Objective: To observe histological changes of the intervertebral disc injected with intradiscal steroid and mollification of discogenic pain.

Method: A study group of 25 Sprague-Dawely rats was divided into five subgroups. A control group of 10 Sprague-Dawely rats was divided into five subgroups. The rats' intervertebral discs were exposed by an anterior surgical approach. For study group, the rats were injected intradiscally methylprednisolone acetate 4 mg (Depomedrol, 40 mg/ml) to the L4-L5 intervertebral disc, methylprednisolone sodium succinate 4 mg (Solumedrol, 40 mg/ml) to the L5-L6 intervertebral disc, and triamcinolone acetonide 4 mg (Triamcinolone, 40 mg/ml) to the L6-S1 intervertebral disc. For control group, the rats were injected intradiscally 0.1 ml of saline to the L5-L6 intervertebral disc and a needle was inserted in the L6-S1 intervertebral disc. The intervertebral discs were extracted after 1 week, 2 weeks, 3 weeks, 4 weeks, and 16 weeks. The extracted intervertebral discs were stained with Hematoxylin-Eosin and examined histomorphometrically.

Results: There is no significant histological change in either group until 4 weeks after the different types of steroid were injected. Focal fibrotic change was present in the Solumedrol and Triamcinolone injection subgroups after 16 weeks.

Conclusion: We concluded that rapid mollification of discogenic pain following intradiscal steroid injection may not result from histological change of the disc. Further biochemical study will be neccessary to clarify mollification mechanism of discogenic pain by intradiscal steroid injection.

Objective: To investigate the optimal condition for activation of motor cortex by electrical stimulation of forelimb in rat.

Method: Eleven adult rats (Sprague-Dawley rat) were studied, each of which was anesthetized and craniotomized. While the electrical stinulation was given on the contralateral forelimb of the fixed rat at stereotaxic frame, the evoked potential (EP) was obtained at the motor cortex of rat brain. The conditions of electrical stimulation were changed with 5 kinds of frequencies (1, 3, 5, 10, 15 Hz), 4 kinds of stimulus intensities (1, 3, 5, 7 mA) and 3 kinds of pulse widths (100, 200, 300μsec).

Results: The peak latencies of EPs in the motor cortex were significantly decreased and the amplitudes were significantly increased along with the decrement of stimulus frequency and the increment of stimulus intensity. The peak latencies and amplitudes of EPs were not significantly changed by stimulus pulse widths.

Conclusion: The motor cortex of rat was more activated with lower frequency and higher intensity regardless of pulse width in the given condition of electrical stimulation in this study. Key_words: 전기적 자극, 운동 피질, 유발전위, Electrical stimulation, Motor cortex, Evoked potential

Objective: The purpose of this study is to develop a new neuropathic pain model in the rat.

Method: Each male adult rat was anesthetized and the sciatic nerve was exposed. Each exposed nerve was injected with 0.03 cc of 1% phenol solution. Normal saline 0.03 cc was injected to the placebo group. Rats were tested for the presence of mechanical allodynia by von Frey hair. Spontaneous pain behavior (paw shaking, paw elevation) was examined for 5 minutes in the cage.

Results: Phenol injected group developed allodynia after the second post-injection day for up to 1 month. Allodynia was also observed in the contralateral legs of phenol injected group. The control group did not develop allodynia. Spontaneous pain behavior was not observed in either group.

Conclusion: Neuropathic pain model was developed by 1% phenol solution injection to the rat sciatic nerve. This study suggests an easier method for making the neuropathic pain model. Key_words: 페놀, 신경병증성 통증 모형, 좌골 신경, Phenol, Neuropathic pain model, Sciatic nerve

Objective: To determine whether the cause of sympathetic dysfunction is due to increased regional sympathetic outflow or receptor supersensitivity to circulating catecholamines in the pathogenesis of reflex sympathetic dystrophy in hemiplegia.

