The accessory deep peroneal(ADP) nerve is known as a common anatomical variant. It may alter the usual clinical and electrophysiological charateristics of peroneal nerve lesions. The purpose of the study was to investigate the frequency of occurrence and the electrophysiologic characteristics of the ADP nerve. We performed peroneal motor nerve conduction studies in 434 patiets with conventional method. When the CMAP amplitudes evoked by distal peroneal stimulation is smaller than that by proximal stimulation, we searched ADP nerve by stimulation at posterior to the lateral malleolus. In 60 patients, we searched ADP nerve regardless of CMAP amplitude difference. Additionally, we routinely stimulated the region of posterior to the lateral malleolus with recording at the medial and lateral extensor digitorum brevis(EDB) muscles using multi channel EMG in 34 patients. In conventional peroneal nerve conduction study, ADP nerves were detected in 27(8.2%) patients out of 330 studied patients(right 7, left 15, both 5). Mean amplitue of ADP nerve was 1. 52mV (right 1. 90, left 1. 84). In routine ADP stimulation study, ADP nerve was detected in 5(21.7%) out of 23 patients(left 2, both 3). In 4 of them, the distal peroneal amplitudes were greater than the proximal. Mean amplitude was 1.86mV(right 1.38, left 1.65). In conclusion, we confirmed that the accessary deep peroneal nerve is a relatively common variant and its presence may not be predicted by the difference of amplitudes between the distal and proximal peroneal segments in conventional peroneal nerve conduction study. So in cases of suspected peroneal nerve lesions, ADP nerve should be searched.
Adenosine Diphosphate ; Humans ; Muscles ; Neural Conduction ; Peroneal Nerve*

BACKGROUND: A nerve conduction study (NCS) is a useful method to diagnose and evaluate the therapeutic effect of carpal tunnel syndrome (CTS). Severe CTS often shows evidence of axonal injury, which may lead to incomplete recovery of symptoms or NCS abnormalities. To evaluate the degree of NCS recovery after decompression in patients with severe CTS, we studied NCS before and after surgical release in severe CTS with electrophysiological evidence of axonal injury. METHODS: We analyzed the NCS changes in 17 patients (21 hands) with severe CTS just before and 1 year after CTS release. The severe CTS was electrophysiologically defined with the following criteria; 1) prolonged median sensory and motor distal latencies, 2) either an absent SNAP or low amplitude/absent thenar CMAP, and 3) abnormal needle EMG findings. The patients averaged 53.3 years of age and all were females. RESULTS: The mean interval between the first and second NCS was 20.5 months and post-operation symptoms were free in 8 hands, markedly (>50%) improved in 11 hands, and symptoms remained (< 50%) in 2 hands. In 13 hands, SNAPs were not elicitable before surgery, but all were obtainable after surgery. One patient who had no CMAP did not show recovery after surgery. The mean median sensory latency, SNAP amplitude, and sensory NCV over the finger-wrist segment improved significantly (P < 0.05). The mean median motor latency and CMAP amplitude also improved significantly (P < 0.05). The parameters of NCS, however, showed incomplete and subnormal recovery after decompression except for sensory latency, amplitudes of SNAP and CMAP which recovered to the normal range. CONCLUSIONS: After CTS release even with electrophysiologically defined severe CTS patients, there were significant improvements of clinical symptoms and electrophysiological parameters. However, only some parameters(median sensory latency, SNAP amplitude and CMAP amplitude) were restored to the normal range.
Axons ; Carpal Tunnel Syndrome* ; Decompression ; Female ; Hand ; Humans ; Median Neuropathy ; Needles ; Neural Conduction* ; Reference Values

Subacute paraneoplastic myelopathy is a rare cause of myelopathy. Serepositivity for antineuronal nuclear antibodies-1(ANNA-1, Anti-Hu) is a sensitive and specific marker for the paraneoplastic syndrome with small cell lung cancer. A 57-year-old male patient was admitted because of acutely progressive paraparesis, anesthesia of both lower limbs and loss of bladder function over 3 days. He was subsequently found to have small cell lung carcinoma of limited stage. Magnetic resonance image of the thoracic spine showed signal abnormalities with mild focal enhancement in the intramedullary portion of C7-T10 segments. Concurrent CSF cytology showed no abnormal findings. He had high sero-logic titer of ANNA-1. These findings suggest of a paraneoplastic syndrome although we didn't have nectrotic patholog-ic findings. Five months after onset of neurological symptoms, he died inspite of chemotherapy and radiotherapy. We report a case of intramedullary myelopathy, probably of paraneoplastic origin, associated with small cell lung cancer.
Anesthesia ; Drug Therapy ; Humans ; Lower Extremity ; Male ; Middle Aged ; Paraneoplastic Syndromes ; Paraparesis ; Radiotherapy ; Small Cell Lung Carcinoma* ; Spinal Cord Diseases* ; Spine ; Urinary Bladder

