The beneficial effects of exercise in patients with type 2 diabetes mellitus (T2DM) are caused by improvement of various cardiovascular risk factors. Previous studies have shown that there is a dose-dependent negative relationship between aerobic exercise and risk of cardiovascular disease (CVD). Furthermore, many recent studies reported that both aerobic and resistance exercise are equally beneficial for improvement of diverse CVD risk factors as well as better glucose control. Exercise especially improves HbA1c, HDL-cholesterol, blood pressure, and central obesity.Aerobic exercise that uses large muscle structure leads to improve aerobic fitness (VO2max). Increase of VO2max and improvement of insulin sensitivity is strongly correlated. On the other hand, resistance exercise induces a hypertrophy of muscle and muscle-fiber type shifting. Therefore, resistance training is beneficial for increment of muscle mass. These changes allow potential increase of glucose utilization. In patients with type 2 diabetes, exercise training is useful for controlling glucose and other metabolic risk factors. However, exercise training must be implemented with proper pre-assessment of cardiovascular risk.
Blood Pressure ; Cardiovascular Diseases ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Exercise ; Glucose ; Hand ; Humans ; Hypertrophy ; Insulin Resistance ; Muscles ; Resistance Training ; Risk Factors

No abstract available.
Brain* ; Child* ; Humans ; Magnetic Resonance Imaging*

Glycogen Storage Disease Type II is caused by the deficiency of acid maltase resulting in lysosomal accumulation of glycogen. There are two major clinical syndromes, a severe generalized and invariable fatal disease of infancy, and a myopathy starting in juvenile or adult life. The clinical and laboratory findings of a patient with Glycogen Storage Disease Type II are presented. The patient, a 17-year-old male, experienced slowly progressive weakness of muscle of the pelvis shoulder girdles and trunk. Muscle biopsy showed vacuolar myopathy and electromyograph showed features of myopathy with fibrillation potentials, positive sharp waves, myotonic discharges, without clinical myotonia at rest, and polyphasic potentials on volition. Clinical features, histopathologic and electrophysiologic findings of this disease and differential diagnosis were reviewed.
Adolescent ; Adult ; alpha-Glucosidases ; Biopsy ; Diagnosis, Differential ; Glycogen Storage Disease Type II* ; Glycogen Storage Disease* ; Glycogen* ; Humans ; Male ; Muscular Diseases ; Myotonia ; Pelvis ; Shoulder ; Volition

BACKGROUND: Rapid-sequence intubation is a common technique to reduce anesthetic complication. Due to side effects of succinylcholine, nondepolarizing muscle relaxants have been tried. Rocuronium is a new nondepolarizing muscle relaxant with a brief onset of action, but devoid of the adverse reaction associated with succinylcholine. Most local anesthetics decrease neuromuscular transmission and pontentiate neuromuscular blocks of muscle relaxants. The purpose of this study was to examine the effect of lidocaine on the onset time of rocuronium-induced neuromuscular blockade in adults. METHODS: Fourty five patients, ASA physical status I or II, were randomly divided into three groups. Anesthetic induction with thiopental 5 mg/kg was made. Succinylcholine (1.0 mg/kg) was administered intravenously in group 1. Rocuronium (0.6 mg/kg) was given in group 2, additional lidocaine (1.0 mg/kg) was given intravenously 1 minute prior to the administration of rocuronium in group 3. Neuromuscular blockade was assessed by train-of-four at the adductor pollicis muscle with supramaximal stimulation of the ulnar nerve (2 Hz, 0.2 msec) every 10 seconds. The condition of intubation, the appearance of arrhythmias, side effects of drugs, and the changes of mean arterial pressure and heart rate were checked and compared in peri-induction periods. RESULTS: The onset time of group 1 (55.1 14.9 sec) was faster than that of group 2 (137.8 46.0 sec) and group 3 (139.3 41.0 sec), but there was no difference between the onset time of group 2 and that of group 3. Intubating conditions were good or excellent in all groups, but group 1 and 3 were better than group 2. There was no difference between the three groups in hemodynamics. More adverse effects were observed in group 1, that of group 2 and 3 were observed in only one case. CONCLUSIONS: The authors concluded that lidocaine is not effective on the onset time of rocuronium, but improves the intubating condition. Rocuronium is devoid of side effects of succinylcholine, but not a alternative to succinylcholine because its onset time is too slow when compared with succinylcholine.
Adult* ; Anesthetics, Local ; Arrhythmias, Cardiac ; Arterial Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Lidocaine* ; Neuromuscular Blockade* ; Succinylcholine ; Thiopental ; Ulnar Nerve

