Peripheral neuropathy is a common neurological disorder and has a variety of identifiable causes such as diabetes, metabolic derangements, neurotoxic substances, and even genetic abnormalities. Even with a thorough evaluation, however, the underlying cause cannot be identified in a large portion of peripheral neuropathy. In addition to the diagnostic dilemma, the wide spectrum of clinical manifestations with a variety of combinations of altered sensation, muscle weakness, and autonomic symptoms in peripheral neuropathy also makes it difficult to introduce an appropriate management. Treatments for peripheral neuropathy are categorized according to the underlying conditions and the strategies designed to relieve peripheral nerve pain irrespective of the cause. This article summarizes the mechanisms of peripheral neuropathic pain and current pharmacologic treatments including tricyclic antidepressants and anticonvulsants.
Anticonvulsants ; Antidepressive Agents, Tricyclic ; Muscle Weakness ; Nervous System Diseases ; Neuralgia ; Peripheral Nerves ; Peripheral Nervous System Diseases* ; Sensation

Fatigue is probably the most common symptom from both acute and chronic illnesses. It can be defined as a pervasive sense of tiredness or lack of energy that may not be related to exertion. Fatigue is transitory in most cases, however, if it is prolonged or disabling, a significant problem such as chronic fatigue syndrome (CFS) may be warranted. CFS is a complex, debilitating disorder characterized by severe persistent or relapsing fatigue for at least 6 months and a group of characteristic but nonspecific symptoms. Many researchers have proposed that CFS has a specific underlying cause. Currently, however, there is no evidence that supports this view. In addition, since there is no specific physical findings or definitive laboratory tests for consistent biological markers, the diagnosis of CFS depends on operational criteria that do not afford validity and is primarily a diagnosis by exclusion. The prognosis is poor and often the disability and impairment of daily function and performance may be prolonged. The limited understanding of CFS has complicated the management of this disorder. Therefore, the treatment of CFS may be variable and should be tailored to each patient-it should include exercise, diet, good sleep hygiene, antidepressants, and other medications, depending on the patient's clinical presentation.
Antidepressive Agents ; Biomarkers ; Chronic Disease ; Diagnosis ; Diet ; Fatigue ; Fatigue Syndrome, Chronic* ; Hygiene ; Prognosis

Cough remains the most common reason for patients to seek medical attention. Although the exact prevalence is difficult to estimate, recurrent cough is reported in up to 40% of the population. For the investigation and treatment of chronic cough, it is important to understand its etiology, particularly when the underlying pathology exists outside the respiratory tract. Although there is no consensus as to the best diagnostic strategy for chronic cough, many protocols combine laboratory investigations with empirical trials of treatment. Specific treatment for the underlying disease of cough along with etiologic diagnosis should be emphasized rather than nonspecific antitussive therapy because nonspecific pharmacologic treatments have changed little during the last 50 years, without any significant advances from opiatebased compounds. Recently, molecular structures of cough receptors and mediators have been identified. Vanilloid receptor-1 is one of ion channel receptors expressed on the sensory neurons of cough reflex. Substances inhibiting ion channels and receptor antagonists of tachy-or bradykinins are being investigated. Thus safer and more effective agents to deal with this common problem are believed to be available in the near future.
Bradykinin ; Consensus ; Cough* ; Diagnosis* ; Gastroesophageal Reflux ; Humans ; Ion Channels ; Molecular Structure ; Pathology ; Prevalence ; Reflex ; Respiratory System ; Sensory Receptor Cells

