Objective: To investigate variables for assessment of stroke-related sarcopenia that are alternative options to the current assessment for sarcopenia, which focuses on age-related sarcopenia and also has limitations in addressing sarcopenia due to weakness resulting from stroke. Methods: Forty patients (17 men, 23 women; mean age, 66.9±15.4 years) with first-ever stroke who can walk independently were included. Muscle mass was determined by measuring ultrasonographic muscle thickness of vastus intermedius, rectus femoris, tibialis anterior, medial gastrocnemius, and biceps brachii muscles in addition to using the skeletal muscle index (SMI) with bioelectrical impedance analysis. Muscle strength was assessed with the Medical Research Council (MRC) sum score as well as handgrip (HG) strength. Physical performance was measured by the Berg Balance Scale (BBS) along with 4-meter gait speed (4MGS). Correlations between each assessment in the three categories were analyzed and adjusted by stroke severity, comorbidity, and nutritional status. Results: For muscle mass, SMI showed the highest correlation with the tibialis anterior muscle (r=0.783, p<0.001) among the other muscles. Regarding muscle strength, the MRC sum score correlated with the HG (r=0.660, p<0.001). For physical performance, the BBS correlated with the 4MGS (r=0.834, p<0.001). The same result was obtained after adjusting for factors of stroke severity, comorbidity, and nutritional status. Conclusion These results suggest that ultrasonographic muscle thickness of the tibialis anterior, the MRC sum score, and BBS might be alternatives to SMI, HG, and usual gait speed for sarcopenia in stroke patients.

PURPOSE: Recently established in 1997, Sungkyunkwan University School of Medicine was the first medical school in Korea to adopt problem-based learning (PBL) as a core curriculum from the very beginning. The purpose of this study was to evaluate the PBL curriculum from the viewpoint of the medical students. METHODS: This study used a qualitative approach to understand students' perceptions of the positive aspects of PBL. A total of 22 second-year medical students at Sungkynkwan medical school were surveyed. Student perceptions were obtained from questionnaires and face-to-face interviews. The interview was designed to evoke more personal and in-depth responses. RESULTS: Students' perceptions of the effects of PBL were found to be very favorable. Most students showed positive responses on the issues of more active learning attitude, self-directed learning, motivation to study, improved problem solving, and integrated learning. CONCLUSION: The results of this study demonstrated that the students had a good understanding of PBL and experienced its positive aspects of PBL approach. It might be concluded that PBL was successfully implemented into the curriculum and specific and expected effects of PBL accomplished.
Curriculum* ; Evaluation Studies as Topic* ; Humans ; Korea ; Learning ; Motivation ; Problem Solving ; Problem-Based Learning* ; Schools, Medical ; Students, Medical ; Surveys and Questionnaires

BACKGROUND: Pringle maneuver and nitroglycerin (NTG) administration to reduce hemorrhage during hepatectomy may affect renal blood flow (RBF) and renal cortical perfusion (RCP) by reducing blood pressure (BP), perload and others. However, so far there have been no studies on RBF and RCP changes during and after hepatic vascular maneuver in hepatectomy. The purpose of this study was to evaluate the changes in RBF and RCP along with low dose (2 microgram/kg/min) NTG with or without low dose (3 microgram/kg/min) dopamine after the occlusion and reperfusion of hepatic blood flow. METHODS: Eighteen mongrel dogs were divided into three groups according to drug administration after hepatic reperfusion; control group (group C, n = 6), NTG group (group N, n = 6), and NTG with dopamine group (group N-D, n = 6). After femoral arterial and central venous catheterization, a midline abdominal incision was made, and the hepatic artery (HA) and the portal vein (PV) were exposed for clamping and declamping. Thereafter, the right renal artery was exposed, and a doppler probe for measuring RBF was placed around the right renal artery, and a thermal diffusion microprobe was inserted in the renal outer cortex to measure RCP. Hemodynamics, RBF and RCP, were repeatedly measured before and after HA and PV reperfusion. RESULTS: No significant change in heart rate was observed in any group. The BP decreased in all the groups after HA and PV occlusion. In group C, the BP recovered to the baseline level after hepatic reperfusion but not in groups N and N-D. The RBF and RCP decreased in all groups after HA andPV occlusion. The RBF increased compared to baseline in N-D after hepatic reperfusion, and the RCP increased versus baseline in N-D, 10 minutes after hepatic reperfusion. CONCLUSIONS: In conclusion, it was observed that the RBF and RCP increased compared to baseline by administering dopamine during HA and PV reperfusion. Therefore, the prophylactic administration of low dose dopamine during hepatectomy offers an effective method of protecting renal function.
Animals ; Blood Pressure ; Catheterization, Central Venous ; Central Venous Catheters ; Constriction ; Dogs* ; Dopamine* ; Heart Rate ; Hemodynamics ; Hemorrhage ; Hepatectomy ; Hepatic Artery ; Liver* ; Nitroglycerin* ; Perfusion* ; Portal Vein ; Renal Artery ; Renal Circulation* ; Reperfusion* ; Thermal Diffusion

