PURPOSE: The size of the burden placed on all concerned, the chronicity of the disorder, and the importance of patient compliance in optimal management make asthma an excellent target for the development of patient education programs. Despite the usefulness and the need of the asthma education programs, there is no asthma education programs developed in Korea. In order to develop the education programs for childhood asthma, we offer a model for educating parents, as the first step. METHODS: Most1y, adult education programs consist of 3 components-planning, implication, evaluation. At first, we are going to p1an the asthma education programs for parents of the patients. 2O Volunteers in mothers will be gathered in one c1ass. The curiculum is made of four 1-hour sessions. During the each session, mothers wi1l be taught about the asthma, discuss the shared experiences and practice the skins. RESULTS: This model consists of 4 sessions such as the definition of asthma, the treatment-medicines and correct use of inhalation devices, prevention and the management of acute episodes. CONCLUSIONS: Use of this education model wi1l achieve better control of childhood asthma by leading the parents and patients to participate actively in their asthma treatment. The effects of this program will be assessed by a formal objective evaluation using a pretest, posttest experimental research design.
Adult ; Asthma* ; Education* ; Humans ; Korea ; Mothers ; Nebulizers and Vaporizers ; Parents ; Patient Compliance ; Patient Education as Topic ; Research Design ; Skin ; Volunteers

PURPOSE: Patient education is an important part of asthma management. This study was designed to evaluate the role of education program for asthmatic children and their parents. In the western countries, the effectiveness of patient education on improving self-management of asthma has been well documented. However, data from Korean population is lacking. METHODS: We performed the study to evaluate the efficacy of a hospital based education program aimed at improving self-management skills and reducing morbidity. Twenty patient and their parents attending Korea University Ansan Hospital allergy clinic were enrolled in the study. They were instructed 4 times of 10-15 minutes session with every 3 month interval on the pathophysiology of asthma, treatment and the appropriate use of medication including proper inhaler technique and the self-management of their diseases. The instructions were reinforced by three more education session at subsequent outpatient clinic attendance. RESULT: After twelve months, morbidity was assessed by the numbers of hospitalization, emergency department attendance and outpatient clinic attendance, use of oral steroids and steroid inhalation and impairment of quality of life. The efficacy of the education was demonstrated by significant reduction in the number of hospitalization(P<0.005), emergency department visit(P<0.005), outpatient clinic visit(P<0.05) and reduction of oral steroid use(P<0.001). There were also reduction of outpatient department attendance and improvement in steroid inhalation and quality of life. CONCLUSION: The result of this study suggest that a proper patient education is essential in reduction of asthma morbidity and improving in quality of life.
Ambulatory Care Facilities ; Asthma* ; Child ; Education* ; Emergency Service, Hospital ; Gyeonggi-do ; Hospitalization ; Humans ; Hypersensitivity ; Inhalation ; Korea ; Nebulizers and Vaporizers ; Outpatients ; Parents* ; Patient Education as Topic ; Quality of Life ; Self Care ; Steroids

Residual latency is the difference between the expected and measured terminal latencies in nerve conduction study. The main contributors to the residual latency are the nerve tapering in the hand and fingers and the neuromuscular delay. We measured median motor and sensory residual latencies in the controls and in patients with diabetes mellitus(DM) to establish the normal values, to evaluate the diagnostic value of the residual latency in diabetic polyneuropathy. we studied 50 healthy controls and 100 diabetic patients with or without polyneuropathy. The normal residual latency values were 1.42+/-0.41 msec(mean+/-SD) in motor part and 0.44+/-0.20 msec in sensory part of median nerve. The standard deviation of residual latency in median motor nerve was decreased by 12% as compared with that of distal latency in the patient with diabetic polyneuropathy. Duration of DM and age were not related to the residual latency of median nerve. The results suggest that the residual latency of median motor nerve provides a narrower normal range in the diagnosis of diabetic polyneuropathy irrespective of duration of DM or age.
Diabetes Mellitus* ; Diabetic Neuropathies ; Diagnosis ; Fingers ; Hand ; Humans ; Median Nerve* ; Neural Conduction ; Polyneuropathies ; Reference Values

