BACKGROUND AND OBJECTIVES: One of problems for the management of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) is the difficulty of determining the affected ear using Ewald's second law. The purpose of this study is to develop the new "Bow and Lean Test (BLT)" to determine easily the affected ear of HSC-BPPV and evaluate its efficiency. MATERIALS AND METHOD: We compared the efficiency between the classical method and BLT in 26 patients with HSC-BPPV. The classical method is based on Ewald??s second law comparing the intensity of nystagmus or symptoms in head roll test. BLT is based on the direction of both "bowing nystagmus" and "leaning nystagmus" at head's bowing and leaning state on sitting position. The affected ear is the same direction of bowing nystagmus in canalolithiasis and the same direction of leaning nystagmus in cupulolithiasis. RESULTS: In 26 patents (15 canalolithiasis, 11 cupulolithiasis), 3 (11.5%) patients did not show a prominent affected ear in the classical method, and 7 (26.9%) patients showed the different affected ear between two methods. All 10 patients were successfully treated with just one trial of barbecue rotation based on the affected ear in BLT. Three patients did not show any bowing or leaning nystagmus. The side with canal paresis in all 4 patients, who showed significant canal paresis in bithermal caloric tests, was equal to the affected ear based on BLT. CONCLUSION: "Bow and Lean Test" (also called "Choung's test") is a new method which can easily determine the affected ear of HC-BPPV.
Caloric Tests ; Ear ; Head ; Humans ; Jurisprudence ; Paresis ; Semicircular Canals ; Vertigo*

BACKGROUND AND OBJECTIVES: One of problems for the management of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) is the difficulty of determining the affected ear using Ewald's second law. The purpose of this study is to develop the new "Bow and Lean Test (BLT)" to determine easily the affected ear of HSC-BPPV and evaluate its efficiency. MATERIALS AND METHOD: We compared the efficiency between the classical method and BLT in 26 patients with HSC-BPPV. The classical method is based on Ewald??s second law comparing the intensity of nystagmus or symptoms in head roll test. BLT is based on the direction of both "bowing nystagmus" and "leaning nystagmus" at head's bowing and leaning state on sitting position. The affected ear is the same direction of bowing nystagmus in canalolithiasis and the same direction of leaning nystagmus in cupulolithiasis. RESULTS: In 26 patents (15 canalolithiasis, 11 cupulolithiasis), 3 (11.5%) patients did not show a prominent affected ear in the classical method, and 7 (26.9%) patients showed the different affected ear between two methods. All 10 patients were successfully treated with just one trial of barbecue rotation based on the affected ear in BLT. Three patients did not show any bowing or leaning nystagmus. The side with canal paresis in all 4 patients, who showed significant canal paresis in bithermal caloric tests, was equal to the affected ear based on BLT. CONCLUSION: "Bow and Lean Test" (also called "Choung's test") is a new method which can easily determine the affected ear of HC-BPPV.
Caloric Tests ; Ear ; Head ; Humans ; Jurisprudence ; Paresis ; Semicircular Canals ; Vertigo*

No abstract available.
Hernia, Diaphragmatic*

BACKGROUND: It is well known that intracoronary thrombolysis during the early period of acute myocardial infarction leads to the limitation of myocardial necrosis, preserves left ventricular function, and improves survivals. The recanalization rate of intracoronary rrokinase infusion into infarct-related coronary artery was known as 62-94 percents in previos studies. The various factors influence the outcome of intracoronary thrombolysis, including total dose of urokinase, time from onsrt of chest pain to thrombolysis. The purpose of this study was to evaluate whether the occlusion site morphology influences recanalization rates of intracoronary thrombolysis. METHODS: We evaluated infarct-related coronary artery morphology of 56 acute mycardial infarction patients who performed intracoronary thrombolytic therapy within 6-12 hours after the onset of acute myocardial infarction. Intracoronary urokinase infusion was performed at a rate of 25000 IU/minute. The presence of calcification, collaterals, side branches and the stump site morphologies(thrombus type, pencil type, cutting type) were identified on magnified 35mm cine frames. RESULTS: Reperfusion was successed in 34 patients and failed in 22 patients. There were no statistically significant difference in the pressure of calcification, collaterals, and side branches between success and failure groups. Intracoronary thrombus was identified in 21 percent of success group, but not in failure group. The reperfusion rates according to stump site morphology were 76% in thrombus type, 58% in cutting type, and 42% in pencil type(p<0.05). CONCLUSION: Our study indicates the presence of intracoronary thrombus and the morphology of thrombus type is more effective in intracoronary thrombolysis in acute myocardial infarction. The identification of types of the coronary obstruction will be helpful for the selection of intracoronary thrombolysis in acute myocardial infarction patients. And the results suggest that the difference of stump composition show different stump morphologies.
Chest Pain ; Coronary Vessels* ; Humans ; Infarction ; Myocardial Infarction* ; Necrosis ; Reperfusion ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Ventricular Function, Left