As the survival rate of patients with complex congenital heart disease has improved and the number of adult patients with congenital heart disease has risen, arrhythmias and heart failure have become important issues in these patients. Cardiac implantable electronic devices, including pacemakers, are also on the rise. Transvenous implantation or epicardial pacemaker implantation is challenging in patients with complex congenital heart disease. Here we report a case in which a dual-chamber pacing, dual-chamber sensing, dual response and rate-adaptive (DDDR) pacemaker was implanted transvenously into a patient with congenital heart disease. A 34-year-old male with extracardiac conduit Fontan circulation complained of dizziness; an electrocardiogram revealed junctional bradycardia. We performed transvenous implantation of a DDDR pacemaker via trans-conduit puncture. In conclusion, transvenous implantation of a pacemaker is feasible in patients with extracardiac conduit Fontan circulation.
Adult ; Arrhythmias, Cardiac ; Bradycardia ; Dizziness ; Electrocardiography ; Fontan Procedure ; Heart Defects, Congenital ; Heart Failure ; Humans ; Male ; Pacemaker, Artificial ; Punctures ; Sick Sinus Syndrome ; Survival Rate

The elevation and fusion of palatine are essential processes in the completion of the palatal development. It is believed that the mesenchyme plays a major role in the ascent of the palatal process, and that the palatal epithelium is involved in its fusion. The mechanism of fusion requires several different morphologic and molecular changes prior to the completion of the mesenchymal continuity between different palatine processes. The mechanism of removing the epithelial cells from the fusion zone could include either programmed cell death, epithelial-mesenchymal transformation or migration to adjacent epithelia. Retinoic acid has been known to induce cleft palate by disturbing mesenchymal growth and/or epithelial fusion. The effect of retinoic acid on the epithelium of the palatine process was studied in the fetus of the Sprague- Dawley rat with feeding 100 mg/kg of retinoic acid mixed in olive oil on the 10th day of fetal age and controlled with feeding pure olive oil. The epithelium of the palatine process was examined by PAS reaction and electron- microscopy on the 14th, 15th, 16th and 18th day of fetal age. The obtained results were as follows: 1. In the control group, glycogen was plentiful at the entire epithelium of the palatine process during the pre-fusion period(14th and 15th day), but it diminished in contact epithelium at the fusion stage(16th day). On the contrary, in the experimental group treated with retinoic acid, glycogen was plentiful and did not change from the 14th to 18th day of gestation. 2. In the control group at fusion stage(16th and 18th day), PAS-positive cells increased in the nasal and oral epithelium adjacent to the fusion site, and in the mesenchyme around the fusion site. 3. As a result of electronmicroscopic findings, the epithelium in the experimental group with retinoic acid seemed to be injured by retinoic acid; RER was composed of flattened cisternas and ribosomes were detached, mitochondrial crista and membrane were destructed and sacculated, and Golgi complex was extremely atrophied. According to the results, it seems that apoptosis as well as cell migration and transformation happen in the mechanism of cleaning the epithelium at the contact site, and that retinoic acid injures directly intracytoplasmic organelles and disturbs apoptosis, a sort of normal developmental process. More studies should be done to verify relations between apoptosis and large-sized glycogen granule in superficial epithelium.
Animals ; Apoptosis ; Cell Death ; Cell Movement ; Cleft Palate ; Epithelial Cells ; Epithelial-Mesenchymal Transition ; Epithelium* ; Fetus* ; Gestational Age ; Glycogen ; Golgi Apparatus ; Membranes ; Mesoderm ; Microscopy ; Olea ; Organelles ; Periodic Acid-Schiff Reaction ; Pregnancy ; Rats* ; Ribosomes ; Tretinoin* ; Olive Oil

