PURPOSE:Autonomic neuropathy in adult diabetics is known to be common and poor in prognosis. Cardiac autonomic neuropathy increases sudden cardiac death and is present before apparant cardiac symptoms. Subclinical diabetic peripheral neuropathy is common with type 1 diabetes. In children, few studies for subclinical peripheral neuropathy and cardiac autonomic neuropathy were reported but the results were inconsistent. The authors investigated subclinical cardiac and peripheral neuropaties and evaluated correlation between nerve conduction velocity(NCV) and cardiac autonomic function(CAF) test in type 1 diabetic children and adolescents METHODS:Over 5 years from 1997 to 2002, 27 IDDM without clinical neuropathy were registered. Total 57 CAF and NCV were tested every 2 or 3 years. Duration of diabetes, average HbA1c during 1 year prior to the test, and urinary microalbumin excretion for 24 hours were assessed. Diabetic autonomic nervous function was evaluated by cardiovascular reflex test:falling systolic blood pressure in response to standing, heart rate changes in response to standing, beat-to-beat rate variation during deep breathing, RR interval change during and after Valsalva maneuver. Subclinical peripheral neuropathy was evaluated by NCV in both upper and lower extremities. Correlation of parameters according to NCV abnormality and microalbuminuria were analyzed. RESULTS:The age, duration of diabetes and microalbuminuria were not statistically different between children with normal and abnormal NCV. The level of HbA1c was associated with NCV abnormality. In a multivariate logistic model for NCV abnormality, level of HbA1c showed statistical significance after controlling the effects of age, duration of diabetes, and urinary microalbumin level, and the odd ratio was 1.532. The degree of CAF abnormality was marginally significant in the logistic model. Children with microalbuminuria showed older age and longer duration of diabetes than those without microalbuminuria. However, mean HbA1c level was not significantly different between the two groups. Degree of CAF abnormality was not significantly associated with microalbuminuria, either. In a general linear model including urinary albumin level as the dependent variable, none of independent variables was statistically significant. CONCLUSION: Therapy against neuropathy should be considered in patients with high HbA1c and abnormal CAF test even without clinically apparent neuropathy.
Adolescent ; Adult ; Blood Pressure ; Child* ; Death, Sudden, Cardiac ; Diabetes Mellitus, Type 1 ; Diabetic Neuropathies ; Heart Rate ; Humans ; Linear Models ; Logistic Models ; Lower Extremity ; Neural Conduction ; Peripheral Nervous System Diseases ; Prognosis ; Reflex ; Respiration ; Valsalva Maneuver

In cases of L4-5 spinal fusions, L5-S1 segment used to be included in the fusion traditionally for fear of progressive deterioration of the lumbosacral motion segment after fusion above. The purpose of this study was to evaluate the advisability of extension to L5-S1 segment in cases of L4-5 fusion for an isolated pathologic condition in L4-5 sement. A retrospective review of 72 patients with spinal fusion for an isolated pathologic condition in L4-5 segment was undertaken to compare the clinical results and adverse effects in two groups. One group consisted of 39 patients with floating L4-5 fusion(SF), and the other group consisted of 33 patients with L4-S1 fusion(LSF). The age, pathologic condition at L4-5, and the fusion method(lateral fusion) were matched in two groups. The mean follow-up period was 43.6 months(ranging 24-69 months). Comparisons were made for operative problems, post-operative complications, the amount of changes in angular motion at the adjacent segments to fusion at the last follow-up compared to the pre-operative motion, and the clinical results of treatment. The LSF group took 38 more minutes and lost 245 grams of more blood in averages to complete the additional surgical procedures compared with those in SF group. Several considerable post-operative complications were one deep infection in SF group and three metal failures of sacral fixation with subsequent two fusion failures in LSF group which were mostly concerned with the sacral fixations. The changes of angular motion at follow up compared to pre-operative motion in SF group were 1.5° gain in average (ranging 3° loss-6° gain) in L3-4 segment and 0.6° gain in average (ranging 5° loss-5° gain) in the L5-S1 segment. Those in L3-4 segment of LSF were 2.8° gain in average (ranging 2°-loss 9° gain). Therefore the higher stress and subsequent degeneration are more likely expected above the L4-S1 fusion rather than below the L4-5 fusion. The satisfactory clinical results were 89.7% in SF group and 87.9% in LSF group without significant difference between two groups. In conclusion there is no need to include the L5-S1 segment in the L4-5 fusion when the pathology is limited to L4-5 segment.
Follow-Up Studies ; Humans ; Pathology ; Retrospective Studies ; Spinal Fusion

