• Tuberculosis and Respiratory Diseases
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• v.60 no.3
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• pp.353-356
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• 2006

Acute transverse myelitis (TM) is a neurological syndrome caused by inflammation of the spinal cord. TM is rare but is frequently caused by viral or bacterial infections. TM caused by tuberculosis (TB) is extremely rare and there are no reports of TM caused by multidrug-resistant TB (MDR-TB). We report a case of acute TM due to MDR-TB in a 40-year-old man. The patient had been diagnosed with pulmonary TB and was started on the first-line anti-TB treatment. However, the chest radiographic findings were aggravated and neurological symptoms such as weakness in both lower extremities, sensory changes, and voiding difficulty were newly developed. The T2-weighted magnetic resonance image of the spine showed diffusely increased signal intensity in the spinal cord, particularly at the lower cervical and upper thoracic levels, without any definite evidence of myeloradicular compression, which is consistent with a diagnosis of TM. A drug susceptibility test revealed MDR and second-line anti-TB drugs were prescribed. The chest radiographic findings showed improvement after treatment, the mycobacterial culture converted to negative, the MRI findings improved, and there was partial improvement in the low extremity weakness. The patient has been prescribing second-line anti-TB medications for 14 months.

• Journal of muscle and joint health
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• v.1 no.1
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• pp.97-115
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• 1994

The purpose of this study was to examine the reliability and validity of the observed behaviors of subjects who suffered from low back pain with spinal diseases, Thirty two low back pain patients admitted on the neurosurgical unit in an army hospital were compared with 30 normal controls belonged to an army unit, by means of matching the age, hight and weight. Observed pain behaviors were developed by the researcher on the bases of literature and patient observation. This tool consists of 18 behaviors seperated into two major groups : mutually exclusive and concomittent behaviors. The mutually exclusive behaviors included coding cathegories for 6. body motions assumed by the subjects during the observation session. These 6 standardized motions consisted of sitting from standing first, and serially tying down, reclining, sitting again, and then standing, 6 steps walking. Concomittent behaviors consisted of 12 observable patterns that can be observed systematically from the face, grimacing, bracing, rubbing, walking with arms fixed, support with hands on sitting or standing, guarded movement, limping, unbalaced weightbearing, stopped movement from tying position to sitting, sighing and graoning. Subjects were videotrecorded as they performed a 6-standardized sequence of motions, simultanously researcher measured the time spent performing each motion and step length. Patients were asked torate their subjective pain score on the 10 mm graphic rating scale ranging from 'no pain' to 'sever pain'. For scoring of the pain behaviors, two trained nursing officiers independently and simutanously viewwd each videorecording and checked subject 'pain behaviors at the observational item checklist. The result of the study are summarized as follows : 1. Reability of the observational tool was a=.845. 2. Spearman's rho and percentage agreement were p=.97 and 81.7 persent respectively, that indicate adequate interrater reability of this tool. 3. The sensitivity rate of the tool was .875 while specificity rate .866 for differentiating patient from the normal. 4. When difference in the objective pain indices between patient group and control were compared, there was significant difference of all indices, such as pain behavior(t=7.71, p=.0001). spent time performing motion(t=14.2, p=.0001), step length (t=-10.72, p=.0001). 5. There were differences in the objective indices the subjective pain subgroups (low, medium, high). Differences in the mean score of objective pain behavior (F=6.376. p=.005) and spent time for moyion(F=4.631, p=.018). But there were no significant differences in the step length among the subgroups(F=.667, p=.521). 6. Highly correlated pain behavior items wiyh subjective pain score were 'stopped movement from lying position to sitting', 'limping', 'support with hands on sitting or standing', 'bracing', 'guarding' and 'walking with arms fixed'. In summary, although some of rho behavior items such as sighing and groaning in this study could not be observed because of videotaped datd, the reliability and validity of the over all observation method were satifactory. Thus, the results of the present study demonstrate rye potetional utility of the tool in assessing objective pain complementing self-reported pain in low back pain patients.

