OBJECTIVE: To localize the site of motor points within human biceps brachii muscles through surface mapping using electrophysiological method. METHOD: We recorded the compound muscle action potentials of each lattice of the biceps brachii in 40 healthy subjects. Standardized reference lines were made as the following: 1) a horizontal reference line (elbow crease) and 2) a vertical reference line connecting coracoid process and mid-point of the horizontal reference line. The Compound muscle action potentials were mapped in reference to the standardized reference lines. The locations of motor points were mapped to the skin surface, in the ratio to the length of the vertical and the half of the horizontal reference lines. RESULTS: The motor point of the short head of biceps was located at 69.0+/-4.9% distal and 19.1+/-9.5% medial to the mid-point of horizontal reference line. The location of the motor point of the long head of the biceps was 67.3+/-4.3% distal and 21.4+/-8.7% lateral. The motor point of the short head of the biceps was located more medially and distally in the male subjects compared to that in the female (p<0.05). CONCLUSION: This study showed electrophysiological motor points of the biceps brachii muscles through surface mapping. This data might improve the clinical efficacy and the feasibility of motor point targeting, when injecting botulinum neurotoxin in biceps brachii.
Action Potentials ; Botulinum Toxins ; Female ; Head ; Humans ; Male ; Muscles ; Skin

OBJECTIVE: To localize the site of motor points within human biceps brachii muscles through surface mapping using electrophysiological method. METHOD: We recorded the compound muscle action potentials of each lattice of the biceps brachii in 40 healthy subjects. Standardized reference lines were made as the following: 1) a horizontal reference line (elbow crease) and 2) a vertical reference line connecting coracoid process and mid-point of the horizontal reference line. The Compound muscle action potentials were mapped in reference to the standardized reference lines. The locations of motor points were mapped to the skin surface, in the ratio to the length of the vertical and the half of the horizontal reference lines. RESULTS: The motor point of the short head of biceps was located at 69.0+/-4.9% distal and 19.1+/-9.5% medial to the mid-point of horizontal reference line. The location of the motor point of the long head of the biceps was 67.3+/-4.3% distal and 21.4+/-8.7% lateral. The motor point of the short head of the biceps was located more medially and distally in the male subjects compared to that in the female (p<0.05). CONCLUSION: This study showed electrophysiological motor points of the biceps brachii muscles through surface mapping. This data might improve the clinical efficacy and the feasibility of motor point targeting, when injecting botulinum neurotoxin in biceps brachii.
Action Potentials ; Botulinum Toxins ; Female ; Head ; Humans ; Male ; Muscles ; Skin

PURPOSE: Cortisol awakening response (CAR) and nighttime cortisol levels have been used as indices of adrenocortical activity. However, population-based statistical information regarding these indices has not been provided in healthy subjects. This study was carried out to provide basic statistical information regarding these indices. MATERIALS AND METHODS: Cortisol levels were measured in saliva samples collected immediately upon awakening (0 min), 30 min after awakening and in the nighttime on two consecutive days in 133 healthy subjects. RESULTS: We determined the mean [standard deviation (SD)], median (interquartile range) and 5th-95th percentile range for each measure and auxiliary indices for CAR, i.e., the secreted cortisol concentration within 30 min of awakening (CARscc) and absolute and relative increases in cortisol level within 30 min of awakening (CARi and CARi%, respectively). We also determined these values for auxiliary indices derived from nighttime cortisol level, i.e., the ratio of cortisol level 30 min after awakening (CA30 min) to nighttime level (CA30 min/NC), as well as absolute and relative decreases in cortisol levels from CA30 min to nighttime (DCd and DCd%, respectively). We found no significant differences in cortisol level for any time point or in auxiliary indices between collection days, genders and ages. CONCLUSION: The provided descriptive information and statistics on the CAR and nighttime cortisol level will be helpful to medical specialists and researchers involved in hypothalamus-pituitary-adrenal axis assessment.
Adult ; Circadian Rhythm ; Female ; Humans ; Hydrocortisone/*metabolism ; Hypothalamo-Hypophyseal System/physiology ; Male ; Middle Aged ; Pituitary-Adrenal System/physiology ; Republic of Korea ; Saliva/*metabolism ; Wakefulness