Method: Ten hemiplegic patients with reflex sympathetic dystrophy were instructed to refrain from smoking or using caffeine and alcohol, and medications that influence catecholamine metabolism were witheld for 24 hours before blood sampling. Patients with cardiovascular disease, diabetes or abnormal liver and renal function tests were excluded from the study. Patients with a history of sympathectomy were also excluded. Ten hemiplegic patients without reflex sympathetic dystrophy served as the control group. Both groups of patients rested in supine position in a quiet room for 30 minutes. A needle with heparin cap was inserted into the dorsal venous arches of the affected hand and patients rested for another 20 minutes, after which blood was drawn through the heparin cap. The blood samples were assayed using high-performance liquid chromatography (HPLC) and norepinephrine and epinephrine were detected electrochemically. 24 hour urine was collected during rest and vanillylmandelic acid (VMA) and metanephrine were also detected using HPLC.

Results: The mean plasma norepinephrine levels were 1.05⁑0.24 ng/ml and 0.47⁑0.06 ng/ml in RSD affected and unaffected groups respectively, and the plasma norepinephrine level was significantly higher in the patient group with reflex sympathetic dystrophy (p＜0.05). The plasma epinephrine and 24-hour urine VMA and metanephrine levels were not significantly different in two groups.

Conclusion: These results may support a hypothesis of increased regional sympathetic outflow in the pathogenesis of reflex sympathetic dystrophy in hemiplegia.

Objective: Treatment of children with cerebral palsy needs much time and effort, so it is very hard for many patients to get hospital based treatment. To develop the home treatment program with the parents, we tried to elucidate the current difficulties to which therapists were facing during the treatment of cerebral palsies.

Method: A cross-sectional study was performed to 250 physical therapists in 110 hospitals with a questionaire by mail. Sixty two universities and general hospitals, 37 rehabilitation centers and 31 community rehabilitation centers were involved in treatment for cerebral palsy, 51% of them are located in Seoul and Kyungi-do.

Results: 1) The current treatment time was 33.7 minutes, but most therapists replied that 45 minutes would be optimal. 2) Fifty four therapists (86.1%) had reviewed on introduction or basic course of the Bobath or Vojta program; the duration of the course ranged from 5 days to 1 to 2 months. 3) Fifty five cerebral palsy patients (66.7%) continued treatment for 1 to 2 years and 25% received treatment for more than 2 years. 4) Twenty nine patients (35%) received home therapy from trained parents, 75% of the cases noted significant improvement.

Conclusion: Cerebral palsy treatment programs require more time than the actural duration of time given during therapy sessions. Thus, parent education for home therapy is considered to be an essential part of cerebral palsy management.

Objective: This study was designed to evaluate the usefulness of stretch reflex threshold speed (SRTS) in biomechanical assesment of spasticity of hemiplegic patients.

Method: Thirty-eight hemiplegic patients and twenty-seven control subjects were studied. The spasticity of ankle plantar flexor muscles were assessed both clinically and biomechanically. Modified Ashworth scale (MAS) and Brunnstrom stage were used in clinical assessment. For biomechanical assessment, ankle plantar flexor muscles were stretched isokinetically while EMG signals were recorded simultaneously. SRTS was defined as a minimum angular velocity in which EMG signals evoked by stretch reflex were recorded.

Results: SRTSs of ankle plantar flexors were 128.1⁑47.1^o/sec in control group, 163.7⁑79.7^o/sec in intact legs, and 83.4⁑69.1^o/sec in involved legs of hemiplegic group. STRS was significantly lower in involved legs of hemiplegic group than in intact legs of hemiplegic group and control group. Significant reverse correlation was observed between SRTS and MAS. There was significant difference in SRTS between MAS 0 group and other groups. The patients with Brunnstrom stage 3 and 4 groups showed decreased SRTS compared to the patients with other groups.

Conclusion: SRTS is thought to reflect increased excitability of stretch reflex and seems to be one of useful parameters in quantitative assessment of spasticity.

Objective: The risk of barium aspiration has been reported through animal and clinical studies. Although the barium aspiration occurs frequently during videofluoroscopic barium swallowing study (VFSS) that is used in a standard method for diagnosis of dysphagia, there has been no research about the risk of VFSS.