BACKGROUND: Rapid-sequence intubation is a common technique to reduce anesthetic complication. Due to side effects of succinylcholine, nondepolarizing muscle relaxants have been tried. Rocuronium is a new nondepolarizing muscle relaxant with a brief onset of action, but devoid of the adverse reaction associated with succinylcholine. Most local anesthetics decrease neuromuscular transmission and pontentiate neuromuscular blocks of muscle relaxants. The purpose of this study was to examine the effect of lidocaine on the onset time of rocuronium-induced neuromuscular blockade in adults. METHODS: Fourty five patients, ASA physical status I or II, were randomly divided into three groups. Anesthetic induction with thiopental 5 mg/kg was made. Succinylcholine (1.0 mg/kg) was administered intravenously in group 1. Rocuronium (0.6 mg/kg) was given in group 2, additional lidocaine (1.0 mg/kg) was given intravenously 1 minute prior to the administration of rocuronium in group 3. Neuromuscular blockade was assessed by train-of-four at the adductor pollicis muscle with supramaximal stimulation of the ulnar nerve (2 Hz, 0.2 msec) every 10 seconds. The condition of intubation, the appearance of arrhythmias, side effects of drugs, and the changes of mean arterial pressure and heart rate were checked and compared in peri-induction periods. RESULTS: The onset time of group 1 (55.1 14.9 sec) was faster than that of group 2 (137.8 46.0 sec) and group 3 (139.3 41.0 sec), but there was no difference between the onset time of group 2 and that of group 3. Intubating conditions were good or excellent in all groups, but group 1 and 3 were better than group 2. There was no difference between the three groups in hemodynamics. More adverse effects were observed in group 1, that of group 2 and 3 were observed in only one case. CONCLUSIONS: The authors concluded that lidocaine is not effective on the onset time of rocuronium, but improves the intubating condition. Rocuronium is devoid of side effects of succinylcholine, but not a alternative to succinylcholine because its onset time is too slow when compared with succinylcholine.
Adult* ; Anesthetics, Local ; Arrhythmias, Cardiac ; Arterial Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Lidocaine* ; Neuromuscular Blockade* ; Succinylcholine ; Thiopental ; Ulnar Nerve

Uterine arteriovenous malformations are considered very rare conditions, potentially life-threatening lesions combined with various degrees of menorrhagia, postpartum bleeding, postmenopausal bleeding, an asymptomatic mass, and congestive heart failure. Clinical suspicion is essential for a prompt diagnosis and treatment. They may be diagnosed by gray-scale ultrasonography and Color Doppler imaging. Additionally, they can be detected using contrast material-enhanced computed tomography (CT), conventional angiography, hysteroscopy and hysterosalpingogram. More recently, diagnosis of uterine AVM with magnetic resonance imaging (MRI) has been reported. In the past, laparotomy with uterine artery ligation or hysterectomy was the only treatment available. However, successful conservative management with embolization of the affected vessels or methylergonovine maleate has been reported recently. A 37-year-old woman, gravida 3, para 1, presented with massive uterine bleeding that started abruptly four weeks after D and C. We promptly performed non-invasive diagnositic evaluations including color Doppler, MRI and MRA, with a clinical impression of uterine AVM. In this case, we describe the appropriate diagnosis and management of uterine AVMs with literatures.
Adult ; Angiography ; Arteriovenous Malformations* ; Diagnosis ; Female ; Heart Failure ; Hemorrhage ; Humans ; Hysterectomy ; Hysteroscopy ; Laparotomy ; Ligation ; Magnetic Resonance Imaging ; Menorrhagia ; Methylergonovine ; Postpartum Period ; Pregnancy* ; Ultrasonography ; Uterine Artery ; Uterine Hemorrhage*

