• Title/Summary/Keyword: evidence based diagnosis

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A Study on the Wrist Pulse Six Positions Correlation in the Maiyaojingweilun Chapter of the Huangdineijing (『소문(素問)·맥요정미론(脈要精微論)』의 촌구(寸口) 육부정위(六部定位)에 대한 고찰)

  • Jang, Woochang;Nan, Jie
    • Journal of Korean Medical classics
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    • v.34 no.3
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    • pp.101-123
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    • 2021
  • Objectives : To examine the six positions correlation[六部定位] principle that is the basis of the wrist pulse diagnosis in the Neijing. Methods : The basis for argument was established by correcting an interpretation error of the theory of chi (尺) skin diagnosis. In order to accomplish this, the annotations of Yang Shangshan and Wangbing were investigated first, after which the specific meaning and methodology of the chi diagnostic method as written in many chapters of the Neijing were examined. The evidence and reasoning for the six positions correlation[六部定位] was looked into, in relation to Wangbing's annotation of the chapter, Maiyaojingweilun. The theoretical basis of the six positions correlation was searched throughout the entire Neijing, based on the correlation between Liuhe and the six positions, the five elements inter-supporting theory embedded in the six positions correlation as a diagnosis model that integrates zhangfu and meridians/channels, and the meaning of the spacial concepts used when describing the tactile technique within the chapter. Lastly, contents related to the five zhang channels within the Neijing were reviewed, to determine whether the six positions correlation was applied in wrist pulse taking Results & Conclusions : Some interpretations of the verse on matching the positions in the Maiyaojingweilun chapter of the Neijing are erroneous, while the argument that the three positions[cun-guan-chi] cannot be found in the Neijing is false as well. The wrist pulse taking in the Neijing is precisely based on the three positions correlation that divides the cun-guan-chi positions into three, and the correlation verse in the Maiyaojingweilun chapter clearly suggests the principle of matching the zhangfu and meridian/channels to the six positions of the cun-guan-chi of both left and right.

Diagnosis and Management of Low Back Pain (요통의 진단과 치료)

  • Jang, Jae Hong;Kim, Byung-Jo
    • Annals of Clinical Neurophysiology
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    • v.14 no.1
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    • pp.1-6
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    • 2012
  • Low back pain is a common clinical condition with heterogeneous causes and challenges to manage. High prevalence and numerous assessments result in an enormous socioeconomic burden. Clinician must conduct efficient and stepwise evaluation process to rule out serious spinal pathology, neurologic involvement, and identify risk factors for chronicity. The process can be achieved through the focused history taking and physical examination. Certain factors related to serious spinal pathology include age (>50 years), trauma, unexplained fever, recent urinary or skin infection, unrelenting night or rest pain, unexplained weight loss, osteoporosis, immunosuppression, steroid use, and widespread neurological symptoms. In non-specific low back pain, diagnostic imaging and laboratory studies are often unnecessary and can disturb an appropriate management. For the management of acute low back pain, patient education and medication such as acetaminophen, non-steroidal anti-inflammatory drugs, and muscle relaxants are recommended. For chronic low back pain, behavior therapy, back exercise, and spinal manipulation are beneficial. The evidence based approach could improve success rate of management, result in prevention of acute low back pain from being chronic intractable pain.

Non-Dura Based Intaspinal Clear Cell Meningioma

  • Ko, Jun-Kyeung;Choi, Byung-Kwan;Cho, Won-Ho;Choi, Chang-Hwa
    • Journal of Korean Neurosurgical Society
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    • v.49 no.1
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    • pp.71-74
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    • 2011
  • A 34-year-old female patient was presented with leg and hip pain for 6 months as well as voiding difficulty for 1 year. Magnetic resonance imaging revealed a well-demarcated mass lesion at L2-3. The mass was hypo-intense on T1- and T2-weighted images with homogeneous gadolinium enhancement. Surgery was performed with the presumptive diagnosis of intradural extramedullary meningioma. Complete tumor removal was possible due to lack of dural adhesion of the tumor. Histologic diagnosis was clear cell meningioma, a rare and newly included World Health Organization classification of meningioma usually affecting younger patients. During postoperative 2 years, the patient has shown no evidence of recurrence. We report a rare case of cauda equina clear cell meningioma without any dural attachment.

