The functional derangement of skeletal muscles which may be attributed to chronic hypoxia has been accepted as a possible mechanism of exercise impairment in patients with chronic obstructive pulmonary disease (COPD). The metabolc changes in skeletal muscle in patients with COPD are characterized by impaired oxidative phosphorylation early activation of anaerobic glycolysis and excessive lactate and hydrogen ion production with exercise. But the cause of exercise limitation in patients with chronic lung disease without hypoxia has not been known. In order to evaluate the change in the skeletal muscle metabolism as a possible cause of the exercise limitation in chronic lung disease patients without hypoxia, we compared the muscular metabolic data of seven male patients which had been derived from noninvasive 31P magnetic resonance spectroscopy(MRS) with those of five age-matched normal male control persons. 31P MRS was studied during the sustained isometric contraction of the dominant forearm flexor muscles up to the exhaustion state and the recovery period. Maximal voluntatry contraction(MVC) force of the muscle was measured before the isometric exercise, and the 30% of MVC force was constantly loaded to each patient during the isometric exercise. There were no differences of intracellular pH (pHi) and inorganic phosphate/phosphocreatine (Pi/PCr) at baseline, exhaustion state and recovery period between two groups. But pHi during the exercise was lower in patients group than the control group (p<0.05). Pi/PCr during the exercise did not show significant difference between two groups. These results suggest that the exercise limitation in chronic lung disease patients without hypoxia also could be attributed to the abnormalities in the skeletal muscle metabolism.
Anoxia ; Exercise ; Forearm ; Glycolysis ; Humans ; Hydrogen-Ion Concentration ; Isometric Contraction ; Lactic Acid ; Lung Diseases ; Lung* ; Magnetic Resonance Spectroscopy* ; Male ; Metabolism* ; Muscle, Skeletal* ; Muscles ; Oxidative Phosphorylation ; Protons ; Pulmonary Disease, Chronic Obstructive

Klinefelter syndrome is the most common form of male hypogonadism. It is characterized by small, firm testis, gynecomastia, a variable degree of eunuchoidism, azoospermia, elevated gonadotropin level. Increased frequency of diabetes mellitus, breast cancer, empysema, chronic bronchitis, varicose vein, germ cell neoplasia occurs in Klinefelter syndrome. We report a 19 year-old male patient with diabetes mellitus in association with Klinefelter syndrome, which was confirmed by chromosome analysis. The patient is being treated with insulin for diabetes mellius and with testostrone replacement for Klinefelter syndrome.
Azoospermia ; Breast Neoplasms ; Bronchitis, Chronic ; Diabetes Mellitus ; Eunuchism ; Germ Cells ; Gonadotropins ; Gynecomastia ; Humans ; Hypogonadism ; Insulin ; Klinefelter Syndrome ; Male ; Testis ; Varicose Veins

BACKGROUND: Pressure support ventilation(PSV) is a new form of mechanical ventilatory support that assists spontaneous inspiratory effort of an intubated patient with a clinician-selected amount of positive airway pressure. Low level pressure support during inspiration can overcome the resistive component of inspiratory work imposed by ah endotracheal tube. However the clinical efficacy of PSV as a weaning method has not been established yet. Object : The aim of study was to evaluate the efficacy of PSV when it is added to intermittent mandatory ventilation (IMV) in facilitating weaning process compared to IMV mode alone. METHOD: When the subject patients became clinically stable with their arterial blood gas analysis in acceptable range, they underwent weaning process either by IMV alone or by IMV plus PSV. The level of pressure support was held constant through the weaning period. For the patients who required mechanical ventilation for less than 72hr, 2h weaning trial was performed with IMV rate starting from 6/min. For the patients who required mechanical ventilation more than 72 hr, 7 hr weaning retrial was performed with IMV rate starting from 8/min. For the patients who failed three consecutive trials of weaning, retrial of weaning was attempted over 3 days with IMV rate starting from 8/min. Clinical characteristics, APACHE II score and nutritional status were compared. For all patients, heart rate, mean blood pressure and respiratory rate were mornitored for 48 hrs after weaning trial started. RESULTS: The total number of weaning trial was 37 in 23 patients(18 by IMV, 19 by IMV+PSV). Total ventilation time, APACHE II score and nutritional status were not statistically different between the two groups. The weaning success rate were not statistically different(38.3% by IMV, 42.1% by IMV+PSV) and the changes of mean blood pressure, heart rate, respiratory rate during first 48 hours were not different between the two groups. CONCLUSION: Low level PSV when added to IMV for weaning trial does not seem to improve the success rate of weaning from mechanical ventilation. PSV at 10cm H2O did not induce significant physiologic changes during weaning process.
APACHE ; Blood Gas Analysis ; Blood Pressure ; Heart Rate ; Humans ; Nutritional Status ; Respiration, Artificial ; Respiratory Rate ; Ventilation* ; Weaning*