Method: One hundred VFSS of sixty nine patients were analyzed prospectively. The patients were diagnosed to dysphagia clinically. VFSS findings were classified into 5 groups according to the severity of aspiration. The incidences of complications, such as fever (＞38.3^oC), leukocytosis (＞10,000), dyspnea and abnormality of chest roentgenogram within 24hours after VFSS were determined in each group. Odds ratios of complications after VFSS for severity of their findings were calculated.

Results: The complications of VFSS are as follows; five febrile conditions, three leukocytosis and three dyspnea among 100 VFSS cases. Odds ratios for complications were over 1 except for the abnormality of chest roentgenogram, but which was not statistically significant.

Conclusion: The incidence of complication after VFSS was 5% in dysphagic patients. But the severity of complication was mild and there was no statistical significance between complication and aspiration on VFSS, so VFSS was a relatively safe procedure.

Objective: To investigate the characteristics of the motor cortex map for abductor pollicis brevis muscle (APB) using transcranial magnetic stimulation (TMS) in normal subjects.

Method: Ten adults without neurological disorder were studied. A piece of cloth which marked at 1 cm interval was fixed on the head of the subject. The motor cortex mapping for APB was done with butterfly magnetic stimulator, and then with round magnetic stimulator.

Results: The average optimal scalp position for left APB was located on lateral 6.2 cm, anterior 0.1 cm from Cz and that for right APB was located on lateral ⁣6.0 cm, anterior 0.1 cm from Cz when stimulated with butterfly magnetic stimulator. The differences between hemispheres were less than 1 cm in the location of optimal scalp position and less than 10% in excitatory threshold (ET) irrespective of magnetic stimulator. The ipsilateral motor evoked potential (MEP) was not evoked in all subjects. The ET when stimulated with butterfly magnetic stimulator was higher to that when stimulated with round magnetic stimulator.

Conclusion: We conclude that TMS using butterfly and round magnetic stimulator is useful for the motor cortex mapping.

Objective: Tarsal tunnel syndrome (TTS) is relatively rare and can be difficult to diagnose with conventional electrodiagnostic techniques. To increase the diagnostic sensitivity, we measured transtarsal conduction velocities of medial and lateral plantar nerves recorded by orthodromic near-nerve recording.

Method: Twenty normal subjects (aged 24∼59) were studied. For below flexor retinaculum (BFR) recordings, near-nerve needle recording electrodes were positioned posteriorly to the flexor digitorum longus tendon in medial plantar nerve and anteriorly to the calcaneus in lateral plantar nerve at the level of lower border of medial malleolus. For above flexor retinaculum (AFR) recordings, near-nerve needle recording electrodes were positioned anteriorly to the Achilles tendon 4 cm proximal to the BFR recording electrodes in medial and lateral plantar nerves. Stimulating ring electrodes were placed to the digit I and V.

Results: Transtarsal latencies and conduction velocities for medial plantar nerve were 0.7⁑0.1 msec, 56⁑6 m/sec, respectively. Transtarsal latencies and conduction velocities for lateral plantar nerve were 0.8⁑0.1 msec, 54⁑6 m/sec, respectively.

Conclusion: This approach may improve the diagnostic sensitivity in TTS.

Objective: The purpose of this study was to determine the difference of temperature effects on the nerve conduction variables and to obtain correction factors for temperature in demyelinated and normal peripheral nerves.

Method: The compound muscle action potentials (CMAPs) were recorded with wrist stimulation during cooling and warming in 10 control subjects and 13 subjects with demyelinating neuropathies. The temperature of cooling and warming were 18^oC and 40^oC, respectively. The time of cooling and warming were 60 minutes and composed of successive 4 sessions of 15 minutes. The skin temperature of thenar area, latency, amplitude, duration, and area of CMAPs were measured before and after each session of 15 minutes of cooling or warming.

Results: The time constants of parameters of CMAPs were of higher tendency in cooling than in warming. The time constants of latency of CMAP were higher in subjects with demyelinating neuropathy than in controls (p＜0.05): 33.3⁑4.0 minutes versus 27.2⁑2.2 minutes in cooling; 30.0⁑7.8 minutes versus 19.6⁑3.3 minutes in warming. The temperature correction factor of latency of CMAPs was ⁣0.23⁑0.03 msec/^oC in control and ⁣0.33⁑0.06 msec/^oC in subjects with demyelinating neuropathies (p＜0.05).

