OBJECTIVE: To evaluate and compare the organization of descending motor pathways to upper extremity muscles among healthy children. METHOD: The healthy children were 16 males and 7 females aged 1-19 years (average, 9 years), and eight healthy adults were enrolled as the control group. Transcranial magnetic stimulation was applied to bilateral motor cortices, and motor evoked potentials (MEPs) were recorded using surface electrodes from the first dorsal interossei (FDI), the biceps brachii (BIC), and the deltoid (DEL) muscles. The onset latency, central motor conduction time (CMCT), and amplitude were obtained during a relaxed state. RESULTS: MEPs of FDI were obtained from subjects aged 13 months. The frequency of obtaining MEPs in proximal and distal muscles increased with age, although there was a less frequent incidence of obtaining MEPs in the proximal BIC and DEL muscles compared with those in the distal FDI muscle. MEP amplitudes increased with age, whereas latencies were relatively constant. CMCTs showed a similar pattern of maturation, and adult values were obtained by 13-years-of-age. CONCLUSION: These results suggest that the proximal and distal muscles of the upper extremities show different maturation and organization patterns.
Adult ; Aged ; Child ; Efferent Pathways ; Electrodes ; Evoked Potentials, Motor ; Female ; Humans ; Incidence ; Male ; Muscles ; Nitrogen Mustard Compounds ; Transcranial Magnetic Stimulation ; Upper Extremity

Epilepsy is an intractable disease, though many treatment modalities have been developed. Recently, noninvasive transcranial direct current stimulation (tDCS), which can change brain excitability, was introduced and has been applied for therapeutic purposes regarding epilepsy. A suppression of seizures was experienced by cathodal tDCS in a medication refractory pediatric epileptic patient. The patient was an 11-year-old female who had focal cortical dysplasia of the cerebral hemisphere. The patient was treated with antiepileptic drugs but the mean seizure frequency was still eight episodes per month. The tDCS cathode was placed at the midpoint of P4 and T4 in the 10-20 EEG system where the abnormal wave was observed on a sleep EEG. Two mA of tDCS was applied 20 minutes a day, five days a week for two weeks. During a two-month period after treatment termination, only six seizure attacks occurred, and the duration of each seizure episode also decreased. tDCS was applied under the same conditions for another two weeks. For two months after the second treatment session, only one seizure attack occurred, and it showed great improvement compared to the eight seizure attacks per month before the tDCS treatment. The medications were not changed, and there were no notable side effects that were caused by tDCS.
Anticonvulsants ; Brain ; Cerebrum ; Child ; Electrodes ; Electroencephalography ; Epilepsy ; Female ; Humans ; Malformations of Cortical Development ; Seizures

OBJECTIVE: To evaluate normal healthy persons without spasticity to observe normal findings of the elbow stretch reflex using a newly developed, portable, hand-driven spasticity-measuring system. METHOD: Thirty normal persons without any disease involving the central or peripheral nervous system were enrolled in this study. The portable hand-driven isokinetic system is able to measure the joint angle, angular velocity, electromyographic (EMG) signals, and torque during elbow passive extension-flexion. One set of 10 passive elbow extension and flexion movements was performed for data acquisition at each angular velocity, including 60, 90, 120, 150 and 180 degrees per second (degrees/sec). Electromyographic data were collected from the biceps brachii and the triceps brachii. Torque data were collected from sensors around the wrist. RESULTS: We were able to detect EMG activity and torque in all subjects by using the new portable hand-driven isokinetic system. EMG activity and torque increased with incremental increase of angular velocities. The joint angle of maximal EMG activity according to different angular velocities did not show any significant difference (116degrees-127degrees in elbow extension and 37degrees-66degrees in elbow flexion). The joint angles of maximal torque according to different angular velocities were not significantly different either. CONCLUSION: Using the portable hand-driven isokinetic system on the elbows of normal subjects, we were able to obtain expected results. By considering our normal findings of the elbow stretch reflex using this system, we propose that the various aspects of spasticity-related data can be measured successfully.
Adult ; Elbow ; Humans ; Joints ; Muscle Spasticity ; Peripheral Nervous System ; Reflex, Stretch ; Torque