PURPOSE: The aim of this study was to investigate the effects of new herbal formula (KBMSI-1) on erectile dysfunction in streptozotocin-induced diabetic rat model. MATERIALS AND METHODS: We used male Sprague-Dawley rats aged 12 weeks and divided into three groups; control (n=8), diabetes (DM) (n=8), DM+KBMSI-1 200 mg/kg treatment (n=8) groups. The DM groups received a single intraperitoneal injection of streptozotocin (STZ). Distilled water was administered in the control and DM group. To investigate the penile erection, intracavernosal pressure (ICP) and intracavernosal pressure/mean arterial pressure (ICP/MAP) were recorded in all groups. Serial sections of the penis were used to perform Masson's trichrome stain. We analyzed the expression of nNOS and eNOS concentration in the isolated corpus cavernosum by western blotting. RESULTS: Peak ICP/MAP ratio was markedly increased in the treatment group with KBMSI-1 compared with DM group (p<0.05). Masson's trichrome staining of corpus cavernosum showed increase in smooth muscle volume and the regular arrangement of collagen fibers in KBMSI-1 treatment group compared with DM group. Western blot analysis revealed that the penile expressions of nNOS and eNOS protein were significantly higher in KBMSI-1-treated group than in DM group. CONCLUSIONS: This study showed that herbal formulation of KBMSI-1 enhances the penile erection and the level of eNOS and nNOS expression of penile corpus cavernosum in streptozotocin-induced diabetic rat model.
Aged ; Animals ; Arterial Pressure ; Azo Compounds ; Blotting, Western ; Collagen ; Diabetes Mellitus ; Eosine Yellowish-(YS) ; Erectile Dysfunction ; Humans ; Injections, Intraperitoneal ; Male ; Methyl Green ; Muscle, Smooth ; Penile Erection ; Penis ; Rats ; Rats, Sprague-Dawley ; Streptozocin ; Water

PURPOSE: The aim of this study was to evaluate Cyanidin-3-O-beta-d-glucopyranoside on improvement and protection for erectile function. MATERIALS AND METHODS: Sprague-Dawley rats (12wks old) were divided into three groups (n=12 in each): normal control, diabetes (DM), and diabetes with Cyanidin-3-O-beta-d-glucopyranoside (C3G) concentration materials treatment (DM+C3G). DM and DM+C3G group received a single injection of streptozotocin (50 mg/kg), and 4 wk after induction of diabetes, DM+C3G group were treated with daily C3G (10 mg/kg) dissolved in water for 8 wk. After 12 wk of streptozotocin injections, rats in each group underwent intracavernosal pressure measurement (ICP) and then the corporal tissues were sampled. RESULTS: DM group showed markedly lower erectile parameters than those in the control group, whereas rats in the DM+C3G group showed improved erectile function by minimizing corporal apoptosis. CONCLUSIONS: The current study is the first to suggest that Cyanidin-3-O-beta-d-glucopyranoside may have a potency to improve and protect erectile function in a rat model of diabetic erectile dysfunction.
Animals ; Diabetes Mellitus ; Erectile Dysfunction ; Male ; Penile Erection ; Rats ; Rats, Sprague-Dawley ; Streptozocin ; Water

There are various causes of acute pancreatitis, and accurately determining the etiology is pivotal for selecting appropriate management. Other hidden causes, such as congenital anomaly, should be considered in patients with recurrent abdominal pain or unexplained recurrent pancreatitis. A santorinicele is a focal cystic dilatation of the terminal dorsal pancreatic duct, and this is usually associated with pancreas divisum and it is a risk factor for acute pancreatitis due to the accompanying relative stenosis of the minor papilla. We present here the case of a patient who was treated for acute pancreatitis that was presumably was caused by either Rifampin or Brucellosis, and the patient recovered with conservative management. However, we eventually diagnosed pancreas divisum with santorinicele by performing MRCP and ERCP after the pancreatitis had relapsed. We report here on a case of successful endoscopic treatment for pancreas divisum with santorinicele as a cause of recurrent pancreatitis, and this was initially confused with drug or infection related pancreatitis.
Abdominal Pain ; Brucellosis ; Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Dilatation ; Humans ; Pancreas ; Pancreatic Ducts ; Pancreatitis ; Rifampin ; Risk Factors

