A possible therapeutic effect of acetyl-L carnitine (ALCAR) on peripheral nerve injuries and the expression of Jun, the protein products of immediate-early genes(IEGs), in the spinal cord were investigated after sciatic nerve injury in Sprague-Dawley rats. Experimental animals were divided into 3 groups: intact sciatic nerve as a control group, surgical repair alone, and surgical repair with ALCAR treatment. Toe-spreading response, pinprick response, and compound action potential were measured to evaluate the recovery of sciatic nerve injury. Recovery of behavioral function and electrophysiological function both improved in the surgical repair with ALCAR treatment group. Weak basal expression of Jun was shown in the ventral horn the of spinal cord in the control group. In the surgical repair alone group or the surgical repair with ALCAR treatment group, Jun expression persisted until 28 days after injury in the ventral horn of the spinal cord. Moreover, the surgical repair with ALCAR treatment group showed more increased expression of Jun than the surgical repair alone group. These results suggest that ALCAR facilitates the functional recovery after peripheral nerve injury.
Acetylcarnitine ; Action Potentials ; Animals ; Carnitine* ; Horns ; Peripheral Nerve Injuries ; Rats* ; Rats, Sprague-Dawley ; Sciatic Nerve* ; Spinal Cord

In the case of a soft tissue defect which requires thin & pliable tissues, the choice of donor site is limited due to flap bulkiness and donor site morbidity. To overcome these problems, a variety of perforator-based flaps such as paraspinous and parasacral perforator flap, deep inferior epigastric perforator flap, gluteal perforator flap, and thoracodorsal artery perforator flap have recently been introduced. We experienced 8 cases of soft tissue defects from December 1996 to March 1999 using the thoracodorsal artery perforator flap for reconstruction. We could elevate the cutaneous flap with preservation of the latissimus dorsi muscle flap only when it was based on one cutaneous perforator. Defatting procedure was possible for further thinning of skin flap. In one case, axillary defect after release of postburn scar contracture was repaired with island perforator flap and the other seven cases were repaired with free flap. The results were satisfactory. We believe the thoracodorsal artery perforator flap is useful for reconstruction of soft tissue defects which are large or under conditions requiring thin flap.
Arteries* ; Cicatrix ; Contracture ; Free Tissue Flaps ; Humans ; Perforator Flap ; Skin* ; Superficial Back Muscles ; Tissue Donors

Pseudoxanthoma elasticum (PXE) is an uncommon heritable disorder of elastin characterized by cutaneous, ocular and vascular abnormalities. Typical skin lesion shows yellowish papules and redundant skin folds on the neck, axilla and groin due to degeneration and calcification of elastic fibers in deep dermis. As in all heritable disorders of connective tissue, no curative therapy is presently know. Redundant and unsightly skin folds about the neck can be improved by surgery, but irregular papular lesion on skin does not improved by surgery. A-44-year-old female who had a skin lesion and angioid streak was treated as follows: Skin folds on the neck were excised successfully without any significant problem such as intraoperative bleeding, wound dehiscence or hypertrophic scar formation. To evaluate whether we could smooth the irregular skin surface due to multiple papules, laserbrasion with a SLT contack Nd:YAG laser system was performed experimentally on a limited area which was located on the right supracla-vicular area about 2 x 3cm in size. An acceptable aesthetic appearance was achieved with surgical excision 12 months after the operation. Biopsy of the laserbrasion site revealed disappearance of the calcium deposit. This study emphasizes the possibility of using laserbrasion in solving troblesome skin lesion of the PXE.
Angioid Streaks ; Axilla ; Biopsy ; Calcium ; Cicatrix, Hypertrophic ; Connective Tissue ; Dermis ; Elastic Tissue ; Elastin ; Female ; Groin ; Hemorrhage ; Humans ; Neck* ; Pseudoxanthoma Elasticum ; Skin ; Wounds and Injuries