• Tuberculosis and Respiratory Diseases
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• v.65 no.6
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• pp.517-521
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• 2008

A tuberculous psoas abscess is a frequently described complication of tuberculous spondylitis. Although rare, a tuberculous psoas abscess can develop without any demonstrable spinal involvement. In patients with no evidence of sponylitis, the abscess may result from direct spread from the involved lymph node or via a hematogeous route. The treatment of a psoas abscess is either drug therapy or surgical intervention in conjunction with drug therapy. Image-guided percutaneous drainage in conjunction with drug therapy is also a safe and effective treatment for a tuberculous psoas abscess. We report an unusual case of bilateral tuberculous psoas abscesses without any concomitant spinal involvement. The tuberculous psoas abscess may have formed by fistulization between the necrotic lymph node and psoas sheath. The diagnosis was confirmed by computed tomography and a histology examination of the biopsy sample. The patient improved after administering anti-tuberculous agents for 2 years along with surgical and percutaneous drainage of the abscess.

• Journal of Magnetics
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• v.22 no.1
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• pp.146-149
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• 2017

In this study, we compared the standardized value of each signal intensity, the apparent diffusion coefficient (ADC) that digitizes the diffusion of water molecules, and the signal to noise ratio (SNR) using b value 0 400, 1400 ($s/mm^2$). From March 2013 to December 2013, patients with suspicion of simple compound fracture and metastatic spine cancer were included in the MR readout. We used a 1.5 Tesla Achieva MRI system and a Syn-Spine Coil. Sequence is a DWI SE-EPI sagittal (diffusion weighted imaging spin echo-echo planar imaging sagittal) image with b-factor ($s/mm^2$) 0, 400, 1400 were used. Data analysis showed ROI (Region of Interest) in diseased area with high SI (signal intensity) in diffusion-weighted image b value 0 ($s/mm^2$) Using the MRIcro program, each SI was calculated with images of b-value 0, 400, and 1400 ($s/mm^2$), ADC map was obtained using Metlab Software with each image of b-value, The ADC is obtained by applying the ROI to the same position. The standardized values ($SI_{400}/SI_0$, $SI_{400}/SI_0$) of simple compression fractures were $0.47{\pm}0.04$ and $0.23{\pm}0.03$ and the standardized values ($SI_{400}/SI_0$, $SI_{400}/SI_0$) of the metastatic spine were $0.57{\pm}0.07$ and $0.32{\pm}0.08$ And the standardized values of the two diseases were statistically significant (p < 0.05). The ADC ($mm^2/s$) for b value 400 ($s/mm^2$) and 1400 ($s/mm^2$) of the simple compression fracture disease site were $1.70{\pm}0.16$ and $0.93{\pm}0.28$ and $1.24{\pm}0.21$ and $0.80{\pm}0.15$ for the metastatic spine. The ADC ($mm^2/s$) for b value 400($s/mm^2$) was statistically significant (p < 0.05) but the ADC ($mm^2/s$) for b value 1400 (p > 0.05). In conclusion, multi - b value recognition of signal changes in diffusion - weighted imaging is very important for the diagnosis of various spinal diseases.

• Journal of Korean Neurosurgical Society
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• v.52 no.4
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• pp.359-364
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• 2012

