Search

Upper-extremity deep vein thrombosis (DVT) accounts for 1% to 4% of DVT cases. Brachial plexus injury can result from venous distention due to thrombosis in the upper extremity, leading to neurologic deficits. We report a patient diagnosed with brachial plexopathy caused by venous thrombosis in the upper extremity. A 66-year-old female patient with a medical history of Parkinson disease and dementia presented to the emergency department with drowsy mental status. She was diagnosed with pre-renal acute kidney injury with multi-organ dysfunction. On the second hospital day, right upper extremity edema and muscle weakness were observed. On the sixth hospital day, the patient’s overall medical condition improved after conservative treatment, but severe edema was noticed, and muscle weakness did not show significant improvement in the right upper extremity. Computed tomography showed multifocal pulmonary thromboembolism and DVT in the pulmonary arteries, superior vena cava, and popliteal veins. After anticoagulant administration, the swelling subsided, but the weakness in the entire right upper extremity did not improve. Electromyography demonstrated right brachial pan-plexopathy involving the upper, middle, and lower trunks. A follow-up examination showed no significant improvement of muscle strength and function in the right upper extremity at 3 months after the first hospital day.

Background To validate the clinical application of chromosomal microarray analysis (CMA) as a first-tier clinical diagnostic test and to determine the impact of CMA results on patient clinical management, we conducted a multicenter prospective study in Korean patients diagnosed as having developmental delay/intellectual disability (DD/ID), autism spectrum disorders (ASD), and multiple congenital anomalies (MCA). Methods We performed both CMA and G-banding cytogenetics as the first-tier tests in 617 patients. To determine whether the CMA results directly influenced treatment recommendations, the referring clinicians were asked to complete a 39-item questionnaire for each patient separately after receiving the CMA results. Results A total of 122 patients (19.8%) had abnormal CMA results, with either pathogenic variants (N=65) or variants of possible significance (VPS, N=57). Thirty-five well-known diseases were detected: 16p11.2 microdeletion syndrome was the most common, followed by Prader-Willi syndrome, 15q11-q13 duplication, Down syndrome, and Duchenne muscular dystrophy. Variants of unknown significance (VUS) were discovered in 51 patients (8.3%). VUS of genes putatively associated with developmental disorders were found in five patients: IMMP2L deletion, PTCH1 duplication, and ATRNL1 deletion. CMA results influenced clinical management, such as imaging studies, specialist referral, and laboratory testing in 71.4% of patients overall, and in 86.0%, 83.3%, 75.0%, and 67.3% of patients with VPS, pathogenic variants, VUS, and benign variants, respectively. Conclusions Clinical application of CMA as a first-tier test improves diagnostic yields and the quality of clinical management in patients with DD/ID, ASD, and MCA.

The objective of this clinical trial was to compare the efficacy and safety of letibotulinum toxin A and onabotulinum toxin A for improving dynamic equinus foot deformity in children with cerebral palsy (CP). In total, 144 children with spastic CP who had dynamic equinus foot deformity were assigned randomly to the Botulax group (injection of letibotulinum toxin A) or the Botox group (injection of onabotulinum toxin A). The Physician’s Rating Scale (PRS), ankle plantar flexor spasticity using the Modified Tardieu Scale, the Gross Motor Function Measure (GMFM)-88, and the GMFM-66 were completed before injection and at 6, 12, and 24 weeks after injection. The PRS responder rate was 60.27% in the Botulax group and 61.43% in the Botox group at 12 weeks after treatment, and the lower limit of the 95% confidence interval for the between-group difference in responder rates was −17.16%, higher than the non-inferiority margin of −24.00%. The clinical efficacy and the safety profiles of the groups did not significantly differ. The results suggest that injection of letibotulinum toxin A is as effective and safe as that of onabotulinum toxin A for the treatment of dynamic equinus foot deformity in children with spastic CP.

In this paper, a new texture coding algorithm for arbitrarily shaped image segments is introduced. In contrast to other methods described in the literature, the proposed coding algorithm has low computational complexity, is based on the widely used 8 × 8 2D-DCT, and thus, can be readily implemented using existing block-based coding standards such as JPEG, H.261, MPEG. And the content based functionalities currently discussed in the MPEG-4 standardization phase can be easily achieved with the proposed algorithm. Computer simulations and comparisons with other results from the literature reveal that our proposed technique is quite promising and competitive.

The purpose of this study was to compare the posterior superior iliac spine (PSIS) and the iliac crest as accurate anatomical landmarks for identifying spinal level.This study was conducted in 2 stages. First, 4 examiners examined 60 patients and blindly identified iliac crest and PSIS levels, and the interexaminer reliability of PSIS and iliac crest palpation were then analyzed. Second, 4 examiners attached a radio opaque marker at presumed PSIS and iliac crest levels in 72 patients, and posteroanterior lumbar radiographs were then taken. Four examiners then confirmed PSIS and iliac crest levels after radiographically identifying the marker levels and checked the spinal level at which the spinous process or interspace was crossed by drawing a horizontal line drawn between radio opaque markers.The interexaminer reliability of palpation was significantly greater for PSIS level than for the iliac crest (P.05). Spinal levels of estimated PSISs identified by palpation ranged from the L5-S1 interspace to the S2 spinous process, and the spinal levels of estimated iliac crest ranged from the L2-3 interspace to the L5 spinous process.Although PSIS palpation showed statistically higher interexaminer reliability than iliac crest level, clinicians should be cautious when applying this method as a measurement tool because estimated spinal level by palpation can be influenced inadvertently by examiner skill and anatomical variations.

PURPOSE We investigated the usefulness of video based, fluoroscopically guided abduction motion analysis of hemiplegic shoulders. PATIENTS AND METHODS Twenty-two stroke patients with Brunnstrom stages 3-4 (Group 1) or 5-6 (Group 2) were enrolled in this study. Patients with shoulder pain and significant spasticity (MAS 2) were excluded. We recorded motion pictures of the abductions of affected and unaffected shoulder joints under an AP fluoroscopic guide. Lateral scapular slide distances (D1: T2- superior angle, D2: T3- scapular spine, D3: T7-inferior angle) were measured at 30 degrees , 60 degrees , 90 degrees during glenohumeral abduction in a captured photographic image. The angles of scapular rotation and trajectory (stromotion) of the humeral head center, relative to the 3rd thoracic spine in the abduction motion were analyzed. RESULTS In Group 1, a significant difference was found in the lateral scapular slide distance between the affected and sound sides. However, no significant side to side difference was found in Group 2. Scapular angles in abduction were also increased in Group 1. Patients with a more synergistic movement pattern showed less scapular stabilizing muscle activity and, instead, exhibited a compensatory ''shrugging'' like motion accomplished by spinal tilting. CONCLUSION The present findings support the notion that the above parameters of fluoroscopically guided shoulder abduction motion analysis correlate well with clinical findings. These parameters should be useful for evaluations of hemiplegic shoulder biomechanics.