Velopharyngeal function refers to the combined activity of the soft palate and pharynx in closing and opening the velopharyngeal port to the required degree. In normal speech, various muscles of palate & pharynx function as sphincter and occlude the oropharynx from the nasopharynx during the production of oral consonant sounds. Inadequate velopharyngeal function caused by neurologic disorder-cerebral apoplexy, regressive diseases-disseminated sclerosis, Parkinson's disease, congenital deformity-cleft palate, cerebral palsy and etc. may result in abnormal speech characterized by hypernasality, nasal emission and decreased intelligibility of speech due to weak consonant production. In our study, we constructed speech aids prosthesis-Palatal lift in acquired idiophathic VPI patient and assessed velopharyngeal function with various diagnostic instruments which can evaluate the speech characteristics objectively.
Cerebral Palsy ; Humans ; Muscles ; Nasopharynx ; Oropharynx ; Palate ; Palate, Soft ; Parkinson Disease ; Pharynx ; Sclerosis ; Stroke

PURPOSE: Esophageal tolerance is needed to guide the safe administration of stereotactic radiosurgery (SRS). We evaluated comprehensive dose-volume parameters of acute esophageal toxicity in patients with spinal metastasis treated with SRS. MATERIALS AND METHODS: From May 2008 to May 2011, 30 cases in 27 patients with spinal metastasis received single fraction SRS to targets neighboring esophagus. Endpoints evaluated include length (mm), volume (mL), maximal dose (Gy), and series of dose-volume thresholds from the dose-volume histogram (volume of the organ treated beyond a threshold dose). RESULTS: The median time from the start of irradiation to development of esophageal toxicity was 2 weeks (range, 1 to 12 weeks). Six events of grade 1 esophageal toxicity occurred. No grade 2 or higher events were observed. V15 of external surface of esophagus was found to predict acute esophageal toxicity revealed by multivariate analysis (odds radio = 1.272, p = 0.047). CONCLUSION: In patients with spinal metastasis who received SRS for palliation of symptoms, the threshold dose-volume parameter associated with acute esophageal toxicity was found to be V15 of external surface of esophagus. Restrict V15 to external surface of esophagus as low as possible might be safe and feasible in radiosurgery.
Esophagus ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Radiation Tolerance ; Radiosurgery*

Peripheral nerve sheath tumors (PNSTs) are heterogeneous tumor groups of peripheral nerves that originate from either Schwann cells or modified Schwann cells, fibroblasts, or perineural cells. In this study, signalment and clinical data such as tumor location and size were evaluated for 15 cases of PNSTs collected from local animal hospitals. The mean age of dogs with malignant PNST was higher than that of dogs with benign PNST. Additionally, the male to female ratio in dogs with PNST was 1 : 4. In dogs with PNST, the primary sites of involvement were the hindlimb, forelimb, around the mammary glands, the neck, and the abdomen. Histiopathologic examination revealed that eight PNSTs were benign and seven were malignant. The tumor cells were composed of loosely to densely arranged interlacing bundles and wavy spindle cells arranged in short bundles, palisading, and whirling. High mitotic figures, local invasion, multifocal necrosis and atypical multinucleated giant cells were observed in malignant PNST cases. All PNSTs showed immunoreactivity for vimentin and S-100. However, only 93.3% and 73.3% were immunoreactive for NSE and GFAP, respectively. Overall, these results indicated that immunohistochemical markers such as vimentin, S-100 and NSE could help confirm the diagnosis of canine PNSTs.
Abdomen ; Animals ; Diagnosis ; Dogs* ; Female ; Fibroblasts ; Forelimb ; Giant Cells ; Hindlimb ; Hospitals, Animal ; Humans ; Immunohistochemistry ; Male ; Mammary Glands, Human ; Neck ; Necrosis ; Nerve Sheath Neoplasms* ; Peripheral Nerves* ; Schwann Cells ; Vimentin

Calcifying cystic odontogenic tumor (CCOT) is an uncommon benign cystic neoplasm of the jaw that develops from the odontogenic epithelium. Invasion into the maxillary sinus by a CCOT is not a typical, and the recurrence of the cystic variant of CCOT in the posterior maxilla is rare. This report describes a recurrent CCOT occupying most of the maxillary sinus of a 24-year-old male patient. As a treatment, marsupialization was carried out as a means of decompression, and the involved teeth were all endodontically treated. Afterward, surgical enucleation was performed. The size of the lesion continued to shrink after marsupialization, and the maxillary sinus restored its volume. This patient has been followed-up for 3 years after the surgery, and there have not been any signs of recurrence.
Decompression ; Epithelium ; Humans ; Jaw ; Male ; Maxilla ; Maxillary Sinus* ; Odontogenic Cyst, Calcifying ; Odontogenic Tumors* ; Recurrence ; Tooth ; Young Adult