INTRODUCTION: Lymphedema develops due to the abnormality of the transport capacity of the lymphatic system. Clinically lymphedema is not only a cosmetic deformity, but also a disabling and distressing condition. CLASSIFICATION: Primary lymphedema is an inborn defect caused by such condition as absence or underdevelopment of the lymphatic system. It occurs in approximately 1 in 10,000 persons less than 20 years of age, with females being affected more frequently than males. Secondary lymphedema is an acquired condition resulting from loss or obstruction of the previously normal lymphatic system due to infection, tumor, filariasis and other miscellaneous conditions. CLINICAL FEATURES: Clinical symptoms and signs depend on the duration and the severity of the lymphedema. In the early stage of disease, the edema is soft and pits easily with pressure (pitting edema) and may decrease or disappear with elevation of the limbs. In the advanced stage, the skin texture turns woody as the surrounding tissue becomes indurated and fibrotic. DIAGNOSIS: Lymphangiography was introduced in the early 19th century. But there are several drawbacks to this procedure, including the complexity of the procedure, irradiation by contrast agent that may result in lymphangitis and potentially worsen the lymphedema. Lymphoscintigraphy is easier to perform than lymphangiography and is not reported to cause lymphangitis. Lymphoscintigraphy is gradually replacing lymphangiography. TREATMENT: The mainstay of the treatment is complex decongestive physical therapy including leg elevation, elastic or rigid compression, manual lymph drainage, and intermittent pneumatic compression. When the function of the limb is significantly impaired, surgical reduction is considered. The surgery is not curative, but it can make the disorder more manageable by complex decongestive physical therapy.
Classification ; Congenital Abnormalities ; Diagnosis ; Drainage ; Edema ; Extremities ; Female ; Filariasis ; Humans ; Leg ; Lymphangitis ; Lymphatic System ; Lymphedema* ; Lymphography ; Lymphoscintigraphy ; Male ; Skin

The possibility to use cord blood stem cells in clinical transplantations has been recently realized. Cord blood was introduced as an alternative source to hematopoietic tissue for allogeneic transplantation following the successful use of a cord blood transplant in a child with Fanconi anemia. So far, more than 5,000 umbilical cord blood (UCB) transplants have been performed worldwide. In Korea, 100 cases of cord blood trans plantation have been done at 11 cord blood transplantation centers by November 2003. Another important field to explore is the capacity of stem cells in cord blood to differentiate into mesenchymal progenitor cells, which are capable of differentiating into cells of different connective tissue lineages such as bone, cartilage, and adipose tissues, and thus they are the best candidate for tissue engineering of musculoskeletal tissues. Although it is still controversial whether UCB contains mesenchymal stem cells, UCB can serve as an alternative source of mesenchymal stem cells to bone marrow and should not be regarded as a medical waste.
Bone Marrow ; Cartilage ; Cell- and Tissue-Based Therapy* ; Child ; Connective Tissue ; Fanconi Anemia ; Fetal Blood* ; Humans ; Korea ; Medical Waste ; Mesenchymal Stromal Cells ; Stem Cells* ; Tissue Engineering ; Transplantation, Homologous

Stem cell therapy is providing a new paradigm of medical approach in many intractable diseases by regenerating injured or degenerated tissues and is opening the era of regenerative medicine. While the validity of newly discovered multipotentiality of various stem cells are still under investigation, scientists are making a significant progress in the medical application of stem cell therapy in the area of adult stem cell therapy, particularly using the hematopoietic and mesenchymal stem cells. These hematopoietic stem cells could be useful in cell therapies for liver diseases, heart diseases and neuronal diseases. Furthermore, due to their ability to induce donor-specific immune tolerance, these cells can be used in organ transplantation and autoimmune diseases. With further development of a high-performance cell therapeutic strategy, more intractable disease will be managed by stem cell therapy.
Adult Stem Cells ; Autoimmune Diseases ; Cell- and Tissue-Based Therapy* ; Heart Diseases ; Hematopoietic Stem Cells* ; Immune Tolerance ; Liver Diseases ; Mesenchymal Stromal Cells ; Neurons ; Organ Transplantation ; Regenerative Medicine ; Stem Cells ; Transplants

Recent progress shows that neurons suitable for transplantation can be generated from neural stem cells (NSCs) in culture, and that the adult brain produces new neurons from its own stem cells in response to injury. In this article, we discuss how the subventricular zone of the forebrain is the most active neurogenetic area and the richest source of NSCs. This review also focuses on the nature and functional properties of NSCs of the adult mammalian brain, and we propose our views on the strategy from bench to the clinic with particular concerns and considerations.
Adult ; Brain ; Humans ; Nervous System Diseases* ; Neural Stem Cells* ; Neurons ; Prosencephalon ; Stem Cells ; Transplantation

