Atrophy ; Maxillary Sinus ; Osseointegration ; Transplants

OBJECTIVE: To investigate the association of the muscle contraction with gating of the sensory input at central and peripheral levels according to the intensity of muscle contraction and location of the muscles, somatosensory evoked potentials (SSEPs) studies were evaluated at different levels of isometric contraction in the different muscles. METHOD: Median nerve SSEPs were recorded at Erb's point and scalp in the ten healthy adult subjects with isometric contraction of ipsilateral abductor pollicis brevis (APB), ipsilateral abductor digiti minimi (ADM) and contralateral APB. Median nerve SSEPs were recorded in each of these conditions during precontraction, weak contraction, strong contraction and 4 minutes after contraction. RESULTS: 1) N9 amplitudes of median SSEPs recorded at Erb's point were augumented during weak contraction and these amplitude augumentations were statistically significant in the ipsilateral APB contraction (p<0.05). 2) N20 amplitudes recorded at scalp were inhibited during strong isometric contraction and these amplitude inhibitions were statistically significant in the ipsilateral APB contraction (p<0.05). 3) The latencies of N9 and N20 potentials were not significantly changed during isometric contraction. CONCLUSION: Therefore peripheral nervous system as well as central nervous system is responsible for gating, so the subject should be asked for the best relaxation possible for higher reliability of SSEPs.
Adult ; Central Nervous System ; Evoked Potentials, Somatosensory* ; Humans ; Isometric Contraction ; Median Nerve ; Muscle Contraction* ; Muscles ; Peripheral Nervous System ; Relaxation ; Scalp

Thoracic empyema can result from the pleural accumulation of infected fluid or the infection of accumulated pleural fluid. The causes of empyema are pneumonia, surgery of lung, mediastinum, diaphragm, trauma, and so on. The impact of anesthetic technique (regional versus general versus combination of both) on the respiratory complication rate has not been established. A 86-yr-old male patient, who had COPD about 15 years and chronic empyema for several months, scheduled to operation for a femur neck fracture. We report a case that this patient with COPD and empyema operated under combined spinal-epidural anesthesia and converted to general anesthesia because of the rupture of the chronic empyema.
Anesthesia* ; Anesthesia, General ; Diaphragm ; Empyema ; Empyema, Pleural* ; Femoral Neck Fractures* ; Femur Neck* ; Femur* ; Humans ; Lung ; Male ; Mediastinum ; Pneumonia ; Pulmonary Disease, Chronic Obstructive ; Rupture*

BACKGROUND: Patient-centered care (PCC) and integrative care approach are widely advocated. However, their implementation usually requires an extended consultation time. Despite significant advances in medical diagnosis and treatment, no studies have examined consultation time and patient centeredness in Korea. METHODS: We conducted a “15-Minute Consultation” for first-time patients in outpatient clinics of 13 departments. A control group was selected from the same physicians' first-time patients, adjusting for age and gender. A total of 275 patients were selected for receiving in-depth consultation and 141 control patients were selected for regular consultation. Data were collected from patients using a questionnaire comprising a patient-centeredness scale and items on potential predictors such as socio-demographic and clinical factors. We also investigated the participating physician's professionalism. RESULTS: As compared to the control group, the in-depth consultation group scored higher on 5 variables associated with PCC, including (patients' perception of) medical professionals, wait and consultation times, treatment, patient advocacy, and patient satisfaction. While 92.4% of patients in the in-depth consultation group reported that the consultation time was sufficient, only 69.0% of those in the control group reported the same (P < 0.01). In the in-depth consultation group, scores on satisfaction level were the highest for the department of internal medicine, followed by departments of surgery and pediatrics. Participating physicians' improved satisfaction following the intervention proved that in-depth consultation facilitated building a rapport with patients. CONCLUSION: This study illustrated that the provision of sufficiently long consultation for serious and rare diseases could improve PCC and physicians' professionalism. Health authorities should reshuffle the healthcare delivery system and provide sufficient consultation time to ensure PCC and medical professionalism.
Ambulatory Care Facilities ; Delivery of Health Care ; Diagnosis ; Humans ; Internal Medicine ; Korea ; Outpatients ; Patient Advocacy ; Patient Satisfaction ; Patient-Centered Care ; Pediatrics ; Professionalism ; Rare Diseases ; Tertiary Care Centers

