Diaphragm is though to play the most role in breathing and has a substantially greater proportion of slow oxidative and fast glycolytic fibers, and low proportion of fast oxidative fibers. The respiratory muscle, diaphragm, has the functional characteristics of slow speed of contraction, high resistance to fatigue and the ability to respond to intermittent ventilatory loads, for example of exercise. In the present study, the characteristics of the metabolism (depletion and repletion) of glycogen and the structural changes of diaphragm during depletion and repletion of glycogen were observed in rats. For comparison, the red gastrocnemius muscle which has a greater proportion of fast oxidative glycolytic (FOG) and slow oxidative (SO) fibers, and low proportion of fast glycolytic (FG) fiber, was also studied. The glycogen concentration of diaphragm in overnight fasted rats was 2.30+/-0.14mg/gm wet weight. The values of glycogen concentration at 60, 90 and 120minutes of treadmill exercise loaded rats was significantly decreased compared to that of the overnight fasted rats. There was no significant difference among the glycogen concentration of diaphragm at 60, 90 and 120minutes of exercises. The glycogen concentration of diaphragm was decreased to 1.12+/-0.17 from 2.30+/-0.14mg/gm wet weight by treadmill exercise. The glycogen depletion rats of diaphragm during exercise was faster than that of red gastrocnemius in both of the first 60minutes and 120minutes duration of exercise. The glycogen repletion of diaphragm after intragastric glucose administration by stomach tube was studied in control and exercise groups. The glycogen concentration was significantly increased after glucose administration in both of the control and exercise groups. All of the concentration of exercise group at 60, 120 and 180minutes after glucose administration was significantly higher than those of control group. In conclusion, one of the characterics of diaphragm in glycogen metabolism is fast glycogen depletion during exercise, and slowness of glycogen repletion after glucose ingestion in rats.
Rats ; Animals

The authors present 43 cases of intracranial acute epidural hematomas(EDH's) managed by close observation. In each of 43 cases, the following criteria were met:1) the patient was conscious soon after head injury;2) the volume of hematoma was under 30ml(10ml in case of posterior fossa EDH's);3) there was no severe effacement of basal cistern or 4th ventricle;4) there was no associated intradural lesion;5) the patient showed neither cerebral herniation nor cardiorespiratory abnormalies. Of the 43 patients, 31(72%) showed no hematoma enlargement, and showed rsolution of hematoma on computerized tomography(CT) scans over a period of 4 to 11 weeks. Repeat CT scans within 24 hours of initial CT revealed enlargement of EDH in 12 of 43 patients(28%), of these 12 EDH's, 5 were reabsorbed spontaneously from 6 to 10 weeks, and 7 were evacuated surgically. All patients recovered without morbidity except one who had craniotomy during observation. There was no specific location of EDH which was indicated or contraindicated for conservative treatment. Factors that influence outcome include the age of patient, initial CT finding, cerebrospinal fluid(CSF) leakage, the use of mannitol, and recovery from shock. Hematoma enlargement did not always accompany deterioration of consciousness, therefore repeat CT scans within 24 hours is strongly recommended.
Consciousness ; Craniotomy ; Head ; Hematoma* ; Humans ; Mannitol ; Shock ; Tomography, X-Ray Computed

The cavitron ultrasonic surgical aspirator(CUSA) has been used for the surgical removal of 26 cases of spinal intradural tumors. In 26 patients, total removal was possible in 77% and there was no neurological deterioration due to surgical removal using CUSA. 21 of 26 patients(84%) showed neurological improvement at long term follow-up examination. The cavitron ultrasonic surgical aspirator had advantages in the surgical removal of spinal intradural tumors, as follows:1) precise removal of tumor without excessive meahcnical manipulation of normal tissue;2) rapidity of action relative to the consistency of the tissue;3) direct visualization of the tissue being removed and good proprioceptive feedback for the surgeon;4) preservation of large vessel and very little bleeding;5) lack of thermal injury. The limitation of CUSA was obscuring of operation field by large and straight hand piece.
Feedback, Sensory ; Follow-Up Studies ; Hand ; Humans ; Ultrasonics*