Renal tubular dysfunctions have been observed in hydronephrosis, resulting in metabolic acidosis, hyperkalemia and excessive free water diuresis. These findings are occasionally found in infant and children. Batle et al. first reported distal tubular acidosis associated with low potassium excretion resulting from aldosterone resistance in adults with obstructive uropathy. We have experienced a case of transient hyperkalemia and hyperaldosteronism secondary to hydronephrosis in 63-year-old female patient. The causes of hyperkalemia were examined under the impression of secondary adrenal insufficiency due to corticosteroid abuse or hyporeninemic hypoaldosteronism due to diabetic nephropathy. But it proved to be resulted from hyperaldosteronism due to hydronephrosis. The hyperkalemia resulting from hyperaldosteronism is rare in adults. It may result from aldosterone resistance at distal nephron due to obstructive uropathy or the defect of distal nephron in hydrogen and potassium secretion in the distal nephron rather than from aldosterone deficiency. After she underwent percutaneous nephrostomy, serum potassium was maintained within normal range. She performed total cystectomy with ureterocutaneostomy in purpose for treatment of bladder cancer. So we report this case with a review of literature.
Acidosis ; Adrenal Insufficiency ; Adult ; Aldosterone ; Child ; Cystectomy ; Diabetic Nephropathies ; Diuresis ; Female ; Humans ; Hydrogen ; Hydronephrosis* ; Hyperaldosteronism* ; Hyperkalemia* ; Hypoaldosteronism ; Infant ; Middle Aged ; Nephrons ; Nephrostomy, Percutaneous ; Potassium ; Reference Values ; Urinary Bladder Neoplasms ; Water

Constrictive pericarditis is an uncommon post-inflammatory disorder characterized by a variably thickened, fibrotic, and frequently calcified, pericardium. Etiology of the constriction can occur for many reasons. Although foreign bodies are not the common cause of constrictive pericarditis, the long-term presence of foreign bodies, like bullets, is presumed to cause chronic constrictive pericarditis even after a very long asymptomatic period. A 69-year-old patient with atrial flutter was admitted to the hospital. A cardiac computed tomography showed a bullet located adjacent to the right atrium. The transthoracic echocardiography showed a thickened pericardium and septal bouncing motion, which were compatible with constrictive pericarditis. The history of the patient revealed an injury by gunshot during the Korean War in 1950. Radiofrequency ablation of the atrial flutter was performed, and after ablation, the bullet was removed surgically. The patient was discharged home after surgery without complications.
Aged ; Atrial Flutter ; Catheter Ablation ; Constriction ; Echocardiography ; Foreign Bodies ; Foreign-Body Reaction ; Heart Atria ; Humans ; Korean War ; Pericarditis, Constrictive* ; Pericardium ; Wounds, Gunshot*

Biliary cystadenomas are very rare cystic neoplasms usually arising from the intrahepatic bile ducts. The majority of patients are middle-aged women who present with abdominal discomfort and/or a palpable mass. The diagnosis was performed using several methods such as abdominal ultrasonography, computed tomography, percutaneous cholangiography or endoscopic retrograde cholangiopancreatography, and showed multiloculated cystic tumors with multiple internal septation. But confirmatory diagnosis was done by surgical pathology. Because the prognosis is comparatively better than after complete resection and the cystadenoma is warranted to avoid malignant change, early detection and surgical resection must be needed. We have experienced two cases, 30 and 50 year old females, which presented with nonspecific abdominal pain and dyspepsia. They were diagnosed as having intrahepatic biliary cystadenoma histopathologically which was confirmed after surgical resection. We report two cases of intrahepatic biliary cystadenoma with a review of literature.
Abdominal Pain ; Bile Ducts, Intrahepatic ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Cystadenoma* ; Diagnosis ; Dyspepsia ; Female ; Humans ; Liver ; Middle Aged ; Pathology, Surgical ; Prognosis ; Ultrasonography