BACKGROUND: Currently, the cardiopulmonary machine with non-pulsatile pumps, which are low in internal circuit pressure and cause little damage to blood cells, is widely used. However, a great number of experimental studies shows that pulsatile perfusions are more useful than non-pulsatile counterparts in many areas, such as hemodynamic, metabolism, organ functions, and micro-circulation. Yet, many concerns relating to pulsatile cardiopulmonary machines, such as high internal circuit pressure and blood cell damage, have long hindered the development of pulsatile cardiopulmonary machines. Against this backdrop, this study focuses on the safety and effectiveness of the pulsatile cardiopulmonary machines developed by a domestic research lab. MATERIAL AND METHOD: The dual-pulsatile cardiopulmonary bypass experiment with total extracorporeal circulation was conducted on six calves. Extracorporeal circulation was provided between superior/inferior vena cava and aorta. The membrane oxygenator, which was placed between the left and right pumps, was used for blood oxygenation. Circulation took four hours. Arterial blood gas analysis and blood tests were also conducted. Plasma hemoglobin levels were calculated, while pulse pressure and internal circuit pressure were carefully observed. Measurement was taken five times; once before the operation of the cardiopulmonary bypass, and after its operation it was taken every hour for four hours. RESULT: Through the arterial blood gas analysis, PCO2 and pH remained within normal levels. PO2 in arterial blood showed enough oxygenation of over 100 mmHg. The level of plasma hemoglobin, which had total cardiopulmonary circulation, steadily increased to 15.87+/-5.63 mg/dl after four hours passed, but remained below 20 mg/dl. There was no obvious abnormal findings in blood test. Systolic blood pressure which was at 97.5+/-5.7 mmHg during the pre-circulation contraction period, was maintained over 100 mmHg as time passed. Moreover, diastolic blood pressure was 72.2+/-7.7 mmHg during the expansion period and well kept at the appropriate level with time passing by. Average blood pressure which was 83+/-9.2 mmHg before circulation, increased as time passed, while pump flow was maintained over 3.3 L/min. Blood pressure fluctuation during total extracorporeal circulation showed a similar level of arterial blood pressure of pre-circulation heart. CONCLUSION: In the experiment mentioned above, pulsatile cardiopulmonary machines using the doual-pulsatile structure provided effective pulsatile blood flow with little damage in blood cells, showing excellence in the aspects of hematology and hemodynamic. Therefore, it is expected that the pulsatile cardiopulmonary machine, if it becomes a standard cardiopulmonary machine in all heart operations, will provide stable blood flow to end-organs.
Animals* ; Aorta ; Arterial Pressure ; Blood Cells ; Blood Gas Analysis ; Blood Pressure ; Cardiopulmonary Bypass* ; Extracorporeal Circulation ; Heart ; Hematologic Tests ; Hematology ; Hemodynamics ; Hydrogen-Ion Concentration ; Metabolism ; Models, Animal* ; Oxygen ; Oxygenators, Membrane ; Perfusion ; Plasma ; Pulsatile Flow

PURPOSE: The proportion of early gastric cancer has recently increased. Although early gastric cancer has a very good prognosis following a curative resection, and recurrences rarely occur, if there is a distant recurrence the prognosis is grave. To predict to the potential of a recurrence after a gastrectomy, early gastric cancer patients were retrospectively analyzed. METHODS: 1, 131 early gastric cancers were curatively resected at the Asan Medical Center between Jan, 1990 and Sep, 1997. Recurrences were observed in 46 patients during the follow up period. The clinical characteristics of the recurred and cured groups were compared. Any statistical significance was calculated using Chi-Squared and Log rank tests, using SPSS version 10.0. RESULTS: The recurrence and 5-year survival rates of the recurred patients were and 9%, respectively. Hematogenous recurrences were the most common mode of recurrence, followed by lymph node recurrences. The mean tumor size, numbers of lesions, location of tumor, status of lymph node dissection and operation type, did not affect tumor recurrences. The grossly elevated type of tumor, submucosal layer invasion and differentiated cancer, most frequently recurred. The rate of recurrence linearly increased with increase of the nodal stage. All patients with a lymph node recurrence had lymph node metastasis at the initial surgery. CONCLUSION: In early gastric cancer patients, the elevated type, or a differentiated adenocarcinoma, may recur at a distant organ. A more careful follow-up will be required if the surgical removal of a metastatic tumor is intended, as chemotherapy is ineffective. The sentinel lymph node should be examined by a frozen biopsy at the beginning of the initial surgery, in order to determine the range of a lymph node dissection to avoid a nodal recurrence.
Adenocarcinoma ; Biopsy ; Chungcheongnam-do ; Drug Therapy ; Follow-Up Studies ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