PURPOSE: This study aims to explore an one-year experience of intensive core clinical clerkship (student internship, subinternship) in Gachon Medical School for junior clinical students, and the immediate outcome of the program was discussed along the with advantages and student load. METHODS: 36 junior medical students (M5) were exposed to 36 weeks of core clinical clerkship including internal medicine (12wks), pediatrics (6wks), obstetrics-gynecology (6wks), general surgery (4wks), psychiatry (4wks), and emergency medicine (4wks). The clinical service team was made of faculty member (1), senior resident (1), intern (1) and M5 students (1-2), and the students who were involved a wide range of baseline responsibilities corresponding to those of regular rotating interns. They were encouraged to participate the various procedures and decision making process, but their participation was restricted by keeping 3 levels of performance policy according to degree of supervision. Questionnaire analysis was carried out immediate after the student internship. RESULTS: Students were proud of themselves being as the subinterns and showed a strong motivation, while they had a difficulty to tolerate a strong psychologic pressure by taking their roles of subinternship. Major responsibilities of clerkship were focused on the clinical information collection (history taking and physical examination), students-directed group conference, faculty-led small group discussion, technical skill learning and ward round in order. Students appreciated well to this internship in terms of acquisition of clinical skills and identification of their role, but shortage of space, frequent on-call, lack of self-directed learning opportunity, unclarified requests from the hospital authority were pointed out. CONCLUSION: It is assumed that student internship is a strong tool to promote the quality of clinical learning process, but requires details of teaching instructions (manuals) aside from solving a series of legal on malpractice, for which critical defining of clinical participation is essential to upgrade the Korean version of clerkship.
Clinical Clerkship ; Clinical Competence ; Decision Making ; Education, Medical ; Emergency Medicine ; Humans ; Internal Medicine ; Internship and Residency* ; Learning ; Malpractice ; Motivation ; Organization and Administration ; Pediatrics ; Program Development* ; Schools, Medical* ; Students, Medical ; Surveys and Questionnaires

PURPOSE: A chemotherapy response assay test is performed to evaluate the degree of tumor growth inhibition by a chemotherapeutic agent. Several studies have been done on its usefulness; however, to the best of our knowledge, only a few studies concerning the relationship between chemotherapy response assay test results and breast cancer patients' prognoses have been conducted. Thus, we performed this study to analyze this relationship. METHODS: Among breast cancer patients who underwent curative surgery and neoadjuvant or adjuvant chemotherapy between August 2004 and December 2009, 102 were enrolled in this study. Chemotherapeutic regimens for patients were doxorubicin plus taxane or doxorubicin plus cyclophosphamide followed by taxane. We divided these patients into two groups (sensitive group [n=19] and resistant group [n=83]) and analyzed the relationship between chemosensitivity results and patient prognosis. RESULTS: The sensitive group was associated with poor disease-free survival (DFS) (p=0.003) and overall survival (OS) (p<0.001). No significant differences were observed in tumor histology (p=0.548), tumor size (p=0.479), number of metastatic lymph nodes (p=0.326), histologic grade (p=0.077), or nuclear grade (p=0.216) between the two groups. However, in respect to molecular subtype, the HER2-positive type and triple negative breast cancer were more frequently observed in the sensitive group (p=0.001). In a univariate and multivariate analysis for DFS, doxorubicin sensitivity was significantly associated with a poor prognosis (p<0.05). CONCLUSION: Better chemosensitivity results are associated with a poor prognosis in breast cancer patients who have undergone anthracycline- and taxane-based chemotherapy, however, examination of additional cases and the use of a longer study period are needed.
Breast ; Breast Neoplasms ; Bridged Compounds ; Chemotherapy, Adjuvant ; Cyclophosphamide ; Disease-Free Survival ; Doxorubicin ; Humans ; Lymph Nodes ; Multivariate Analysis ; Prognosis ; Taxoids

