Objective
To observe the effect of the depolarizing stimulation in amyotrophic lateral sclerosis (ALS) mouse model on the survival and behavioral performance. Method: Transgenic male mouse model of ALS at the age of 9∼11 weeks were divided into sham control group (n=10) and stimulation group (n=9). Electrode was implanted in the motor cortex in left hemisphere. Movement thresholds (MT) were regularly checked. Half threshold of MT, unipolar, and continuous electrical stimulation (frequency, 50 Hz; pulse duration, 220Ռs) was delivered through implanted electrode. Behavioral tests including Rota-rod and Paw-grip endurance were checked every day. Results: Induction of symptom was delayed in 8 days in stimulation than sham control group. However, there was no significant difference in survival in both groups. Behavioral tests showed that stimulation group is significantly better than sham group in Rota-rod (11∼15 weeks) and in grip endurance (11∼14, 16 weeks). MT was always between 1.0 volt and 3.2 volt in sham group, however, MT was between 0.8 volt and 2.8 volt in stimulation group. MT was jumped up around the time of death in both groups. Conclusion: Electrical stimulation is considered to be one of possible trial methods in ALS model. However, parameters of the stimulation in the experiment should be modified for better results. (J Korean Acad Rehab Med 2009; 33: 507-513)

Objective
To investigate the changes of apoptosis related factors after denervation and disuse in skeletal muscles and to find out the role of apoptosis in atrophic process. Method: 30 male Sprague-Dawley rats, 8 weeks of age were treated with three different atrophy models (10 rats in each group); hind-limbs suspension (HS) as a disuse model, complete denervation by sciatic nerve transsection (CD) and partial denervation by sciatic nerve crushing (PD). At 2 weeks and 4 weeks after each experiment, both gastrocnemius were dissected and their weights were measured. Western blotting for BAX and Bcl-2 and TUNEL assay were used to assess the changes of apoptosis related factors in muscle cell. Results: The muscle weight of PD and CD group decreased 38.6%, 65.6%, respectively, of intact side at 4 weeks after injuries. The loss of muscle weight in HS group was smaller than that of denervated muscles. CD group showed high expression of BAX (3.45±0.32→2.87±0.48) and Bcl-2 (3.63±0.40→3.33±0.50) at 2 and 4 weeks after denervation, but in PD group, BAX at 2 weeks significantly decreased at 4 weeks (3.40±0.55→2.13±0.25). In HS group, their expressions were slightly increased only immediate after 14 days suspension (BAX: 1.30±0.38 and Bcl-2: 1.29±0.28). CD group showed higher number of positive nuclei (27.6±8.8%) than PD group (10.4±5.3%) and HS group (4.4±1.6%) in TUNEL assay. Conclusion: Unlike temporary increase of apoptosis related factors in disuse, increase of these factors are remarkable and persisted after denervation. Muscle apoptosis may be the major cause of muscle atrophy during degeneration process. (J Korean Acad Rehab Med 2009; 33: 514-519)

Objective
To define the migration and differentiation of adult human mesenchymal stem cells (hMSCs) derived from bone marrow, and their effect on neurobehavioral and cognitive improvements, after traumatic brain injury (TBI) in rats. Method: Two days after TBI, 1×106 hMSCs were injected into the corpus callosum of fifteen rats, on the contralateral side of TBI. Eleven rats received sham-operation as a control group. Neurobehavioral and Barnes maze tests, and magnetic resonance spectroscopy (MRS) were performed on days 1 and 28 after TBI. Immunohistochemical staining was performed to evaluate distribution and differentiation of hMSCs on day 56. Results: After 28 days, scores on the neurobehavioral test, Barnes maze test, and magnetic resonance spectroscopy (MRS) were higher than on day 1 in both the stem-cell and control groups, but there were no between-group differences. On day 56, injected hMSCs stained positively with MAB- 1281 were distributed in ipsilateral corpus callosum, lesion boundary zone, parietal cortex, and thalamic area around the lateral ventricle. Conclusion: hMSCs injected to the contralateral side of TBI survive and migrate to various areas of the ipsilateral hemisphere. We observed no neurobehavioral or cognitive improvements in test animals, indicating the need to adjust experimental methodologies including the development of appropriate tests to evaluate neurobehavioral and cognitive functions of rats. (J Korean Acad Rehab Med 2009; 33: 520-526)