BACKGROUND/AIMS: Large common bile duct (CBD) stones accompanied by risk factors can be difficult to extract using conventional techniques. This study investigates the efficacy of combination therapy using multiple double pigtail stents and ursodeoxycholic acid (UDCA). METHODS: A total of 895 patients underwent the attempted removal of CBD stones. Multiple double pigtail stents (7 Fr or 10 Fr) were inserted into the CBD over a guidewire. The stents remained in place until endoscopic removal during a second attempt. All patients received oral UDCA (600 mg/day) during the follow-up. RESULTS: In 21 patients (2.34%), complete clearance was not achieved by the conventional method. Large, multiple stones, the presence of periampullary diverticulum, stricture of the distal CBD, and severe cardiopulmonary disease were observed as limiting factors for the successful removal of CBD stones. Complete endoscopic clearance was achieved in 12 patients (57.1%), and there was a statistically significant reduction in stone size (mean 4.60+/-2.45 mm, p=0.002). The mean duration of stenting and administration of medicine was 73.9 days. There was no immediate complication related to the procedure. CONCLUSIONS: Our results suggest that combination therapy using pigtail stents and UDCA may be an easy and effective method for removal of difficult CBD stones.
Bile ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Constriction, Pathologic ; Diverticulum ; Follow-Up Studies ; Gallstones ; Humans ; Hypogonadism ; Mitochondrial Diseases ; Ophthalmoplegia ; Risk Factors ; Stents ; Ursodeoxycholic Acid

Biliary stent-related enteric perforations are very rare complications that are caused by the sharp end of a metallic stent, stent migration, or tumor invasion. Moreover, the choledochoduodenal fistula resulting from metallic biliary stent-induced perforation is extremely rare. Here, we report a case in which a spontaneous choledochoduodenal fistula occurred after biliary metallic stent placement in a patient with an Ampulla of Vater carcinoma but was successfully managed by supportive treatments, including nasobiliary drainage. This case might have occurred as the result of a rupture of the bile duct following pressure necrosis and inflammation caused by impacted calculi and food materials over the tumor ingrowth in the uncovered biliary stent.
Ampulla of Vater ; Bile Ducts ; Calculi ; Drainage ; Fistula ; Humans ; Inflammation ; Necrosis ; Rupture ; Stents

PURPOSE: The primary objective of this study was to examine the changes of basal cortisol and DHEA levels present in saliva and serum with age, and to determine the correlation coefficients of steroid concentrations between saliva and serum. The secondary objective was to obtain a standard diurnal rhythm of salivary cortisol and DHEA in the Korean population. MATERIALS AND METHODS: For the first objective, saliva and blood samples were collected between 10 and 11 AM from 359 volunteers ranging from 21 to 69 years old (167 men and 192 women). For the second objective, four saliva samples (post-awakening, 11AM, 4PM, and bedtime) were collected throughout a day from 78 volunteers (42 women and 36 men) ranging from 20 to 40 years old. Cortisol and DHEA levels were measured using a radioimmunoassay (RIA). RESULTS: The morning cortisol and DHEA levels, and the age-related steroid decline patterns were similar in both genders. Serum cortisol levels significantly decreased around forty years of age (p < 0.001, when compared with people in their 20s), and linear regression analysis with age showed a significant declining pattern (slope= -2.29, t= -4.297, p < 0.001). However, salivary cortisol levels did not change significantly with age, but showed a tendency towards decline (slope= -0.0078, t= -0.389, p=0.697). The relative cortisol ratio of serum to saliva was 3.4 - 4.5% and the ratio increased with age (slope=0.051, t=3.61, p < 0.001). DHEA levels also declined with age in saliva (slope= -0.007, t= -3.76, p < 0.001) and serum (slope= -0.197 t= -4.88, p < 0.001). In particular, DHEA levels in saliva and serum did not start to significantly decrease until ages in the 40s, but then decreased significantly further at ages in the 50s (p < 0.001, when compared with the 40s age group) and 60s (p < 0.001, when compared with the 50 age group). The relative DHEA ratio of serum to saliva was similar throughout the ages examined (slop = 0.0016, t = 0.344, p = 0.73). On the other hand, cortisol and DHEA levels in saliva reflected well those in serum (r = 0.59 and 0.86, respectively, p < 0.001). The highest salivary cortisol levels appeared just after awakening (about two fold higher than the 11 AM level), decreased throughout the day, and reached the lowest levels at bedtime (p < 0.001, when compared with PM cortisol levels). The highest salivary DHEA levels also appeared after awakening (about 1.5 fold higher than the 11 AM level) and decreased by 11AM (p < 0.001). DHEA levels did not decrease further until bedtime (p=0.11, when compared with PM DHEA levels). CONCLUSION: This study showed that cortisol and DHEA levels change with age and that the negative slope of DHEA was steeper than that of cortisol in saliva and serum. As the cortisol and DHEA levels in saliva reflected those in serum, the measurement of steroid levels in saliva provide a useful and practical tool to evaluate adrenal functions, which are essential for clinical diagnosis.
Adult ; Age Factors ; Aged ; Analysis of Variance ; *Circadian Rhythm ; Dehydroepiandrosterone/blood/*metabolism ; Female ; Humans ; Hydrocortisone/blood/*metabolism ; Male ; Middle Aged ; Saliva/*metabolism