Fractal behavior identification for monitoring data of dam safety

  • Su, Huaizhi;Wen, Zhiping;Wang, Feng
    • Structural Engineering and Mechanics
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    • v.57 no.3
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    • pp.529-541
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    • 2016
  • Under the interaction between dam body, dam foundation and external environment, the dam structural behavior presents the time-varying nonlinear characteristics. According to the prototypical observations, the correct identification on above nonlinear characteristics is very important for dam safety control. It is difficult to implement the description, analysis and diagnosis for dam structural behavior by use of any linear method. Based on the rescaled range analysis approach, the algorithm is proposed to identify and extract the fractal feature on observed dam structural behavior. The displacement behavior of one actual dam is taken as an example. The fractal long-range correlation for observed displacement behavior is analyzed and revealed. The feasibility and validity of the proposed method is verified. It is indicated that the mechanism evidence can be provided for the prediction and diagnosis of dam structural behavior by using the fractal identification method. The proposed approach has a high potential for other similar applications.

Myofascial Orofacial Pain Exacerbated after Masseteric Nerve Neurectomy

  • Nam, Hyun;Ko, Daeun;Kang, Jin-Kyu;Shim, YoungJoo
    • Journal of Oral Medicine and Pain
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    • v.45 no.4
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    • pp.110-114
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    • 2020
  • Myofascial pain (MFP) is one of the most common causes of persistent orofacial pain. Patients with chronic myofascial orofacial pain may present with diffuse heterotopic pain, complicating the correct diagnosis. Treatment of chronic MFP should focus on the elimination of aetiologic factors. This article describes two cases of chronic MFP of the masticatory muscles, whose symptoms were exacerbated after masseteric nerve neurectomy. The patients had suffered from irrelevant treatment which did not resolve the symptom. Their symptom was managed by conventional treatment protocol. These cases emphasize the importance of correct diagnosis and evidence-based approach.

Comparative Analysis of American Academy of Pediatrics and European Society of Hypertension Guidelines for the Diagnosis and Treatment of Pediatric Hypertension

  • Park, Se Jin;Shin, Jae Il
    • Childhood Kidney Diseases
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    • v.25 no.2
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    • pp.71-77
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    • 2021
  • Childhood hypertension (HTN) has become a significant public health issue because of the increased risk of cardiovascular disease in adulthood. However, childhood HTN is underrecognized and underdiagnosed in clinical practice. The European Society of Hypertension in 2016 and the American Academy of Pediatrics (AAP) in 2017 published updated guidelines for the screening, prevention, and management of pediatric HTN. There were notable differences between the two guidelines as well as many similarities. The updated AAP guidelines have clarified and simplified the recommendations for screening, diagnosis, and treatment of childhood HTN based on current evidence. This review highlights the important developments in both guidelines, focusing on recent advances in the classification and treatment of childhood HTN.

Korean Guidelines for Diagnosis and Treatment of Tuberculosis in Children and Adolescents (소아청소년 결핵의 진료 지침)

  • Choi, Kyong Min;Kim, Nam Hee;Kim, Dong-Ho;Kim, Yae Jean;Kim, Jong-Hyun;Oh, Sung Hee;Eun, Byung Wook;Lee, Soo-Young;Lee, Taek Jin;Chun, Jin-Kyong;Hong, Jung Yun
    • Pediatric Infection and Vaccine
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    • v.18 no.1
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    • pp.1-14
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    • 2011
  • Tuberculosis is a disease with high morbidity and mortality in children worldwide. Despite the decrease in the incidence of tuberculosis in Korea, more than 30,000 new patients are diagnosed each year. Active tuberculosis is less frequent in children compared to adults but the risk of miliary tuberculosis and CNS tuberculosis is much higher. The diagnosis of tuberculosis in children and adolescents is difficult due to the nonspecific symptoms upon presentation. Diagnostic work up is based on the confirmation of tuberculosis infection by tuberculin skin test, abnormal radiologic findings, and contact with an adult with active tuberculosis. Anti-tuberculosis medications are prescribed according to the drug susceptibility of the index patient. Latent tuberculosis infection plays an important role in adult tuberculosis by reactivation. Thus, it is critical to accurately diagnose latent tuberculosis in children to prevent reactivation in adulthood. Korean guidelines for diagnosis and treatment of tuberculosis in children and adolescents provide evidence based recommendations in the optimal diagnosis and treatment for active and latent tuberculosis in children and adolescents based on the current Korean situation.