Whole or partial liver transplantation has become one of the main treatment strategies for hepatic failure. The availability of a donor liver is the single most limiting factor in liver transplantation. In cell therapy, liver cells have been used clinically to bridge patients to whole organ transplantation and/or as an alternative to whole organ transplants. The crucial property that defines a stem cell is its ability to give rise to a large family of descendants, and at least some hepatocytes do exhibit this pleuripotency. Thus hepatocyte-like cells derived from the bone marrow, embryonal stem cells, or placental sources can also be used. Stem cells of many types have been prodded and cajoled by combinations of growth factors, matrix and culture modifications to identify conditions that favor differentiation or transdifferentiation of stem/progenitor cells into hepatocytes. Additional studies are needed to determine whether hepatocyte-like cells derived from the bone marrow or other sources express the full complement of hepatic functions. If a sufficient number of differentiated hepatocytes can be produced from these stem cells, they could be useful in clinical transplantation programs.
Bone Marrow ; Cell- and Tissue-Based Therapy ; Complement System Proteins ; Cytochrome P-450 CYP2B1 ; Hepatocytes ; Humans ; Intercellular Signaling Peptides and Proteins ; Liver Failure* ; Liver Transplantation ; Liver* ; Organ Transplantation ; Stem Cell Transplantation* ; Stem Cells* ; Tissue Donors ; Transplants

Myocardial infarction is the leading cause of congestive heart failure and deaths in developed countries. Current therapy is limited to the prevention of the progression of ventricular remodeling. The transplantation of stem cells into the injured myocardium is a novel and promising approach for the restoration of myocardial function. Various animal studies have suggested the potential of stem cell transplantation to regenerate myocardium and to improve cardiac function. Recently early phase I clinical studies show that stem cell therapy may have beneficial effects on ventricular remodeling. In this article, the state of the art in both laboratory and clinic on myocardial regeneration with various types of stem cells is introduced. Finally the current and intrinsic limitations of stem cell therapy are discussed along with future directions for research on stem cell therapy for ischemic heart diseases.
Animals ; Developed Countries ; Heart Failure ; Myocardial Infarction ; Myocardial Ischemia* ; Myocardium ; Regeneration ; Stem Cell Transplantation ; Stem Cells* ; Ventricular Remodeling

The 21st century is considered as the era of Biotechnology (BT). Recently, the regenerative medicine using stem cells has been recognized as the future medicine, especially for the devastating diseases such as neurodegenerative diseases, heart disease, diabetes, infertility and liver diseases. Human embryonic stem cells (hESCs) are at the center of the stem cell research due to its ability to proliferate unlimitedly without differentiation (self-renewal) and to differentiate into the derivatives of all three germ layers including germ cells with appropriate treatments (pluripotency). A total of 173 hESC lines have been derived since the first derivation by Thomson et al. in 1998, and 70 hESC lines are currently available for distribution including hESC line (Miz-hES1) established at the MizMedi Hospital. The major goal of hESC research is to provide basic and clinical clues for cell replacement therapy, whose targets are aforementioned incurable diseases. One of the landmarks in hESC research is the derivation of a hESC line from a cloned human blastocyst, which has recently been done by Korean scientists. This made it possible to overcome the issue of immune-mediated rejection following cell replacement therapy using hESCs. Guided differentiation of hESCs into specific cell types by treating growth factors and drugs or by genetic manipulation by using overexpression or an RNAi knockdown system is one of the most active research areas. Combined efforts towards the guided differentiation of hESC into specific cell types and the cloning of hESC from a cloned human blastocyst will overcome a list of diseases hitherto considered to be incurable.
Biotechnology ; Blastocyst ; Clone Cells ; Cloning, Organism ; Embryonic Stem Cells* ; Germ Cells ; Germ Layers ; Heart Diseases ; Humans* ; Infertility ; Intercellular Signaling Peptides and Proteins ; Liver Diseases ; Neurodegenerative Diseases ; Regenerative Medicine ; Stem Cell Research* ; Stem Cells