Conclusion: When studying a subject with demyelinating neuropathies, we should warm the extremity for more sufficient time than in normal subject, or may applicate a differenct temperature correction factors.

Objective: The sural nerve is a sensory nerve in the lower extremity which is formed by the union of the medial sural cutaneous nerve of tibial nerve and the communicating branch of the common peroneal nerve. The objective of this study is to standardize the electrodiagnostic technique of proximal conduction of sural nerve and to investigate the usefulness of the technique in evaluation for the patients with peripheral neuropathy.

Method: Fifty eight extremities in 29 normal adults without the clinical signs and symptoms of peripheral neuropathy were evaluated with sural nerve conduction study. The active recording electrode was placed over 14 cm proximal to the lateral malleolus, and the reference electrode was placed over 4cm distal to the active electrode. The antidromic evoked responses were recorded with stimulation at points 7, 14, 21 cm proximal to the recording electrode and directly over the sural nerve.

Results: The mean values of proximal conduction study of sural nerve in normal adults were 2.40⁑1.03 msec for peak latency, 11.55⁑7.31μV in amplitude with stimulation at 7 cm proximal to the recording electrode; 3.43⁑0.78 msec for peak latency, 10.87⁑5.86μV in amplitude with stimulation at 14 cm; 4.51⁑0.83 msec for peak latency, 8.78⁑4.10μV in amplitude with stimulation at 21 cm.

Conclusion: A method of proximal conduction study of sural nerve was introduced which could be used as a valuable technique for the evaluation of peripheral neuropathy.

Objective: To assess the facial and trigeminal nerve involvement in diabetic patients using blink reflex study and direct facial motor conduction study.

Method: The subjects were 397 diabetic patients and 34 normal controls. Diabetic patients were subdivided into two groups based on the findings of nerve conduction studies of limb nerves.: Group I, patients with diabetic polyneuropathy; Group II, patients without diabetic polyneuropathy. The blink reflexes and direct facial motor responses and R1 latency/direct response latency (R/D) ratio were obtained in all the subjects. R1 latency was correlated to the findings of nerve conduction studies of limb nerves.

Results: 1) R1 latencies or R2 latencies were abnormally prolonged in 22.4% of Group I, 3.3% of Group II, and direct facial responses were abnormal in 11.8% of Group I, 2% of Group II. 2) There were no significant differences in R/D ratio between the two groups. 3) These findings suggest that not only the facial nerve, but also the trigeminal nerve or brain stem could be affected in diabetic patients with polyneuropathy.

Conclusion: In diabetic patients, blink reflex can provide useful information in determining the degree and distribution of cranial nerve and brain stem lesions.

Objective: The purposes of this study were to evaluate the relation of the lumbar plexus with the psoas compartment, to measure the distance from skin to psoas compartment, and to determine the efficacy of psoas compartment block for the unilateral leg pain and/or low back pain.

Method: Six cadavers were dissected and the computed tomography of the lumbar region were performed in 22 subjects. The psoas compartment block of 10 ml of 0.5 percent lidocaine were performed in 31 patients with unilateral leg pain and/or low back pain. Visual Analog Scale (VAS) and sensory, motor functions were assessed before the block and 5, 30 minutes, and 1, 2, 3 hours and 1 week after the block. The distance from skin to psoas compartment were measured during the procedure. The questionnaires on the procedure were completed after 1 week.

Results: Cadaver dissections demonstrated that the 3 main nerves of lumbar plexus were within the psoas compartment between the level of L4 and L5. Computed tomography provided that the average distances of anterior and posterior borders of psoas major from the low back skin were 10.8 & 6.3 cm and that of medial & lateral borders from the median sagital plane were 2.9 & 7.1 cm respectively. There were statistically significant correlations between distance from skin to psoas compartment and body weight, abdominal circumference as well as body mass index (p＜0.0001). The VAS was 7.7 before the block and 5.4 1 week after the block (p＜0.05) and satisfactory outcomes were shown in 71 percent of the subjects.

