PURPOSE: The purpose of this study was to resolve, in an efficient manner, the mechanoreceptor problems of the part far from the paretic upper extremity in stroke patients, as well as to provide clinical basic data of an intervention program for efficient neurodynamic in stroke patients, by developing a rhythmic neurodynamic exercise program and verifying functional changes depending on the increase in the upper extremity nerve conduction velocity. METHODS: Samples were extracted from 18 patients with hemiplegia, caused by stroke, and were randomly assigned to either the experimental group I for the general upper extremity neurodynamic (n=9) and the experimental group II for rhythmic upper extremity neurodynamic (n=9). An intervention program was applied ten times per set (three sets one time) and four times a week for two weeks (once a day). As a pre-test, changes in the upper extremity nerve conduction velocity and functions were assessed, and two weeks later, a posttest was conducted to re-measure them in the same manner. RESULTS: The wrist and palm sections of the radial nerve and the wrist and elbow sections of the median nerve, as well as the wrist, lower elbow, upper elbow, and axilla sections of the ulnar nerve had significant differences with respect to the upper extremity nerve conduction velocity between the two groups (p<0.05)(p<0.01), and significant differences were also found in the upper extremity functions (p<0.05). CONCLUSION: Rhythmic neurodynamic accelerated the nerve conduction velocity more in broader neural sections than the general neurodynamic. In conclusion, rhythmic neurodynamic was proven to be effective for improving the functions of upper extremity.
Axilla ; Elbow ; Hemiplegia ; Humans ; Mechanoreceptors ; Median Nerve ; Neural Conduction* ; Radial Nerve ; Stroke* ; Ulnar Nerve ; Upper Extremity* ; Wrist

PURPOSE: This study aims to investigate the changes in pulmonary function, gait ability, and quality of life when NMES is applied along with CBE and to provide basic clinical data to be used in pulmonary rehabilitation guidelines for patients with COPD to treat patients with severe COPD. METHODS: For this study, CBE and NMES of quadriceps femoris on both sides were applied to the experimental group (n=10), and only CBE was applied to the control group (n=10). For a pre-test, a 6-minute walk test was performed, and pulmonary function and health-related quality of life were measured. Moreover, an exercise program was applied to each group for 30 minutes per session, 5 times a week, for 6 weeks. After that, a post-test was conducted the same way as the pre-test. RESULTS: In the within-group comparison, there were significant differences in forced expiratory volume in one second, 6-minute walk test and health-related quality of life between the experimental group and the control group (p < 0.01)(p < 0.05). In the between-group comparison, the experimental group showed an increase in forced expiratory volume in one second and 6-minute walk test (p < 0.05) and showed a decline in health-related quality of life (p < 0.05). CONCLUSION: The 6-weeks NMES program improved health-related quality in patients with severe COPD by increasing expiratory volume by reinforcing the function of quadriceps femoris. This finding implies that NMES could be an alternative mode for improving physical functions of patients with severe COPD, who cannot participate in a breathing exercise program or are reluctant to participate.
Electric Stimulation* ; Forced Expiratory Volume ; Gait* ; Humans ; Pulmonary Disease, Chronic Obstructive* ; Quadriceps Muscle ; Quality of Life* ; Rehabilitation ; Respiration

Purpose: This study investigated the effects of an intervention that combined the abdominal drawing-in maneuver and frequency-specific neuromuscular electrical stimulation on changes in trunk muscle activity, muscle fatigue, and balance in stroke patients. Methods: Thirty stroke patients were randomly assigned to two groups. Fifteen subjects were assigned to group I which performed the abdominal drawing-in maneuver combined with low-frequency neuromuscular electrical stimulation and the other 15 subjects to group II where the abdominal drawing-in maneuver was combined with high-frequency neuromuscular electrical stimulation. Muscle activity and fatigue were measured using surface electromyography before the intervention. Balance was measured using the Trunk Impairment Scale and re-measured after six weeks of intervention for comparative analysis. Results: Both groups showed a significant increase in muscle activity and balance (p < 0.05), and there was no significant difference between the groups (p > 0.05). In the changes in muscle fatigue, only the experimental group II showed a significant increase in muscle fatigue (p < 0.05). The difference between the groups was statistically significant (p < 0.05). Conclusion It was confirmed that among stroke patients, the combination of the abdominal drawing-in maneuver and low-frequency neuromuscular electrical stimulation was more effective in changing the muscle activity and balance of the trunk by minimizing the occurrence of muscle fatigue compared to the combination of the abdominal drawing-in maneuver and high-frequency stimulation. These results can be used as basic data for clinical trunk stabilization training.

Objectives: To determine the clinical characteristics of Korean patients with sporadic oculopharyngodistal myopathy. Methods: Three consecutive unrelated Korean patients with sporadic oculopharyngodistal myopathy participated in this study. Stepwise approaches were performed including careful clinical examination, electrophysiological study, pathology evaluation and genetic study. The literature on oculopharyngodistal myopathy was reviewed. Results: Clinically, our patients showed consistent features of initial distal limb weakness with variable ophthalmoplegia, bulbar weakness or proximal weakness. All the patients showed rimmed vacuoles and myopathic changes. Conclusion: Through the literature review and this study, we believe that initial distal limb weakness is a characteristic fi nding in patients with oculopharyngodistal myopathy in some ethnic groups.