Objective
To investigate the correlation between poststroke depression (PSD) and the cognitive impairment in the patients with subacute stroke. Method: The subjects were 53 patients with cerebral infarction (n=28) and cerebral hemorrhage (n=25). These patients had a mean age of 64.3. The mean onset time was 2.7 months. The location of stroke was in the right hemisphere in 24 subjects, left hemisphere in 23, and bilateral in 6. The severity of PSD was evaluated by Beck Depression Inventory (BDI), Korean Geriatric Depression Scale (KGDS), and Hamilton Rating Scale for Depression (HRS-D) and the evaluation of cognitive impairments was based on Computerized Neuro-psychological Test (CNT), Mini-Mental State Examination (MMSE). The Pearson correlation was used as a measure of the strength of association between cognitive impairments and PSD. Independent t-tests were calculated to compare differences in cognitive functioning according to hemispheric involvement. Results: PSD was diagnosed in 33 of 53 patients by the BDI, in 28 of 43 patients by the KGDS and in 22 of 45 patients by the HRS-D. Scores in the verbal and visual learning domains of the CNT were significantly correlated with scores on the BDI, KGDS, and HRS-D, but scores on the MMSE were unrelated to any of these measures of depression. Conclusion: We suggest the use of the CNT in poststroke depression patients could be a useful tool from the viewpoint of differentiation of PSD patients with or without cognitive impairment and the diagnosis for poststroke depression should be conducted by self rating and objective assessments. (J Korean Acad Rehab Med 2009; 33: 527-532)

Objective
To determine the relationship and difference of the Short Physical Performance Battery (SPPB) between normal population and stroke patients, and to examine the relationship of the SPPB that used to assess lower extremity function in old, and Functional Independence Measure (FIM), Modified Barthel Index (MBI) in stroke patients. Method: One hundred and fifty nine stroke patients and 159 sex, age-matched normal population were included. All subjects were enrolled to interview and administer the SPPB and FIM, MBI. The SPPB included assessment of standing balance, a walking speed (timed 4 m walk), and chair stand (timed test of rising 5 times from a chair). Results: The stroke patients showed significantly lower SPPB score than control group. The age, sex, direction of affection, and duration of stroke did not influence SPPB score respectively. In comparison of FIM and MBI, SPPB was significantly correlated with FIM and MBI, especially motor subtotal score of FIM. Conclusion: SPPB may be useful tool to assess and predict the physical function in stroke patients. (J Korean Acad Rehab Med 2009; 33: 533-537)

Objective
To investigate the postural stability of patients with mild to moderate stage of idiopathic parkinson's disease (IPD) using Tetra-ataxiometric posturography (Tetrax) and to evaluate the correlation between balance and activity of daily living (ADL). Method: Twenty patients with IPD at mild to moderate stage, twenty young controls and twenty elderly controls were enrolled in this study. In order to evaluate postural stability, we checked stability index, fourier index, weight distribution index, synchronization index, and fall index at eight positions using Tetrax. We also assessed Berg Balance Scale, Postural Instability and Gait Difficulty (PIGD) score of Unified Parkinson Disease Rating Scale (UPDRS). In order to evaluate the correlation between balance and functional performance, the ADL score of UPDRS was checked in the patients with IPD. Results: The patients with IPD showed a significantly higher fall index, weight distribution indices in five positions than the elderly controls. The stability indices of the patients with IPD were higher in all positions, but significantly higher in only one position than the elderly controls. The fallers in the IPD patients had a higher fall index and lower synchronization indices than the non-fallers. The balance and functional performance showed significant correlations in the IPD patients. Conclusion: We could identify a high falling risk and uneven weight distribution in the IPD patients and a close correlation between balance and functional performance. Therefore the evaluation of postural stability should be considered from mild stage because postural instability might impair activity of daily living and increase fall risk. (J Korean Acad Rehab Med 2009; 33: 538-546)