Conclusion: Psoas compartment block was effective for the patients with unilateral leg pain and/or low back pain without major side effects and complications.

Objective: We compared a few variables such as the type of needle, the direction of bevel, and the effect of stimulation duration in percutaneous peripheral nerve blockade. We also studied the real distribution of injected drug through nerve biopsy.

Method: The sciatic nerve-tibialis posterior muscle preparation of rabbit was chosen as a model. Experimental rabbits were divided into 3 groups: Group 1 (16 legs), use of insulated needle and 100μs stimulation duration; Group 2 (9 legs), use of insulated needle and 240μs stimulation duration; Group 3 (6 legs), use of uninsulated needle and 100μs stimulation duration. The mixed solution, 0.1 cc, of 5% phenol and indian ink was injected in 10 legs and the muscles were obtained to observe the spreads of injected solution after 2 weeks.

Results: The minimal stimulation currents of group 1, 2, 3 were 0.49 mA, 0.37 mA, 2.07 mA, respectively. The distance between needle and sciatic nerve sheath of group 1, 2, 3 were 0.09 mm, 0.11 mm, 0.20 mm in width, and 1.84 mm, 3.33 mm, 4.50 mm in depth, respectively. The current required to stimulate the nerve increased rapidly as the tip of the insulated needle passed the nerve, and the direction of bevel had no effect on the minimal stimulation current. Injected indian ink was located alongside the perineurium.

Conclusion: In three methods, the most exact method was the use of insulated needle and 100s stimulation duration. The needle tip was located 1.84 mm past the nerve.

Objective: To find the characteristics of the nerve stimulator for the peripheral nerve blockade.

Method: We studied four different nerve stimulators currently available in the clinical setting. The output characteristics(wave shape, voltage and duration of the stimulus impulse) were measured for each stimulator using an oscilloscope. Target current from 0 mA to 5 mA and load resistances from 200 Ω to 10 kΩ were selected to model the normal ranges of operating current and tissue impedance when performing peripheral nerve block technique.

Results: There was a marked variation in performance of nerve stimulators depending on the target current value and resistances. Measured pulse width was not identical to the target pulse width in three nerve stimulators. Measured voltage with a fixed resistance was smaller in two nerve stimulators than the target voltage which was supposed to be produce in target current value of same resistance. One nerve stimulator showed the differences of calculated current value according to the used resistances.

Conclusion: For the successful nerve block, it is important for the operator to be aware of the design and functional limitations of the nerve stimulator being used in clinical practice.

Objective: To evaluate the correlation of the cross-sectional areas (CSA) of paraspinal muscles (back extensors and psoas muscles) and full range-of-motion isometric lumbar extension strength in the individuals with low back pain.

Method: Twenty four subjects (14 men and 10 women) with low back pain completed a maximum isometric lumbar extension strength test at seven angles through a 72^o range of motion (0, 12, 24, 36, 48, 60, 72 degrees of lumbar flexion). CSA of back extensors and psoas muscles were measured from standardized transaxial view by CT scanner.

Results: CSA of lumbar extensor and psoas were correlated with isometric lumbar extension strength from full flexion to extension in the low back pain patients. The greater the lumbar flexion angle, the greater the coefficient of determination (R²). The correlation coefficients of psoas muscles were greater than those of lumbar extensors.

Conclusion: Both back extensors and psoas muscles do their important role during isometric lumbar extension. Isometric lumbar extension strength of full lumbar flexion is well correlated with CSA of paraspinal muscles.

Objective: The purpose of this study was to determine the knee extension force of healthy Korean adults by using a hand-held dynamometer and evaulate the relationship of knee extension force between each decade.

Method: One hundred and twenty healthy subjects (60 males, 60 females) between the ages of 20 and 79 years were tested for knee extension force by using Nicholas Manual Muscle Tester (MMT). Data were analyzed for means, standard deviations, test-retest reliability and correlation with variables by using the SPSS^Ⱂ software package.