Whether indwelling urethral catheter should be removed after urethroplasty or visual internal urethrotomy in patients with posterior urethral injured is still controversial. From May 1990 to February 1995, 28 patients with posterior urethral injury underwent retrograde pericatheter urethrography for the purpose of the evaluation of urethral continuity in the timing of the removal of indwelling urethral catheter. The indwelling catheter was removed in 24 patients whose urethra did not have any extravasation, and 4 patients had detectable extravasation. We conclude that retrograde pericatheter urethrogram is the most useful radiologically diagnostic method to evaluate in the timing of the removal of indwelling urethral catheter and to obtain the objective parameter of urethral patency in posterior urethral injured patients, postoperatively.
Catheters* ; Catheters, Indwelling ; Humans ; Urethra ; Urinary Catheters

Stress urinary incontinence is mainly treated by major surgical procedures. Bolstering the urethra with injectable compound is an attractive, although not new, procedure for stress urinary incontinence. Recently it has been popularized to use the autologous fat for injection. A total of 6 women with stress urinary incontinence underwent periurethral injection of autologous fat. Patients' age ranged from 41 to 69 years( mean 55.8). The fat was harvested from the low abdominal wall by liposuction unit. Follow up was 2 to 10 months( mean 6.8). of the patients, 5(83%) are cured, 1 is improved significantly( from Grade III to I). We conclude that the periurethral autologous fat injection is a reliable, safe, low-cost, and high benefit procedure.
Abdominal Wall ; Female ; Follow-Up Studies ; Humans ; Lipectomy ; Urethra ; Urinary Incontinence*

BACKGROUND: Sleep-related disturbances and sleep disorders are common in Parkinson's disease (PD) and have a great impact on daily life of PD patients. This study was done to find the sleep characteristics and sleep disturbing factors in PD patients according to disease severity through clinical interview and polysomnographic (PSG) study. METHODS: Fifty patients with PD (22 males, age 60.6 +/- 6.4, Hoehn and Yahr (HY) stage 2.7 +/- 1.0) were recruited and thoroughly interviewed about their sleep. PSG was performed on the patients taking routine antiparkinsonian medications. Patients were grouped into mild and moderate/severe group according to HY stage, and the results were compared between each group. RESULTS: Ninety-four percent of total patients had one or more sleep-related disturbances based on the interview or PSG. On interview, the moderate/severe group complained more insomnia and REM sleep behavior disorder (RBD) than mild group. In PSG findings, the moderate/severe group showed lower sleep efficiency, longer sleep latency, REM sleep latency, waking time after sleep onset, and higher prevalence of RBD. CONCLUSIONS: In this study, most patients with PD had sleep disturbances. Clinical interview and PSG findings revealed deterioration of sleep quality along the disease severity. Our results suggest that sleep disturbances in PD patients are prevalent and warrant clinical attention, especially to the patients with advanced disease.
Humans ; Male ; Parkinson Disease* ; Polysomnography ; Prevalence ; REM Sleep Behavior Disorder ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders ; Sleep, REM