OBJECTIVE: To demonstrate the bifurcation pattern of the tibial nerve and its branches. METHODS: Eleven legs of seven fresh cadavers were dissected. The reference line for the bifurcation point of tibial nerve branches was an imaginary horizontal line passing the tip of the medial malleolus. The distances between the reference line and the bifurcation points were measured. The bifurcation branching patterns were categorized as type I, the pattern in which the medial calcaneal nerve (MCN) branched most proximally; type II, the pattern in which the three branches occurred at the same point; and type III, in which MCN branched most distally. RESULTS: There were seven cases (64%) of type I, three cases (27%) of type III, and one case (9%) of type II. The median MCN branching point was 0.2 cm (range, -1 to 3 cm). The median bifurcation points of the lateral plantar nerves and inferior calcaneal nerves was -0.6 cm (range, -1.5 to 1 cm) and -2.5 cm (range, -3.5 to -1 cm), respectively. CONCLUSION: MCN originated from the tibial nerve in most cases, and plantar nerves were bifurcated below the medial malleolus. In all cases, inferior calcaneal nerves originated from the lateral plantar nerve. These anatomical findings could be useful for performing procedures, such as nerve block or electrophysiologic studies.
Cadaver ; Leg ; Nerve Block ; Tarsal Tunnel Syndrome ; Tibial Nerve

PURPOSE: The aims of this study were to examine indoor concentrations of air pollutants in socioeconomically disadvantaged houses and to investigate relationships between indoor air pollutant levels and the severity of atopic dermatitis (AD). METHODS: A total of 54 children who had a past history or current symptoms of AD were enrolled in the study. To evaluate the levels of indoor air pollutants, we measured concentrations of CO2, total volatile organic compounds (TVOC), formaldehyde, particulate matter with diameter less than 10 microm (PM10), airborne mold and numbers of house dust mite (HDM) in dust of the children's houses. All studied subjects completed physical examination for the severity of AD and blood tests. RESULTS: Although the mean (+/-standard deviation [SD]) concentration of indoor CO2 (600.6+/-179.4 ppm) was lower than the standard recommended levels of multiplex buildings in Korea, there was a significant correlation between CO2 concentrations and the severity of AD (r=0.302, P=0.030). The geometric means (range of 1 SD) of TVOC (42.5 microg/m3 [22.2-81.5]), formaldehyde (24.3 microg/m3 [15.0-39.9]), PM10 (26.6 microg/m3 [14.6-48.4]), and airborne mold (49.9 CFU [colony forming unit]/m3 [26.3-94.6]) were not significantly higher than the standard recommended levels of multiplex buildings. Two-thirds of the subjects were sensitized to at least 1 of the common allergens. CONCLUSION: Generally, indoor air pollution was not serious in socioeconomically disadvantaged households. However, indoor CO2 concentrations are closely related to the severity of AD in children living in socioeconomically disadvantaged houses. Environmental amelioration targeting vulnerable population may improve the quality of life and decrease the prevalence of environmental allergic diseases.
Air Pollutants* ; Air Pollution, Indoor ; Allergens ; Child* ; Dermatitis, Atopic* ; Dust ; Family Characteristics ; Formaldehyde ; Fungi ; Hematologic Tests ; Humans ; Korea ; Particulate Matter ; Physical Examination ; Prevalence ; Pyroglyphidae ; Quality of Life ; Volatile Organic Compounds ; Vulnerable Populations*