Results: The mean value of the knee extension force was 25.9⁑5.8 kg in the males and 16.5⁑4.1 kg in the females. Significant difference between each decade was found in the males but not in the females. The knee extension force of the males was stastically correlated with all of variables, i.e., age, weight and height, but the knee extension force of the females, was correlated only with weight. Intratester correlation coefficients were high for the Nicholas MMT to measure the knee extension force for healthy adults. Also the difference between the dominant and nondominant side for the knee extensor force was not significant, stastically.

Conclusion: This MMT may be useful to quickly and objectively evaluate force in the clinical setting.

Objective: To examine the stiffness of finger joints with StifMeter among the patients with rheumatoid arthritis and to calculate the absolute value of the stiffness with a unit of power and to compare the values of the StifMeter with visual analog scale about stiffness (VASstiff).

Method: Subjects were 53 rheumatoid arthritis patients (male 8, female 45) with disease duration at least 6 months. StifMeter was made up of 10 graded springs of a same spring-constant. Stiffness and pain by VAS and StifMeter, finger circumference and pinch strength were measured at outpatient clinic as well as questionaire, prospectively. Laboratory data were reviewed from medical records to verify the state of disease. We compared StifMeter with VASstiff and VASpain.

Results: Mean score of StifMeter was 5.59 on the right side and 5.53 on the left. The corrected values of the StifMeter with a unit of power were 0.01684 on the right side and 0.01672 on the left side. VASstiff score was positively correlated with that of StifMeter. The older the age, the higher the score of VASstiff that was positively correlated with that of StifMeter. The longer the duration of disease, the higher the score of VASstiff that was positively correlated with that of StifMeter.

Conclusion: StifMeter is a semi-objective method which may be of value in the measurement of finger joint stiffness.

Objective: To evaluate the effects of strengthening exercise for isolated lumbar extensor muscles on chronic low back pain patients.

Method: 28 patients with chronic low back pain in back school program participated in this study. Initially, isometric lumbar extensor strength, 10 point of Visual analog scale (VAS) and questionnaires related to self-experienced symptoms and daily activity (ADL) were checked. Isometric lumbar extensor strength test and strengthening exercise were performed with MedX^TM lumbar extensor machine, which was designed to stabilize the pelvis. After 8 weeks of training program, isometric lumbar extensor strength & other pain related variables were checked again in the same way.

Results: The results were as follows: 1) After 8 weeks of lumbar extensor strengthening program, isometric lumbar extensor strength was increased at all the measured points significantly (p＜0.01). 2) VAS and ADL were improved from 6.7 to 3.7, and from 6.9 to 9.1 respectively (p＜0.05).

Conclusion: 8 weeks of lumbar extensor strengthening program with pelvic stabilization was effective therapeutic tools for patients with chronic low back pain.

Objective: To survey the prevalence of Cumulative trauma disorders (CTDs) and to analyze the ergonomic factors among the bank workers and post officers.

Method: Seventy seven subjects were collected from bank workers (50) and post officers (27) from the multiple areas of country who had been exposed to risky working environment regarding CTDs. The subjects were first screened by occupational medicine specialists and confirmed by rehabilitation medicine specialist. The serologic test, radiologic imaging, electrodiagnostic study were performed in all the subjects. Ergonomists analyzed the job element to identify the risk factors by baseline checklist of CTDs.

Results: Among bank workers, 30 (60%) of 50 were confirmed as having CTDs. MPS was present in 30 patients (60%), latenl epicondylitis in 5 (10%), medial epicondylitis in 3 (6.0%), tendinitis 3 (6.0%), and other disease in 3 (6.0%). Among post officers, 14 (51.9%) of 27 were confirmed as having CTDs. MPS present in 10 (37.0%), cervical disc disease in 4 (14.8%), others in 4 (14.8%). The ergonomic risk score was highest 1.87 in the 'package deviding' job, and 1.82 in 'bagging to cart', 1.62 in 'initial devision'.

Conclusion: The result would be helpful for the prevention and management of CTDs in the bank workers and post officers.