PURPOSE: Extensor toe signs are neurologic abnormal finding in upper motor neuron impairment, such as spastic diplegia in cerebral palsy. Though classic Babinski sign is widely used, many other methods elicit extensor toe signs are used as substitutes. However, these methods are not tried whether they are clinically valuable or not. So, we carried out these methods to spastic cerebral palsy patients, compared the sensitivities of these extensor toe sign tests and estimated their clinical value. METHODS: From April, 2000 to August, 2001, thirty patients who had been diagnosed spastic cerebral palsy at Chungnam National University Hospital were tested for extensor toe signs at restful supine position. The sensitivity of every extensor toe sign was compared with each other. RESULTS: The sensitivity of Babinski sign is 76%, Gonda-Allen sign 86%, Allen- Cleckley sign 63%, Chaddock sign 63%, Oppenheim sign 50%, Gordon sign 22% and the others less than twenty percent. Although the sensitivity of Gonda-Allen sign is higher than Babinski sign, it is not statistically significant. But these two methods are superior than the others. CONCLUSION: In patients having upper motor neuron impairments, Gonda-Allen sign and classical Babinski sign are more useful and more sensitive than the other tests, which elicit of extensor toe signs.
Cerebral Palsy* ; Child* ; Chungcheongnam-do ; Humans ; Motor Neurons ; Reflex, Babinski ; Supine Position ; Toes*

Artifact corrections including normalization and attenuation correction were important for quantitative analysis in Nuclear Medicine Imaging. Normalization is the process of ensuring that all lines of response joining detectors in coincidence have the same effective sensitivity. Failure to account for variations in LOR sensitivity leads to bias and high-frequency artifacts in the reconstructed images. Attenuation correction is the process of the correction of attenuation phenomenon lies in the natural property that photons emitted by the radiopharmaceutical will interact with tissue and other materials as they pass through the body. In this paper, we will review the several approaches for normalization and attenuation correction strategies.
Artifacts ; Bias (Epidemiology) ; Enzyme Multiplied Immunoassay Technique ; Nuclear Medicine ; Photons

Objective: Hypercholesterolaemia transforms macrophages into lipid-laden foam cells in circulation, which can activate the immune response. Compromised autophagy and inflammatory cytokines are involved in the pathogenesis and progression of metabolic diseases.The aim of this study was to identify the role of autophagy as a modulator of the inflammatory response and cytotoxicity in macrophages under hypercholesterolaemic conditions. Methods: High cholesterol-induced cytokine secretion and alteration of autophagyassociated molecules were confirmed by cytokine array and western blot analysis, respectively. To confirm whether autophagic regulation affects high cholesterol-induced cytokine release and cytotoxicity, protein levels of autophagic molecules, cell viability, and cytotoxicity were measured in cultured macrophages treated autophagy enhancers. Results: Cholesterol treatment increased cytokine secretion, cellular toxicity, and lactate dehydrogenase release in lipopolysaccharide (LPS)-primed macrophages. Concomitantly, altered levels of autophagy-related molecules were detected in LPS-primed macrophages under hypercholesterolaemic conditions. Treatment with autophagy enhancers reversed the secretion of cytokines, abnormally expressed autophagy-associated molecules, and cytotoxicity of LPS-primed macrophages. Conclusion Autophagy enhancers inhibit inflammatory cytokine secretion and reduce cytotoxicity under metabolic disturbances, such as hypercholesterolaemia. Modulation of autophagy may be a novel approach to control the inflammatory response observed in metabolic diseases.