A 78-year-old female was admitted due to nasal bleeding and purpuric macules on both legs. The patient underwent renal biopsy, and a diagnosis of Henoch-Schonlein purpura nephritis was made. The patient's platelet count was 1.6x10(10)/L, and, based on results from bone marrow biopsy, the patient was diagnosed with immune thrombocytopenic purpura. Despite treatment with glucocorticoid and IV immunoglobulin, thrombocytopenia continued. The patient's blood group was Rhesus D positive and treatment with IV anti-D immunoglobulin followed. Thereafter, platelet count showed a rapid increase; however, occurrence of hemolytic anemia, hyperbilirubinemia, and hemoglobinuria consistent with intravascular hemolysis was observed.
Aged ; Anemia, Hemolytic ; Biopsy ; Bone Marrow ; Epistaxis ; Female ; Hemoglobinuria ; Hemolysis ; Humans ; Hyperbilirubinemia ; Immunoglobulins ; Isoantibodies ; Leg ; Nephritis ; Platelet Count ; Purpura, Schoenlein-Henoch ; Purpura, Thrombocytopenic, Idiopathic ; Thrombocytopenia

BACKGROUND: Recent studies have suggested associations between cardiovascular diseases (CVD) and osteoporosis and between serum lipids and osteoporosis. However, there are only a few studies about the relationship between bone mineral density (BMD) and serum lipids in Koreans. The aim of this study was to evaluate the correlation of serum lipid levels with osteoporosis in postmenopausal women in Korea. METHODS: This cross-sectional study consisted of 1,093 Korean postmenopausal women who visited a university hospital for medical checkup from March 2007 to March 2009. Anthropometric measurements and blood tests were done for body mass index (BMI), plasma lipids, and fasting glucose. BMD was measured using a dual energy X-ray absorptiometry. Blood pressure was taken. After the subjects were classified into three groups (osteoporosis, osteopenia, or normal) by lumbar or femur BMD, the correlation between serum lipids and BMD was analyzed. RESULTS: Serum high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in the osteoporosis group (52.74+/-13.94 mg/dL) than in the other two groups (osteopenia, 56.22+/-13.40 mg/dL; normal, 56.54+/-13.22 mg/dL; p=0.007) when participants were grouped by lumbar BMD. In addition, serum triglyceride in the osteoporosis group was higher than in the other two groups. The results were statistically significant after adjusting for confounding factors including age, BMI and blood pressure. However, there was no significant difference when grouped by femur BMD. CONCLUSION: With decreasing lumbar BMD, we saw lower HDL-C levels and higher triglyceride levels. Osteoporosis may play a role as a risk factor for CVD through its relationships with lumbar BMD and serum lipids.
Absorptiometry, Photon ; Blood Pressure ; Body Mass Index ; Bone Density ; Bone Diseases, Metabolic ; Cardiovascular Diseases ; Cholesterol ; Cross-Sectional Studies ; Fasting ; Female ; Femur ; Glucose ; Hematologic Tests ; Humans ; Lipoproteins ; Osteoporosis ; Plasma ; Risk Factors ; Triglycerides

BACKGROUND: QT dispersion(QTd) has been shown to be ventricular electrical instability, especially predictor of ventricular arrythmia and indicator of antiarrythmic effect. It was reported that there was a relationship between acute myocardial infarction and increased QTd in that QTd is dependent of the degree of reperfusion as well as the site and size of infarction. In this study, we intended to verify a significant association between myocardial ischemia and QTd by comparing the changes in QTd with or without chest pain in patients with unstable angina who had proven myocardial ischemic changes. METHOD: We studied 20 patients (12 men and 8 women : mean age, 58+/-3.4 years) with unstable angina who had proven myocardial ischemic changes and perfusion defect by 24 hour Holter monitoring, Treadmill test, or coronary angiography. Each case was measured QTd during chest patin and resting state 24 hours after chest pain. All standard 12-lead ECGs were recorded at a speed of 25 mm/sec and examined retrospectively by one observer. QTd corrected for heart rate (QTcd) was calculated by Bazett's formula. The difference of QTd was assessed by comparing by paired t-test. RESULTS: The mean values of QTd were 117.9+/-49.9 msec and 69.7+/-30.2 msec with existence and the absence of chest pain. There was significant increment of QTd when the paients with unstable angina had chest pain(p<0.01). QTcd also significantly increased with the mean value of 119.7+/-57.1 and 74.9+/-36.6 msec (p=0.015). CONCLUSIONS: The results of this study clarified the change of QTd with myocardial ischemia. We expect QTd using a single, noninvasive method to indicate that the chest pain is induced by myocardial ischemic changes. For the furture, it may be possible to study as to the significance of QTd as a predictor of cardiovascular accidents in patients with unstable angina by measuring the serial QTd.
Angina, Unstable ; Arrhythmias, Cardiac ; Chest Pain ; Coronary Angiography* ; Coronary Stenosis* ; Coronary Vessels* ; Electrocardiography ; Electrocardiography, Ambulatory ; Exercise Test ; Female ; Heart Rate ; Humans ; Infarction ; Male ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion ; Reperfusion ; Retrospective Studies ; Thorax

