Review on Physical Therapy for Patients with Vestibular Disorder

Effort to improve balance ability in the field of rehabilitation has been constantly issued and developed up to now. A variety of subcomponent of postural control including function and cognition should be needed in many body systems and be complicatedly linked to each system. In South Korea, although decreased postural dysfunction due to neurological or musculoskeletal disorders has been well documented, we do not have many experience and knowledge of vestibular rehabilitation for maintain and improve balance function. In the United States, vestibular physical therapy is already acknowledged as clinical subspecialty by American Physical Therapy Association. However, there is no curriculum subject related to vestibular rehabilitation in standard education of physical therapy and no specialist who has clinical experience and knowledge of this realm. Therefore, we reviewed general information and basic knowledge of vestibular rehabilitation such as current state of vestibular disorder in South Korea, pathology, major causes of vestibular dysfunction including peripheral vestibular disorders, vestibular neuritis, benign paroxysmal positional vertigo, and central disorder, evaluation of vestibular dysfunction, and treatment for vestibular dysfunction new approaches. We expect that physical therapist in South Korea recognize clinical significance of vestibular exercise and that clinical concern and research will be begun in near future.

Precommissural Fornix in the Human Brain: A Diffusion Tensor Tractography Study

PURPOSE: Other than a single case report, no diffusion tensor tractography (DTT) studies of the precommissural fornix in the human brain have been conducted. In the current study, we attempted to visualize the precommissural fornix in the human brain using DTT. MATERIALS AND METHODS: We recruited 36 healthy volunteers for this study. Diffusion tensor images were scanned using a 1.5-T scanner, and the precommissural fornix was analyzed using Functional Magnetic Resonance Imaging of the Brain (FMRIB) software. Values of fractional anisotropy (FA), mean diffusivity (MD), and tract volume of the precommissural fornix were measured. RESULTS: The precommissural fornix originated from the hippocampal formation on each hemisphere as a crus; both crura were then joined to the body of the fornix. The body of the fornix continued anteriorly to the level just superior to the anterior commissure, where it divided into each column of the precommissural fornix. Each column descended anteriorly to the anterior commissure and terminated in the septal nuclei. Values of FA, MD, and tract volumes of the precommissural fornix did not differ between the right and left hemispheres (p>0.05). CONCLUSION: We believe that the methodology and results of this study would be helpful to future research on the precommissural fornix and in the elucidation of the pathology of diseases involving the precommissural fornix.

Erratum: Urodynamic Findings in an Awake Chemical Cystitis Rat Model Observed by Simultaneous Registrations of Intravesical and Intraabdominal Pressures / 대한배뇨장애요실금학회지

No abstract available.

Urodynamic Findings in an Awake Chemical Cystitis Rat Model Observed by Simultaneous Registrations of Intravesical and Intraabdominal Pressures / 대한배뇨장애요실금학회지

PURPOSE: The aim of this study was to investigate the effect of urinary bladder inflammation on bladder function in a rat chemical cystitis model. We also histologically confirmed the effects of inflammation in the detrusor on chronically inflamed bladder in rats. MATERIALS AND METHODS: A total of 13 female Sprague-Dawley rats were used in this study. In seven rats, intravesical instillation of HCl induced chemical cystitis, and the other rats with intravesical instillation of saline were used as the sham. After 2 weeks, cystometrograms were obtained with additional intraabdominal pressure measurements in all unanesthetized, unrestrained rats in metabolic cages. The rats were killed just after cystometry. The bladders were removed and examined histologically for mast cells and inflammatory changes. RESULTS: The rats with acute injury by HCl showed no differences in pressure parameters, including basal pressure, threshold pressure, and maximum bladder pressure, compared with the sham rats. They showed significantly increased bladder capacity, micturition volume, residual volume, and micturition interval compared with the sham group. They also showed an increased frequency of detrusor overactivity compared with the sham group. The percent of detrusor overactivity was 56.3% among the total intravesical pressure rises above 2 cmH2O. The histological findings of the rats with acute injury by HCl were consistent with chemical cystitis. CONCLUSIONS: Overlapping patterns of lower urinary tract symptoms and pelvic pain are common disease characteristics among interstitial cystitis patients. The situation in an animal model of interstitial cystitis is similar, as observed in this study by the histologic and awake cystometric examinations. However, the interstitial cystitis model showed detrusor overactivity during the filling phase without a decrease in bladder capacity and micturition intervals, which differs from the characteristics of overactive bladder patients.