Renal transplantation is now a well established mode of optimal therapy for children with end-stage renal disease. A total of 119 pediatric renal transplantations were performed during last 20 years but 6 cases (early 3 cases treated with azathioprine and most recent 3 cases) were excluded for this study. A total of 113 pediatric renal transplants out of total 1,906 kidney transplantation recipients receiving cyclosporine A and low dose prednisone as the main immunosuppressive agent were the subjects of this study to find out the risk factors which might influence the pediatric renal allograft survival in a single center. When the potential donor was living related, at least the HLA 1-haplotype matched relative was selected, but, when unrelated, at least DR-1/2 or A+B 2/4 matching was required for selection. Living related donation from parent, brothers, sisters (n=82), and unrelated donation (n=31) through the swap program or from fully motivated healthy volunteers were the major source of kidney for allograft. The mean age of the recipient was 14.1 years ranging from ages 2.1 to 19.9. During a mean follow-up of 68.1 months, there were 21 cases of graft loss, and 3 recipient deaths. The major causes of graft loss were acute and/or chronic rejection, poor compliance and patients death. The 1-, 3- and 5-year graft survival were 94.6%, 88.9% and 79.2% respectively. There was no significant difference between children and adult in graft survival rate. No significant graft survival difference between the related and unrelated donors (73.3 vs 77.2% at 5-year, p>0.05) was found. The significant risk factors for the outcome were the ABO compatibility (p=0.0001) and development of more than 1 episode of acute rejection within 6 month (p=0.01) and 1 year (p=0.0016). Graft survival decreased with increasing number of rejection episode within 6 month (p=0.009) and 1 year (p=0.002). Other factors such as recipients age, original kidney diseases, type and duration of dialysis before transplantation, combined native kidney removals did not influence the outcome of graft. And because of presence of only 2 cadaveric donor in this analysis, we could not demonstrate any benefit of living donor transplantation. In conclusion, pediatric renal transplantation in at least older children (>5 years) is encouraging. The outcome of pre- emptive renal transplantation is also promising. More aggressive ABO matching and effort for reducing the rejection episode within 6 months and 1 year might be important factors for the successful outcome of pediatric renal transplantation. So development and application of more effective immunosuppressive agents such as mycophenolate mofetil or rapamycin to reduce the rejection episodes is to be needed in near future.
Adult ; Allografts* ; Azathioprine ; Cadaver ; Child ; Compliance ; Cyclosporine* ; Dialysis ; Follow-Up Studies ; Graft Survival ; Healthy Volunteers ; Humans ; Immunosuppressive Agents ; Kidney ; Kidney Diseases ; Kidney Failure, Chronic ; Kidney Transplantation ; Living Donors ; Parents ; Prednisone ; Risk Factors* ; Siblings ; Sirolimus ; Tissue Donors ; Transplants ; Unrelated Donors

PURPOSE: To determine the postnatal changes in aldosterone action on the renal tubular reabsorption in low birth weight(LBW) infants, we assessed the relation of the aldosterone concentrations to renal parameters during the first 10 days of life. METHODS: Twenty LBW infants were evaluated and their gestational ages ranged from 32.4 to 39.3 weeks and their birth weights ranged from 1,440 to 2,500 g. Estimated glomerular filtration rate, fractional excretion of sodium(FENa) and potassium(FEK), and plasma aldosterone concentrations were analyzed according to the postnatal age and the conceptional age(CA). RESULTS: Glomerular functions were improved after birth and were correlated with CA. FENa and FEK decreased after birth and correlated with CA. Plasma aldosterone concentrations increased to 318.6 +/- 147.2 ng/dL at 48 hours and then decreased to 162.0 +/- 72.2 ng/dL at 10 days after birth. Plasma aldosterone concentrations of infants less than 38th week of CA were higher than that of infants more than 38th week. There was a significant negative correlation coefficient between plasma aldosterone concentrations and FENa in infants more than 34th week of CA, but not in that of less than 34th week. CONCLUSIONS: LBW infants have higher plasma aldosterone concentrations, but a poor correlation between plasma aldosterone concentration and urinary sodium excretion for the first few days of life and in lower chronologic aged infants. These results show that the renal tubule reabsorption of sodium is less responsive to plasma aldosterone in these infants and, therefore, the careful management of fluid and electrolyte balance is mandatory.
Aldosterone* ; Birth Weight ; Gestational Age ; Glomerular Filtration Rate ; Humans ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Parturition ; Plasma ; Sodium ; Water-Electrolyte Balance