Objective
To provide information of charged nursing care facility for helping to establish geriatric health care policy, and to figure out which factors would be the main determinants for the choice of it. Method: 46 males and 53 females, and the same number of their caregivers admitted into the charged nursing care facility were recruited for intensive interview including personal information, disease information, and economic, familial, marital and emotional statuses. This is a cross sectional study and we analyzed the data qualitatively. Results: Patients had 3.2 diseases and a hospitalization for 2.3 years on average. They were consists of 46 singles (46.9%), 8 unmarried (8.2%), 5 divorced (5.1%) and 32 married (32.7%). More than two third (70.1%) were supported by their eldest son or daughter. Mostly, the family caregivers decided to admit into the facilities by the doctor's recommendation (68.4%). When they made a choice for a facility, most of them (42.9%) considered environmental and sanitary conditions. According to their expectation for management in nursing care facility, most caregivers (59.2%) wanted simple-staying for the duration, but most patients (61.3%) expected to be home after taking comprehensive rehabilitation. Three quarter of the caregivers would agree to use nursing care facilities in the future, if they would be the same situation. Conclusion: Life style and environment are rapidly changing. In the near future, we need lots of the charged nursing care facilities for the old, thus this study can be the good reference for the preparing upcoming aged and super aged society. (J Korean Acad Rehab Med 2009; 33: 547-551)

Objective
To investigate differences in the dynamic postural control in unstable sitting position between children with spastic diplegic cerebral palsy (CP) and normally developing children. Method: Sixteen children with spastic diplegic CP who could sit alone and walk independently and sixteen age- matched normally developing children were included. The evaluation system for postural control consisted of unstable platform, force plate, frame, safety harness, monitor and computer. Force plate on unstable platform measured center of pressure (COP) of the subject. COP sway, COP maintaining time and COP moving time were recorded in both groups. In diplegic CP group, Gross Motor Function Measure (GMFM) was evaluated. Results: In COP sway, the distance away from central location was significantly increased and time maintaining on circle at center decreased significantly in diplegic CP group (p＜0.05). The children with diplegic CP showed significant decrease in maintaining time and significant increase in moving time in all directions. COP sway was significantly correlated with GMFM. Conclusion: Postural control in children with spastic diplegic CP walking independently was revealed to be significantly worse compared to normal age-matched children. Further studies are necessary to find out whether the training for seated postural control could improve the motor function. (J Korean Acad Rehab Med 2009; 33: 552-556)

Objective
To investigate prevalence of ossification of posterior longitudinal ligament (OPLL) in Korean patients with Spondyloarthropathies (SpA), and the associations between OPLL and clinical, radiologic findings of SpA. Method: A cross-sectional radiological review was performed in patients diagnosed with SpA from 2000 to 2007. Each of two physiatrists and musculoskeletal radiologists screened the cervical (lateral) and pelvis (anterior-posterior) radiographs of these patients separately, then confirmed presence of OPLL. Bath ankylosing spondylitis radiology index (BASRI) of the cervical spine and grade of sacroiliitis were also measured. A review of the medical records and laboratory findings was conducted to investigate the association between the clinical, laboratory findings and the OPLL. Results: Among 172 patients with SpA, OPLL was found in 16 patients (9.3%; 95% CI 5.0, 13.6). There were significant associations between OPLL and old age (p=0.043), symptoms and signs of myeloradiculopathy (p=0.030), and diabetes mellitus (DM) (p=0.022). Conclusion: The prevalence of OPLL in Korean patients with SpA is 9.3%. OPLL in patients with SpA is associated with old age, symptoms and signs of myeloradiculopathy, and diabetes. However, no factors specific characteristics of SpA were associated with OPLL. (J Korean Acad Rehab Med 2009; 33: 557-563)