Objective: The purpose of this study was to evaluate the severity and frequency of osteoporosis of the foot in patients with diabetes mellitus using bone densitometry, and to determine whether plain radiologic evaluation can be used as a cheap and reliable screening of osteoporosis.

Method: We studied plain X-ray including AP and lateral views of the feet of the patients. Bone densitometry studies were performed on the feet of both diabetic and age-matched control groups.

Results: Forefoot bone densitometry scores were significantly lower in the male diabetic group compared to the control group (p＜0.05). Furthermore, the female diabetics had significantly lower bone densitometry scores for forefoot and hindfoot than the control group (p＜0.05). Bone densitometric evaluation of the diabetic patients' feet revealed scores significantly lower than those of the controls in cases which the radiologist interpreted as normal finding in plain roentgenogram alone (p＜0.05).

Conclusion: Plain radiologic studies of the feet in patients with diabetes mellitus are not effective in identifying osteoporotic change; thus, they should not be used as the screening method of diabetic foot lesions.

Objective: To determine whether estradiol (E₂), lipid profile, biochemical markers, and bone mineral density (BMD) are related according to postmenopausal period.

Method: One hundred fifty four women were divided into four groups according to the time past menopause: group I (0∼5 years), group II (6∼10 years), group III (11∼15 years), group IV (more than 16 years). Group I, II, III were subdivided into osteoporosis group (t-score＜⁣2.5) and non-osteoporosis group (t-score≥⁣2.5). E₂, lipid profile, osteocalcin, alkaline phosphatase, deoxypyridinoline, and BMD by DEXA were measured in all groups.

Results: There were significant inverse correlation between BMD and postmenopausal period (p＜0.05). Deoxypyridinoline and osteocalcin were correlated with postmenopausal period but there was no statistical significance. Deoxypyridinoline and osteocalcin were increased in osteoporosis group compared to non-osteoporosis group but there was no statistical significance. E₂ had significant inverse correlations with postmenopausal period (p＜0.05). E₂ had no correlation with factors such as biochemical markers and lipid profile in group I, II, III but had adverse correlation with deoxypyridinoline in group IV.

Conclusion: No specific biochemical markers regarding the duration of menopause were found. Regardless of the duration of menopause, checking both osteocalcin and deoxypyridinoline was statistically significant for the evaluation of postmenopausal osteoporosis.

For the management of refractory radicular pain, traditional injection techniques such as transcaudal or translumbar epidural steroid injection may be indicated. This epidural injection, done blindly, may result in improper needle placement. Fluoroscopically guided transforaminal epidural steroid injection and computerized tomography-controlled periganglionic foraminal steroid injection are selective nerve blocks. These procedures are useful for the diagnosis. The advantages of these procedures are precise anatomic location provided by fluoroscope or CT.

Intraforaminal or periganglionic steroid injection is useful in the treatment of radicular pain. Thus we introduce a case of selective epidural steroid injection in a patient with refractory radicular pain.

The association between pediatric Chiari malformation and the development of syringomyelia has been well documented. Scoliosis in the patient with syringomyelia is thought to be secondary to anterior horn cell damage, which innervate the muscles of trunk, by an asymmetrically expanded syrinx. In pediatric patients, the neurologic signs and symptoms due to Chiari malformation and syringomyelia show much lower frequency but the incidence of scoliosis is very high. Thus, the MRI study for the diagnosis of the underlying syringomyelia and Chiari malfornation is essential in pediatric scoliosis patients, which may otherwise be misdiagnosed for idiopathic scoliosis.

We present a case of Chiari type I malformation associated with syringomyelia and scoliosis.

Myasthenia gravis, a disease characterized by weakness and easy fatigue of skeletal muscles, has been associated with other diseases of presumed autoimmune nature. These include rheumatoid arthritis, systemic lupus erythematosus, thyroid dysfunction, hematologic disease, gammopathy, infection, cancer, inflammatory myopathy, etc. In some cases of myasthenia gravis, an inflammatory myopathy develops and adds to the weakness already caused by the transmission defect. We report a 31-year-old female who had the manifestations of myasthenia gravis and polymyositis with the brief review of literatures.