BACKGROUND/AIMS: Depression and allergic diseases, including asthma, are frequently reported as comorbid conditions. However, their associations have been rarely examined in community-based elderly populations. METHODS: The analyses were performed using the baseline data set of the Korean Longitudinal Study of Health and Aging, which consists of 1,000 elderly participants (aged > 65 years) randomly recruited from an urban community. Depression was assessed using the Geriatric Depression Scale, Center for Epidemiologic Studies Depression Scale, and Hamilton Rating Scale for Depression. Major and minor depressive disorders were diagnosed by psychiatrists. Allergic conditions were assessed using structured questionnaires, lung function, and skin prick test. Quality of life and comorbidities were assessed using structured questionnaires. RESULTS: Prevalence of asthma and major depressive disorder were 5.4% and 5.3%, respectively. The rate of depression was not significantly different between the non-asthmatic and asthmatic groups. No correlation was observed between the scores obtained using the depression scales and self-reported asthma. However, chronic, frequent, and nocturnal cough were significantly associated with depression and scores obtained using the depression scales, which remained significant in multivariate logistic regression analyses (chronic cough: odds ratio [OR], 3.23; 95% confidence interval [CI], 2.57 to 12.74; p = 0.04). Rhinitis was independently associated with high Mini-Mental State Examination scores (OR, 1.11; 95% CI, 1.05 to 1.17; p < 0.001) and low 36-item short-form (OR, 0.96; 95% CI, 0.80 to 0.98; p = 0.002). CONCLUSIONS Depression may not be significantly associated with asthma and allergic diseases in elderly populations, but cough is a significant factor affecting depression.

BACKGROUND: Fascin is associated with motility in various transformed cells. Overexpression of fascin is known to aid in the progression of some cancers and is associated with a poor prognosis. E-cadherin is a major protein of epithelial cells and its expression is involved in the regulation of cell proliferation and differentiation. The aim of this study was to determine the expression pattern for fascin and E-cadherin and how it is related to the prognostic factors for renal cell carcinoma (RCC). METHODS: The expression of fascin and E-cadherin was evaluated in 208 RCCs including 175 clear cell, 20 papillary, and 9 chromophobe types using tissue array analysis. RESULTS: The expression of fascin increased as the tumor stage (p=0.00) and Fuhrman grade (p=0.00) increased. A high positive rate of expression for fascin was observed in cases with sarcomatoid changes (p=0.27). E-cadherin expression was seen in the distal tubules and collecting ducts of normal kidneys with a membranous pattern. The positive rate of expression for E-cadherin increased as the Fuhrman grade increased (1, 0%; 2, 23.2%; 3, 34.9%; and 4, 53.8%, p=0.00). An inverse correlation in RCCs was observed in the expression of fascin and E-cadherin (p=0.026, r=-0.158). CONCLUSIONS: In patients with RCC, the increased expression of fascin and E-cadherin was positively correlated to poor prognostic factors such as a higher Fuhrman nuclear grade and advanced pTNM stage.
Cadherins ; Carcinoma, Renal Cell ; Carrier Proteins ; Cell Proliferation ; Epithelial Cells ; Humans ; Kidney ; Microfilament Proteins ; Prognosis ; Tissue Array Analysis

Human uterus has been known as a immune privileged site for the product of conception. At the feto-maternal interface, Fas system is a underlying main mechanism of maternal immune acceptance. To date, the TRAIL (TNF-related apoptosis-inducing ligand) system is known to be another pivotal mechanism. OBJECTIVE: To clarify the protein expression of TRAIL ligand and receptors in the normal and pathologic (preeclampsia, hydatidiform mole) placenta, chorioamnion, decidua. METHODS: we investigated the expression of TRAIL system in the above-mentioned tissues by using Western Hybridization. RESULTS: All tissues expressed TRAIL ligand and only a DcR2 among TRAIL receptors (DR4, DR5, DcR1, DcR2). CONCLUSION: we demonstrated the expression of TRAIL ligand and DcR2 protein at the feto-maternal interface of the normal and pathologic pregnancies. Further study regarding the expression of other receptors and quantitative analysis between normal and pathologic pregnancies should be followed.
Apoptosis* ; Decidua ; Female ; Fertilization ; Gestational Trophoblastic Disease* ; Humans* ; Placenta ; Pregnancy ; Receptors, TNF-Related Apoptosis-Inducing Ligand ; Uterus

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Iodinated contrast media (ICM) can cause not only immediate onset hypersensitivity but also delayed onset hypersensitivity. While the most common form of delayed onset hypersensitivity reaction to ICM is exanthematous eruption, fixed drug eruption (FDE) can occur rarely related to ICM. A 70-year-old male with liver cirrhosis and hepatocellular carcinoma repeatedly experienced erythematous patches on his right forearm and hand 6 hours after exposure to iopromide for computed tomography scan. ICM induced FDE was diagnosed clinically. Intradermal test with 6 kinds of ICM (iobitridol, iohexol, iomeprol, iopamidol, iopromide, and iodixanol) was performed and showed the weakest positive reaction to iohexol compared to the others in 48 hours. After changing iopromide to iohexol based on these results, FDE did not recur. We report here a case of iopromide induced FDE which was successfully prevented by changing ICM to iohexol based on intradermal test results.
Aged ; Carcinoma, Hepatocellular ; Contrast Media ; Drug Eruptions* ; Forearm ; Hand ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Intradermal Tests ; Iohexol ; Iopamidol ; Liver Cirrhosis ; Male