• Title/Summary/Keyword: EXTREMITIES

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MRI Evaluation of Suspected Pathologic Fracture at the Extremities from Metastasis: Diagnostic Value of Added Diffusion-Weighted Imaging

  • Sun-Young Park;Min Hee Lee;Ji Young Jeon;Hye Won Chung;Sang Hoon Lee;Myung Jin Shin
    • Korean Journal of Radiology
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    • v.20 no.5
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    • pp.812-822
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    • 2019
  • Objective: To assess the diagnostic value of combining diffusion-weighted imaging (DWI) with conventional magnetic resonance imaging (MRI) for differentiating between pathologic and traumatic fractures at extremities from metastasis. Materials and Methods: Institutional Review Board approved this retrospective study and informed consent was waived. This study included 49 patients each with pathologic and traumatic fractures at extremities. The patients underwent conventional MRI combined with DWI. For qualitative analysis, two radiologists (R1 and R2) independently reviewed three imaging sets with a crossover design using a 5-point scale and a 3-scale confidence level: DWI plus non-enhanced MRI (NEMR; DW set), NEMR plus contrast-enhanced fat-saturated T1-weighted imaging (CEFST1; CE set), and DWI plus NEMR plus CEFST1 (combined set). McNemar's test was used to compare the diagnostic performances among three sets and perform subgroup analyses (single vs. multiple bone abnormality, absence/presence of extra-osseous mass, and bone enhancement at fracture margin). Results: Compared to the CE set, the combined set showed improved diagnostic accuracy (R1, 84.7 vs. 95.9%; R2, 91.8 vs. 95.9%, p < 0.05) and specificity (R1, 71.4% vs. 93.9%, p < 0.005; R2, 85.7% vs. 98%, p = 0.07), with no difference in sensitivities (p > 0.05). In cases of absent extra-osseous soft tissue mass and present fracture site enhancement, the combined set showed improved accuracy (R1, 82.9-84.4% vs. 95.6-96.3%, p < 0.05; R2, 90.2-91.1% vs. 95.1-95.6%, p < 0.05) and specificity (R1, 68.3-72.9% vs. 92.7-95.8%, p < 0.005; R2, 83.0-85.4% vs. 97.6-98.0%, p = 0.07). Conclusion: Combining DWI with conventional MRI improved the diagnostic accuracy and specificity while retaining sensitivity for differentiating between pathologic and traumatic fractures from metastasis at extremities.

A Case Report of Allergic Purpura (알레르기성 자반증의 증례보고 1례)

  • Lee, Ji-Hong;Yu, Sun-Ae;Lee, Seung-Yeon
    • The Journal of Pediatrics of Korean Medicine
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    • v.26 no.3
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    • pp.12-19
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    • 2012
  • Objectives The purpose of this study is to report the clinical effects of an oriental medical treatment on the patient with allergic purpura. Methods A 7-year-old female patient, who was suffering from the purpura on her extremities: swelling and arthralgia on her lower extremities, was treated by herb medicine, acupuncture and pediluvium. Results Treated only with oriental medicine, the patient's allergic symptoms were improved. When we checked back on her condition after 2 months later, she did not show any recurrence of the flares, and regained her health. Conclusions This study shows that oriental medical treatments are effective on allergic purpura, but further clinical studies are needed.

Gender Differences in Movement Patterns Used by Teenage to Rise from Supine to Erect Stance (누운 자세에서 똑바로 일어서기의 남여별 운동형태 분석)

  • Bae Sung-Soo;Park Sang-Ock
    • The Journal of Korean Physical Therapy
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    • v.6 no.1
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    • pp.147-153
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    • 1994
  • The purpose of this study were to describe the movement pattern used to rise from supine to erect stance and to evaluate the influence gender might have on the movement patterns used for rising. Fifty males and fifty-three females, mean 14 years of age, performed the rising task while being videotaped. Movement patterns were classified using categorical descriptions of the action of three body regions; the upper extremities, lower extremities, and head-trunk region. The most common pattern of males and females were symmetrical push(upper extremity), symmetrical(head-trunk) and symmetrical squat(lower extremity). In the upper extremity component, a symmetrical reach to push pattern was new category. Eighteen of males and twenty-one of females different movement pattern combinations were observed. Results indicate physical therapists should consider the patient's age and gender.