Objective
To investigate the prevalence and clinical features of diffuse idiopathic skeletal hyperostosis (DISH) in patients with dorsal back pain. Method: A total of 229 patients (119 men and 110 women) with dorsal back pain were included. Medical records including age, sex, chief complaints, medical history, physical findings, laboratory data, and musculoskeletal radiographs were reviewed retrospectively. Results: Twenty-seven (11.8%, by Resnick's criteria) and thirty-eight (16.6%, by Julkunen's criteria) of the 229 patients were diagnosed with DISH by thoracic spine radiographs. A significant increase of risk with age was observed (Resnick's criteria: odds ratio 1.10, 95% CI 1.05∼1.16, p＜ 0.001, Julkunen's criteria: odds ratio 1.08, 95% CI 1.04∼1.12, p＜0.001). Male sex (Resnick's criteria: odds ratio 2.65, 95% CI 1.01∼6.95, p=0.048, Julkunen's criteria: odds ratio 2.87, 95% CI 1.27∼6.59, p=0.011) and inflammatory pain (Resnick's criteria: odds ratio 7.76, 95% CI 2.69∼22.33, p＜0.001, Julkunen's criteria: odds ratio 3.84, 95% CI 1.55∼9.47, p=0.004) showed higher risk for development of DISH. Mean body mass index of patients with DISH were higher in all age groups, and they showed higher prevalence of DM and hyperlipidemia than general population. Conclusion: Patients with dorsal back pain showed higher prevalence of DISH than previous results with random samples. Aging, male sex and inflammatory pain might be a risk factor for development of DISH. Also, obesity, DM and hyperlipidemia might be strongly related with DISH. (J Korean Acad Rehab Med 2009; 33: 564-571)

Objective
To investigate the changes of myocardial oxygen demand and rate of perceived exertion (RPE) during treadmill or bicycle exercise in patients with ischemic heart disease. Method: 73 consecutive male patients who were referred to cardiac rehabilitation unit after taking coronary angioplasty were selected. All patients took exercise test by modified Bruce protocol and exercise intensity were prescribed by Karvonen's formula. On the first day of exercise, patients performed exercise by treadmill or bicycle with 60% heart rate reserve for 24 minutes, and on the second day of exercise, mode of exercise was switched with same intensity. On the third day, patients performed treadmill or bicycle exercise with 85% heart rate reserve for 24 minutes and also switched on the fourth day. Heart rate, blood pressure, and Borg's RPE were recorded on 2 minutes before exercise termination during all 4 days. Results: Blood pressure was higher in bicycle exercise than treadmill, and there was no significant difference in the change rate of blood pressure between 60% and 85% heart rate reserves. Myocardial oxygen demand and RPE were also higher in patients exercised on bicycle exercise than treadmill at 60% and 85% heart rate reserves. With the intensity of 85% heart rate reserve, RPE was higher in bicycle exercise (15, hard) than treadmill (13, somewhat hard). Conclusion: In patient with ischemic heart disease, bicycle exercise at 85% heart rate reserve might be heavy burden during the early cardiac rehabilitation. (J Korean Acad Rehab Med 2009; 33: 572-577)

Objective
To investigate the possible relationship between the anthropometric data, the foot types, sex and the dynamic plantar pressure of normally developed teenagers. Method: The height, weight, body mass index and dynamic plantar pressure were measured from 98 teenagers. Foot types were classified to high arch, normal and flat foot groups depending on the value derived by dividing the minimal length of mid foot area by the maximal length of the rear foot area. Results: The area with the highest plantar pressure was the middle metatarsal area at both feet. However the plantar pressure of the right medial metatarsal and lateral calcaneal areas was greater than the left, while the plantar pressure of the left lateral metatarsal and medial calcaneal areas was greater than the right. Therefore, supinating and pronating forces were applied to the right and left feet. There were statistically significant differences in body weight and BMI among three groups. The comparison between men and women in plantar pressure measurements and foot type determinations showed that the number of pronated feet group and plantar pressures was greater in males than in females. Conclusion: The dynamic plantar pressure of teenagers showed high correlation to weight and BMI. Just like the hands, there was lateral dominance at the feet, and analysis of dynamic plantar pressure of each foot showed asymmetry and asymmetrical turning forces. (J Korean Acad Rehab Med 2009; 33: 578-583)

