OBJECTIVE: To investigate whether there is a significant effect of growth hormone(GH) treatment with diet and exercise over the diet and exercise alone in obese non-insulin dependent diabetes mellitus(NIDDM). METHOD: Twenty obese NIDDM adults were studied. We measured the body weight, body composition and exercise capacity before and after 12 weeks of treatment program. The subjects were assigned in a double-blind manner either to the diet, aerobic exercise with placebo treatment group(group A) or to the diet, aerobic exercise with GH treatment group(group B) for twenty-week period. Two groups were compared for the demographic data. RESULTS: After 12-weeks of treatment program, each group showed a significant weight loss (group A: 8.54+/-2.29 kg vs group B: 7.14+/-2.99 kg) than before the treatment, however there was no significant weight loss between two groups. After 12-weeks, the fat fraction of body weight loss was significantly higher in group B than group A(0.80+/-0.40%kg versus 0.55+/-0.30%kg). After 12-weeks, the maximal oxygen consumption was similarly increased in both groups(23.75% in the group A versus 29.2% in the group B). After 12-weeks, the peak torque was similarly increased in both groups(9.7% in the group A versus 17.3% in the group B). After 12-weeks, the endurance was similarly increased in both groups(10.1% in the group A versus 8.1% in the group B). CONCLUSION: Both group A and B showed a significant weight loss and resulted in a comparable gain in the muscle strength, endurance, and maximal oxygen consumption. The addition of GH in a low dose to a the calorie-restricted diet and aerobic exercise resulted in a significant fat loss especially around the visceral area.
Adult ; Body Composition ; Body Weight ; Diabetes Mellitus, Type 2 ; Diet* ; Exercise ; Growth Hormone* ; Humans ; Muscle Strength ; Obesity ; Oxygen Consumption ; Torque ; Weight Loss

OBJECTIVE: The aim of this study was to investigate the prevalence of spinal deformities such as scoliosis, thoracic kyphosis and lumbar lordosis in Korean elementary school students. METHOD: Five hundred forty Korean elementary school students were preliminary screened for spinal deformities by physical examinations and the three dimensional skeletal analysis system. The study time and pain regions were investigated in sitting on chairs that commonly used in Korean elementary school. RESULTS: The prevalence of scoliosis, thoracic kyphosis and lumbar lordosis were 9.8%, 18.7% and 23.1%. There was a significant difference in study time between spinal deformity group and control group (p<0.01). In spinal deformity group, pain regions were low back (45%), posterior neck (23%), buttock (21%) and shoulder and elbow joints (11%). CONCLUSION: The spinal deformities showed high prevalence in elementary school students assessed by the three dimensional skeletal system analyser. The long term follow-up evaluation and confirmative radiographic study will be necessary to assess curve progression in spinal deformity group.
Animals ; Buttocks ; Congenital Abnormalities* ; Elbow Joint ; Humans ; Kyphosis ; Lordosis ; Neck ; Physical Examination ; Prevalence ; Scoliosis ; Shoulder

OBJECTIVE: The patients with glottic dysfunction cannot cough effectively. It is difficult to eliminate pulmonary secretions and to provide lung expansion exercise in those patients. Thus we made a device which substitutes the function of glottis and examines the effectiveness of the external glottic function of the device. METHOD: This new device was made of two parts: connection and control part. Connection part had three ports: patient connection, insufflation and connection port. The insufflation port with one-way valve allows additional air stacking using a manual resuscitation bag after a patients's deep inspiration. Control part had external glottic function by air flow control with button pushing simply. The vital capacity (VC), maximal insufflation capacity (MIC), MIC with device (MICdevice), unassistive peak cough flow (UPCF), assistive peak cough flow (APCF) and assistive peak cough flow with device (APCFdevice) were measured in six patients. RESULTS: In tested patients, four were amyotrophic lateral sclerosis patients and two were cervical spinal cord injury patients with tracheostomized. The value of MICdevice or APCFdevice was higher than MIC or APCF in all patients. CONCLUSION: This new device can improve the bronchial toileting by improving cough function and also provide lung expansion exercise effectively in patients with glottic dysfunction.
Amyotrophic Lateral Sclerosis ; Cough* ; Glottis ; Humans ; Insufflation ; Lung ; Resuscitation ; Spinal Cord Injuries ; Vital Capacity

