorectomy (2.8%), hyperthyroidism (2.6%), and chronic renal failure (1.0%). 3) Fracture sites and their incidences were single spine (4.89%), multiple spine (2.99%), and femur (2.0%). 4) Mean BMD and T-score in fracture group was 0.687+/-0.16 g/cm2, 3.51+/-1.3 in lumbar spine and 0.578+/-0.14 g/cm2, 2.70+/-1.1 in femur, respectively. CONCLUSION: Osteoporosis is a major public health problem among the elderly, demanding effective strategic approach for prevention and treatment. We concluded that further studies of male osteoporosis are required.

Observation of Treatment Outcome with Radiography in Adhesive Capsulitis of Shoulder

OBJECTIVE: In adhesive capsulitis, assessment of the mobility of the shoulder are likely to have intrinsic error because of the altering scapulohumeral rhythm and extrinsic error. For more objective and the precise assessment of shoulder mobility in adhesive capsulitis, we observed proper glenohumeral movement, the change of scapulohumeral angle, the scapulohumeral rhythm were evaluated with radiography and compared with clinical measurement of shoulder range of motion (ROM). METHOD: The subjects were 19 patients (21 shoulder) with adhesive capsulitis of the shoulder and undertook combination treatment of distention arthrography, per os medication of non-steroid anti- inflammatory drug, stellate ganglion block, physical therapy including exercise. We assessed change in visual analogue scale (VAS), joint space capacity, shoulder mobility by measurement of ROM, and scapulohumeral angle in active shoulder abduction under the fluroscopy. RESULTS: All the subjects experienced pain relief, increased shoulder mobility and restoration of scapulohumeral rhythm. The improvement of the shoulder extension and scapulohumeral angle is well correlated with the change of VAS and joint capacity. However, the improvement of the shoulder flexion, abduction, external rotation and internal rotation were poor correlated with them. CONCLUSION: We propose the measurement of scapulohumeral angle with active shoulder abduction in shoulder AP view as an assessment method for shoulder mobility in adhesive capsulitis.

Change of Abnormal Spontaneous Activities According to Time Course in Hemiplegic Upper Limb

OBJECTIVE: To evaluate the change of abnormal spontaneous activities according to the clinical and radiologic findings, and to the time course after onset in hemiplegic upper limb. METHOD: We scored abnormal spontaneous activities of hemiplegic upper limb muscles (infraspinatus, deltoid, extensor carpi radialis, abductor pollicis brevis, abductor digiti minimi) in 100 hemiplegic patients without peripheral neuropathy. The abnormal spontaneous activities were evaluated according to their radiologic findings and to Brunnstrom stage and the presence of reflex sympathetic dystrophy (RSD), and the time course after the onset (A cross-sectional study). In addition we repeatedly examined 40 hemiplegic patients until 12 weeks after the onset to define the pattern of change (A prospective study). RESULTS: There was no significant difference in the score of abnormal spontaneous activities according to the radiologic findings. The score of abnormal spontaneous activities decreased while Brunnstrom stage progressed. In both the cross-sectional and prospective studies, we found that the abnormal spontaneous activities decreased according to the time course after the onset in the limb without RSD, but sustained in the limb with RSD. CONCLUSION: Abnormal spontaneous activities decreased according to the progression of Brunnstrom stages. The hemiplegic patients with RSD showed more profuse and sustained abnormal spontaneous activities at needle EMG study of hemiplegic upper limb than the patients without RSD.

A Case Report of Congenital Carpal Tunnel Syndrome

OBJECTIVE: To evaluate a child who presented bilateral hypoplasia of the thenar eminences and clumsy hands without sensory loss or nocturnal pain. METHOD: A careful history taking, physical examination, plain X-ray and electrophysiologic examination. RESULT: No familial history nor a systemic etiology were identified in this patient. Physical examination revealed a marked flattening of both thenar eminences and weakness of the abductor pollicis brevis and opponens pollicis of both hands. There was no sensory loss nor neurologic abnormality. X-rays of the hands showed thin both proximal end of the first metacarpals. The electrophysiologic examination showed electreical silence of both thenar eminences. History taking, physical examination, X-ray findings and electrophysiologic findings were all compatible with the Cavanagh syndrome. CONCLUSION: A careful history taking, physical examination and electrophysiologic examination are improtant for the diagnosis of congenital carpal tunnel syndrome.

Mononeuritis Multiplex in Association with Anti-neutrophil Cytoplasmic Autoantibody(?) Vasculitis: A case report

Mononeuritis multiplex may be a manifestation of systemic vasculitis or of other illnesses such as sarcoidosis, diabetes, lymphoma, and AIDS. Anti-neutrophil cytoplasmic autoantibody(ANCA) is a serologic marker for pauci-immune crescentic glomerulonephritis and systemic necrotizing arteritis, including polyarteritis nodosa, Wegener's granulomatosis and so-called ANCA-associated vasculitis. We report a case of mononeuritis multiplex due to ANCA associated vasculitis. A 46-year-old female visited hospital because of peripheral edema, pain and dyspnea. We diagnosed neuropathy associated with vasculitis by electrophysiologic study, sural nerve biopsy and angiography. The patient was treated with prednisolone and cyclophosphamide. Her symptoms and signs improved and her ANCA test was converted from positive to negative.

99mTc-HMPAO regional cerebral blood flow SPECT in cerebral infarctsand ischemia

No abstract available.