The Effects of Additional Balance Training in Subacute Hemiplegic Stroke Patients

OBJECTIVE: This study investigated the effects of additional balance training using three dimensional balance trainer on dynamic balance, gait symmetry and fall efficacy in subacute hemiplegic stroke patients. METHOD: This study designed pretest-posttest control group. Twenty subacute stroke patients were randomly assigned to an experimental or a control group. All patients had conventional physical therapy. In addition, 10 patients in experimental group was trained with the three dimensional balance trainer (BalPro(R)) for 30 min/day, 5 day/week for 4 weeks. All participants were assessed by: Berg Balance Scale (BBS), Timed Up and Go test (TUG), gait symmetry, and Fall efficacy scale-Korea (FES-K) before and after training. RESULTS: All participants of both group showed statistically significant improvements in dynamic balance, gait symmetry and fall efficacy. More improvements were shown significantly in experimental group than those in control group in BBS, TUG, step length symmetry (p<0.05) and single limb support symmetry (p<0.01). CONCLUSION: Additional balance training with conventional physical therapy is feasible and may be an effective tool to improve dynamic balance and gait symmetry in subacute patients.

Expression of cartilage derived morphogenic protein in pleomorphic adenoma

The bone morphogenic protein(BMP) can promote migration and growth of mesenchymal cells and initiate process for bone and cartilage formation. Cartilage-derived morphogenic protein(CDMP)-1 and -2 belong to the bone morphogenetic protein family in the transforming growth factor(TGF)-beta superfamily. Although pleomorphic adenoma of the salivary glands is an epithelial tumor, it frequently shows ectopic cartilaginous formation with biomolecular studies. The mechanism of pathogenesis in cartilaginous formation is still controversy. We examined the expression and localization of CDMP-1 and -2, in comparison with the localization of cartilaginous matrix proteins, in human normal salivary glands and 20 cases of pleomorphic adenoma using immunohistochemical methods. The results were followed. 1. CMP-1 was immunolocalized in the striated ducts and the intercalated ducts , but not expressed in excretory duct, CDMP-2 was not expressed in the normal salivary glands. 2. CMP-1 was immunolocalized in the ductal cell and cuboidal neoplastic myoepithelial cells around the chondroid areas of the pleomorphic adenomas, whereas these molecules were not localized in the spindle-shaped neoplastic myoepithelial cells of the myxoid element in these tumors. CDMP-2 was expressed neither in normal salivary glands nor in any elements of the pleomorphic adenomas. 3. In transmission electron microscopic view, the tumor cells are composed of modifed myoepithelial cells between hyaline and myxoid stroma. 4. In Immuno-blot analysis, strong overexpression of CDMP-1 was frequently seen in pleomorphic adenomas, but the level of CDMP-2 was expressed minimally in pleomorphic adenoma. From the these results, it should be suggested that undifferentiated neoplastic myoepithelial cells around the chondroid areas expressed CDMP-1 and suggested that this molecule may play a role in the differentiation of neoplastic myoepithelial cells in pleomorphic adenoma, but not CDMP-2.

Gender Differences in Patient-Controlled Epidural Analgesia with Butorphanol and Fentanyl / 대한마취과학회지

BACKGROUND: Differences between sexes in sensitivity to nociceptive stimuli and response to analgesics have been noted in humans and animals. Male rats are more sensitive than female rats to the antinociceptive properties of morphine. Kappa-opioid analgesia is greater in women than in men. The purpose of this study was to evaluate the difference between the sexes in postoperative analgesic responses to patient-controlled epidural analgesia (PCEA) with butorphanol or fentanyl in 0.05% bupivacaine solution. METHODS: After obtaining their consents, 30 men and 30 women, less than 60 years old, undergoing elective gastrectomy under general anesthesia were randomly allocated into four groups of 15; butorphanol-female, butorphanol-male, fentanyl-female and fentanyl-male. An epidural catheter was introduced at the T7-8 or T8-9 interspinous space before the operation. Postoperative analgesia was provided with PCEA with butorphanol 50 microgram/ml or fentanyl 5 microgram/ml in a 0.05% bupivacaine solution. When patients first required analgesics after complete recovery of consciousness from anesthesia, a bolus of 5 ml was initially administered. The PCEA device was set to deliver a bolus of 2 ml, a lockout interval of 10 min and no basal infusion. PCEA consumption, pain intensity using a 10-cm visual analog score (VAS), patient's satisfaction to PCEA and side effects were evaluated at 3, 6, 24, and 48 h after the surgery. RESULTS: Cumulative PCEA consumption with butorphanol was less in the butorphanol-female group than in the butorphanol-male group at 24 and 48 h postoperatively. VAS pain scores and patients' satisfaction to PCEA were not different between the butorphanol-female group and the butorphanol-male group. Cumulative PCEA consumption with fentanyl was less in the fentanyl-male group than in the fentanyl-female group at 6, 24 and 48 h postoperatively. VAS pain scores and patients' satisfaction to PCEA were not different between the fentanyl-female group and the fentanyl-male group. There was no differece in side effects in both butorphanol groups and in both fentanyl groups. CONCLUSION: For postoperative analgesia with PCEA, butorphanol may be better for females than males, and fentanyl may be better in males than in females.

Clinical Evaluation of Low-Flow Enflurane Anesthesia in Infants / 대한마취과학회지

BACKGROUND: The purpose of this study was to evaluate the safety and efficacy of low-flow anesthesia with a semi-closed circle anesthesia system in infants. METHODS: Twenty, ASA physical status 1 or 2, infants were randomly assigned into two groups: high-flow anesthesia (HFA) or low-flow anesthesia (LFA). An identical semi-closed Dr ger circle anesthesia system (Cato) was used to all patients. Initial fresh gas flow (FGF) was N2O 1.5 L/min and O2 1.5 L/min in both groups. This FGF of 3 L/min was maintained in the HFA group. After 10 min of HFA, the FGF was reduced to 500 ml/min (N2O 250 ml/min and O2 250 ml/min) in the LFA group. RESULTS: Hypoxic or hypercarbic gas concentrations were not observed in all patients. Enflurane consumption during LFA was about 1/3 of that during HFA (6.8 +/- 1.3 ml vs. 19.5 +/- 5.8 ml). The mean highest esophageal temperature was similar in both groups. The mean highest inspiratory gas and soda lime temperatures were significantly higher in the LFA group than in the HFA group. CONCLUSIONS: Low-flow anesthesia in a circle system with a fresh gas flow of N2O 250 ml/min and O2 250 ml/min could be performed safely and economically for infants.