PURPOSE: The primary objective of this study was to examine the changes of basal cortisol and DHEA levels present in saliva and serum with age, and to determine the correlation coefficients of steroid concentrations between saliva and serum. The secondary objective was to obtain a standard diurnal rhythm of salivary cortisol and DHEA in the Korean population. MATERIALS AND METHODS: For the first objective, saliva and blood samples were collected between 10 and 11 AM from 359 volunteers ranging from 21 to 69 years old (167 men and 192 women). For the second objective, four saliva samples (post-awakening, 11AM, 4PM, and bedtime) were collected throughout a day from 78 volunteers (42 women and 36 men) ranging from 20 to 40 years old. Cortisol and DHEA levels were measured using a radioimmunoassay (RIA). RESULTS: The morning cortisol and DHEA levels, and the age-related steroid decline patterns were similar in both genders. Serum cortisol levels significantly decreased around forty years of age (p < 0.001, when compared with people in their 20s), and linear regression analysis with age showed a significant declining pattern (slope= -2.29, t= -4.297, p < 0.001). However, salivary cortisol levels did not change significantly with age, but showed a tendency towards decline (slope= -0.0078, t= -0.389, p=0.697). The relative cortisol ratio of serum to saliva was 3.4 - 4.5% and the ratio increased with age (slope=0.051, t=3.61, p < 0.001). DHEA levels also declined with age in saliva (slope= -0.007, t= -3.76, p < 0.001) and serum (slope= -0.197 t= -4.88, p < 0.001). In particular, DHEA levels in saliva and serum did not start to significantly decrease until ages in the 40s, but then decreased significantly further at ages in the 50s (p < 0.001, when compared with the 40s age group) and 60s (p < 0.001, when compared with the 50 age group). The relative DHEA ratio of serum to saliva was similar throughout the ages examined (slop = 0.0016, t = 0.344, p = 0.73). On the other hand, cortisol and DHEA levels in saliva reflected well those in serum (r = 0.59 and 0.86, respectively, p < 0.001). The highest salivary cortisol levels appeared just after awakening (about two fold higher than the 11 AM level), decreased throughout the day, and reached the lowest levels at bedtime (p < 0.001, when compared with PM cortisol levels). The highest salivary DHEA levels also appeared after awakening (about 1.5 fold higher than the 11 AM level) and decreased by 11AM (p < 0.001). DHEA levels did not decrease further until bedtime (p=0.11, when compared with PM DHEA levels). CONCLUSION: This study showed that cortisol and DHEA levels change with age and that the negative slope of DHEA was steeper than that of cortisol in saliva and serum. As the cortisol and DHEA levels in saliva reflected those in serum, the measurement of steroid levels in saliva provide a useful and practical tool to evaluate adrenal functions, which are essential for clinical diagnosis.
Adult ; Age Factors ; Aged ; Analysis of Variance ; *Circadian Rhythm ; Dehydroepiandrosterone/blood/*metabolism ; Female ; Humans ; Hydrocortisone/blood/*metabolism ; Male ; Middle Aged ; Saliva/*metabolism