No abstract available.
Cryptococcosis* ; Humans

Brachial plexus is vulnerable to injury because it is close to shoulder joint of which the range of motion is very large and it is surrounded by many complex structures. Iatrogenic injuries are commonly associated with surgeries such as procedures in the posterior neck or in the shoulder and open thoracotomy, during regional anesthetic blocks, and during other procedures that use needles and cannulas. Radiation therapy can cause brachial plexus injury. A case of brachial plexus injury after thoracoscopic sympathectomy for treatment of primary hyperhidrosis is discussed in this report. Twenty eight years old male patient developed motor and sensory paralysis of Rt. upper extremity shortly after thoracoscopic sympathectomy performed with hyperabduction position of Rt. upper extremity for 2 hours and 30 minutes. Electrodiagno stic study was performed on the 11th day after paralysis. Electrodiagnostic findings from the which was compatible with showed abnormal spontaneous activities at rest and decreased numbers of MUAPs on volition sampled muscles innervated by brachial plexus. The motor power of these muscles was trace or fair grade. On the 14th day after paralysis the patient recoverd the motor power to near nomal on muscle testing. The reason of this complication is not clear, but it might have occurred most likely in association with tension and traction forces applied to patient's brachial plexus while hyperabducting the arm for a long period of time during surgery. In this study we have reviewed perioperative brachial plexus injuries and their possible mechanisms, of injury hoping to decrease the occurrence of perioperative brachial plexus injuries.
Arm ; Brachial Plexus ; Brachial Plexus Neuropathies* ; Catheters ; Hope ; Humans ; Hyperhidrosis* ; Male ; Muscles ; Neck ; Needles ; Paralysis ; Range of Motion, Articular ; Shoulder ; Shoulder Joint ; Sympathectomy* ; Thoracoscopy ; Thoracotomy ; Traction ; Upper Extremity ; Volition

OBJECTIVE: To determine the normal data of R3 component of blink reflex in normal adults. METHOD: Subjects included 17 healthy males and 16 healthy females. Five trials of blink reflex were recorded from each side. The shortest latency of R3 response was the shortest among the 5 consecutive trials was selected. RESULTS: Mean onset latency of R3 was 79.8 ms, mean duration 31.0 ms, mean amplitude 399.5 V and a side-to-side difference of latency was 2.3 ms. The amplitude of R3 decreased with age. The latencies and durations of R1 and R2 were not related to those of R3. The amplitude of R2 was correlated with that of R3. CONCLUSION: This data will be useful for the localization of brainstem and cervical spinal cord lesions.
Adult ; Blinking* ; Brain Stem ; Female ; Humans ; Male ; Reference Values* ; Spinal Cord

OBJECTIVE: To assess intra- and inter-observer reproducibility of a new point shear wave elastography technique (pSWE, S-Shearwave, Samsung Medison) and compare its accuracy in assessing liver stiffness (LS) with an established pSWE technique (Virtual Touch Quantification, VTQ). MATERIALS AND METHODS: Thirty-three patients were enrolled in this Institutional Review Board-approved prospective study. LS values were measured by VTQ on an Acuson S2000 system (Siemens Healthineer) and S-Shearwave on an RS-80A (Samsung Medison) in the same session, followed by two further S-Shearwave sessions for inter- and intra-observer variation at 8-hour intervals. The technical success rate (SR) and reliability of the measurements of both pSWE techniques were compared. The intra- and inter-observer reproducibility of S-Shearwave was determined by intraclass correlation coefficients (ICCs). LS values were measured by both methods of pSWE. The diagnostic performance in severe fibrosis (F ≥ 3) and cirrhosis (F = 4) was evaluated using the receiver operating characteristics curve analysis and the Obuchowski measure with the LS values of transient elastography as the referenced standard. RESULTS: The VTQ (100%, 33/33) and S-Shearwave (96.9%, 32/33) techniques did not display a significant difference in technical SR (p = 0.63) or reliability of LS measurements (96.9%, 32/33; 93.9%, 30/32, respectively, p = 0.61). The inter- and intra-observer agreement for LS measurements using the S-Shearwave technique was excellent (ICC = 0.98 and 0.99, respectively). The mean LS values of both pSWE techniques were not significantly different and exhibited a good correlation (r = 0.78). To detect F ≥ 3 and F = 4, VTQ and S-Shearwave showed comparable diagnostic accuracy as indicated by the following outcomes: areas under receiver operating characteristics curve (AUROC) = 0.87 (95% confidence intervals [CI] 0.70–0.96), 0.89 for VTQ (95% CI 0.74–0.97), respectively; and AUROC = 0.84 (95% CI 0.67–0.94), 0.94 (95% CI 0.80–0.99) for S-Shearwave (p > 0.48), respectively. The Obuchowski measures were similarly high for S-Shearwave and VTQ (0.94 vs. 0.95). CONCLUSION: S-Shearwave shows excellent inter- and intra-observer agreement and diagnostic effectiveness comparable to VTQ in detecting LS.
Elasticity Imaging Techniques ; Fibrosis ; Humans ; Liver Cirrhosis ; Liver Diseases* ; Liver* ; Observer Variation ; Prospective Studies* ; ROC Curve