Objective
To investigate the effect of cycling ergometry and to compare energy expenditure and walking performance after arm cycling with those after leg cycling in patients with brain diseases. Method: Twenty-two adults with brain diseases (6 stroke, 4 traumatic brain injury, 4 brain tumor, 4 parkinsonism, 4 cerebral palsy) were recruited as subjects. They were randomly assigned to disease-matched groups; arm cycling and leg cycling (n=11 each). VO2 (L/min), VCO2 (L/min), VE (L/min), O2 rate (ml/kgㆍmin), O2 pulse (ml/kgㆍbpm), O2 cost (ml/kgㆍm) and VO2 peak (ml/kgㆍmin) during cycling test or walking test, and walking performance were evaluated after cycling training for 4∼6 weeks. Results: Arm cycling exercise did not improve any parameters such as VO2, VCO2, O2 rate and O2 cost during walking test, whereas it increased VCO2, VE and O2 pulse during cycling test. In contrast, leg cycling significantly improved walking velocity and distance, and decreased O2 cost during walking test. It also increased all parameters including VO2 peak during cycling test (p＜0.05). Conclusion: Leg cycling exercise improved walking performance and energy efficiency of walking as well as cardiorespiratory fitness relative to arm cycling. Therefore, leg cycling promoted lower-extremity task such as walking in patients with brain diseases. (J Korean Acad Rehab Med 2009; 33: 584-590)

Objective
To evaluate the accuracy of ultrasound guided hip trochanteric bursa (subgluteus maximus bursa) injection by using pelvis computed tomography (CT) scan with contrast dye. Method: Nine patients (37∼79 years old) with greater trochanteric pain syndrome (GTPS) were recruited for the study. In lateral decubitus position with pain side up, ultrasound guided injection was done into trochanteric bursa located between gluteus maximus and medius tendons with a mixture of 10 ml 0.5% lidocaine and 10 ml contrast dye (Omnipaque) in all study subjects. Accuracy of injection was assessed by pelvis CT scan within 1 hour after bursa injection. Results: As results of pelvis CT scan, all subjects' contrast dyes were accurately injected within trochanteric bursa space from trochanter to proximal gluteus. Conclusion: We confirmed that ultrasound guided trochanteric bursa injection was accurate and easy to perform. (J Korean Acad Rehab Med 2009; 33: 591-594)

Objective
To evaluate the diagnostic value of pudendal nerve terminal motor latency (PNTML) and the relationship with manometric profiles in patients with fecal incontinence. Method: A total of 29 patients with fecal incontinence who visited colorectal clinic were recruited. The PNTMLs of 29 patients were compared with those of normal controls (2.03±0.39) using one-sample t test. Patients were classified into three groups according to pudendal nerve latency; Group I (normal latency, n=8), group II (unilaterally delayed latency, n=9), group III (bilaterally delayed latency, n=12) and compared with manometric parameters (mean maximal resting pressure, mean maximal squeezing pressure, 1st sense volume, urge sense volume, maximal tolerance volume). Results: The PNTML is 3.83±2.19 in right side, 4.57±2.19 in left side which are significantly delayed in patients with fecal incontinence compare to that of normal controls, 2.03± 0.39. (p=0.031 in Rt., p=0.000 in Lt.) Among group I∼III, there were no statistically significant differences in the values of mean maximal resting pressure, mean maximal squeezing pressure, 1st sense volume, urge sense volume and maximal tolerance volume. There was no correlation between the PNTML and any of manometric parameters. Conclusion: The PNTML is valuable in diagnosing patients with fecal incontinence. It is suggested that combined assessments are necessary to identify the cause of fecal incontinence. (J Korean Acad Rehab Med 2009; 33: 595-599)

Objective
To introduce and evaluate the availability of a newly devised ambulatory urodynamic system using the abdominal EMG (electromyography) method instead of the rectal catheter in measuring the abdominal pressure, and to compare with conventional urodynamic system in patients with spinal cord injury. Method: We examined 15 hospitalized subjects with spinal cord injury. Patients were investigated by conventional urodynamics in an examination room, and followed by ambulatory urodynamics in a ward. We used the abdominal EMG and the rectal catheter for the abdominal pressure in the study. We measured urodynamic parameters : volumes of sensations in bladder filling, peak Pdet(detrusor pressure) during filling, maximal Pdet during voiding, bladder capacity, compliance and duration of filling. Results: There was no significant statistic difference in the parameters between the conventional and the ambulatory urodynamics. There were strong correlations between the parameters measured by the rectal catheter and the abdominal EMG in the ambulatory system and between the parameters in the conventional system and in the ambulatory system. Conclusion: There were strong correlation and no significant statistic differences in the parameters between the ambulatory system using abdominal EMG method and the conventional system. Therefore, we suggest that the newly devised ambulatory urodynamic system using abdominal EMG method can be used instead of the conventional non-ambulatory system and the conventional ambulatory system. (J Korean Acad Rehab Med 2009; 33: 600-606)