PURPOSE: The purpose of this study was to confirm the immediate effect of wrist joint mobilization with taping on the range of motion, grip strength, and spasticity. METHODS: Thirty stroke patients were randomly divided into two groups: the joint mobilization with taping group (n=15) and a taping group (n=15). For measurement of spasticity and joint range of motion, the modified Tardieu scale, active and passive range of motion of wrist flexion, as well as extension were measured by the Rapael smart glove, and for grip strength measurement, grip dynamometer was performed. RESULTS: The experimental group showed a significant improvement in the range of motion, grip strength, and spasticity after 10 minutes of taping (p<0.05), no significant difference was found in the control group (p>0.05). However, there was no significant difference between the two groups (p>0.05). CONCLUSION: The study found that wrist joint mobilization with taping has an immediate effect on wrist range of motion, grip strength, and spasticity in stroke patients, whereas it was not effective in the control group with just taping. The long-term change still needs to be evaluated, when taking into consideration of the carryover effect.
Hand Strength* ; Humans ; Joints ; Muscle Spasticity* ; Range of Motion, Articular* ; Stroke* ; Wrist Joint* ; Wrist*

PURPOSE: This study examined the effects of neuromuscular electrical stimulation (NMES) and horseback riding using a robotic device on the trunk muscle activity and gross motor function in children with spastic diplegia. METHODS: Children with spastic diplegia were divided into two groups: an experimental group (NMES and horseback riding using a robotic device [n=10]) and a control group (placebo NMES and horseback riding using a robotic device [n=10]). Each group received general physical therapy and occupational therapy. Each intervention involved the administration of NMES for 15 minutes and horseback riding using robotic device therapy for 15 minutes three times a week for 4 weeks. The evaluation included both the rectus abdominis muscles (RA), external oblique muscles (EO), thoracic paraspinal muscles (TP), and lumbar paraspinal muscles (LP) activity and GMFM. RESULTS: The RA, EO, TP, and LP muscle activity, GMFM C, D, and E were increased significantly in the experimental and control groups. A significant increase in both the TP muscle activity and GMFM D was observed in the experimental group compared to the control group. CONCLUSION: This study showed that horseback riding using a robotic device is an effective intervention for trunk muscle activity and GMFM in children with spastic diplegia. However, if NMES is added to the back muscles, it is possible to further increase the thoracic paraspinal muscle activity and standing ability.
Back Muscles ; Cerebral Palsy* ; Child* ; Electric Stimulation ; Humans ; Muscle Spasticity* ; Muscles ; Occupational Therapy ; Paraspinal Muscles ; Rectus Abdominis

PURPOSE: The spasticity of stroke patients decreases the ankle range of motion and increases the gastrocnemius muscle tone. This study examined the effects of stretching exercise and far infrared irradiation on the ankle function in stroke patients with spasticity. METHODS: This study was conducted on 20 stroke patients admitted to Jesaeng General Hospital, who were divided into a study group (stretching exercise with far infrared) and control group (stretching exercise only). The dorsiflexion range of motion was measured using a smartphone and the medial gastrocnemius muscle tone and stiffness were measured using a Myoton pro. RESULTS: With the exception of the non-paretic gastrocnemius muscle tone in the control group, the medial gastrocnemius muscle tone and stiffness decreased significantly in both groups. In both groups, the dorsiflexion range of motion increased significantly. In addition, the experimental group had a significantly higher dorsiflexion range of motion than the control group. On the other hand, there was no significant difference between the two groups in terms of the medial gastrocnemius muscle tone and stiffness. CONCLUSION: For stroke patients with spasticity, stretching exercises increased the ankle's range of motion and decreased the gastrocnemius muscle tone. The addition of heat therapy further increased the ankle's range of motion. On the other hand, as the sample size was small, future studies should include more subjects.
Ankle ; Exercise ; Hand ; Hospitals, General ; Hot Temperature ; Humans ; Muscle Spasticity ; Muscle, Skeletal ; Range of Motion, Articular ; Sample Size ; Smartphone ; Stroke

The coronary artery fistula from right coronary artery to left ventricle is a rare disease among coronary artery anomaly. We experienced three cases of rare coronary fistula and report with literature review. Although symptoms of coronary artery fistula are associated with arteriovenous shunt and coronary steal phenomenon, many cases are asymptomatic. In this report, all patients had no symptom. but incidental murmur was noted (two are continuous, one is diastolic rumbling). The diagnosis was made by transthoracic or transesophageal echocardiogram and selective coronary angiography. Because patients were relatively young and the diameter of dilated coronary artery were huge, we perfomed operation on three patients.
Coronary Angiography ; Coronary Vessels* ; Diagnosis ; Fistula* ; Heart Ventricles* ; Humans ; Rare Diseases

