BACKGROUND: Recently, cardiopulmonary exercise testing (CPX) has become a popular diagnostic method for differentiating the main cause of exertional dyspnea or exercise limitation. We evaluated the difference in the CPX results according to interpretative algorithms and the methods of exercise in Korea. METHOD: Sixty-six patients with chronic lung disease and 48 adults with dyspneic symptoms, but with no abnormalities in a spirometry performed symptom limited CPX, were included in this study. The results were interpreted using both Wasserman's(WA) and Eschenbacher's algorithm (EA), and a comparison between both algorithms was made. Thirty-three healthy medical students performed the CPX with a cycle ergometer and treadmill. The results were interpreted with EA and the concurrenec in interpretations was evaluated according to the methods of exercise. RESULTS: 1. In patients with chronic lung disease, the overall concordance rate between the two algorithms was 63.6%. The concordance rates were 69.8% in patients with obstructive, 25.0% in those with restrictive, and 66.7% in those with mixed pulmonary insufficiency. In patients with dyspneic symptoms but normal findings in resting spirometry, the concordance rate was 60.4%. 2. In healthy medical students, in results interpreted with EA, the concordance rate between the cycle ergometer and treadmill exercise was 25.0%. CONCLUSION: Both interpretative algorithms and methods of exercise may affect the CPX results. In using CPX as a diagnostic test for the causes of dyspnea in the Korean population, the interpretative algorithms and method of exercise need to be standardized, and a predictive VO2max equation needs to be established.
Adult ; Diagnostic Tests, Routine ; Dyspnea ; Exercise Test* ; Humans ; Korea ; Lung Diseases ; Methods* ; Spirometry ; Students, Medical

BACKGROUND: The transposition flap is one of the most useful methods of facial reconstruction after Mohs micrographic surgery of the basal cell carcinoma, but occasionally some variations are needed. OBJECTIVE: We present our experience with several variations of the transposition flap to overcome the disadvantages of classic rhomboid flaps. METHODS: We performed the Webster 30-degree angle flap on the lower eyelid, the double 30-degree angle flap on the temple area and the nasolabial flap on the ala nasi. RESULTS: These variations of the transposition flap gave no complications such as ectropion, tissue distortion, protrusion, or trapdoor deformity. CONCLUSION: The variations of the transposition flap in our cases might be of help in selecting the ideal method in facial reconstruction.
Carcinoma, Basal Cell* ; Congenital Abnormalities ; Ectropion ; Eyelids ; Methods ; Mohs Surgery*

BACKGROUND AND PURPOSE: Valproic acid (2-propylpentanoic acid) which enhances GABA synthesis and blocks it's degradation has been useful treatment of migraine and may activate GABA receptors to modulate trigeminal nociceptive neurons innervating the meninges. But the mechanism and action of sodium valproate in headache is not clear. To investigate the mechanism of valproic acid action in headache model, we compared the change of dural plasma protein extravasation in both substance-P neurogenic inflammation rats with valproic acid pretreatment and without valproic acid pretreatment. METHOD: Sprague-Dawely rats were pretreated with valproate 30 minutes prior to substance-P administration in order to test the effects of sodium valproate on dural plasma protein extravasation by detecting the amount of extravasated Evans blue in the dura matter. To examine the abilities of either bicuculine (GABAA antagonist) and phaclofen (GABAB antagonist) to reverse the effect of valproate, they were administered 5 min before valproate administration. After then we also test the effect of muscimol (GABAA agonist) and bicuculine (GABAA antagonist) in substance-P induced neurogenic inflammation rats. RESULTS: Intraperitoneal injection of sodium valproate and muscimol reduced dural plasma protein extravasation after intravenous substance-P administration. The GABAA antagonist bicuculine completely reversed the effect of valproate and muscimol on plasma extravasation following substance-P administration, whereas the GABAB receptor antagonist, phaclofen, did not. CONCLUSION: We concluded that the attenuation of dural plasma protein extravasation by valproate and muscimol is mediated by via GABAA receptors within the meninges. Agonists and modulators at the GABAA receptor may become useful for the development of selective therapeutic agents for migraine headache.
Animals ; Evans Blue ; gamma-Aminobutyric Acid ; Headache* ; Injections, Intraperitoneal ; Meninges ; Migraine Disorders ; Muscimol ; Neurogenic Inflammation ; Nociceptors ; Plasma ; Rats* ; Receptors, GABA ; Sodium* ; Valproic Acid*

