• Journal of The Korean Society of Integrative Medicine
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• v.9 no.2
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• pp.105-108
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• 2021

Background : Hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome is a rare, autosomal recessive metabolic disorder which is caused by genetic mutations that disrupt the urea cycle. It is characterized by variable clinical presentation and the age of onset. Patients may present with gait disturbance and progressive paraplegia and muscle tightness in the lower extremities. The use of botulinum toxin in metabolic disease has rarely been discussed. We describe a case of a 14-year-old-boy with HHH syndrome, who presented with a several - month history of gait disturbance and lower extremity weakness. Case presentation : A 14-year old male had a history of recurrent upper respiratory tract infections, occasional vomiting, loss of appetite, and general weakness, all of which started since he was 10 months old. He was diagnosed with HHH syndrome at one year of age. At the age of 14, he was referred for the assessment and treatment of his gait disturbance and aggravated weakness of the lower extremities. Brain MRI, electrodiagnostic study and blood test were performed to exclude any lesions related to neurologic dysfunction. Botulinum toxin type A were injected into muscles of adductor longus, adductor magnus, lateral and medial hamstring, and lateral and medial gastrocnemius muscle heads under needle electromyography guidance to reduce lower limb spasticity. Intensive physical therapy including gait training and stretching exercise of adductor and calf muscles were also provided. After intensive physical therapy and botulinum toxin injection to reduce lower limb spasticity, he was able to ambulate for 20 meters independently without any walking aids. There were no adverse events after the injection. Conclusion : Botulinum toxin injection is a safe and effective therapy for patients with HHH syndrome who suffer from gait disturbance.

• Journal of the Korean Society of Physical Medicine
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• v.14 no.3
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• pp.127-133
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• 2019

PURPOSE: The aim of this study was to obtain detailed and quantified data concerning the effects of plantarflexor fatigue induced to the non-paretic side on muscle activities of the bilateral lower extremities during walking in chronic stroke patients. METHODS: In this study, chronic stroke patients were evaluated for six months after the onset of stroke. To induce the non-paretic plantarflexor fatigue, 20 chronic stroke patients were asked to perform their given fatigue affecting assignments, which were presented in a forced contraction fatigue test method, until the range of motion of the plantarflexor was reduced to less than 50%. The muscle activities of the rectus femoris, tibialis anterior and gastrocnemius in the paretic and non-paretic lower extremities were measured using a wireless surface EMG before and after muscle fatigue induction. RESULTS: The findings showed that after plantarflexor fatigue was induced on the non-paretic side, a significant decrease in muscle activities of the rectus femoris on the paretic side was noted (p<.05). The muscle activities of the tibialis anterior and gastrocnemius were also observed to decrease, but, these results were not statistically significant (p>.05). In the non-paretic side, there was a significantly decrease in the muscle activities of the rectus femoris, tibialis anterior, and gastrocnemius (p<.05). CONCLUSION: These finding suggest that the muscle fatigue of the non-paretic plantarflexor affects not only the muscle activity of the ipsilateral lower extremity but also the muscles activity of the contralateral lower extremity. This highlights the necessity of performing exercise or training programs that do not cause muscle fatigue in clinical aspects.

• PNF and Movement
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• v.17 no.2
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• pp.207-214
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• 2019