Objective : Transpedicular screw fixation has some disadvantages such as postoperative back pain through wide muscle dissection, long operative time, and cephalad adjacent segmental degeneration (ASD). The purposes of this study are investigation and comparison of radiological and clinical results between interspinous fusion device (IFD) and pedicle screw. Methods : From Jan. 2008 to Aug. 2009, 40 patients underwent spinal fusion with IFD combined with posterior lumbar interbody fusion (PLIF). In same study period, 36 patients underwent spinal fusion with pedicle screw fixation as control group. Dynamic lateral radiographs, visual analogue scale (VAS), and Korean version of the Oswestry disability index (K-ODI) scores were evaluated in both groups. Results : The lumbar spine diseases in the IFD group were as followings; spinal stenosis in 26, degenerative spondylolisthesis in 12, and intervertebral disc herniation in 2. The mean follow up period was 14.24 months (range; 12 to 22 months) in the IFD group and 18.3 months (range; 12 to 28 months) in pedicle screw group. The mean VAS scores was preoperatively $7.16{\pm}2.1$ and $8.03{\pm}2.3$ in the IFD and pedicle screw groups, respectively, and improved postoperatively to $1.3{\pm}2.9$ and $1.2{\pm}3.2$ in 1-year follow ups (p<0.05). The K-ODI was decreased significantly in an equal amount in both groups one year postoperatively (p<0.05). The statistics revealed a higher incidence of ASD in pedicle screw group than the IFD group (p=0.029) Conclusion : Posterior IFD has several advantages over the pedicle screw fixation in terms of skin incision, muscle dissection and short operative time and less intraoperative estimated blood loss. The IFD with PLIF may be a favorable technique to replace the pedicle screw fixation in selective case.

• Annals of Clinical Neurophysiology
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• v.8 no.1
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• pp.29-35
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• 2006

Background: Transcranial magnetic stimulation (TMS) is a non-invasive diagnostic method particularly suited to investigation the long motor tracts. The clinical value of TMS in most spinal cord diseases has still to be made. Diagnostic value of magnetic motor evoked potential (MEP) parameters in intramedullary spinal cord lesions was investigated. Methods: MEP elicited by TMS was recorded in 57 patients with clinically and radiologically defined intramedullary myelopathy. Twenty five patients with cervical myelopathy (CM) and 32 thoracic myelopathy (TM) were included. Recordings were performed during resting and minimal voluntary contraction at both abductor pollicis brevis (APB) and tibialis anterior (TA) muscles. Stimulation threshold(ST), amplitude, and central motor conduction time (CCT) were measured at resting and facilitated conditions. CCT was calculated by two means; central motor latency (CML)-M using magnetic transcranial and root stimulation, and CML-F using electrical F-wave study. The results were compared between patient groups and 10 normal control group. Results: Facilitated mean ST recorded at TA was elevated in both CM and TM compared with control group. Resting mean CML-M at TA was significantly prolonged in both CM and TM, and CML-M was absent or delayed in 37.1% of CM and 8% of TM at APB with facilitation. Facilitated mean MEP amplitude at ABP was lower in CM than in TM, while MEP/M ratios were not different significantly between groups. Conclusions: Magnetic motor evoked potential has diagnostic value in intramedullary myelopathy and localizing value in differentiating between CM and TM by recording at APB and TA. It is a noninvasive way to investigate the functional status of motor tracts of spinal cord.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.995-1003
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• 2021

Objective : People are living longer and the elderly population continues to increase. The incidence of degenerative spinal diseases (DSDs) in the elderly population is quite high. Therefore, we are facing more cases of DSD and offering more surgical solutions in geriatric patients. Understanding the significance and association of frailty and central sarcopenia as risk factors for spinal surgery in elderly patients will be helpful in improving surgical outcomes. We conducted a retrospective cohort analysis of prospectively collected data to assess the impact of preoperative central sarcopenia, frailty, and comorbidity on surgical outcome in elderly patients with DSD. Methods : We conducted a retrospective analysis of patients who underwent elective spinal surgery performed from January 1, 2019 to September 30, 2020 at our hospital. We included patients aged 65 and over who underwent surgery on the thoracic or lumbar spine and were diagnosed as DSD. Central sarcopenia was measured by the 50th percentile of psoas : L4 vertebral index (PLVI) using the cross-sectional area of the psoas muscle. We used the Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight (K-FRAIL) scale to measure frailty. Comorbidity was confirmed and scored using the Charlson Comorbidity Index (CCI). As a tool for measuring surgical outcome, we used the Clavien-Dindo (CD) classification for postoperative complications and the length of stay (LOS). Results : This study included 85 patients (35 males and 50 females). The mean age was 74.05±6.47 years. Using the K-FRAIL scale, four patients were scored as robust, 44 patients were pre-frail and 37 patients were frail. The mean PLVI was 0.61±0.19. According to the CD classification, 50 patients were classified as grade 1, 19 as grade 2, and four as grade 4. The mean LOS was 12.35±8.17 days. Multivariate stepwise regression analysis showed that postoperative complication was significantly associated with surgical invasiveness and K-FRAIL scale. LOS was significantly associated with surgical invasiveness and CCI. K-FRAIL scale showed a significant correlation with CCI and PLVI. Conclusion : The present study demonstrates that frailty, comorbidity, and surgical invasiveness are important risk factors for postoperative complications and LOS in elderly patients with DSD. Preoperative recognition of these factors may be useful for perioperative optimization, risk stratification, and patient counseling.