Urodynamic Effects of Propiverine on Detrusor Overactivity and Abdominal Straining during Voiding in Awake Rats with Intravesical Prostaglandin E2 Instillation

PURPOSE: We investigated the effect of propiverine on cystometric parameters based on intraabdominal pressure (IAP) in awake rats in an overactive bladder (OAB) model induced by intravesical instillation of prostaglandin E2 (PGE2). MATERIALS AND METHODS: Twenty-two female Sprague-Dawley rats were used. Polyethylene catheters were implanted into the bladder to record the intravesical pressure (IVP) and into the femoral artery to administer medication. A balloon-fitted catheter was positioned in the abdominal cavity to record the IAP. Awake cystometries were performed before and after intraarterial administration of propiverine 1 mg/kg (n=6), intravesical administration of 50microM PGE2 only (n=6), or intravesical PGE2 plus 1 mg/kg (n=4) or 3 mg/kg (n=6) of intraarterial propiverine. Cystometric pressure and volume parameters and variables related to detrusor overactivity (DO) were investigated. RESULTS: Rats administered intravesical PGE2 showed increased pressure parameters and decreased volume parameters comparable to the DO model, which was effectively prevented by propiverine (1 or 3 mg/kg). Typical DO shown during the filling phase was decreased by intraarterial propiverine (3 mg/kg) injection. After propiverine (3 mg/kg) injection, IAP was increased at the time of micturition pressure with or without threshold pressure (p<0.05, p<0.01) depending on the dose administered. CONCLUSIONS: Propiverine improved pressure- and volume-related parameters in an OAB model. Furthermore, it also decreased the frequency of DO. However, higher concentrations of propiverine induced straining voiding.

Application and Limitations of Awake Cystometry in Sprague-Dawley Rats with Partial Bladder Outlet Obstruction as a Model of Overactive Bladder or Obstruction

PURPOSE: Partial bladder outlet obstruction (PBOO) in rats leads to changes in bladder function, such as obstruction and detrusor overactivity (DO). The aim of our study was to observe factors essential for the objective descriptions of PBOO rats as an overactive bladder model as well as an obstruction model under awake cystometry. We also aimed to investigate the urodynamic effects of PBOO objectively in view of DO-related parameters as well as conventional pressure and volume-related parameters. MATERIALS AND METHODS: PBOO was produced in 10 female Sprague-Dawley rats by ligating the proximal urethra over a 0.9 mm metal rod; 10 sham-operated rats were used as controls. Intravesical pressure (IVP) was recorded via an open catheter in the bladder, and intraabdominal pressure (IAP) via an intraabdominal balloon catheter. Continuous cystometry was performed 2 weeks after the PBOO procedure. Conventional and newly developed DO-related urodynamic parameters were investigated. RESULTS: PBOO led to a significant increase in bladder weight. Three rats showed the picture of decompensated bladder and were excluded from the analysis. The obstructed group showed some increased pressure- and volume-related parameters. They showed a DO frequency of 1.5+/-0.3/min, but the sham group did not. CONCLUSIONS: Our results showed that bladder decompensation can happen after PBOO, and we need to describe those exclusions accurately in reports. In conscious PBOO rats, simultaneous registration of IAP and IVP is needed for accurate investigations of DO, because PBOO can lead to DO as well as bladder hypertrophy.

A Case of Skin and Soft Tissue Infection Caused by Mycobacterium abscessus

Mycobacterium abscessus (M. abscessus) is an acid-fast bacillus that's classified as a pathogenic "rapid growing" nontuberculous mycobacteria. It is an uncommon cause of human disease, but it can cause skin and soft tissue infection after skin injury following inoculation, minor trauma and surgery. The single most important factor for determining the course and prognosis of a M. abscessus infection is the underlying immune status of the host. We report here on a 71-year-old female who presented with multiple painful erythematous cutaneous nodules on her left forearm. She had diabetes mellitus and had taken oral steroid by herself for two years because of her osteoarthritis. Histologically, granulomas and inflammatory cell infiltration were observed and M. abscessus was identified via the mycobacterial culture. We performed curettage and drainage, followed by 6 months of oral clarithromycin and the patient's disease completely healed.