We had experienced 2 cases of acute subdural hematoma due to vitaimin K(vit. K) deficiency. They were 44-and 42-day-old. After the adminstration of vit.K1, prolonged prothrombin time(PT) and activated partial thromboplastin time(APTT) were corrected, so the surgical treatment ws performed. We supposed the predisposing factors were breast feeding and unknown hepatic pathology. No complication remained to one infant but the other multiple cerebral infarctions. The etiology, pathogenesis, diagnosis, prevention are discussed. We insist on neonatal administration of vit. K1 for the prevention of bleeding tendency. If intracranial hemorrhage develops, we must keep in mind that the early neurosurgical intervention may be needed.
Breast Feeding ; Causality ; Cerebral Infarction ; Diagnosis ; Hematoma, Subdural, Acute* ; Hemorrhage ; Humans ; Infant* ; Intracranial Hemorrhages ; Partial Thromboplastin Time ; Pathology ; Prothrombin ; Prothrombin Time ; Thromboplastin ; Vitamin K Deficiency ; Vitamins*

No abstract available.
Antibodies, Monoclonal* ; Treponema pallidum* ; Treponema*

On a total 233 sera from the VDRL reactive patients without a history of syphilitic symptoms or treatment for syphilis, TPHA and 19S(IgM)-FTA tests were performed, Also the reactivities of the 19 S (IgM)-FTA test in relation to the VDRL and the TPHA titers were observed. The results are summarized as follows: 1. Among 233 sera, 103 sera(44%) showed negative results in the 19S(IgM)- FTA test. 2. Reactivities of the 19 S(IgM)-FTA test were significantly increased in relation to the VDRL, titers arnong 233 sera reactive in the VDRL test: 47% in the VDRL titer 1: 1, 61% in 1: 2, 71% in 1: 4, 62% in 1: 8, 96% 1: 16 or more. 3. There was no relationship statistically (IgM)-FTA test and the TPHA titers. It can be derived from the above results that when a person with no history of treatment for syphilis and clear of any signs of syphilis shows a positive reaction in the VDRL test, he is less likey to be a syphilis patient when the VDRL titer is low.
Humans ; Immunoglobulin M* ; Syphilis

Basal cell carcinoma is the most common skin cancer, but it rarely metastasizes. Metastatic basal cell carcinoma (MBCC) is rare in terms of incidence as well as absolute numbers. We present a case of 67-year-old woman who had a dirty oozing, ulcerated, tumor mass on the vertex and suffered from dyspnea and mild lumbago. The diagnosis of MBCC was based on clinical, radiological, and histopathological findings. To our knowledge, the occurrence of MBCC has not been reported in the Korean literatures. So we reported herein this case of MBCC of the lung and the bone.
Aged ; Carcinoma, Basal Cell* ; Diagnosis ; Dyspnea ; Female ; Humans ; Incidence ; Low Back Pain ; Lung ; Skin Neoplasms ; Ulcer

No abstract available.
Biofeedback, Psychology* ; Electric Stimulation* ; Pelvic Floor* ; Urinary Incontinence*

Pseudoatrophoderma colli is a symptomless, persistent, persistent, pigmentary disorder involving the neck and upper thorax first described by Becker and Muir in. 1934 The lesion is usually localized to the neck and upper part of the thorax. It consists of macules or papules which show pigmentation or papules which show pigmentation or depigmentation and look atrophic. Histological examination shows hyperkeratosis, hypogranulosis, focal acanthosis and perivascular lymphocytic infiltration. We present herein a case of pseudoatrophoderma colli which showed symptomless, mottled, pigmentated macules involving the neck clinically and compatible findings histopathologically.
Neck ; Pigmentation ; Thorax

BACKGROUND: The purpose of this study was to evaluate the clinical and radiographic outcomes of internal fixation with locking T-plates for osteoporotic fractures of the proximal humerus in patients aged 65 years and older. METHODS: From January 2007 through to December 2015, we recruited 47 patients aged 65 years and older with osteoporotic fractures of the proximal humerus. All fractures had been treated using open reduction and internal fixation with a locking T-plate. We classified the fractures in accordance to the Neer classification system; At the final follow-up, the indicators of clinical outcome-the range of motion of the shoulder (flexion, internal rotation, and external rotation) and the presence of postoperative complications-and the indicators of radiographic outcome-the time-to-union and the neck-shaft angle of the proximal humerus-were evaluated. The Paavolainen method was used to grade the level of radiological outcome in the patients. RESULTS: The mean flexion was 155.0° (range, 90°–180°), the mean internal rotation was T8 (range, T6–L2), and the mean external rotation was 66.8° (range, 30°–80°). Postoperative complications, such as plate impingement, screw loosening, and varus malunion were observed in five patient. We found that all patients achieved bone union, and the mean time-to-union was 13.5 weeks of the treatment. The mean neck-shaft angle was 131.4° at the 6-month follow-up. According to the Paavolainen method, “good” and “fair” radiographic results each accounted for 38 and 9 of the total patients, respectively. CONCLUSIONS: We concluded that locking T-plate fixation leads to satisfactory clinical and radiological outcomes in elderly patients with proximal humeral fractures by providing a larger surface area of contact with the fracture and a more rigid fixation.
Aged ; Classification ; Follow-Up Studies ; Humans ; Humerus ; Methods ; Osteoporotic Fractures ; Postoperative Complications ; Range of Motion, Articular ; Shoulder ; Shoulder Fractures*