PURPOSE: There are several surgical methods for correcting a velopharyngeal insufficiency (VPI) but in some cases, it is not possible to achieve complete recovery of the velopharyngeal function. This paper introduces a new therapy for treating hypernasality without further surgery using continuous positive airway pressure (CPAP). METHODS: CPAP therapy was applied to seven VPI patients for eight weeks from April of 2007 to September of 2009. All patients underwent palatoplasty for the cleft palate and six patients underwent palatal lengthening for VPI before CPAP therapy. A speech pathologist performed an auditory perceptual evaluation to evaluate the improvement in hypernasality after 8-week CPAP therapy. RESULTS: Six patients showed an improvement in hypernasality after CPAP therapy according to the auditory perceptual evaluation. One patient with severe hypernasality responded to the early part of therapy but the hypernasality did not improve after therapy. CONCLUSION: CPAP therapy might be effective in reducing the hypernasality in patients with VPI by providing resistance training to strengthen the velopharyngeal closure muscles. In particular, CPAP therapy could be more effective for patients who show mild to moderate hypernasality after surgery.
Cleft Palate ; Continuous Positive Airway Pressure ; Humans ; Muscles ; Resistance Training ; Velopharyngeal Insufficiency

Pulmonary lymphangitic carcinomatosis is a common secondary neoplasm of the lung that may result from hematogenous dissemination to small pulmonary arteries and arterioles followed by invasion of the interstitial space and lymphatics, or from the retrograde spread of tumors from mediastinal or hilar lymph nodes. Radiologically, irregular interlobular septal thickening, bronchovascular interstitial thickening and/or lymph node enlargement are observed. In this report, we describe an atypical radiological manifestation of lymphan-gitic metastasis of stomach cancer in a 37-year-old woman admitted for dyspnea on exertion and a cough which had been present for one month. HRCT scanning revealed bilateral multifocal ground glass opacity or consolidation, mild diffuse axial interstitial thickening, and slight pleural effusion. These findings were thought to indicate the existence of an air-space disease rather than metastasis. Open lung and endoscopic biopsy, however, demonstrated the presence of lymphangitic metastasis from stomach cancer.
Adult ; Arterioles ; Biopsy ; Carcinoma ; Cough ; Dyspnea ; Female ; Glass ; Humans ; Lung ; Lymph Nodes ; Neoplasm Metastasis* ; Pleural Effusion ; Pulmonary Artery ; Stomach Neoplasms

The aim of this study was to determine if the apoptotic degree could predict the prognosis for breast cancer in mastectomy specimens and to establish if any association existed between the apoptotic degree and clinical variables such as age, size, hormone receptor, lymph node metastasis, stage, result of follow up. The apoptotic degree, defined as the number of morphologically identified apoptotic bodies in the view of a 200X microscope, was calculated for 59 breast cancers. We applied an immunohistochemical procedure for staining the apoptotic cells in parapin sections of 59 breast cancers. The histochemical method used for the analysis of apoptosis was based on the detection of DNA breaks by terminal transferase-mediated in situ end labeling (TUNEL). The results were as follows; 1. An association between apoptotic degree and age was demonstrable (p=0.050). 2. No association between apoptotic degree and tumor size was demonstrable. 3. No association between apoptotic degree and lymph node metastasis was demonstrable. 4. An association between apoptotic degree and stage was demonstrable. 5. No association between apoptotic degree and hormone receptor was demonstrable (p=0.023). 6. No association between apoptotic degree and follow up results was demonstrable, however a low apoptotic degree showed a tendency for a poor clinical outcome, and this result had partiall statistical significance. Thus provisionally its value as an independent prognostic index has yet to be established and demands more study.
Apoptosis* ; Breast Neoplasms* ; Breast* ; DNA Breaks ; Follow-Up Studies ; Lymph Nodes ; Mastectomy ; Neoplasm Metastasis ; Prognosis