To raise the quality of research, medical articles which are feasible and objective must be continuously published and be continuously monitored. All articles published in the Journal of the Korean Society of Emergency Medicine from November, 1990 to November, 1995 were compared with a foreign emergency medical journal, the American Journal of Emergency Medicine(AJE). Classifying the articles in the Journal of the Korean Society of Emergency Medicine, there were 15 (8.4%) review articles, 145 (81.0%) original articles and 19 (10.6%) case reports. In the AJE, there were 103 (15.1%) review articles, 304 (44.4%) original articles and 277 (40.5%) case reports. Classifying the original articles in the Journal of the Korean Society of Emergency Medicine, there were 13 (9.0%) experimental articles, 88 (60.7%) descriptive articles and 44 (30.3%) analytic articles. In the AJE, there were 40 (13.2%) experimental articles, 59 (19.4%) descriptive articles and 205 (67.4%) analytic articles. The classification of original articles according to frequency in the Journal of the Korean Society of Emergency Medicine is trauma, resuscitation, toxicology and medical emergency, where as the AJE is medical emergency, trauma, toxicology and EMS. For statistical methods used in original articles, 90 (62.1%) case did not do any statistical analysis or where only descriptive statistics were used. In 6 (4.1%) cases the statistical level was described but statistical methods were nonmentioned. By simple classification study, there were 44 (30.3%) cases of original articles in the Journal of the Korean Society of Emergency Medicine, and 6 (2.0%) cases in the AJE. Because the development of Emergency Medicine as a special department is based on logical articles, organization of articles have study design, make hypothesis, sample gathering, statistical analysis and feasibility of conclusion. For this, the emergency training course needs a course on research methodology.
Classification ; Emergencies* ; Emergency Medicine* ; Logic ; Research Design ; Resuscitation ; Toxicology

PURPOSE: This study aimed to demonstrate reduction in stroke symptoms by analyzing the changes in respiratory function and activities of daily living (ADL) after respiratory muscle strengthening exercise in patients who had a stroke and thereby, propose an efficient exercise method. METHODS: Twenty patients with hemiplegic stroke were divided into two groups, with 10 patients in each. The control group (CG) received the traditional exercise therapy, and the experimental group (EG) received the traditional exercise therapy combined with expiratory muscle strengthening training. The training continued for 6 weeks, 5 days a week. Forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV1) were measured with a spirometer, SpO₂ was measured with a pulse oximeter, and ADL were assessed by using the modified Barthel index (MBI). A paired t test was applied to compare the differences before and after the intervention, and an independent t test was used to compare the differences between the groups. The level of statistical significance was set as α=0.05. RESULTS: The changes in the FVC and FEV1 values within the group showed significant differences only in the EG (p<0.01). The between-group difference was statistically significant only for FVC and FEV1 in the EG (p<0.01). The changes in SpO₂ and MBI within the group showed significant differences only in the EG and CG (p<0.01). Between-group differences were statistically significant only for SpO₂ and MBI in the EG (p<0.05). CONCLUSION: The interventions with active patient involvement and combined breathing exercises had a positive impact on all the functions investigated in this study.
Activities of Daily Living* ; Breathing Exercises ; Exercise Therapy ; Forced Expiratory Volume ; Humans ; Methods ; Patient Participation ; Respiratory Muscles* ; Stroke* ; Vital Capacity