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Percutaneous Radiofrequency Thermocoagulation of the Stellate Ganglion in the Treatment of Cervical and Upper Extremity Pain -A case report- (경부 및 상지의 통증치료를 위한 성상신경절의 경피적 고주파 열응고술 -증례 보고-)

  • Kim, Ji-Young;Kim, Ki-Yeob
    • The Korean Journal of Pain
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    • v.14 no.2
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    • pp.239-244
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    • 2001
  • Stellate ganglion block (SGB) is a frequently used sympathetic block utilized to diagnose or treat various painful conditions of the cervical regions and the upper extremities. Additionally, RadioFrequency (RF) lesions of the stellate ganglion can be useful in managing sympathetically-maintained pain. Two patients were suffering from pain in the face, neck and the upper extremities were treated with stellate ganglion block. In spite of repeated blocks, the degree and duration of pain did not decrease. However, after performing radiofrequency thermocoagulation of the stellate ganglion under fluroscopy, followed by thermography on the process of treatment with RF stellate ganglion neurolysis, the patients' pain levels were alleviated after the RF lesions of stellate ganglion and the procedure also increased the temperature at the upper extremity on thermogarphy. Additionally, the patients did not complain of any remarkable complications following this procedure.

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Sympathetic Block for Treating Primary Erythromelalgia

  • Bang, Yoo-Jin;Yeo, Jin-Seok;Kim, Si-Oh;Park, Young-Hoon
    • The Korean Journal of Pain
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    • v.23 no.1
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    • pp.55-59
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    • 2010
  • Primary erythromelalgia is a rare condition that’s characterized by erythema, an increased skin temperature and burning pain in the extremities. The pain is often very severe, and treating erythromelalgia is frustrating and difficult. We report here on the case of a 12-year old girl with primary erythromelalgia in both lower extremities. The pain was refractory to medical treatment, but a bilateral sympathetic block with lidocaine and triamcinolone resulted in relief from the pain. Our experience with this disease demonstrates that sympathetic blocks are effective in improving the symptoms and they may be attempted on erythromelalgia patients who do not respond to other treatments, including medication and epidural blocks.

Bone scintigraphy in patients with pain

  • Shin, Seung Hyeon;Kim, Seong Jang
    • The Korean Journal of Pain
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    • v.30 no.3
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    • pp.165-175
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    • 2017
  • Nuclear medicine imaging is widely used in pain medicine. Low back pain is commonly encountered by physicians, with its prevalence from 49% to 70%. Computed tomography (CT) or magnetic resonance imaging (MRI) are usually used to evaluate the cause of low back pain, however, these findings from these scans could also be observed in asymptomatic patients. Bone scintigraphy has an additional value in patients with low back pain. Complex regional pain syndrome (CRPS) is defined as a painful disorder of the extremities, which is characterized by sensory, autonomic, vasomotor, and trophic disturbances. To assist the diagnosis of CRPS, three-phase bone scintigraphy is thought to be superior compared to other modalities, and could be used to rule out CRPS due to its high specificity. Studies regarding the effect of bone scintigraphy in patients with extremity pain have not been widely conducted. Ultrasound, CT and MRI are widely used imaging modalities for evaluating extremity pain. However, SPECT/CT has an additional role in assessing pain in the extremities.

Clear Cell Sarcoma of the Upper Thoracic Back Muscle

  • Kim, Dae-Hyun;Choi, Ki-Hwan;Cho, Young-Dae
    • Journal of Korean Neurosurgical Society
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    • v.45 no.2
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    • pp.112-114
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    • 2009
  • Clear cell sarcoma (CCS), also called malignant melanoma of soft parts, is a rare malignant soft tissue tumor and is often associated with tendons or aponeuroses. Most of CCS involve extremities, especially lower extremities, but a tumor occurring in the trunk is rare. We report an extremely rare case of CCS originated in the upper thoracic back muscle. To our knowledge, this case is the second report of CCS of the back muscle.

Intertester and Intratester Reliability of Tape Measurement on Lower Extremities (줄자를 이용한 하지부피 측정시 부위별 검사자간, 검사자내 신뢰도 측정)

  • Kim, Seng-Jung;Yang, Hoi-Song;Yi, Chung-Hwi
    • Physical Therapy Korea
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    • v.7 no.1
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    • pp.38-45
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    • 2000
  • Tape measurement for evaluating edema is frequently used by clinicians. The primary purpose of this study is to determine the intertester and intratester reliability of tape measurement carried out by two physical therapists on lower extremities. The intertester and intratester reliability of six anatomical landmarks measurements were determined in six healthy subjects. The measurements were taken in five sessions by each tester. The intraclass correlation coefficients (2,1) were between .87 and .99 for intertester reliability. Intratester reliability was .93 and .99 for A tester and .82 and .99 for B tester. The average range of variation was .13 to .54 in six landmarks. The reliability of six volume measurements was very high. These results support the use tape measurement as a reliable tool for measuring limb girth.

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