We experienced a patient who manifested Miller-Fisher syndrome initially, and progressed relapsing ataxia later, There was electrophysiologic evidence of distal sensory polyneuropathy with completely sparig of somatic motor nerves. Sural nerve biopsy showed severe segmental demyelination. All the symptoms improved by intravenous immunoglobulin dramatically but after a period of remission, progressive ataxia reappeared. Plama exchange had some effect and prednisolone alone showed no definite improvement. High dose of prednisolone combined with IVIgG made remission for a long time. We believe that this patient had an unusual form of inflammatory polyneuropathy, a relapsing variant of the Miller-Fisher syndrome of acute idiopathic polyneuritis. In this case, IVIgG was the most effective therapy and prednisolone was added as a long term therapy successfully.
Ataxia* ; Biopsy ; Demyelinating Diseases ; Humans ; Immunoglobulins ; Miller Fisher Syndrome* ; Neuritis ; Polyneuropathies ; Prednisolone ; Sural Nerve

Myotonic dystrophy is an autosomal-dominantly inherited neuromuscular disorder characterized by slowly progressive muscular dystrophy, muscle weakness and myotonia. The clinical features may vary from just cataracts to involvement of multiple organ systems such as various muscles, heart, lung and intestine. During pregnancy and delivery, serious maternal and obstetrical complications may occur. The myotonia is often aggravated during pregnancy and it leads to obstetrical complications such as fetal loss, preterm premature delivery, hydrops, in-utero fetal death, difficulties in fetal expulsion, postpartum hemorrhage and/or anesthetic accidents. The affected neonate may display severe hypotonia, facial displegia and respiratory distress. This report presents a woman with myotonic dystrophy complicated with congestive heart failure and preterm delivery during pregnancy.
Cataract ; Edema ; Estrogens, Conjugated (USP)* ; Female ; Fetal Death ; Heart Failure* ; Humans ; Infant, Newborn ; Intestines ; Lung ; Muscle Hypotonia ; Muscle Weakness ; Muscular Dystrophies ; Myocardium ; Myotonia ; Myotonic Dystrophy* ; Obstetric Labor, Premature* ; Postpartum Hemorrhage ; Pregnancy*

BACKGROUND: Guillain-Barre syndrome (GBS) is defined as a recognizable clinical entity that is characterized by rapidly evolving symmetric limb weakness, loss of tendon reflexes, absent or mild sensory signs, and variable autonomic dysfunctions. Recently, GBS has been classified as a classical demyelinating (acute imflammatory demyelinating polyradiculoneuropathy, AIDP) and two axonal (acute motor axonal neuropathy, AMAN, and acute motor sensory axonal neuropathy, AMSAN) forms. The clinical pattern and prognosis according to type is not clear. METHODS: Forty-one patients clinically diagnosed as GBS were enrolled and classified as AIDP, AMAN, and AMSAN according to electrodiagnostic criteria. We analyzed the clinical data of each subgroup; age, sex, seasonal distribution, history of previous illness, cranial nerve involvement, respiratory involvement, and motor weakness. RESULTS: Forty-one patients with GBS were comprised of 19 patients (46.3%) with AIDP, 12 patients (29.2%) with AMAN, and 10 patients (24.3%) with AMSAN. AIDP was found more frequently in males and in winter (42.1%) while axonal forms of GBS showed neither gender nor seasonal predominance. Frequency of cranial nerve involvement was not different between the sub-groups of GBS, whereas respiratory involvement was more frequent in AMSAN (50%). Upper limbs were weaker in axonal than in demyelinating types of GBS. CONCLUSIONS: Axonal forms of GBS showed some clinical characteristics distinctive from the demyelinating forms, which might be useful in the differential diagnosis of subgroups of GBS. (J Korean Neurol Assoc 19(5):503~508, 2001)
Amantadine ; Axons ; Cranial Nerves ; Diagnosis, Differential ; Extremities ; Guillain-Barre Syndrome* ; Humans ; Male ; Polyradiculoneuropathy ; Prognosis ; Reflex, Stretch ; Seasons ; Upper Extremity