The Effect of tolterodine Via Oral and Intravenous Administrations on Voiding in Awake Spontaneously Hypertensive Rats as an Overactive Bladder Model

PURPOSE: We investigated the effect of oral or intravenous tolterodine on cystometric parameters in awake spontaneously hypertensive rats (SHRs) as a model of overactive bladder (OAB). The aim of our study was to observe the experimental conditions required to reproduce the clinical pharmacological effects of tolterodine, as seen in humans, to decrease bladder pressure or increase bladder capacity. MATERIALS AND METHODS: We studied the effects of the most widely used antimuscarinic drug, tolterodine, on cystometric parameters via two different administrations (oral and intravenous) in awake SHRs. RESULTS: Oral administration of tolterodine 10 mg/kg(-1) body weight in awake rats did not change any cystometric parameters significantly. Intravenous administration of tolterodine 0.3 mg/kg(-1) body weight significantly decreased basal pressure (BP) and micturition pressure (MP), but showed no effect on micturition interval (MI) or bladder capacity (BC). CONCLUSION: Despite a high dose of tolterodine via an oral or an intravenous route, a decrease in BP or MP was the only effect on cystometrographic parameters in awake rats, whereas MI and BC were not significantly affected. Therefore, it is difficult to reproduce in awake rats as an acute response the cystometric increase in the MI that is observed in humans after chronic administration of antimuscarinic agents.

The Significance of Periurethral Fibrosis and the Change of Nitric Oxide Synthase Containing Nerves in the Urethra of Diabetic Rats / 대한비뇨기과학회지

PURPOSE: We have previously demonstrated that increased urethral resistance was more prominent in diabetic rats than in controls. This may result from a compressive obstruction such as damage of the urethral nerve containing nitric oxide. Another possible cause for urethral obstruction could be a constrictive obstruction such as a periurethral fibrosis. In the present study, we investigated the changes in the expression of nitric oxide synthase(NOS) isoforms(compressive obstruction) and collagen subtypes (constrictive obstruction) in the urethral tissues of non-insulin dependent diabetic rats. MATERIALS AND METHODS: Thirty-six male Sprague-Dawley rats(18 diabetic rats and 18 control rats), bred from birth, were included in this study. Diabetes mellitus was induced by intraperitoneal administration of streptozotocin(90mg/kg) on the second day after birth. Urethral tissues were harvested at 12, 24 and 36 weeks after induction of diabetes and were stained for neuronal NOS(nNOS) and Masson trichrome. We also performed reverse transcriptase-polymerase chain reaction or Western blot analysis to evaluate mRNA or protein expression of NOS isoforms and collagen subtypes in the urethral tissues. RESULTS: Immunohistochemical staining and Western blot analysis of nNOS revealed that the immunoreactivity and nNOS expression in the urethra was lower in the diabetic rats than in the controls. The Masson trichrome staining showed that there was urethral fibrosis in the diabetic rats. The mRNA or protein expression of collagen subtypes, especially type I collagen, were higher in the diabetic rat urethra than in the controls. CONCLUSIONS: These data suggest that the increased urethral resistance in diabetic rats may be attributable to a decrease in the urethral nNOS expression and an increase in collagen content. Urethral dysfunction as well as a cystopathy may play an important role in the pathogenesis of diabetes- induced voiding dysfunction. (Korean J Urol 2007;48:1050-1057)

A Case of Black Hairy Tongue / 대한피부과학회지

Black hairy tongue occurs on the dorsum of the tongue, and is characterised by a black, yellowish, or brown plaque with hairlike structures which result from benign hyperkeratosis of the filiform papillae. It may be associated with several conditions such as smoking, oral antibiotics or candida infection. However, the definite etiology is unknown. We report a case of black hairy tongue without any associated condition.

A Case of Basal Cell Carcinoma Treated with Combination of CO2 Laser and 5% Imiquimod Cream / 대한피부과학회지

Basal cell carcinoma is the most common skin cancer and surgical treatments like Mohs surgery have been accepted as ideal for it. Although surgical treatments are very effective, non-invasive treatments such as electrocauterization, cryosurgery, CO2 laser and topical 5-fluorouracil cream have been tried because patients need more simple procedures and better cosmetic results. Imiquimod is a Toll-like receptor 7 agonist and which acts as an immune response modifier by inducing several cytokines including interferon. Previously, many reports showed the usefulness of 5% imiquimod cream in treating basal cell carcinoma. However, some local adverse effects, long treatment time and limitation of deep penetration are problems to be resolved. We tried 5% imiquimod cream application after the removal of a visible basal cell carcinoma using CO2 laser, which gave satisfactory results.