BACKGROUND: There are evidences that uPA and its inhibitor play a key role in tumor spread. We studied whether uPA and PAI-1 expressions could serve as prognostic parameters along with clinical, gross and microscopic findings in gallbladder carcinomas. METHODS: We analyzed 42 cases of gallbladder carcinomas by immunohistochemical staining and clinicopathologic parameters. RESULTS: uPA and PAI-1 were more frequently expressed in the adenocarcinoma than in the normal or benign gallbladder tissue. The uPA expression in the glands of low grade adenocarcinoma was significantly correlated with both distant and lymph node metastases. The uPA expression in the stroma around the low grade adenocarcinoma was significantly correlated with either distant or lymph node metastasis. The PAI-1 expression was significantly correlated with lymph node metastasis only for both distant and lymph node metastases. In multivariate analysis, the lymphatic invasion was significantly related to poor survival (p= 0.0115). In univariate analysis, the cases without lymphatic invasion had prolonged survival. Positive expression of uPA in the glands of low-grade adenocarcinoma was significantly correlated with poor survival (p=0.0391). CONCLUSION: In conjunction with clinicopathologic findings, expressions of uPA and PAI-1 may be useful prognostic markers in gallbladder carcinomas.
Adenocarcinoma ; Gallbladder* ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators* ; Plasminogen* ; Prognosis ; Urokinase-Type Plasminogen Activator*

Lichen planus and vitiligo are common skin disorders, which rarely coexist. We report a case of colocalization of lichen planus and vitiligo in a 42-year-old woman. Furthermore, herein, we discuss the possible mechanism of colocalization of lichen planus and vitiligo, including the role of actinic damage in the initiation of lymphocytic infiltrates of lichen planus in vitiliginous skin.
Actins ; Adult ; Female ; Humans ; Lichen Planus* ; Lichens* ; Skin ; Vitiligo*

Pediatric patients with dissecting aneurysms usually present with ischemia rather than bleeding. We report a case of a 15-year-old boy with a dissecting aneurysm of the posterior cerebral artery (PCA) presenting with hemorrhage. He was first treated with stent-assisted coil embolization, in an attempt to avoid trapping of the PCA and preserve the perforators. After the procedure, he recovered well from general anesthesia, but rebleeding occurred from the same lesion 6 hours after the procedure, therefore endovascular segmental occlusion of the parent artery was performed secondarily. Apparently, a reconstructive method of stent-assisted coiling is worth trying to preserve the parent vessel and perforators, but it is not always efficient and durable for dissecting aneurysms.
Adolescent ; Anesthesia, General ; Aneurysm, Dissecting ; Arteries ; Child ; Glycosaminoglycans ; Hemorrhage ; Humans ; Ischemia ; Parents ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery ; Subarachnoid Hemorrhage

OBJECTIVES: To evaluate the compatability of high school students' desks and chairs to the fittness of their physique, to examine the factors related the posture and pain while they use the classroom desks and chairs, and to analyze the curvature of spine in sitting position. METHOD: Measurements of the dimensions of desks and chairs and a written survey to question students' habits regarding to the usage of classroom desks and chairs along with the physical examinations of spine including the analysis of spine curvature in sitting position with an electrogoniometer. RESULTS: Seven hundred forty nine among 831 male students, and 1,017 among 1,074 female students, complained of discomforts associated with the usage of classroom desks and chiairs. An examination of spine in sitting position using an electrogoniometer showed that both male and female subjects displayed the spine curvatures in the order of thoracic kyphosis, lumbar lordosis, and scoliosis. All subjects displayed pain in the order of low back(38.8%), posterior neck(23.9%), shoulder and elbow joints(15.8%), and buttock(15.7%). CONCLUSION: The study revealed an urgent need for the adaptation of classroom desks and chairs according to the growing physique of the adolescents. A majority of the teenaged subjects experienced the discomfort from the use of improper funiture and a poor posture. Authors highly recommend a formal education to the students regarding the importance of proper posture and the usage of adjustable desks and chairs.
Adolescent* ; Animals ; Education ; Elbow ; Female ; Humans ; Kyphosis ; Lordosis ; Male ; Physical Examination ; Posture ; Scoliosis ; Shoulder ; Spine