BACKGROUND AND OBJECTIVES: Coronary microvascular remodeling is one of the complications associated with diabetic cardiovascular disease. We investigated the effect of long-term treatment with ramipril, an angiotensin converting enzyme inhibitor, on coronary microvascular remodeling on a type II diabetic model, the Otsuka Long-Evans Tokushima Fatty (OLETF) rat. MATERIALS AND METHODS: Twenty OLETF diabetic, and twenty LETO non-diabetic rats at twenty-four weeks old, were randomized into 4 equal groups for treatment with either an aqueous solution of ramipril (5 mg/kg, n=10 for two groups) or saline (n=10 for two groups) for 24 weeks on a daily basis. The blood glucose levels, body weights and blood pressures of the rats were checked on a regular basis. Masson's trichrome and picrosirius red stains were used for the morphometric analysis of the thickening of the coronary arterial wall and the degree of perivascular fibrosis. The myocardial collagen content was determined by measuring the levels of myocardial hydroxyproline. RESULTS: Marked thickening of the coronary microvascular wall and prominent perivascular fibrosis were detected in the hearts of OLETF rats to a greater extent than in the LETO rats (p<0.01). Ramipril significantly prevented coronary microvascular remodeling in OLETF rats (p<0.01), but there was no significant difference in the collagen content/dry heart weight ratio between the groups. CONCLUSION: Long-term treatment with ramipril has an antifibrotic effect, and improves the coronary microvascular remodeling in diabetic OLETF rats.
Angiotensin-Converting Enzyme Inhibitors ; Animals ; Blood Glucose ; Body Weight ; Cardiovascular Diseases ; Collagen ; Coloring Agents ; Coronary Circulation ; Diabetes Mellitus ; Fibrosis ; Heart ; Hydroxyproline ; Microcirculation ; Peptidyl-Dipeptidase A ; Ramipril* ; Rats* ; Rats, Inbred OLETF

BACKGROUND: Hemodialysis via the internal jugular vein (IJV) has been widely used for patients with end stage renal disease (ESRD) patients, as they have a higher risk of arterial diseases. We investigated the ultrasonographic findings of the IJV and carotid artery (CA) in recipients of kidney transplantation (KT) and identified factors influencing IJV/CA abnormalities. METHODS: We enrolled 120 adult KT recipients. Patients in group A (n = 57) had a history of IJV hemodialysis, while those in group B (n = 63) were not yet on dialysis or undergoing dialysis methods not involving the IJV. The day before surgery, we evaluated the state of the IJV and CA using ultrasonography. We followed patients with IJV stenosis for six months after KT. RESULTS: Ultrasonography revealed that four patients (7%) in group A had IJV abnormalities, while no patients in group B had abnormalities (P = 0.118). Of the four patients with abnormalities, one with 57.4% stenosis normalized during follow- up. However, another patient with 90.1% stenosis progressed to occlusion, while the two patients with total occlusion remained the same. Twenty patients in group A (n = 11) and B (n = 9) had several CA abnormalities (P = 0.462). Upon multivariate analysis with stepwise selection, height and age were significantly correlated with IJV stenosis (P = 0.043, odds ratio = 0.9) and CA abnormality (P = 0.012, odds ratio = 1.1), respectively. CONCLUSIONS: IJV abnormalities (especially with a history of IJV hemodialysis) and CA abnormalities may be present in ESRD patients. Therefore, we recommend ultrasonographic evaluation before catheterization.
Adult ; Carotid Arteries* ; Catheterization ; Catheterization, Central Venous ; Catheters ; Constriction, Pathologic ; Dialysis ; Humans ; Jugular Veins* ; Kidney Failure, Chronic ; Kidney Transplantation ; Kidney* ; Multivariate Analysis ; Odds Ratio ; Renal Dialysis ; Transplant Recipients* ; Ultrasonography

BACKGROUND: Hemangioma and vascular malformation are benign vascular lesions that often occur in cephalic and cervical region. Currently, surgical resection, laser therapy, angiographic embolization, use of steroids, and sclerotherapy are used as treatments. CASE PRESENTATION: This study reports three cases of benign vascular lesions that are remarkably treated by sodium tetradecyl sulfate (STS) injection, of which occurred in oral cavity and around the mouth. Three percent of STS was diluted with 0.9 % of normal saline, and it was injected to the lesion site at least once. The result of treatment was evaluated based on clinical findings. CONCLUSION: Surgical treatment of hemangioma and vascular malformation occurred in oral cavity is not normally used because of esthetic issues and potential hemorrhage. On the other hand, sclerotherapy using STS is an effective therapy compare to surgical treatment. Despite the number of STS injection was different for each patient, all three patients had reached satisfactory level through the treatment with gradual diminution of lesions.
Hand ; Hemangioma ; Hemorrhage ; Humans ; Laser Therapy ; Mouth ; Sclerotherapy* ; Sodium Tetradecyl Sulfate* ; Sodium* ; Steroids ; Vascular Malformations