PURPOSE: Little is known with respect to changes in the segmental thoracic and thoracolumbar kyphosis, which are major parameters influencing sagittal balance of the spine. The authors investigated the detailed segmental changes of those parameters by ageing. MATERIALS AND METHODS: A total of 326 normal asymptomatic males were divided into 2 groups; group 1 (mean age, 21.2+/-1.7; n=175) and group 2 (mean age, 64.1+/-6.4; n=151). After taking a standing sagittal radiograph, the sagittal spinal and pelvic parameters were measured. Thoracic and thoracolumbar kyphosis were classified according to segments A, C7 UEP (upper end vertebra)-T5 UEP; B, T5 UEP-T10 UEP; C, T10 UEP-T12 LEP (lower end vertebra); and D, (T12 LEP-L2 LEP), and analyzed between 2 groups, respectively. RESULTS: Thoracic kyphosis (21.1degrees+/-7.7degrees vs. 30.0degrees+/-8.8degrees, p<0.001), segment B (15.8degrees+/-6.1degrees vs. 18.1degrees+/-7.9degrees, p=0.003), and segment C (5.3degrees+/-5.1degrees vs. 11.8degrees+/-6.5degrees, p<0.001) were increased in group 2. In group 2 segment A showed decreased kyphosis (12.1degrees+/-6.4degrees vs. 9.8degrees+/-6.4degrees, p=0.001). In segment D no significant difference was observed between groups. CONCLUSION: Increased thoracic kyphosis was observed in the middle and lower thoracic regions. The authors provided important references of sagittal parameters to determine the expected ranges of kyphosis for a normal asymptomatic male of a given age.
Humans ; Kyphosis* ; Male ; Spine ; Thoracic Vertebrae

In the clinical setting, anabolic agents serve to ameliorate muscle- and bone-wasting diseases. However, many of these anabolic agents are also used by bodybuilders to surpass natural limits of body composition as performanceenhancing drugs (PEDs). The first generation of PEDs comprises testosterone-derived anabolic-androgenic steroids (AAS) which have demonstrated significant myotropic effects. However, AAS lack optimal tissue-selectively and thus, are prone to numerous adverse health consequences. Hence, a newer generation of PEDs, selective androgen receptor modulators (SARMs), was developed with the goal of achieving superior tissue-selectivity (i.e., exerting anabolic effects only in muscle and bone tissue, while minimally affecting other body systems). In general, AAS and SARMs enhance muscle growth primarily through androgen receptor (AR) agonism in target tissues. Despite multiple attempts, no single AAS nor SARM to date is completely risk free. As such, a significant portion of research efforts has been dedicated to manipulating anabolic pathways beyond the AR. Another class of PEDs, myostatin inhibitors, have shown to cause drastic muscle anabolism across multiple species by inhibiting myostatin, the primary deterrent to continuous muscle growth. The myostatin inhibitor, YK-11, blocks myostatin by upregulating its antagonist, follistatin. This effect appears to be mediated through the AR, suggesting a novel and promising gene-selective approach to engineering AR ligands that isolate benefits from risks. At any rate, the exact mechanisms by which these PEDs function is not well understood. Further pioneering regarding these topics is encouraged as it appears that the innovation of a truly tissue-selective anabolic agent is within reach.

Parallel with the current pediatric obesity epidemic, the escalating rates of youthonset type 2 diabetes mellitus (T2DM) have become a major public health burden. Although lifestyle modification can be the first-line prevention for T2DM in youths, there is a lack of evidence to establish optimal specific exercise strategies for obese youths at high risk for T2DM. The purpose of this narrative review is to summarize the potential impact of exercise on 2 key pathophysiological risk factors for T2DM, insulin sensitivity and β-cell function, among obese youths. The studies cited are grouped by use of metabolic tests, i.e., direct and indirect measures of insulin sensitivity and β-cell function. In general, there are an increasing number of studies that demonstrate positive effects of aerobic exercise, resistance exercise, and the 2 combined on insulin sensitivity. However, a lack of evidence exists for the effect of any exercise modality on β-cell functional improvement. We also suggest a future direction for research into exercise medical prevention of youth-onset T2DM. These suggestions focus on the effects of exercise modalities on emerging biomarkers of T2DM risk.

OBJECTIVES: This study was carried out to investigate the aluminum concentrations in blood, urine and drinking water, the factors which affect the concentrations and the role of silicon in patients who were taking antacid containing aluminum. METHODS: We selected 122 peptic ulcer patients as cases and 144 healthy examinees as controls. Blood, urine, and drinking water were collected from the each study subject and we measured aluminum concentrations as well as silicon concentrations in the specimens. The factors including silicon affect on the aluminum concentrations were also analyzed. RESULTS: 1. The mean duration of antacid administration was 12 months, and the mean daily and total amount of aluminum administration were 0.9 g and 304 g per each patient, respectively. 2. The blood and urine aluminum concentrations were significantly higher in the case. 3. The blood silicon concentration was significantly lower in the control group, and the urine silicon concentration was significantly higher in the case. 4. Urine aluminum concentration was significantly correlated with blood aluminum concentration (r=0.18), and urine silicon concentration was correlated with blood aluminum (r=0.19) and urine aluminum concentrations (r=0.13). 5. The longer the duration of antacid administration and the larger the total and daily amount of aluminum in the antacid were, the higher urine aluminum and silicon concentrations were, but not to a statistically significant degree. CONCLUSIONS: Blood and urine aluminum concentrations were higher in the ulcer patients. The authors suggest that follow-up studies of the patients who administered antacid with high aluminum content for long duration should be done.
Aluminum* ; Drinking Water ; Follow-Up Studies ; Humans ; Peptic Ulcer* ; Silicon* ; Ulcer