This study was performed to compare clinical and imaging parameters and prognosis of unprovoked pulmonary embolism (PE), provoked PE with reversible risk factors (provoked-rRF), and provoked PE with irreversible risk factors (provoked-iRF) in Koreans. Three hundred consecutive patients (mean age, 63.6 +/- 15.0 yr; 42.8% male) diagnosed with acute PE were included. The patients were classified into 3 groups; unprovoked PE, provoked-rRF, and provoked-iRF; 43.7%, 14.7%, and 41.7%, respectively. We followed up the patients for 25.4 +/- 33.7 months. Composite endpoint was all-cause mortality and recurrent PE. The provoked-iRF group had significantly higher all-cause mortality, mortality from PE and recurrent PE than the unprovoked and provoked-rRF groups (P < 0.001, P < 0.001, and P = 0.034, respectively). Prognostic factors of composite endpoint in the unprovoked group were high creatinine (> 1.2 mg/dL; P < 0.001; hazard ratio [HR], 4.735; 95% confidence interval [CI], 1.845-12.152), C-reactive protein (CRP; > 5 mg/L; P = 0.002; HR, 5.308; 95% CI, 1.824-15.447) and computed tomography (CT) obstruction index (P = 0.034; HR, 1.090; 95% CI, 1.006-1.181). In conclusion, provoked-iRF has a poorer prognosis than unprovoked PE and provoked-rRF. Renal insufficiency, high CRP, and CT obstruction index are poor prognostic factors in unprovoked PE.
Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; C-Reactive Protein/analysis ; Creatinine/blood ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Pulmonary Embolism/diagnosis/mortality/*radiography ; Recurrence ; Renal Insufficiency/complications ; Republic of Korea ; Risk Factors ; Survival Rate ; Tomography, X-Ray Computed

This study was performed to compare clinical and imaging parameters and prognosis of unprovoked pulmonary embolism (PE), provoked PE with reversible risk factors (provoked-rRF), and provoked PE with irreversible risk factors (provoked-iRF) in Koreans. Three hundred consecutive patients (mean age, 63.6 +/- 15.0 yr; 42.8% male) diagnosed with acute PE were included. The patients were classified into 3 groups; unprovoked PE, provoked-rRF, and provoked-iRF; 43.7%, 14.7%, and 41.7%, respectively. We followed up the patients for 25.4 +/- 33.7 months. Composite endpoint was all-cause mortality and recurrent PE. The provoked-iRF group had significantly higher all-cause mortality, mortality from PE and recurrent PE than the unprovoked and provoked-rRF groups (P < 0.001, P < 0.001, and P = 0.034, respectively). Prognostic factors of composite endpoint in the unprovoked group were high creatinine (> 1.2 mg/dL; P < 0.001; hazard ratio [HR], 4.735; 95% confidence interval [CI], 1.845-12.152), C-reactive protein (CRP; > 5 mg/L; P = 0.002; HR, 5.308; 95% CI, 1.824-15.447) and computed tomography (CT) obstruction index (P = 0.034; HR, 1.090; 95% CI, 1.006-1.181). In conclusion, provoked-iRF has a poorer prognosis than unprovoked PE and provoked-rRF. Renal insufficiency, high CRP, and CT obstruction index are poor prognostic factors in unprovoked PE.
Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; C-Reactive Protein/analysis ; Creatinine/blood ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Pulmonary Embolism/diagnosis/mortality/*radiography ; Recurrence ; Renal Insufficiency/complications ; Republic of Korea ; Risk Factors ; Survival Rate ; Tomography, X-Ray Computed