Clinical Features of Chilblain in Korean Soldiers / 대한피부과학회지

BACKGROUND: Chilblain or pernio is a cold-induced, inflammatory skin problem which occurs usually on acral areas bilaterally. Because chilblain commonly develops in cold, damp climates, many soldiers may experience occupational chilblain during military service in Korea. OBJECTIVE: The purpose of this study is to analyze the clinical characteristics of chilblain in Korean soldiers. METHODS: We reviewed the clinical findings in 199 patients with chilblain who visited the department of dermatology, Armed Forces Capital Hospital during the 5-year period from 2002 to 2007. We investigated the epidemiology, aggravation factors, duration of the disease, clinical manifestations and treatment. RESULTS: The results were as follows; The average age was 21.51+/-1.86 years old. The chilblain usually developed during winter and the duration of symptoms ranged from 1 day to 4 years. All patients developed skin lesions on acral areas. Erythematous skin lesions were observed in 133 patients and purpuric lesions were seen in 56 patients. The lesions were symmetrical in 171 patients 43 patients had history of recurrence. Treatment includes nifedipine and pentoxyfilline. The supportive treatment includes rest and keeping warm, topical corticosteroids or antibiotics and oral antihistamine, analgesics, or antibiotics. CONCLUSION: This investigation is expected to help understand and obtain more information on chilblain.

A Clinical Study of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis over the Last Five-year Period in the Gwangju-Chonnam Area / 대한피부과학회지

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous reactions which are most frequently caused by drugs. The incidence of SJS and TEN is known to be relatively low, however the outcomes may be fatal. OBJECTIVES: To investigate the clinical feature and outcome of 32 patients diagnosed with SJS and TEN. METHODS: Thirty two patients (17 males, 15 females, mean age 50.8 years) with SJS and TEN, diagnosed at the Department of Dermatology, Chonnam National University Hospital from January 2001 to December 2005, were retrospectively evaluated. RESULTS: Thirty two patients were clinically classified with SJS (n=15, 46.9%), overlap SJS/TEN (n=3, 9.4%) and TEN (n=14, 43.7%). Non-steroidal anti-inflammatory drugs (NSAIDs) were most commonly suspected as the causative drug in this series. All patients had involvement of the mucosa, except two. More than two sites were affected in 68.8 percent of cases. Nineteen patients (59.4%) showed abnormal liver function and three patients (9.4%) showed abnormal renal function. Five patients (15.6%) showed leukocytopenia and twenty four patients showed increased lactate dehydrogenase activity. Complications, mainly in the TEN group, included pneumonia, toxic hepatitis, wound infection, septicemia and multiorgan failure. Two patients died from septicemia and multiorgan failure. CONCLUSION: The mortality from SJS and TEN has been quoted as being about 5% and 30%, respectively. However, the mortality in our study was relatively low (SJS 0%, TEN 14.3%). Early intensive treatment is important for reducing the mortality rate in SJS/TEN.

Corticospinal Tract Compression by Hematoma in a Patient with Intracerebral Hemorrhage: A Diffusion Tensor Tractography and Functional MRI Study

The purpose of this study was to demonstrate corticospinal tract compression that was due to a hematoma by using diffusion tensor tractography (DTT) and functional MRI (fMRI) in a patient with an intracerebral hemorrhage (ICH). A 23-year-old right-handed woman presented with severe paralysis of her right extremities at the onset of a spontaneous ICH. Over the first three days from onset, the motor function of the affected upper and lower extremities rapidly recovered to the extent that she was able to overcome applied resistance to the affected limbs, and her limbs regained normal function 3 weeks after onset. The tract of the right hemisphere originated from the primary sensori-motor cortex (SM1) and it passed through the known corticospinal tract pathway. However, the tract of the left hemisphere was similar to that of the right hemisphere except that it was displaced to the antero-medial side by the hematoma at the cerebral peduncle. Only the contralateral SM1 area centered on the precentral knob was activated during affected (right) or unaffected (left) hand movements, respectively. In conclusion, fMRI and DTT demonstrated a corticospinal tract compression due to hematoma in this patient. We conclude that the combined use of these two modalities appears to improve the accuracy of investigating the state of the corticospinal tract.