BACKGROUND: The existing data indicate that obstructive sleep apnea syndrome contributes to the development of cardiovascular dysfunction such as systemic hypertension and cardiac arrhythmias, and the cardiovascular dysfunction has a major effect on high long-term mortality rate in obstructive sleep apnea syndrome patients. To a large extent the various studies have helped to clarify the pathophysiology of obstructive sleep apnea, but many basic questions still remain unanswered. METHOD: In this study, the influence of obstructive sleep apnea on systemic blood pressure, cardiac rhythm and urinary catecholamines concentration was evaluated. Over-night polysomnography, 24-hour ambulatory blood pressure and EGG monitoring, and measurement of urinary catecholamines, norepinephrine (UNE) and epinephrine (UEP), during waking and sleep were undertaken in obstructive sleep apnea syndrome patients group (OSAS, n=29) and control group (Gontrol, n=25). RESULTS: 1) In OSAS and Control, UNE and UEP concentrations during sleep were significantly lower than during waking (P<0.01). In UNE concentrations during sleep, OSAS showed higher levels compare to Control (P<0.05). 2) In OSAS, there was a increasing tendency of the number of non-dipper of nocturnal blood pressure compare to Control (P=0.089). 3) In both group (n=54), mean systolic blood pressure during waking and sleep showed significant correlation with polysomnographic data including apnea index (Al), apnea-hypopnea index (AHI), arterial oxygen saturation nadir (SaO2 nadir) and degree of oxygen desaturation (DOD). And UNE concentrations during sleep were correlated with Al, AHI, SaO2 nadir, DOD and mean diastolic blood pressure during sleep. 4) In OSAS with AI>20 (n=14), there was a significant difference of heart rates before, during and after apneic events (P<0.01), and these changes of heart rates were correlated with the duration of apnea (P<0.01). The difference of heart rates between apneic and postapneic period (deltaHR) was significantly correlated with the difference of arterial oxygen saturation between before and after apneic event (deltaSaO2) (r=0.223, P<0.001). 5) There was no significant difference in the incidence of cardiac arrhythmias between OSAS and Control. In Control, the incidence of ventricular ectopy during sleep was significantly lower than during waking. But in OSAS, there was no difference between during waking and sleep. CONCLUSION: These results suggested that recurrent hypoxia and arousals from sleep in patients with obstructive sleep apnea syndrome may increase sympathetic nervous system activity, and recurrent hypoxia and increased sympathetic nervous system activity could contribute to the development of cardiovascular dysfunction including the changes of systemic blood pressure and cardiac function.
Anoxia ; Apnea ; Arousal ; Arrhythmias, Cardiac ; Blood Pressure* ; Catecholamines* ; Epinephrine ; Heart Rate ; Humans ; Hypertension ; Incidence ; Mortality ; Norepinephrine ; Ovum ; Oxygen ; Polysomnography ; Sleep Apnea, Obstructive* ; Sympathetic Nervous System ; United Nations

Annular elastolytic giant cell granuloma (AEGCG) is an inflammatory disorder characterized by the annular plaques with serpiginous raised borders on the sun-exposed area. Its pathologic finding shows the patchy granulomatous infiltration composed of multinucleated giant cells, histiocytes, lymphocytes and disappearance of the elastic fibers secondary to being engulfed by the giant cells. We report a case of AEGCG in a 59-year-old-male. He had several annular, erythematous plaques with raised borders on his dorsum of the hand, neck, back and the typical histologic features of AEGCG.
Elastic Tissue ; Giant Cells* ; Granuloma, Giant Cell* ; Hand ; Histiocytes ; Lymphocytes ; Neck

The authors has investigated the effect of intracisternal urokinase on the multihemorrhage canine model of chronic post-subarachnoid hemorrhage(SAH) hydrocephalus. Each of 16 adult mongrel dogs was assigned to one of two experimental groups. All animals received a total of 13ml of fresh unheparinized autologous blood via three cisternal injections. Eight animals were treated by intracisternal injection of 20,000 IU of Urokinase every 12 hours for 3 days, and the remaining were not treated. The changes in ventricular volumes were measured by computed tomography(CT) before and 3 months after the initial subarachnoid blood injection. To compare the changes of hydrodynamic properties in chronic phases of post-SAH hydrocephalus, the pressure-volume index(PVI) technique of bolus manipulation of cerebrospinal fluid(CSF) was used to measure the volume-buffering capacity of neural axis and the resistance to the absorption of CSF(before SAH, post-SAH 1 month, 3 months). The final ventricular volume at 3 months of control group was 4 times greater than the initial volume, but Urokinase group less than two times. The mean measured PVI values of control group and Urokinase group were 3.98+/-0.76ml(+/- standard deviation(SD)) and 4.01+/-0.82ml in baseline study, 3.09+/-0.96ml and 3.70+/-0.84ml in post-SAH 3 months. The mean resistance of CSF outflow of control group and Urokinase group were 10.30+/-2.24mm Hg/ml/min), and 10.34+/-1.98mm Hg/ml/min in baseline study. At 1 month and 3 months after SAH control group maintained high absorptive resistance(29.54+/-11.50mm Hg/ml/min, 22.43+/-3.82mm Hg/ml/min), whereas the resistances of Urokinase group were slightly increased and then returned to the original levels(16.04+/-4.87mm Hg/ml/min, 12.87+/-3.06mm Hg/ml/min). The results described in this experimental study indicated that if fibrinolysis of the subarachnoid blood clot can be achieved rapidly after SAH, the complicating chronic hydrocephalus might be prevented.
Absorption ; Adult ; Animals ; Axis, Cervical Vertebra ; Dogs ; Fibrinolysis ; Humans ; Hydrocephalus* ; Hydrodynamics ; Subarachnoid Hemorrhage* ; Urokinase-Type Plasminogen Activator*

Multiple primary cancer is defined as the case of primary malignant tumors of different histologic origins each other in one person, The incidence of multiple primary cancer has been increasing recently due to more developed diagnostie procedure and long survival of cancer patients. In esophageal cancer patients, comibined prevalence of other malignancy is rela tively high. We have experienced three cases of gastric adenocarcinoma with esophageal squamous cell carcinoma and report these cases with a review of literatures.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Esophageal Neoplasms ; Esophagus* ; Humans ; Incidence ; Prevalence ; Stomach*