Infiltration of circulating monocytes into glomeruli has been implicated in the pathogenesis of glomerular injury in many human and experimental forms of glomerulonephritis. Monocyte chemoattractant protein-1(MCP-1), a potent chemokine with considerable specificity for monocytes, can be up-regulated by various cytokines and growth factors in mesangial cells. Glomerular infiltration of monocytes has been reported in diabetic nephropathy as well. However, effect of high glucose on MCP-1 expression in human mesangial cells has not been known well. We investigated the effect of high glucose on MCP-1 expression and its signal transduction pathway. Human mesangial cells were conditioned with glucose(5-60 mM) or mannitol chronically for up to 5 days. Expression of MCP-1 mRNA and protein was measured by Northern blot analysis and ELISA respectively. To examine the role of transcription factor AP-1 or NF-KB, electrophoretic mobility shift assay(EMSA) was performed. Glucose induced MCP-1 mRNA expression in a time and dose dependent manner. MCP-1 protein in cell culture supernant was also increased. Equivalent concentrations of mannitol had no significant effect. EMSA revealed that glucose increased the AP-1 binding activity in a time and dose dependent manner but not NF-B. Inhibitor of AP-1, curcumin(7.5- 15 muM) dose dependently suppressed the induction of MCP-1 mRNA by high glucose. Tyrosine kinase inhibitors such as genistein(12.5-50 muM) and herbimycin A(0.1-1 muM) inhibited the high glucose-induced MCP-1 mRNA expression in a dose dependent manner and also suppressed the high glucose-induced AP-1 binding activity. In summary, high glucose induces mesangial MCP-1 expression partly via tyrosine kinase-AP-1 pathway.
Blotting, Northern ; Cell Culture Techniques ; Cytokines ; Diabetic Nephropathies ; Enzyme-Linked Immunosorbent Assay ; Glomerulonephritis ; Glucose* ; Humans* ; Intercellular Signaling Peptides and Proteins ; Mannitol ; Mesangial Cells* ; Monocytes ; NF-kappa B ; Protein-Tyrosine Kinases ; RNA, Messenger ; Sensitivity and Specificity ; Signal Transduction ; Transcription Factor AP-1 ; Tyrosine*

PURPOSE: Cough and wheezing are the most common respiratory symptoms in children. Recently, the cough-holter monitoring has been used to estimate the frequency and intensity of cough and wheezing, objectively. In this study, we aimed to evaluate the validity of cough-holter monitoring for the objective assessment of cough and wheezing in the hospitalized children with respiratory symptoms. METHODS: Cough-holter monitoring was performed in 59 children who suffered from cough and/or wheezing. We obtained the information on the frequency and intensity of cough and wheezing from the parents, a pediatrician, and cough-holter monitoring. Visual Analogue Scale (VAS) scores were taken by parents, and the pediatrician estimated the wheezing score by using a stethoscope. We assessed a relationship between the VAS scores, wheezing score, and cough-holter monitoring data. RESULTS: The frequencies and intensities of cough correlated positively with the VAS scores (r=0.301, P=0.032; and r=0.540, P=0.001, respectively) and the frequencies and intensities of wheezing also correlated positively with the Wheezing scores. (r=0.335, P=0.011; and r=0.457, P=0.001, respectively) The wheezing intensity did not correlate with the Wheezing score in wheezing children. (r=0.321, P=0.089) CONCLUSION: Cough-holter monitoring correlated positively with the VAS scores and the wheezing scores. Cough-holter monitoring appears to be a useful objective assessment tool for the children who have suffered from cough and/or wheezing.
Child ; Child, Hospitalized ; Cough ; Humans ; Parents ; Respiratory Sounds ; Stethoscopes