Expression of Protoporphyrin IX by Methyl 5-aminolevulinate in Various Dermatologic Diseases and Cells / 대한피부과학회지

BACKGROUND: 5-aminolevulinic acid (ALA), is the precursor of heme biosynthesis and used in photodynamic therapy (PDT). When applied exogenously, it is converted to protoporphyrin IX (PpIX) that is an immediate photosensitizer. PpIX is accumulated selectively in various cells including tumor cells. Because most of photosensitizers emit fluorescence of a specific wavelength, it is very important to identify the fluorescence in the tissues and cells targeted for therapy. OBJECTIVE: This study was undertaken to identify the presence of PpIX fluorescence image and localization in various dermatologic diseases with methyl 5-aminolevulinate (MAL), that satisfactorily penetrates cutaneous lipid layers and cell membranes. METHODS: Various skin diseases such as basal cell carcinoma (6), squamous cell carcinoma (4), keratoacanthoma (6), malignant melanoma (3), extramammary Paget's disease (4), verruca (5), psoriasis vulgaris (5), rosacea (2), and acne (5) were included. We applied MAL, ALA ester, ointment to cutaneous lesions and perilesional area for at least 3 hours. After that, we identified the fluorescence image with Wood's lamp (wavelength 320~400 nm) and photographed fluorescence image. Also, we performed skin biopsies of fluorescence site and investigated the PpIX fluorescent location with a fluorescence microscope. In addition, we treated three cultured cell lines (HaCaT cells, human dermal fibroblasts, A431 cells) with MAL and investigated PpIX fluorescence. RESULTS: The PpIX fluorescence images were observed significantly in basal cell carcinoma, squamous cell carcinoma, extramammary Paget's disease, keratoacanthoma, psoriasis, rosacea, and acne. In tissues, PpIX fluorescence was expressed mainly in the pilosebaceous unit, abnormal keratinocytes, tumor cells including basal cell carcinoma, and extramammary Paget's disease. In addition, PpIX was expressed in the cytoplasm of HaCaT cells, human dermal fibroblasts, and A431 cells in vitro. CONCLUSION: In applieation of photodynamic therapy, this study is expected to be helpful in enhancement of therapeutic effectiveness and increase of indications of diseases.

Evidence of Cortical Reorganization in a Monoparetic Patient with Cerebral Palsy Detected by Combined Functional MRI and TMS / 영남의대학술지

The motor recovery mechanism of a 21-year-old male monoparetic patient with cerebral palsy, who had complained of a mild weakness on his right hand since infancy, was examined using functional Magnetic Resonance Imaging (fMRI) and Transcranial Magnetic Stimulation (TMS). The patient showed mild motor impairment on the right hand. MRI located the main lesion on the left precentral knob of the brain. fMRI was performed on this patient as well as 8 control subjects using the Blood Oxygen Level Dependent technique at 1.5 T with a standard head coil. The motor activation task consisted of finger flexion- extension exercises at 1 Hz cycles. TMS was carried out using a round coil. The anterior portion of the coil was applied tangentially to the scalp at a 1.0 cm separation. Magnetic stimulation was carried out with the maximal output. The Motor Evoked Potentials (MEPs) from both Abductor Pollicis Brevis muscles (APB) were obtained simultaneously. fMRI revealed that the unaffected (right) primary sensori-motor cortex (SM1), which was centered on precentral knob, was activated by the hand movements of the control subjects as well as by the unaffected (left) hand movements of the patient. However, the affected (right) hand movements of the patient activated the medial portion of the injured precentral knob of the left SM1. The optimal scalp site for the affected (right) APB was located at 1 cm medial to that of the unaffected (left) APB. When the optimal scalp site was stimulated, the MEP characteristics from the affected (right) APB showed a delayed latency, lower amplitude, and a distorted figure compared with that of the unaffected (left) APB. Therefore, the motor function of the affected (right) hand was shown to be reorganized in the medial portion of the injured precentral knob.

Motor Recovery in Stroke Patients / 영남의대학술지

Stroke is a leading cause of chronic physical disability. The recent randomized controlled trials have that motor function of chronic stroke survivors could be improved through physical or pharmacologic intervention in the stroke rehabilitation setting. In addition, several functional neuroimaging techniques have recently developed, it is available to study the functional topography of sensorimotor area of the brain. However, the mechanisms involved in motor recovery after stroke, are still poorly understood. Four motor recovery mechanisms have been suggested, such as reorganization into areas adjacent to the injured primary motor cortex (M1), unmasking of the motor pathway from the unaffected motor cortex to the affected hand, attribution of secondary motor areas, and recovery of the damaged contralateral corticospinal tract. Understanding the motor recovery mechanisms would provide neurorehabilitation specialists with more information to allow for precise prognosis and therapeutic strategies based on the scientific evidence; this may help promote recovery of motor function. This review introduces several methodologies for neuroimaging techniques and discusses theoretical issues that impact interpretation of functional imaging studies of motor recovery after stroke. Perspectives, for future research are presented.