• Journal of Home Health Care Nursing
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• v.1
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• pp.71-76
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• 1993

This study was carried out to investigate agreement, content and demand for home nursing care of hospital inpatients in brain, spain and musculoskeletal diseases. The data was collected by interviewing with 242 patients who were hospitalized in university hospital on Taegu, from September 6,60 October 9, 1993. Of 242 patients, 66.1% agreed to home nursing care system and rate of agreement was highest between 30 years to 49 years of age as 40.4% in general characteristics. The rate of agreement according to type of diagnosis was highest inpatients with spinal diseases as 75.6% according to functional status was the highest in patients who had daily living activity freely as 69.4% according to prognosis in patients at terminal stage as 80.0% and the rate of agreement to home nursing care of patients who wanted early discharge was 73.9% The first-ranking reasons of agreement to home nursing care was asking for continuous relationship with doctor as 37.3% and there was statistically significant difference in reasons of agreement to home nursing care according to functional status of patients. The first-ranking reason of early discharge among patients who wanted early discharge(74.8%) was because of long time stay in hospital. Among 23 items of nursing activity that patient wanted, the first-ranking item was recovery promotion, prevention of complication, education and counseling for health as 76.4%, drug management was 2nd-ranking item as 62.1% and the third was regular checking of vital signs as 55.9%, The lowest item of demand for home nursing care was hospice care(3.9%) and airway keep(9.1%).

• Tuberculosis and Respiratory Diseases
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• v.68 no.1
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• pp.29-33
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• 2010

Strongyloides stercoralis is an intestinal nematode that is a parasite to humans. The infecting filariform larvae of S. stercoralis enters the host body via the bloodstream, passes through the lungs, penetrates the alveoli, and then ascends the airway to transit down the esophagus into the small bowel. The infection can persist for decades without causing major symptoms and can elicit eosinophilia of varying magnitudes. Of note, this infection can also develop into a disseminated, often fatal, disease (hyperinfection) in patients receiving immunosuppressive corticosteroids. A 65-year-old man who was receiving corticosteroid therapy for the treatment of spinal stenosis was admitted to the emergency room with complaints of abdominal pain and severe dyspnea. We detected many S. stercoralis larvae in the sputum and in the bronchoalveolar-lavage sample collected by bronchoscopy. Here, we report a fatal case of strongyloidiasis with acute respiratory failure and intestinal perforation. In addition, we provide a brief review of the relevant medical literature.

• Tuberculosis and Respiratory Diseases
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• v.43 no.1
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• pp.113-116
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• 1996

A previously healthy 59-year old male patient was admitted due to cough and abnormal chest x-ray. Cough started 5 months ago and persisted. Two months before admission, abnormality in chest PA was detected. He had no symptom other than cough. He was nonsmoker and physical examination revealed no abnormal finding. His chest X-ray showed ill-defined $2{\times}1\;cm$ ovoid infiltration in left middle lung field. On chest computed tomography, it was located in the subpleural region of posterobasal segment of left lower lobe. Mediastinal lymphadenopathy was absent. Blood test and sputum examination were not diagnostic. Fluoroscopy-guided percutaneous needle biopsy revealed pulmonary cryptococcosis. After central nervous system involvement was excluded by spinal tap, oral ketoconazole therapy was started. The lesion decreased in size after 8 weeks of therapy and almost disappeared on follow-up chest X-ray 4 months later.