Radiograph-based Diagnostic Methods for Thoracic and Lumbar Spine Malposition in Chuna Manual Therapy Using Biomarkers (단순 방사선 영상기반 바이오마커를 활용한 흉·요추의 추나의학적 변위 진단 방법)

  • Jin-Hyun Lee;Minho Choi;Joong Il Kim;Jun-Su Jang;Tae-Yong Park
    • The Journal of Churna Manual Medicine for Spine and Nerves
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    • v.18 no.2
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    • pp.1-8
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    • 2023
  • Objectives This study aimed to propose biomarkers for diagnosing Chuna manual therapy (CMT) based on X-ray images in the thoracic and lumbar spines. Methods Through a literature review and expert consensus process, diagnostic biomarkers for CMT were selected based on the listing system in thoracic and lumbar radiograph anterior-posterior (AP) and lateral views. Results 1. Diagnostic biomarkers were derived from four points on the outer contour of the vertebral body in the thoracic and lumbar spine radiograph lateral view, enabling the diagnosis of flexion and extension malposition. 2. Additional diagnostic biomarkers were identified in the thoracic and lumbar radiographAP view, utilizing points on the outer contour of the vertebral body. These biomarkers facilitate the diagnosis of lateral bending. Moreover, biomarkers derived from the innermost point of the pedicle contour allow for the diagnosis of rotation malposition. 3. Furthermore, through the biomarkers proposed in this study, all malpositions of the thoracolumbar spines and complex Type I and II malpositions can be diagnosed in CMT. Conclusions The biomarkers reported in this study consist of minimal points to determine the position of the vertebral body, providing the advantage of simplicity while minimizing potential errors during the CMT diagnostic process. Further clinical research and the development of related programs should be pursued to expand the evidence for CMT.

Acute disseminated encephalomyelitis in children: differential diagnosis from multiple sclerosis on the basis of clinical course

  • Lee, Yun-Jin
    • Clinical and Experimental Pediatrics
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    • v.54 no.6
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    • pp.234-240
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    • 2011
  • Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the central nervous system (CNS) that typically presents as a monophasic disorder associated with multifocal neurologic symptoms and encephalopathy. ADEM is considered an autoimmune disorder that is triggered by an environmental stimulus in genetically susceptible individuals. The diagnosis of ADEM is based on clinical and radiological features. Most children with ADEM initially present with fever, meningeal signs, and acute encephalopathy. The level of consciousness ranges from lethargy to frank coma. Deep and subcortical white-matter lesions and gray-matter lesions such as thalami and basal ganglia on magnetic resonance imaging (MRI) are associated with ADEM. In a child who presents with signs of encephalitis, bacterial and viral meningitis or encephalitis must be ruled out. Sequential MRI is required to confirm the diagnosis of ADEM, as relapses with the appearance of new lesions on MRI may suggest either multiphasic ADEM or multiple sclerosis (MS). Pediatric MS, defined as onset of MS before the age of 16, is being increasingly recognized. MS is characterized by recurrent episodes of demyelination in the CNS separated in space and time. The McDonald criteria for diagnosis of MS include evidence from MRI and allow the clinician to make a diagnosis of clinically definite MS on the basis of the interval preceding the development of new white matter lesions, even in the absence of new clinical findings. The most important alternative diagnosis to MS is ADEM. At the initial presentation, the 2 disorders cannot be distinguished with certainty. Therefore, prolonged follow-up is needed to establish a diagnosis.

Speech and language disorders in children (소아에서 말 언어장애)

  • Chung, Hee Jung
    • Clinical and Experimental Pediatrics
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    • v.51 no.9
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    • pp.922-934
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    • 2008
  • Developmental language disorder is the most common developmental disability in childhood, occurring in 5-8% of preschool children. Children learn language in early childhood, and later they use language to learn. Children with language disorders are at increased risk for difficulties with reading and written language when they enter school. These problems often persist through adolescence or adulthood. Early intervention may prevent the more serious consequences of later academic problems, including learning disabilities. A child's performance in specific speech and language areas, such as phonological ability, vocabulary comprehension, and grammatical usage, is measured objectively using the most recently standardized, norm-referenced tests for a particular age group. Observation and qualitative analysis of a child's performance supplement objective test results are essential for making a diagnosis and devising a treatment plan. Emphasis on the team approach system in the evaluation of children with speech and language impairments has been increasing. Evidence-based therapeutic interventions with short-term, long-term, and functional outcome goals should be applied, because there are many examples of controversial practices that have not been validated in large, controlled trials. Following treatment intervention, periodic follow-up monitoring by a doctor is also important. In addition, a systematized national health policy for children with speech and language disorders should be provided.