PURPOSE: Preoperative chemotherapy has been extensively used in inoperable or locally advanced breast cancer to achieve tumor reduction and, thus, to facilitate extensive surgery. METHODS: A hospital-based case-control study was carried out to identify the effect of induction chemotherapy on breast cancer. 49 patients with breast cancer were treated with initial chemotherapy between October 1986 and June 1998. 43 patients were treated with three courses of the CMF regimen (cyclophosphamide and metho trexate and 5-fluorouracil), four patients with three courses of the FEC regimen (5-fluorouracil, epirubicine and cyclophosphamide), two patients with three courses of the FAC regimen (5-fluorouracil, adriamycin and cyclophosphamide). RESULTS: The response, rate to induction chemotherapy was 83.7% including 4% complete response, and there were no significant differences in response rates according to the chemo therapy regimen. At a mean follow-up of 51.9 months, recurrence and distant metastasis were observed in 32.7% and 18.4% of the patients, respectively. The five-year disease- free survival rate of the patients in the induction group was lower than that of the patients in the control group (35.5+/-8.7% versus 59.9+/-9.0%), but the five-year overall survival rate in the induction group was higher than control group (88.7 5.3% versus 76.9+/-6.6%). CONCLUSIONS: Preoperative induction chemotherapy is a useful treatment option for patients with locally advanced breast cancer. Also, there is an improvement in the five-year overall survival rate for patients in the induction chemotherapy group compared with that for patients in the age- and stage-controlled postoperative adjuvant chemotherapy group.
Breast Neoplasms* ; Breast* ; Case-Control Studies* ; Chemotherapy, Adjuvant ; Doxorubicin ; Drug Therapy ; Epirubicin ; Follow-Up Studies ; Humans ; Induction Chemotherapy* ; Neoplasm Metastasis ; Recurrence ; Survival Rate

PURPOSE: Reclassfication of the medullary carcinoma using a strict histologic criteria and analysis of the clinical and pathological characteristics of the medullary carcinoma. MATERIAL & METHODS: Thirty-seven cases of the breast carcinoma originally diagnosed as medullary carcinoma were reviewed. One to ten microscopic slides of each case were reexamined and reclassified using the strictly defined histologic criteria defined by Ridolfi et al. Tumors were excluded from the category of the typical medullary carcinoma (TMC) on the basis of presence of glandular features, focal marginal infiltrations, or sparse mononuclear infiltrations. Tumor with two or more atypical features, or extensive marginal infiltrations, no mononuclear cell infiltration and/or less than 75% syncytial growth were classified as infiltrating ductal carcinoma with medullary feature (IDC). A predominantly syncytial growth pattern (75% or more) was requisite for inclusion in both TMC and atypical medullary carcinomas (AMC). RESULTS: Twenty-two tumors (60%) fulfilled the criteria for TMC, and 12 tumors (32%) were AMC and three tumors (8%) were IDC. TMC occupied 3.1% of breast cancer. The mean age of patients with TMC was 45.4+/-11.2 years and the average size of the tumor in TMC was slightly larger than that of breast cancer in general, although not statistically significant. The frequency of lymph node metastasis in TMC was similar to breast cancer in general. Five year survival of patients with TMC was 95.5% which was significantly better than breast cancer in general. CONCLUSION: The TMC occupied 3.1% of breast cancer. The mean age of patient, tumor size and lymphnode metastasis were not different from that of breast cancer but 5 years survival of patient with TMC was significantly better than breast cancer in general.
Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Medullary* ; Humans ; Lymph Nodes ; Neoplasm Metastasis