Cases of hospital acquired pneumonia occurring during the 1st 12 months of Medico-Surgical ICU (Intensive care unit, MSICU) in operation were evaluated retrospectively to determine its incidence, common causative pathogens, outcome and radiological patterns with the new hospital setting providing a unique relatively aseptic environment. Among the 920 admitted patients, 73 episodes of nosocomial pneumonia on 63 patients were identified and the incidence rate was 7%. The most common pathogens were Pseudomonas. Staphylococcus, Serratia, and Enterobacter in the order of frequency of occurrence, and the gram-negative pathogens comprised 70%. Nosocomial pneumonia was more common after use of antibiotics due to such pathogens as Enterobacter, Acinetobacter, and Candida which caused poor outcome. Enterobacter had the greatest tendency to be related with poor outcome and Serratia the least. Overall mortality was 25%. Bronchopneumonia was the most common type of pneumonia caused by any pathogen except Acinetobacter which caused a mixed type of nosocomial pneumonia.
Cross Infection/epidemiology/*etiology/radiography ; Enterobacter/isolation & purification ; Humans ; Incidence ; *Intensive Care Units ; Outcome Assessment (Health Care) ; Pneumonia/epidemiology/*etiology/radiography ; Pseudomonas/isolation & purification ; Retrospective Studies ; Staphylococcus/isolation & purification

BACKGROUND: The occurrence of lung complications after allogenic bone marrow transplantation(BMT) has been reported as 40-60 percent. The risk factors for lung complications are whole body irradiation, high dose chemotherapy, graft versus host disease, old age and CMV infection. The prevalence of graft versus host disease is less in Korea than in Western countries, but frequency of CMV infection is higher. Therefore, the pattern of lung complications may be different in Korea from those in Western countries. METHODS: A retrospective cohort study was performed on one hundred consecutive adult patients who underwent allogenic bone marrow transplantation from December, 1993 to May, 1999 at Asan Medical Center. Lung complications were divided into two groups by the time of development, within 30days (pre-engraftment) and beyond 30 days (post-engraftment), and then subdivided into infectious and non-infectious complication. Infectious complications were defined as having the organism in blood, BAL fluid, pleural fluid or sputum, or compatible clinical findings in patients, which improved with antibiotics or an anti-fungal therapy. RESULT: 1) Eighty three episodes of lung complications had occurred in 54 patients. 2) Within thirty days after BMT, non-infectious complications were more common than infetions, but this pattern was reversed after 30days. After one year post-BMT, there was no infectious complication except in cases of recurrence of underlying disease or development of chronic GVHD. 3) Among the non-infectious complication, pleural effusion (27 episodes) was most common, followed by pulmonary edema(8 episodes), bronchiolitis obliterans(2 episodes), diffuse alveolar hemorrhage(1 episode) and bronchiloitis obliterans with organizing pneumonia(1 episode), 4) The infectious complications were pneumonia(bacterial:9 episodes, viral:4 episodes, fungal:5 episodes, pneumocystis carinii:1 episode), pulmonary tubercoulosis(3 episodes) and tuberculous pleurisy(3 episodes). 5) Lung complications were more frequent in CMV positive patients and in patients with delayed recovery of neutrophil count. 6) The mortality was higher in the patients with lung complications. CONCLUSION: Lung complications developed in 54% after allogenic BMT and were associated with higher mortality.
Adult ; Anti-Bacterial Agents ; Bone Marrow Transplantation* ; Bone Marrow* ; Bronchiolitis ; Chungcheongnam-do ; Cohort Studies ; Drug Therapy ; Graft vs Host Disease ; Humans ; Korea ; Lung* ; Mortality ; Neutrophils ; Pleural Effusion ; Pneumocystis ; Prevalence ; Recurrence ; Retrospective Studies ; Risk Factors ; Sputum ; Whole-Body Irradiation

BACKGROUND: Tracheal Gas Insufflation (TGI) is one of the newer ancillary measures in mechanical ventilation employed to enhance carbon dioxide elimination.7G1 exerts its effect through reduction of deadspace ventilation, but the factors determining its effect are not well studied yet. METHOD: The subjects were seven mechanically-ventilated patients (58.8+/-10.6 yrs) who showed increased Physiologic deadspace greater than 60%. After 30 min of stabilization with 100% oxygen on pressure control ventilation, continuous flow TGI was administered via the insufflation lumen of Hi-Lo Jet Tracheal Tube (Mallincrodt, USA) for 15 min at 3 L/min and 5 L/min each. RESULTS: PaCO2 was decreased (51.4+/-17.6 at baseline,49.1+/-18.9 at TGI 3 L/min, 45.0+/- 14.9 mmHg at TGI 5 L/min, p=0.050), and pH was increased (7.37+/-0.12, 7.38+/-0.13, 7.39+/-0.12, respectively, p=0.037) while mixed expired CO2 (PECO2) was not changed significantly from baseline (p=0.336) by TGI. Physiologic deadspace(Vdphy) was decreased (73.0+/-7.9% at baseline, 69.8+/-10.0% at TGI 3 L/min, and 67.1+/-10.1% at TGI 5 L/mi% p=0.015). AaDO2(p=0.147), Vt(p=0.2140), Pmean(p=0.7788) and mean arterial pressure(p=0.4169) were not changed. The correlation between % maximal decrease of Vdphy were r=0.790 with the ratio of baseline Vdana/vdphy(p=0.035) and r=-0.754 with baseline Vdalv(p=0.050). CONCLUSION: TGI was effective in reducing PaCO2 and deadspace, and the deadspace-reducing effect was best correlated with baseline anatomic/physiologic deadspace ratio.
Carbon Dioxide ; Humans ; Hydrogen-Ion Concentration ; Insufflation* ; Oxygen ; Respiration, Artificial ; Ventilation