OBJECTIVE: Inappropriate neural control of the quadriceps femoris muscle group has been implicated in patellofemoral pain syndrome (PFPS) and the methods of biomechanical assessment of PFPS has been developed recently. The aims of the present investigation were to evaluate the effects of therapeutic exercise in the alleviation of PFPS and to develope objective clinical test for PFPS. METHOD: We investigated the onset time of the isometric contraction of vastus medialis oblique muscle (VMO) and the vastus lateralis muscle (VL) under four different conditions: knee flexion and extension in weight bearing (standing) and non-weight bearing (sitting on chair) situations. For each condition, onset times of EMG activities and onset times for VMO and VL were determined from five trials of isometric contraction. In addition, we compared knee flexor and extensor torques in control group and subjects with PFPS. To evaluate the effects of the exercise we compared the onset time difference (onset time of VL-onset time of VM) and quadriceps muscle torque at pre- and post- exercise in PFPS groups. RESULTS: In PFPS group, onset time of VMO during knee extension was significantly longer than the onset time of VL and the knee extensor torque was considerably weaker in comparison with normal group. Although onset time difference was not changed after exercise program, there were significant increase in knee extensor torque in subjects with PFPS. CONCLUSION: The role of exercise in the rehabilitation of quadriceps functions is to reduce the pain, to strengthen the knee extensor, and further accurate diagnostic tools and methods for the result of therapeutic exercise in PFPS are needed.
Isometric Contraction ; Knee ; Patellofemoral Pain Syndrome* ; Quadriceps Muscle ; Rehabilitation ; Torque ; Weight-Bearing

OBJECTIVE: To investigate the pathologic pulmonary mechanics and analyze the factors affecting cough ability in patients with Duchenne muscular dystrophy (DMD). METHOD: Thirty-one patients with DMD were investigated. The vital capacity (VC), maximum insufflation capacity (MIC), maximal inspiratory (MIP), and expiratory pressure (MEP) were measured. Unassisted peak cough flow (UPCF) and assisted PCF at three different conditions were evaluated. RESULTS: The mean value of MICs (1, 873 +/- 644 cc) was higher than that of VCs (1, 509 +/- 640 cc). MIP and MEP were 48.8 +/- 21.4% and 29.5 +/- 19.5% of predicted normal value respectively. MIP was correlated with UPCFs as well as MEP. All of three assisted cough methods showed significantly higher value than unassisted method (p<0.01). The manual assisted PCFs at MIC significantly exceeded those produced by manual assisted or PCFs at MIC. The positive correlation between the MIC-VC difference and PCF at MIC-UPCF difference was seen (p<0.01). CONCLUSION: Inspiratory muscle strength and the preservation of pulmonary compliance is important for the development of effective cough as well as expiratory muscle power. Thus, the clinical implication of the inspiratory phase in assisting a cough should be emphasized.
Compliance ; Cough* ; Humans ; Insufflation ; Mechanics* ; Muscle Strength ; Muscular Dystrophy, Duchenne* ; Reference Values ; Vital Capacity

The function of inspiratory muscles is crucial for effective cough as well as expiratory muscles in patients with Duchenne muscular dystrophy (DMD). However, there is no report on the correlation between cough and inspiratory muscle strength. To investigate the relationships of voluntary cough capacity, assisted cough techniques, and inspiratory muscle strength as well as expiratory muscle strength in patients with DMD (n=32). The vital capacity (VC), maximum insufflation capacity (MIC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured. Unassisted peak cough flow (UPCF) and three different techniques of assisted PCF were evaluated. The mean value of MICs (1918 +/- 586 mL) was higher than that of VCs (1474 +/- 632 mL) (p < 0.001). All three assisted cough methods showed significantly higher value than unassisted method (212 +/- 52 L/min) (F = 66.13, p < 0.001). Combined assisted cough technique (both manual and volume assisted PCF; 286 +/- 41 L/min) significantly exceeded manual assisted PCF (MPCF; 246 +/- 49 L/ min) and volume assisted PCF (VPCF; 252 +/- 45 L/min) (F = 66.13, p < 0.001). MIP (34 +/- 13 cmH2O) correlated significantly with both UPCF and all three assisted PCFs as well as MEP (27 +/- 10 cmH2O) (p < 0.001). Both MEP and MIP, which are the markers of respiratory muscle weakness, should be taken into account in the study of cough effectiveness.
Respiratory Muscles/*pathology ; Pressure ; *Oxygen Consumption ; Muscular Dystrophy, Duchenne/*genetics ; Muscles/pathology ; Muscle Weakness/pathology ; Models, Statistical ; Male ; Inspiratory Capacity ; Humans ; Cough ; Biopsy ; Adult ; Adolescent