BACKGROUND: Malignant follicular lesion is not differentiated from benign lesions cytologically. The objective of this study was to assess the rate and the risk of malignancy in thyroid nodules which were cytologically diagnosed as follicular neoplasm by fine-needle aspiration (FNA) cytology. METHODS: All the patients who had undergone surgery with cytological diagnosis of follicular neoplasm from January 1996 through December 2001 in Asan Medical Center were studied retrospectively. Patients' and nodule characteristics were analyzed for factors associated with the presence of cancer. Two hundred and fifteen patients (196 females, 19 males) were included and their mean age was 39.4 years (range: 12~76). RESULTS: About half of the patients (102 out of 215, 47.4%) had malignancy with 29 papillary carcinomas, 57 follicular carcinomas, 15 H rthle cell carcinomas and 1 medullary carcinoma. Previously suggested factors associated with risk for malignancy, such as male gender, large tumor size (> 4 cm) or age of patients (> 45 years), were not associated with increased risk. Diagnosis of H rthle cell neoplasia on FNA was also not associated with increased risk. Only the extremes in age of the patients (below 20 or above 60 years) were associated with increased risk for malignancy. CONCLUSION: In our findings, prevalence of carcinoma in thyroid nodule patients with cytological diagnosis of follicular neoplasm was much higher than those reported. Clinical characteristics, such as male gender, age and nodule size, are not useful predictors for the presence of malignancy. Thyroid nodules with cytological diagnosis of follicular neoplasm warrant immediate surgery.
Adenocarcinoma, Follicular/pathology ; Adenoma, Oxyphilic/pathology ; Adolescent ; Adult ; Age Factors ; Aged ; Biopsy, Needle ; Carcinoma, Medullary/pathology ; Carcinoma, Papillary, Follicular/pathology ; Child ; Female ; Human ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Thyroid Neoplasms/*pathology ; Thyroid Nodule/*pathology ; Thyroidectomy ; Thyroiditis, Autoimmune/pathology

PURPOSE: To compare outcomes of open and arthroscopic inferior capsular shifts in multidirectional instability of the shoulder and to evaluate the factors affecting the outcomes. MATERIALS AND METHODS: We measured outcomes in 81 patients (84 shoulders) receiving open or arthroscopic inferior capsular shifts because of multidirectional instability of the shoulder from February, 1994, to April, 2006. There were 76 males and 8 females. Their mean age was 22 years at the time of surgery. The visual analogue scale (VAS) for pain, shoulder range of motion (ROM), and Rowe scores were evaluated preoperatively and postoperatively. RESULTS: In open surgery, the VAS for pain was 5.3 preoperatively and 2.1 postoperatively. VAS for instability changed from 4.6 to 1.7, and the average postoperative Rowe score was 83.7. Forward flexion was 173.7degrees preoperatively and 166.1degrees postoperatively. External rotation on the side changed from 75.5degrees to 62.7degrees. In arthroscopic surgery, the VAS for pain was 4.6 preoperatively and 1.2 postoperatively. VAS for instability changed from 5.9 to 1.2, and the average postoperative Rowe score was 87.4. Forward flexion was 169.5degrees preoperatively and 171.2degrees postoperatively. External rotation changed from 70.8degrees to 61.4degrees. CONCLUSION: Arthroscopic surgery was more effective in decreasing pain and conserving forward flexion of the shoulder than open surgery. Postoperative instability appeared to be related with generalized or bilateral shoulder joint laxity. Pain during motion after the operation was more significant during a voluntary subluxator. Low clinical scores were related with the operation on the dominant side or postoperative instability.
Arthroscopy ; Female ; Humans ; Male ; Range of Motion, Articular ; Shoulder ; Shoulder Joint ; Shoulder Pain

Kerosene is one of the petroleum distillates with low viscosity and high volatility. Kerosene is widely used in Korean home in heating and cooking. Kerosene ingestion or aspiration is one of the most common poisonings in young children but extremely rare in adults because kerosene is not taken with the intention of committing suicide. We report four adult cases of aspiration pneumonitis by accidental aspiration of kerosene with similar clinical presentation.
Adult ; Apoptosis ; Child ; Cooking ; Eating ; Epithelial Cells ; Heating ; Helicobacter pylori ; Hot Temperature ; Humans ; Intention ; Kerosene* ; Neutrophils ; Petroleum ; Pneumonia* ; Poisoning ; Suicide ; Viscosity ; Volatilization

The term MYH9-related disorders indicates a group of autosomal dominant illnesses, formerly known as May-Hegglin anomaly, Sebastian syndrome, Fechtner syndrome and Epstein syndrome, caused by mutations of MYH9, the gene encoding for the heavy chain of non-muscle myosin IIA (NMMHC-IIA). We experienced a family with macrothrombocytopenia without leukocyte inclusion. A 5-year-old girl was found to have macrothrombocytopenia incidentally. Her father also had macrothromtocytopenia, but had been suffering from hearing loss and chronic renal failure. Meticulous search by light and electron microscopy failed to detect leukocyte inclusions. To our knowledge, these cases seem to be the first description of autosomal dominant Epstein giant platelet syndrome in Korea.
Bernard-Soulier Syndrome* ; Child, Preschool ; Fathers ; Female ; Hearing Loss ; Humans ; Kidney Failure, Chronic ; Korea ; Leukocytes ; Microscopy, Electron ; Nonmuscle Myosin Type IIA