Purpose: Although multi-directional reaching exercises are commonly used clinically, the effects of specific movement directions on the muscle systems of the lower extremities have not been explored. We therefore investigated lower extremity muscle activity during reaching exercises with different sagittal and horizontal plane movements. Methods: The surface electromyography responses of the bilateral rectus femoris, tibialis anterior, peroneus longus, and gastrocnemius muscles were measured during reaching exercises in three directions in the horizontal plane (neutral, $45^{\circ}$ horizontal shoulder adduction, and $45^{\circ}$ abduction) and three directions in the sagittal plane (neutral, $120^{\circ}$ flexion, and $60^{\circ}$ flexion). A total of 20 healthy, physically active participants completed six sets of reaching exercises. Two-way repeated ANOVA was performed: body side (ipsilateral and contralateral) was set as the intra-subject factor and direction of reach as the inter-subject factor. Results: Reaching at $45^{\circ}$ horizontal shoulder adduction significantly increased the activity of the contralateral rectus femoris and gastrocnemius muscles, while $45^{\circ}$ horizontal shoulder abduction activated the ipsilateral rectus femoris and gastrocnemius muscles. The rectus femoris activity was significantly higher with reaching at a $120^{\circ}$ shoulder flexion compared to the other conditions. The gastrocnemius activity decreased significantly as the shoulder elevation angle increased from $60^{\circ}$ to $120^{\circ}$. Conclusion: Our results suggest that multi-directional reaching stimulates the lower extremity muscles depending on the movement direction. The muscles acting on two different joints responded to the changes in reaching direction, whereas the muscles acting on one joint were not activated with changes in reaching direction.

• The Journal of the Korean bone and joint tumor society
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• v.4 no.2
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• pp.88-93
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• 1998

Neurilemoma usually discovered incidentally, is a benign nerve-sheath tumor which has been described as a painless mass. In most cases, the size of the mass was smaller than 5cm. However, it was reported that there were masses, sometimes associated with local tenderness and pain, whose size was over 6cm. Then, we have found there is a relationship between mass size and neurologic symptoms, as well as with, postoperative complications. It is important to diagnose early and to treat it. Twenty neurilemoma patients, who were treated at Keimyung University Dongsan Medical Center were analyzed using their clinical symptoms, pathologic findings, radiologic findings and complications. There was no sexual difference in tumor incidence. The anatomical locations of tumors were as follows. ; upper extremities in 15 cases(69%), axilla in 1 case(4%) and lower extremities in 6 cases(27%). Symptoms were palpable mass in 22 cases, local tenderness in 8 cases(36%), radiating pain in 6 cases(27%) and paresthesia in 6 cases(27%), Median nerve was involved most frequently(33%). There were 2 patients(10%) with multiple symptoms. Tumor enucleation was done in all cases. The size of tumors in longest axis was smaller than 2cm in 2 cases, between 2 and 4cm in 11 cases and more than 5cm in 9 cases. There was no case of malignant transformation or recurrence. In conclusion, incidence of clinical symptom and postoperative complications are increased with the size of the tumor especially over the 5cm. Preoperative MRI finding was the most accurate method of diagnosis and most helpful in determining surgical resection margin.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.1
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• pp.79-80
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• 2008

Including malignancy, various disease can show abnormal uptake in bone marrow. We report a case of non-specific inflammatory FDG uptake in bone marrow mimicking malignancy. A 35-year old woman with fever of unknown origin (FUO) underwent $^{18}F$-FDG PET/CT to find out fever $^{18}F$-FDG and unknown malignancy. $^{18}F$-FDG was injected and imaged 1hr after injection with Discovery ST (GE, USA), $^{18}F$-FDG PET/CT whole body image showed abnormal uptake in lower extremities (Fig. 1). MRI and biopsy was also done in the sites of abnormal uptake. PET and MRI suspect malignancy (Fig. 2, 3), but biopsy result was non-specific inflammatory process (Fig. 4). The patient was improved her clinical condition after antibiotics therapy.

• Physical Therapy Korea
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• v.13 no.3
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• pp.18-23
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• 2006

The limited walking ability after a stroke restricts a patient's independent mobility at home and in the community. It also brings about significant social handicaps. Therefore, it is necessary to improve walking ability in community-dwelling persons with stroke. The purpose of this study was to evaluate the effectiveness of gait training and muscle strengthening exercise of lower extremities in persons with chronic stroke. Nineteen community-dwelling individuals with stroke participated in this program. The exercise program lasted for seven weeks, with a 1-hour program twice per week, and it consisted of balance training, gait training, and strengthening of lower extremities. The outcome of the program was assessed by the gait speed, Wisconsin Gait Scale (WGS), Berg Balance Scale (BBS), and Stroke Impact Scale (SIS). Significant effects were found for the WGS, BBS, and mobility and hand function domain of the SIS (p<.05). It was found that short-term gait training exercise could improve quality of gait, balance, and mobility. Therefore, a more effective exercise program is required for community-based persons with stroke.