BACKGROUND: There is a clinical need for a simpler measurement of global cardiac function incorporating elements of both systole and diastole. Doppler time index is theoretically regarded as a sensitive index of global left ventricular perfomance and defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET). This study was designed to determine the clinical usefulness of the Doppler time index in patients with left ventricular diastolic dysfunction as well as systolic dysfunction. METHODS: The study population consisted of 23 patients with hypertension as a diastolic dysfunction group, 16 patients with low ejection fraction as a systolic dysfunction group and 31 subjects with normal LV function. The ejection fraction (EF) was measured using M-mode echocardiography. Doppler profiles such as IVCT, IVRT and ET were obtained from Doppler echocardiography. The Doppler time index [ (IVCT+RT)/ET] was calculated from each Doppler velocity profiles. RESULTS: IVRT, IVRT/ET and (IVCT+VRT)/ET were significantly increased in the diastolic dysfunction group (120.5+/-19.5 msec, 0.45+/-0.1, 0.64+/-0.2, respectively:p<0.001, p<0.001, p<0.001, respectively) compared with normal subjects (66.1+/-17.4 msec, 0.25+/-0.0, 0.41+/-0.1). IVCT and IVRT were significantly increased and ET was significantly shortened in systolic dysfunction group (75.4+/-25.7, 144.0+/-39.5 msec, 242.7+/-46.5 msec respectively:p<0.001, p<0.05, p<0.05, respectively) compared with diastolic dysfunction group (50.4+/-23.0 msec, 120.5+/-19.5 msec, 276.8+/-44.6 msec, respectively). IVCT/ET, IVRT/ET and (IVCT+IVRT)/ET also were increased in patients with systolic dysfunction group (0.32+/-0.1, 0.61+/-0.2, 0.93+/-0.2 respectively:p<0.01, p<0.01, p<0.001, res-pectively) compared with diastolic dysfunction group (0.19+/-0.1, 0.45+/-0.1, 0.64+/-0.2). Ejection fraction calculated by M-mode parameters was significantly correlated with (IVCT+IVRT)/ET (correlation coefficient - 0.605, p<0.001). CONCLUSION: The Doppler time index was significantly difficient from normal subjects in patients with isolated LV diastolic dysfunction as well as in those with systolic dysfunction. Thus, this index can be used as a sensitive indicator of myocardial performance.
Diastole ; Echocardiography ; Echocardiography, Doppler ; Humans ; Hypertension ; Relaxation ; Systole ; Ventricular Dysfunction, Left

PURPOSE: inhaled nitric oxide(iNO) is an excellent method for the postoperative pulmonary hypertension in congenital heart disease. But more detailed care is needed because of the development of rebound pulmonary hypertension after NO Withdrawal. We performed this study in order to discontinue the iNO successfully by way of presenting the adequate weaning and supplying methods. METHODS: Between January, 1998 and August, 1999 we sudied 10 patients who had rebound pulmonary hypertension(RPH) after iNO withdrawal. We completed the iNO in these patween the first the second trial of the weaning process. We tried to discover the differences between the first and second weaning process. We measured NO concentration at the start and just before NO withdrawal and during the period of weaning process. Moreover, to identify the iNO effects during the weaning of the iNO, we counted the degree of the change of PaO2/FiO2and mean PAP/SAP beween initial and at half of the initial NO concentration. RESULTS: Second weaning had a longer duration weaning process(11+/-0 cersus 5+/- hours, P<0.05), lower NO concentration just before NO withdrawal(2+/-.6 versus 4+/-ppm, P<0.05). In the change of the mean PAP/SAP and PaO2/FiO2as iNO was weaning from the initial iNO concentration to a half of the initial iNO concentration, the degree of increase in mean PAP/SAP(0.026+/-.07 versus 0.054+/-.07, P<0.05) and the degree of decrease in PaO2/FiO2(49+/-4 versus 65+/-2, P<0.05) were smaller in the second in the second weaning process than the first weaning process. CONCLUSION: A successful weaning of iNO can be performed with a low iNO concentration at the start and just before withdrawal and with the long duration iNO weaning process. Moreover, We speculate that the degree of change in the mean PAP/SAP and PaO2/FiO2at the half of the iNO weaning process are an indicator for the development of RPH.
Heart Defects, Congenital ; Humans ; Hypertension, Pulmonary ; Nitric Oxide* ; Weaning*