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이베나 ( Be Na Lee ),유순희 ( Soon Hee Yoo ),조덕원 ( Duk Won Cho ) 한국정맥경장영양학회 2010 한국정맥경장영양학회지 Vol.3 No.1
Purpose: We wanted to compare the nutritional status of stroke patients who are in the acute state with that of stroke patients who are in the chronic state and to evaluate the factors that may affect stroke patients` nutritional status in Korea. Methods: This is a retrospective study. We reviewed the medical histories of stroke patients who were hospitalized in St. Paul`s hospital from January 2005 to February 2007.The applied measurements were the body mass index (BMI) and the biochemical findings such as albumin, the total lymphocyte count (TLC) and the hemoglobin level. We considered the factors that might affect the patient`s nutritional status, including the patient`s mobility, the mode of feeding, the type of medical insurance as an indicator of the socioeconomic status, diabetes mellitus, dysphagia and a medication for depression. Results: Thirty four males and 27 females were studied and the mean age of the patients was 60.13 years old. The mean follow up duration was 456.64 days. The BMI was decreased from 23.85 to 23.16 kg/m2 (P-value=0.049), the albumin was decreased from 4.09 to 3.88 g/dl (P-value=0.012) and the TLC was decreased from 2,056.6 to 1,772.3/L(P-value=0.034) in the chronic state. Specially, the nutritional imbalance was severe in the chronic patients who were undergoing tube feeding, in those who had poor mobility, in those who had dysphagia or those who were taking a medication for depression. Conclusion: Control of stroke patients` nutritional state is crucial for a better outcome, not only at the acute stage but also at the chronic stage. Therefore, medical personnels should be aware of and care for the nutritional state of stroke patients. (KJPEN 2010;3(1):33-39)
무증상 한국 성인의 발근육과 허리엉치 척추옆 근의 탈신경 전위의 빈도
오주선,이베나,임정훈,송대헌,이원일 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.1
Objective: To determine the prevalence of denervation potentials from the foot intrinsic and the lumbosacral paraspinal muscles in asymptomatic persons in Korea. Method: Nerve conduction studies were performed in 80 asymptomatic persons at sural, peroneal and tibial nerves. We excluded 15 persons with abnormal values of nerve conduction studies. In our study, 36 males and 29 females participated and the mean age of subjects was 52.9 years. We checked denervation potentials from unilateral lumbosacral paraspinal (L4-S1) and foot intrinsic muscles (abductor hallucis and extensor digitorum brevis muscle) by needle EMG. Results: The prevalence of denervation potentials from foot intrinsic muscles was 3% (2 cases out of 65 asymptomatic subjects). Denervation potentials consisting of a positive sharp wave were seen from the abductor hallucis muscle. No subjects showed any denervation potentials from the lumbosacral paraspinal muscles in our study. Abnormal X-ray findings were seen in subjects who had denervation potentials from the foot intrinsic muscles. Conclusion: The prevalence of denervation potentials from the foot intrinsic and the lumbosacral paraspinal muscles in asymptomatic person was not as high as previously reported.
정중 운동신경 전도검사 시 7 cm 근위 자극과 완관절 주름 자극의 비교
김형진,이베나,신창혁,이진영,이원일 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.1
Objective: To determine optimal stimulation site for median motor conduction study, we compared fixed distance (7 cm proximal to the recording electrode) stimulation method and distal wrist crease stimulation method. Method: Nerve conduction studies were performed in 65 hands of 36 healthy adults without neurologic abnormality. Median motor responses were recorded from abductor pollicis brevis (APB) with the stimulations at the point 7 cm proximal to the recording electrode and at the distal wrist crease. The distal latencies and onset-to-peak amplitudes were measured and compared between two techniques. The distal latencies were also compared to that of ulnar compound muscle action potential (CMAP) obtained with fixed distance stimulation (7 cm proximal to the recording electrode). And we measured median nerve actual length from distal wrist crease to APB muscle motor point by anatomic dissection of 12 hands. Results: The distal latencies of median CMAP to APB with 7 cm fixed distance stimulation and distal wrist crease stimulation were 2.91±0.37 ms and, 2.75±0.41 ms respectively. The differences were statistically significant. The distal latency of ulnar CMAP was 2.50±0.32 ms. Differences in distal latencies between ulnar CMAPs and not only 7 cm fixed distance median stimulation but also distal wrist crease median stimulation were also statistically significant. The mean length of median nerve from distal wrist crease to APB motor point was 5.91±0.77 cm. Conclusion: We suggest that the median motor nerve conduction study using distal wrist crease stimulation was an easier and more rapid procedure than fixed distance median motor nerve conduction study.