BACKGROUND: Coronary artery spasm plays an important role in the pathogenesis of not only variant angina but also other forms of angina,acute myocardial infarction, and sudden death. However precise mechanisms by which coronary spasms occur remains unknown. The role of increased coronary artery tone as a part of pathogenesis of conary spasm and relation to the severity of coronary artery disease are still controversial. Thus we underwent this study to investigate the role of increased coronary artery tone as a part of pathogenesis of conary spasm and realtion to the severity of coronary artery disease. METHODS: Intracoronary acetylcholine and isosorbide dintrate were used as a spasm-provocative agent and vasodilator respectively. We analyzed 176 vessels(69 right coronary artery, 58 left anterior descending coronary artery, 49 left circumflex coronary artery) of 75 patients admitted for evaluation of chest pain syndrome. Among the 176 vessels, spasm occurred in 39 vessels of 25 patients. RESULTS: 1)Coronary artery spasm occured in 30.4%(21/69), 17.2%(10/58), 16.3%(8/49) of right coronary artery, left anterior descending coronary artery, left circumflex coronary artery respectively. 2) There is no relationship between angiographically visible minimal coronary artery disease and occurrence of spasm provoked by acetylcholine. 3) There was no significant difference of coronary risk factor predicting coronary spasm between two groups. 4) There is more significant % vasodilation by isosorbide dintrate(ISDDN) occurred din both the spastic and nonspastic arterial segment of vasospastic angina group than no spasm group(30.2%, 28.4% vs 14.2%, p<0.05). 5) Degree of % vasodilation by ISDN was more significantly larger in vasospastic angina group than no spasm group despite the presence of same amount of angiographically visible minimal coronary artery disease(38.3% vs 12.5%, p<0.05). CONCLUSION: These findings suggests that the occurrence of conronary artery spasm is not related to minimal coronary artery disease. Increased coronary artery tone observed only in vasospastic angina group may be part of pathogenesis of coronary spasm.
Acetylcholine* ; Arteries ; Chest Pain ; Coronary Artery Disease ; Coronary Vessels* ; Death, Sudden ; Humans ; Isosorbide ; Muscle Spasticity ; Myocardial Infarction ; Risk Factors ; Spasm ; Vasodilation

BACKGROUND: Among the various mechanisms of Myocardial reperfusion injuries, neutrophil is thought to be one of them. Endogenous coronary vasodilator adenosine is known to have myocardial protective effect through variable pharmacologic action, influencing the function of several cell types involved in the pathogenesis of myocardial reperfusion injury. This study was designed to determine the beneficial effect of adenosine on the left ventricular function during reperfusion and whether this effect is due to the adenosine on the role of neutrophil. METHODS: 27 open-chest cats were randomly divided into 3 groups. 6 cats received ischemic injury without reperfusion(group 1). 21 cats were subjected to 60 minutes of proximal left anterior descending coronary artery occlusion followed by a 60-minute reperfusion. 11 of 21 cats received intravenous adenosine(0.15mg/Kg/min) infusion starting 5 minutes before reperfusion throughout the entire period(group 3). 10 cats received equal volume of saline instead of adenosine(group 2). RESULTS: 1) During the experimental period, significant decrease of heart rate, blood pressure, RPI, negative dP/dT and increase of LVEDP were noted in group 2 and 3 with no difference between the two groups. The reduction of positve dP/dT was more significant in group 2 at 30 and 60 minute of reperfusion than the preocclusion value(1404+/-111, 1631+/-161 vs 1832+/-169mmHg/sec at baseline, p<0.05). In contrast, positive dP/dT in group 3 at 30 and 60 minute of reperfusion were similar to baseline values(1890+/-92, 2052+/-112 vs 2025+/-227mmHg/sec at baseline, p=NS). These were significantly higher(p<0.05) than untreated group 2. 2) Infarct size was significantly reduced in adenosine-treated group 3, when expressed as a percentage of the area at risk(28.4+/-3.3% vs 44.5+/-3.2% of group 2, p<0.05). The significant increase in myeloperoxidase activity observed after reperfusion was not detected in adenosine treated group 3.(0.18+/-0.05 vs 0.46+/-0.09 unit/100mg wet tissue weight, p<0.05). A significant correlation was present between infarct size (% of left ventricle) and myeloperoxidase activity(r=0.72, p<0.01). 3) Light microscopic examination demonstrated the decreased acute interstitial and intra vascular inflammatory infiltration and capillary plugging together with decreased tendency of incidence of contraction band necrosis in adenosine treated group 3. CONCLUSION: These findings suggest that intravenous administration of adenosine during the early reperfusion period significantly reduces infarct size, improving the early recovery of global ventricular function. The probable cause is the effect of adenosine on neutrophil as one of the various protective mechanisms of adenosine in feline heart model subjected to coronary occlusion and reperfusion, 60 minutes each.
Adenosine* ; Administration, Intravenous ; Animals ; Blood Pressure ; Capillaries ; Cats ; Coronary Occlusion ; Coronary Vessels ; Heart Rate ; Heart* ; Incidence ; Myocardial Reperfusion Injury* ; Myocardial Reperfusion* ; Necrosis ; Neutrophils ; Peroxidase ; Reperfusion ; Reperfusion Injury ; Ventricular Function ; Ventricular Function, Left