• Journal of the Korea Safety Management & Science
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• v.15 no.4
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• pp.153-160
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• 2013

The purpose of this study was to compare biomechanical factors on badminton shoes between anti-slip outsole and non anti-slip outsole. Six subjects participated in this experiment. For three-dimensional analysis, eight cameras (Oqus 3series, Qualisys) were used to acquire raw data, and then the parameters were calculated and analyzed with Visual-3D. In conclusion, the patterns of spent time during side step, and maximum velocities of CoGs were consistent without joint angles of lower extremities in spite of small differences. Those of GRFs, and moment of lower extremities were absolutely consistent. This trend of biomechanical factors was that Y shoe (ante-treatment) was much greater and PS shoe (treatment) was greater than Y shoe (treatment). (That was, Y shoe (ante-treatment) > PS shoe (treatment) >Y shoe (treatment)). The findings of this study showed that anti-slip outsole was effective and brought increasing performance and decreasing injuries. It is suggested that further study of these phenomena will help understand many aspects of human locomotion, including work, performance, fatigue and possible injuries.

• Journal of Korean Academy of Nursing
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• v.42 no.3
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• pp.396-404
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• 2012

Purpose: The purpose of this study was to identify the features, risk scores and risk factors for deep vein thrombosis in critically ill patients who developed deep vein thrombosis in their lower extremities. Methods: The participants in this prospective descriptive study were 175 adult patients who did not receive any prophylactic medication or mechanical therapy during their admission in the intensive care unit. Results: The mean age was 62.24 (${\pm}17.28$) years. Men made up 54.9% of the participating patients. There were significant differences in age, body mass index, and leg swelling between patients who developed deep vein thrombosis and those who did not have deep vein thrombosis. The mean risk score was 6.71(${\pm}2.94$) and they had on average 4.01(${\pm}1.35$) risk factors. In the multiple logistic regression, body mass index (odds ratio=1.14) and leg swelling (odds ratio=6.05) were significant predictors of deep vein thrombosis. Conclusion: Most critically ill patients are in the potentially high risk group for deep vein thrombosis. However, patients who are elderly, obese or have leg edema should be closely assessed and more than one type of active prophylactic intervention should be provided.

• Tuberculosis and Respiratory Diseases
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• v.67 no.6
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• pp.574-576
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• 2009

An intramedullary spinal cord metastasis (ISCM) rarely develops in systemic cancer but is indicative of a poor prognosis. A 56-year-old man was admitted due to weakness of the lower extremities. He had received radiotherapy 3 months prior for a brain metastasis that had developed 1 year after achieving a complete response from chemotherapy for extended stage small cell lung cancer. Although the brain lesion had improved partially, ISCM from the cervical to lumbar-sacral spinal cords, which was accompanied by a leptomeningeal dissemination, was diagnosed based on magnetic resonance imaging of the spine and cerebrospinal fluid cytology. Finally, he died of sudden cardiac arrest during treatment. This is the first case of ISCM involving the whole spinal segments. Physicians should be aware of the subsequent development of ISCM in lung cancer patients with a previously known brain metastasis who present with new neurological symptoms.

• Journal of The Korean Society of Clinical Toxicology
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• v.5 no.1
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• pp.50-52
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• 2007

Certain parts of shellfish contain poisonous substances and cause intoxication. Tetramine toxin is found in the salivary gland of Neptunea. Three family members were admitted to the hospital with chief complaints of dizziness and blurred vision, gait disturbance, and spasms of the lower extremities after ingesting Neptunea. Physical examination revealed sluggish pupil light reflexes, but laboratory studies were normal. Symptoms were completely resolved within 24 hours after injection of atropine. We report a case of three patients with dizziness and blurred vision, gait disturbance, and spasms of the lower extremities due to Neptunea tetramine toxin.