The uvulopalatal flap (UPF) technique is a modification of uvulopalatopharyngoplasty (UPPP) for the surgical treatment of obstructive sleep apnea. In the UPF technique, an uvulopalatal flap is fabricated and sutured to the residual mucosa of the soft palate to expand the antero-posterior dimensions of the oropharyngeal inlet. In the extended uvulopalatal flap (EUPF) technique, an incision at the tonsillar fossa is added to the classical UPF technique followed by the removal of mucosa and submucosal adipose tissue for additional expansion of the lateral dimension. The EUPF technique is more conservative and reversible than UPPP. Therefore, complications, such as velopharyngeal insufficiency, dysphagia, dryness, nasopharyngeal stenosis and postoperative pain, are reduced. In the following case report, the patient was diagnosed with obstructive sleep apnea and treated with the EUPF technique. The patient's total respiratory disturbance events per hour (RDI) was decreased to 15.4, the O2 saturation during the sleep was increased, and the excessive daytime sleepiness had disappeared after the surgery without complications. The authors report this case with a review of the relevant literature.
Adipose Tissue ; Bays ; Constriction, Pathologic ; Deglutition Disorders ; Humans ; Mucous Membrane ; Pain, Postoperative ; Palate, Soft ; Sleep Apnea, Obstructive ; Surgical Flaps ; Treatment Outcome ; Uvula ; Velopharyngeal Insufficiency

BACKGROUND: Monocyte chemoattractant protein-1 (MCP-1) and reactive oxygen species (ROS) play an important role during glomerular inflammation. We investigated the effect of aspirin metabolite, salicylate on the pro-inflammatory cytokine-induced MCP-1 expression and lysophosphatidylcholine -induced intracellular ROS formation in human mesangial cells. METHODS: Cells were pretreated with salicylate, and then stimulated with tumor necrosis factor-alpha (TNF-alpha) or interleukin-1beta (IL-1beta). The expression of MCP-1 mRNA and MCP-1 protein were measured by Northern blot analysis and enzyme-linked immunosorbent assay, respectively. Nuclear factor-kappa B (NF-kappaB) activity was measured by electrophoretic mobility shift assay. Degradation of Ikappa B-alpha was assessed by Western blot analysis. Intracellular ROS production was monitored by flow cytometry using 2'7'-dichlorofluorescin diacetate. RESULTS: Salicylate inhibited the TNF-alpha- or IL-1beta- induced MCP-1 mRNA expression in a dose dependent manner (1-20 mM) and also suppressed the MCP-1 protein expression. Its effect was not attributable to de novo synthesis of intermediary proteins. Salicylate inhibited the TNF-alpha- or IL-1beta-induced NF-kappa B binding activity and also suppressed the TNF-alpha-induced Ikappa B-alpha degradation. Low concentration of salicylate (0.01-1 mM) suppressed the lysophosphatidylcholine-induced ROS formation. CONCLUSION: Milimolar concentration of salicylate inhibited the MCP-1 expression at least in part, via suppression of NF-kappaB by reducing the degradation of Ikappa B-alpha. On the other hand, lower concentration of salicylate could suppress the lysophosphatidylcholine-induced intracellular ROS formation.
Aspirin ; Blotting, Northern ; Blotting, Western ; Chemokine CCL2* ; Electrophoretic Mobility Shift Assay ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Hand ; Humans* ; Inflammation ; Interleukin-1beta ; Lysophosphatidylcholines ; Mesangial Cells* ; Monocytes* ; NF-kappa B ; Reactive Oxygen Species* ; RNA, Messenger ; Tumor Necrosis Factor-alpha

The endoscopic assisted approach for the treatment of condylar fracture is a less invasive alternative treatment modality and is considered to be able to overcome the limited access to the operation field to obtain an accurate reduction and fixation. Six patients with condylar neck and subcondylar fracture underwent the endoscopic assisted open reduction and internal fixation through the transoral approach at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. The endoscope was inserted through an intraoral incision and the reduction of fracture fragment was performed via a transbuccal approach with two transcutaneous stab incisions. Five patients showed anatomic reduction without any complications. One patient, whose fracture site was fixed with a single plate, showed displacement of fractured condylar segment during the follow up period. No patient had any facial nerve damage.
Endoscopes ; Endoscopy ; Facial Nerve ; Follow-Up Studies ; Humans ; Neck ; Seoul ; Surgery, Oral