BACKGROUND: The Stroop color word test is useful to examines the frontal lobe function of selective attention and inhibition. The Korean Color Word Stroop Test(K-CWST) was widely used in Korea. But, it was difficult in elderly individual with low educational level and visual problem and in patients with more progressed dementia. So we developed the Korean Stroop Test(KST). METHODS: The KST consist of word reading(WR), color naming(CN), interference word reading(IWR) and interference color naming (ICN). The interference tasks are naming the ink color of color words which were mismatched with word meaning. We measured reaction time and number of error. This study used the K-CWST to assess and compare the KST in eighteen probable alcohol related dementia patients and nineteen normal control. All subjects received the Korean version of Mini-Mental State Examination (K-MMSE) and the K-CWST and the KST. We tested reliability and validity of the KST. Also we enrolled normal adult from 41 to 80 year old for evaluating the change of the KST test with age. RESULTS: The KST tasks were correlated with K-MMSE -0.33(p<0.05) to -0.63(p<0.001) and K-CWST correlated with K-MMSE 0.37 (p<0.05) to 0.55(p<0.01). The interference color naming of KST was correlated the most to K-MMSE -0.78(p<0.001). The interference color naming of KST and interference color naming of K-CWST was correlated by 0.81(p<0.001). The internal consistency were 0.78 (Cronbach's alpha). The KST score was statistically different between alcohol related dementia patients and normal subjects in CN, ICN and ICN error. The KST was not differ in old age group except some tasks. CONCLUSION: The KST has a excellent reliability and validity. It takes less time and easy than the K-CWST. So the KST is a good test for evaluating frontal lobe function in elderly with low educational level of older people.
Adult ; Aged ; Aged, 80 and over ; Dementia ; Frontal Lobe ; Humans ; Ink ; Korea ; Reaction Time ; Reproducibility of Results ; Stroop Test*

STUDY DESIGN: A cross-sectional imaging study. PURPOSE: The objective was to assess the degree of degeneration and the associated factors through imaging studies of the lesion segment and the adjacent superior and inferior segments of isthmic and degenerative spondylolisthesis. OVERVIEW OF LITERATURE: Few articles existed for degeneration and related factors in isthmic and degenerative spondylolisthesis. METHODS: The subjects were 95 patients diagnosed with spondylolisthesis. Simple plain radiographs including flexion and extension and magnetic resonance imaging were used to investigate the degree of translation, disc degeneration, high intensity zone (HIZ) lesion, Schmorl's node (SN) and Modic changes. RESULTS: Advanced disc degeneration, grade 5, was shown to be significant in the index segment of the isthmic type (p=0.034). Overall, type 2 Modic change was most common in both groups and also, it was observed more in the isthmus group, specifically, the index segment compared to the degenerative group (p=0.03). For the SN, compared to the degenerative type, the isthmus type had a significantly high occurrence in the index segment (p=0.04). For the HIZ lesions, the isthmus type had a higher occurrence than the degenerative type, especially in the upper segment (p=0.03). CONCLUSIONS: Most advanced disc degeneration, fifth degree, SN and Modic change occurred more frequently in the lesions of the isthmus type. HIZ lesions were observed more in the isthmus type, especially in the segment superior to the lesion.
Humans ; Intervertebral Disc Degeneration ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; Spondylolisthesis

The aim of this study were to measure and compare the stress level on three type brackets and each other material (stainless steel, ceramic) with tipping and torquing forces by using the finite element analysis and to design bioniechanically favorable brackets. For this study, three kinds of brackets were selected(A:Transcend-RMO, B:Signature-Unitek, C:PAW plain archwire appliance-applied for a patent in Yonsei University). The slot size of bracket was 0.022inch and the size of archwire was 0.0175x0.025inch and taper shaped archwire was used in PAW. Loading force in tipping was 4.27N and torquing force was 32.858N applied by archwire torsion with 19.7degree and 113 degree in C type bracket. The conclusions were that (1) The finite element method proved to be a useful tool in the stress analysis of orthodontic bracket subjected to various forces. (2) With tipping, the stresses were concentrated at the gingival wall of the wire slot where it meets the mesial bracket surface and the incisal wall of the wire slot where it meets the distal bracket surface and with torquing, the stresses were concentrated at the junction of the gingival or incisal wall and base of the slot. (3) The maximum stress value was higher in torquing force than tipping force and therefore it is desirable to design on the basis of torquing force. (4) It was considered that the change in material might be affect on the diminish of stress value in the place of stess concentration. (5) The maximum stress value was highest on PAW bracket when the tipping and torquing force was applied and therefore it would be desirable to use mechanically favorable material on PAW bracket.
Finite Element Analysis ; Orthodontic Brackets* ; Steel