Objective
To describe the frequency and reasons for rehospitalization in patients with spinal cord injury (SCI) living in the community. Method: A total 388 patients with SCI living in community participated in the nationwide questionnaire-based study. A self-administered questionnaire was used. Results: Of the 459 patients originally enrolled, 388 completed questionnaires, yielding response rate of 84.5%. The reasons for rehospitalization were SCI related complications (71.7%), periodic health evaluation (44.7%), and other causes (28.3%). The most frequent SCI related complications for rehospitalization were urinary tract infections (45.2%), pressure sores (39.7%), fever (18.3%), pain (18.3%), and autonomic dysreflexia (7.6%). The number of rehospitalized cases due to SCI related complication including urinary tract infection was significantly higher in complete SCI. Rehospitalization due to pressures sore was more frequent in people with paraplegia, male and complete injuries. Conclusion: In our study, 71.7% of patients with SCI experienced rehospitalization for SCI related complication after initial hospitalization. Urinary tract infection and pressure sores were the most common SCI related complications for rehospitalization. (J Korean Acad Rehab Med 2009; 33: 607-613)

Objective
To examine changes in seat-interface pressure in wheelchair seated spinal cord injured patients. Method: Twenty-six spinal cord injured patients, who were motor complete tetraplegic and paraplegic patients, were included in this study. After 5 cm air-filled cushion (ROHOⰒ) was placed on their own wheelchair seat, patients were seated on wheelchair with neutral position for sixty minutes. The interface pressure and contact area of buttock was measured every 5 minutes. Results: Significant increases of interface pressure were found in maximal and mean interface pressure during 0 to 25 minutes of sitting (p＜0.05). An increased tendency of contact area of buttock was observed during sitting time but it was not significant. Conclusion: There were no significant changes of interface pressure after 25 minutes of sitting in spinal cord injured patients. Therefore, twenty-five minutes may be a reasonable sitting time before interface pressure is recorded. (J Korean Acad Rehab Med 2009; 33: 614-618)

Objective
To investigate the peak torque of shoulder according to the size of the rotator cuff tear. Method: With 26 patients of unilateral rotator cuff tear, we measured the concentric isokinetic peak torque of shoulder, using Con-Trex isokinetic dynamometer (CMV AG, Deubendorf, Switzerland). We measured flexion, extension, abduction, adduction, external rotation, and internal rotation torques and calculated the peak toque ratio of flexion/ extension, abduction/adduction and external rotation/internal rotation. Before the test, we injected 1% lidocaine to the subacromial bursa to minimize the error that can be caused by pain. The difference of peak torque according to the size of tear was compared. Results: Comparing the peak torque between affected and sound side, significant difference in flexion, extension, abduction, adduction, internal rotation, and external rotation were shown, but there were no difference in peak torque's ratio in flexion/extension, abduction/adduction, and internal rotation/external rotation. When we compared the peak torque according to the tear size, it didn't show significant difference and also there were no difference of peak torque's ratio in flexion/extension, abduction/adduction, internal rotation/external rotation. Conclusion: When we measured the shoulder's strength of rotator cuff tear, peak torque decreased in all motion. But the peak torque's loss and peak torque's ratio is not related with size of tear. (J Korean Acad Rehab Med 2009; 33: 619-626)