복합부위통증증후군에서 비스포스포네이트와 스테로이드 치료의 효과
박근영,박주현,이베나,임선,민지혜 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.1
Objective: To determine the effects of the antiresorptive agent bisphosphonate in hemiplegic patients with CRPS and to compare its effects to standard steroid pulse therapy. Method: Thirteen randomly selected hemiplegic patients diagnosed with CRPS received bisphosphonate therapy which consisted of intravenous pamidronate injection of a total cumulative dose of 180 mg in one week. Eleven hemiplegic patients with CRPS received the standard 2-week steroid pulse therapy. Clinical assessments were made for temperature, pain score, volumetry and circumference of both the third digit and wrist. All assessments were carried out twice; before the initiation of therapy and two weeks after pamidronate or steroid therapy. Results: The steroid group showed statistical improvement in pain (p=0.039), total hand volume(p=0.006) wrist (p= 0.007) and 3rd digit (p=0.003) circumference. The pamidronate group showed statistical improvement in pain (p=0.011), wrist (p=0.043) and 3rd digit (p=0.021) circumference; however no statistical improvement was observed in total hand volume (p=0.767). Neither group showed any statistical significance in temperature change. Conclusion: Pamidronate therapy may be an alternative method in managing CRPS in hemiplegic patients with multiple medical comorbidities who are not eligible to receive the conventional steroid therapy. Objective: To determine the effects of the antiresorptive agent bisphosphonate in hemiplegic patients with CRPS and to compare its effects to standard steroid pulse therapy. Method: Thirteen randomly selected hemiplegic patients diagnosed with CRPS received bisphosphonate therapy which consisted of intravenous pamidronate injection of a total cumulative dose of 180 mg in one week. Eleven hemiplegic patients with CRPS received the standard 2-week steroid pulse therapy. Clinical assessments were made for temperature, pain score, volumetry and circumference of both the third digit and wrist. All assessments were carried out twice; before the initiation of therapy and two weeks after pamidronate or steroid therapy. Results: The steroid group showed statistical improvement in pain (p=0.039), total hand volume(p=0.006) wrist (p= 0.007) and 3rd digit (p=0.003) circumference. The pamidronate group showed statistical improvement in pain (p=0.011), wrist (p=0.043) and 3rd digit (p=0.021) circumference; however no statistical improvement was observed in total hand volume (p=0.767). Neither group showed any statistical significance in temperature change. Conclusion: Pamidronate therapy may be an alternative method in managing CRPS in hemiplegic patients with multiple medical comorbidities who are not eligible to receive the conventional steroid therapy.
만취 상태로 수면 후 동시에 발생한 대퇴신경과 좌골신경병증 1예
김은혜,송대헌,이베나,조덕원,양병우,정현석 대한근전도전기진단의학회 2010 대한근전도 전기진단의학회지 Vol.12 No.1
Focal peripheral neuropathy may occur by compression or traction in the setting of depressed consciousness.We report a rare case of 37-year-old female patient with combined femoral and sciatic nerve palsy after a night of alcohol intoxication. Femoral and sciatic neuropathies were confirmed by physical examination and electrodiagnostic study. The patient’s history and electrodiagnosis suggest that the injury is related to compression and traction of nerve with prolonged maintenance of “hanging leg” posture on the affected side.