Lymphangiomatosis is a very rare and slow-growing benign tumor generally accepted to be the result of a congenital malformation of the lymphatic system. It is most commonly found in the neck, axilla and less commonly retroperitoneum, mediastinum, mesentery, omentum, pelvis, bone, skin, scrotum, and spleen. We present a patient who had systemic lymphangiomatosis with splenic involvement. She was presented with the cystic neck mass suspected to be a cystic hygroma during the first decade. She complained of the mass on left upper quadrant of abdomen at the age of 28. Under full investigations, we had diagnosed the lymphangiomatosis involving spleen and right adrenal gland, and splenectomy was done. We present a case of systemic lymphangiomatosis with emphasis on diagnosis, management, and prognosis.
Abdomen ; Adrenal Glands ; Axilla ; Diagnosis ; Humans ; Lymphangioma, Cystic ; Lymphatic System ; Mediastinum ; Mesentery ; Neck ; Omentum ; Pelvis ; Prognosis ; Scrotum ; Skin ; Spleen ; Splenectomy

BACKGROUND: Pulmonary embolism is associated with varying degrees of pulmonary vascular obstruction. This study was undertaken to establish whether the extent of perfusion defect in lung scintigraphy can be predicted from analysis of echocardiographic measurements in patients with pulmonary embolism. METHODS: We retrospectively studied 28 patients who presented with clinical evidence of pulmonary embolism. In order to compare the extent of perfusion defect in lung scintigraphy, we devised a scoring system (echocardiographic severity index, ESI) for various echocardiographic parameters, which include right ventricle size, area, shape, systolic function, and pulmonary artery pressure. [ESI=sum of scores/number of parameters measured]. RESULTS: The mean values (+/-SD) of each parameter were as follow; right ventricular end-diastolic dimension (RVedD), 34.5+/-5.7 mm; LVedD, 40.9+/-5.2 mm; ratio of RVedD to LVedD, 0.87+/-0.2; right ventricular end-diastolic area (RVedA), 24.7+/-9.5 cm2; right ventricular end-systolic area (RVesA), 17.8+/-7.8 cm2; fractional area change, 28.8+/-9.7%; angle between IVS and RV, 96.0+/-14.8degrees; RV hypokinesia, absence or mild in 29%, moderate in 50%, severe in 21%; TR grade, absence or mild in 25%, moderate in 43%, severe in 32%; pulmonary artery systolic pressure, <30 mmHg in 21%, 30 to 50 mmHg in 68%, >50 mmHg 11% of patients. The echocardiographic severity index (ESI) in patients with pulmonary embolism was 0.52+/-0.24, and the perfusion defect score was 0.21+/-0.14. There was a close correlation between the ESI and the extent of perfusion defect (r=0.622, p<0.01). CONCLUSION: The echocardiographic severity index may reflect the extent of the perfusion defects in patients with pulmonary embolism, therefore it is potentially applicable in clinical practice for evaluating patients with pulmonary embolism and furthermore in their follow-up over a period of time.
Blood Pressure ; Echocardiography* ; Follow-Up Studies ; Heart Ventricles ; Humans ; Hypokinesia ; Lung ; Perfusion ; Pulmonary Artery ; Pulmonary Embolism* ; Radionuclide Imaging ; Retrospective Studies

Diagnosis of a thymic carcinoid was made on transthoracic fine needle aspiration in a 36-year old woman who had an anterior mediastinal mass on chest X-ray and CT scan. The aspiration smears showed numerous anastomosing ribbons and cords of small round tumor cells. The tumor cells had slightly eccentric nuclei and some granular cytoplasm. The small and uniform nuclei of the tumor cells had finely granular chromatin and thin nuclear membrane. The cytologic diagnosis of a carcinoid was confirmed on histopathologic, immunohistochemical, and electromicroscopic examination of surgical specimen.
Adult ; Alleles* ; Biopsy, Fine-Needle ; Carcinoid Tumor ; Carotid Body ; Child* ; Chromatin ; Cytoplasm ; Diagnosis ; Female ; Humans ; Immunoglobulin A* ; Nuclear Envelope ; Paraganglioma ; Thorax ; Tomography, X-Ray Computed