BACKGROUND: Researchers have reported that the prevalence of abdominal aortic aneurysm(AAA) is 1~4% in the entire population and 4~9% in the population older than 65 years. 40 to 50% of AAA patients die before arrival at a hospital; and mortality from a ruptured AAA is greater than 90%. Moreover, diagnosis is frequently delayed because the majority of patients are asymptomatic. Even if AAA is quickly diagnosed(ruptured or symptomatic) and operated on, survival rate is less than 50%. Recently, trials have been done to detect asymptomatic AAA by ultrasonography in the elderly population with a subsequent increase in the number of surgeries of asymptomatic AAA. Method: We measured the diameter of the abdominal aorta in all patients aged 65 years and older seen in the emergency room at Chuncheon Sacred Heart Hospital, Hallym University. We investigated the correlations between risk factors and prevalence of AAA and the diameter of the abdominal aorta. We also screened for age, gender, and history of smoking, hypertension, coronary heart disease, and CVA. RESULTS: 444 cases were enrolled in this study with 185 being male(41.7%) and 259 female(58.3%). Mean age was 73.91+/-7.02 years. Mean maximum diameter of the abdominal aorta was 2.08+/-0.37cm. Comparing maximum diameters, men averaged 2.17+/-0.37cm and women 2.01+/-0.35 cm (p<0.001); smokers 2.16+/-0.39cm and nonsmokers 2.05+/-0.35cm(p=0.007); hypertension history 2.10+/-0.42 cm and no hypertension history 2.06+/-0.33cm(p=0.246); coronary heart disease history 2.35+/-0.84cm and no coronary heart disease 2.07+/-0.35 cm(p=0.01); and CVA history 2.08+/-0.37 cm and no CVA history 2.08+/-0.37cm(p=0.997). CONCLUSION: There were notable differences in the maximum abdominal aortic diameter with gender and histories of smoking, hypertension, and coronary heart disease. Ultrasound screening of AAA should be strongly recommended in male smokers 65 years and older with a history of coronary heart disease. Overall, ultrasound screening of AAA for elderly patients should be carefully considered.
Aged ; Aorta, Abdominal ; Aortic Aneurysm, Abdominal ; Coronary Disease ; Emergencies ; Female ; Heart ; Humans ; Hypertension ; Male ; Mass Screening ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Survival Rate

Background: Verbal learning test is useful and significant test to evaluating memory function. There were many memory tests but few for elderly and dementia patients. Although there have been a variety of Korean memory tests developed, these tests were difficult to administer to dementia patients and elderly individuals with low educational levels. Therefore, we developed the Korean Memory Test (KMT). Methods: The KMT task consists of three trials of free recall of 10 simplified line drawing figures of familiar materials. Three immediate recall trials and one 20 minutes delayed recall and one recognition trial were administered. Sixty-five of probable Alzheimer's patients received the Korean version of Mini-Mental State Examination (K-MMSE), Korean version of expanded Clinical Dementia Rating Scale (CDR) and KMT. Also sixty-seven of normal controls were enrolled. We tested reliability and validity of the KMT and also evaluated scores of the KMT with progression of dementia. Results: The parameters of the KMT correlated with CDR -0.74~-0.77 (p<0.01), K-MMSE 0.66~0.68 (p<0.01). The internal consis- tency was 0.78 (Cronbach's alpha). Most of the KMT's parameters decreased with CDR significantly (p<0.01). Conclusions: The KMT is a good test for evaluating memory function of elderly with low educational level. Also it is a sensitive and specific test to detection of dementia in early stage and has excellent reliability and validity.
Aged* ; Alzheimer Disease ; Dementia ; Humans ; Memory* ; Memory, Short-Term ; Neuropsychology ; Reproducibility of Results* ; Verbal Learning