Objective
To examine the usefulness of ratio of maximal swelling to normal cross sectional area (CSA) of median nerve with ultrasound in patients with carpal tunnel syndrome (CTS) and healthy controls. Method: Patients with electrodiagnostically proven CTS underwent ultrasonography of the median nerve. The median nerve area was measured at three points (maximal swelling site, 2 cm proximal to maximal swelling site, 12 cm proximal to maximal swelling site) and compared to values from asymptomatic volunteers. Results: The ratio of maximal swelling site to 12 cm proximal was 1.34±0.14 in asymptomatic volunteers and 2.31±0.43 in patients presenting with CTS. The ratio of maximal swelling site to 12 cm proximal gave 73.7% sensitivity and 90.0% specificity. While using only median nerve area at the wrist resulted in 81.6% sensitivity and 70.0% specificity, depending on the cutoff value used. Conclusion: The ratio of maximal swelling site to proximal in patients with CTS is elevated as compared to asymptomatic controls. The ratio of maximal swelling site to 12 cm proximal has higher specificity to diagnose CTS, and may be superior to measuring median nerve area at the wrist alone. (J Korean Acad Rehab Med 2009; 33: 627-631)

Male osteoporosis is known to progress slowly and is less severe compared to female osteoporosis, and the incidence of lumbar compression fracture is considerably lower in male population. Hypogonadism which can develop from various causes including hypopituitarism is a common cause for secondary male osteoporosis. Hypopituitarism as a late complication of severe form of hemorrhagic fever with renal syndrome (HFRS) is known to occur occasionally but its clinical symptoms rarely appear. A 75-year-old male patient who had recovered from HFRS 13 years ago was admitted due to severe low back pain. He presented with gradually developed symptoms of hypogonadism and hypothyroidism resulting from hypopituitarism. MRI revealed collapsed pituitary gland and empty sella. This case presents with a male patient with multiple lumbar compression fractures due to severe osteoporosis secondary to hypogonadism, which resulted from hypopituitarism as a late complication of HFRS. (J Korean Acad Rehab Med 2009; 33: 632-634)

Spontaneous psoas hematoma in patients receiving anticoagulation therapy is a rare condition, but sometimes very serious even fatal, if not properly treated on time. One of our patients developed large spontaneous psoas hematoma while intensive rehabilitation therapy due to recent stroke with global aphasia and right hemiplegia. He had undergone anticoagulation therapy with warfarin and prothrombin time was within therapeutic range. Patient revealed sudden cold sweating with change of vital sign. Because of global aphasia, he could not explain subjective symptoms, but revealed rebound tenderness in right lower quadrant on physical examination. Emergency abdominal & pelvic CT scan showed large hematoma on right iliopsoas area with retroperitoneal extension. Because of unstable hemodynamics and high risks for surgery, transcatheter arterial emboilzation was recommended. Bleeding was controlled successfully after transcatheter arterial embolization, and vital sign was stabilized without other neurologic change. (J Korean Acad Rehab Med 2009; 33: 635-638)

Neurofibromatosis (NF) is a dysplastic disease which consists of multiple café-au-lait spots and neurofibromas from neural sheath. The 61-year-old male patient complained of sudden severe pain on the left buttock started one month ago. On physical examination, multiple "lentigines" were seen on his left buttock which spreaded to the thigh and small soft protruding nodules were observed on the right side of the back and left shoulder. Histopathologic finding of a specimen obtained from a nodule was consistent with neurofibroma. Magnetic resonance imaging (MRI) and ultrasonography revealed asymmetrical hypertrophy of neurovascular bundle located in the left greater sciatic foramen. On diagnosing as NF, he was treated with medication, physical modalities and therapeutic intervention (caudal block). Visual analogue scale (VAS) went down to 3/10 with these treatments and he was discharged. We report successful treatment of buttock pain rarely associated with segmental neurofibromatosis. (J Korean Acad Rehab Med 2009; 33: 639-643)

Stroke in young adults is uncommon and may require extensive evaluation to elucidate an underlying cause. A 21- year-old male professional golfer experienced left side weakness, dysarthria, headache during golfing. Magnetic resonance imaging (MRI) revealed broad ischemia on right basal ganglia, frontal and temporal lobes. Magnetic resonance angiography (MRA) and 4-vessel angiography revealed beading of right intracranial internal carotid and middle cerebral arteries which suggests fibromuscular dysplasia. We report a case of intracranial fibromuscular dysplasia without renal involvement resulting in cerebral infarction in young male professional golfer. (J Korean Acad Rehab Med 2009; 33: 644-647)