PURPOSE: To assess, using functional MRI and by comparing activated motor sensory areas, the independence ofbrain activation during single and alternative multiple hand tasks. MATERIALS AND METHODS: The subjects were sixhealthy volunteers. Using at 1.5T Siemens system and single shot FID-EPI sequencing(T2* weighted image;TR/TE0.96msec/61msec, flip angle 90 degrees, matrix size 96X128, slice thickness/gap 5mm/0/8mm, FOV 200mm) and T1-weightedanatomic images, functional MRI was performed. The paradigm of motor tasks consisted of appositional fingermovements; the first involved the separate use of the right, left, and both hands, while an alternative taskinvolved the use of the right, left, and both hands in sequence. Using cross-correlation method(threshold:0.6) andfMRI analysis software (Stimulate 5.0), functional images were obtained. The activated area of brain cortex, thenumber of pixel, the aberage percentage change in signal intensity, and correlation of the time-signal intensitycurve in the activated motor area were analysed and compared between the two task groups. Statistical analysisinvolved the use of Wilcoxon signed-rank test. RESULTS: It was seen on fMRI that durina both single andalternative motor tasks, the same areas were consistently activated; in four volunteers, most activation occurredin the contralateral primary motor area. Between the two task methods, the average change in the number ofactivated pixels was 12.3+/-5%, but the difference was not statistically significant(P>0.1). Increased signalintensity in the alternative task group(7.48+/-1.22%) was more statistically significant than in the single taskgroup(5.77+/-0.9%)(p<.001). With regard to the time-intensity curve, there was significant correlation between thetwo groups(0.87+/-0.07). CONCLUSION: Brain activation did not differ according to whether the motor task wassingle or alternative. We therefore suggest that during multiple stimuli, the relevant functional areas andneuronal column are activated independently.
Brain ; Hand* ; Magnetic Resonance Imaging ; Volunteers

Pulmonary rehabilitation has been known to improve dyspnea and exercise tolerance in patients with chronic lung disease, although it does not improve pulmonary function. The mechanism of this improvement is not clearly explained till now ; however some authors suggested that the improvement in the skeletal muscle metabolism after the rehabilitation could be a possible mechanism. The metabolc changes in skeletal muscle in patients with COPD are characterized by impaired oxidative phosphorylation which causes early activation of anaerobic glycolysis and excess lactate production with exercise. In order to evaluate the change in the skeletal muscle metabolism as a possible cause of the improvement in the exercise tolerance after the rehabilitation, noninvasive 31P magnetic resonance spectroscopy(MRS) of the forearm flexor muscle was performed before and after the exercise training in nine patients with chronic lung disease who have undertaken intensive pulmonary rehabilitation for 6 weeks. 31P MRS was studied during the sustained isometric contraction of the dominant forearm flexor muscles up to the exhaustion state and the recovery period. Maximal voluntary contraction(MVC) force of the muscle was measured before the isometric exercise, and then 30% of MVC force was constantly loaded to each patient during the isometric exercise. After the exercise training, exercise endurance of upper and lower extremities and 6 minute walking distance were significantly increased(p<0.05). There were no differences of baseline intracellular pH (pHi) and inorganic phosphate/phosphocreatine(Pi/PCr). After rehabilitation pHi at the exercise and the exhaustion state showed a significant increase(6.91+/-0.1 to 6.99+/-0.1 and 6.76+/-0.2 to 6.84+/-0.2 respectively, p<0.05). Pi/PCr at the exercise and the recovery rate of pHi and Pi/PCr did not show significant differences. These results suggest that the delayed intracellular acidosis of skeletal muscle may contribute to the improvement of exercise endurance after pulmonary rehabililtation.
Acidosis ; Dyspnea ; Exercise ; Exercise Tolerance ; Forearm ; Glycolysis ; Humans ; Hydrogen-Ion Concentration ; Isometric Contraction ; Lactic Acid ; Lower Extremity ; Lung Diseases ; Magnetic Resonance Spectroscopy* ; Metabolism* ; Muscle, Skeletal* ; Muscles ; Oxidative Phosphorylation ; Pulmonary Disease, Chronic Obstructive ; Rehabilitation* ; Walking