EFFECT OF ELECTRICAL STIMULATION ON BONE FORMATION IN THE EXTRACTION SOCKET OF RAT / 대한치주과학회지

On the basis of the evidence that electrical stimulation could promote healing and regeneration of bone, this study was performed to investigate the effects of electrical stimulation on rat extraction socket, and to evaluate the potential of clinical application of electrical stimulation. Forty rats were used and divided into control groups(10)and the experimental groups(30) in this study. The maxillary 1st molar were extracted in both groups. In experimental group, electrical stimulation was given at the current intensity of 1mA(Test-1), 10mA(Test-2), 25mA(Test-3) each day. At 1, 3, 5, 7 days after the tooth extraction, rats in both groups were serially sacrificed. And the specimens were prepared with Hematoxylin-Eosin stain for the light microscopic evaluation. The results of this study were as follows; 1. At 1 day after the extraction, the periodontal ligament was found in the extraction socket wall. The formation of blood clot with dense infiltration of inflammatory cells in control group and there were less inflammatory cells in test group. 2. At 3 day after the extraction, the cells and collagen of the periodontal ligament were so actively proliferated and synthesized that invaded into the connective tissue of the extraction sockets in the control group. There were the formation of new bone in the basal & lateral portion of socket wall in test -2 and -3. 3. At 5 days after the extraction, there were no formation of new bone in control group. But the more electrical stimulation was applied, the more formation of new bone in test group. 4. At 7 days after the extraction, the extraction sockets were almost filled with trabecular bone in each group. Bone maturarity was remarkable in test-3. 5. The electrical stimulation at 10mA and 25mA was more effective in the bone formation at 5 and 7 days after the extraction. From the above results, electrical stimulation could promote the extraction socket wound healing, and be utilized in the clinical application of the residual ridge expansion.

Waveform Effects of Electrical Stimulation on Wound Healing in Rats

OBJECTIVE: To examine the effects of two stimulation waveforms on wound healing in rats. METHOD: 30 Sprague-Dawley rats with a 7-mm diametrical round incision including skin and subcutaneous tissue on the dorsum were divided into three groups. A(n=10) and B groups(n=10) were given rectangular and triangular monophasic pulsed current 1 hr daily until the wound healed completely (duty cycle 10%, absolute spatial current density 0.022 mA/cm2 for A group and 0.011 mA/cm2 for B group), and C group (n=10) received no electrical stimulation. As the indicator of wound healing effect, percentage of reduction in wound area, duration of complete healing and antibacterial effect were evaluated and statistically compared among three groups. RESULTS: The mean values of percentage of reduction in wound area were 75.1+/-3.0% for A group, 74.2+/-5.1% for B group and 68.7+/-5.4% for C group. The mean values of duration of complete healing were 11.1+/-1.3 days for A group, 12.0+/-1.4 days for B group and 16.1+/-1.0 days for C group. The mean antibacterial effect were 0.5+/-0.5 for A group, 0.6+/-0.5 for B group and 2.1+/-0.6 for C group on 2 days post wounding, and 0.4+/-0.5 for A group, 0.5+/-0.5 for B group and 1.4+/-0.7 for C group on 6 days post wounding. Although those for A and B groups were significantly different from those for C group, no significant difference in all values of three indicators existed between A and B groups. CONCLUSION: Results suggest that two stimulation waveforms have no significantly different effects on wound healing in rats.

Physical Parameters of the Elderly

OBJECTIVE: To obtain the mean value of physical parameters of those over 65- years of age. METHODS: Physical parameters including body weight, height, chest circumference, length of upper limb and lower limb, hand power, and range of motion of cervical, thoracic, lumbosacral spines and other major joints were measured in two hundred fourteen elderly subjects. RESULTS: Subjects were divided into three groups according to age (group 1, 65~74 years; group 2, 75~84 years; group 3, above 85 years) and sex (male; female). Descriptive statistical analysis of data provided the following results. 1) Mean measurement in order of group 1-men, group 2-men, group 3-men followed by women of each group: Body weight (kg) - 60.2, 59.6, 54.9, 56.8, 51.6, 47.2; Standing height (cm) - 156.7, 160.8, 156.6, 151.2, 146.9, 142.2; Sitting height (cm) - 99.8, 100.8, 103.1, 100.9, 104.9, 97.0; Chest circumference (cm) - 91.5, 93.5, 91.4, 92.1, 89.5, 86.4; Upper limb length (cm) - 72.3, 72.5, 71.3, 67.1, 66.9, 65.4; Lower limb length (cm) - 82.3, 82.1, 81.4, 77.3, 76.1, 74.6. 2) The hand power of grasping, tip pinch, lateral pinch, palmar pinch showed a decreasing trend in older age group in both sexes. 3) The range of motion of cervical, thoracic, and lumbosacral spine in group 1 had limitation of about 50% compared to normal range. 4) Of the major joints, limitation of motion or deformity was most common in the shoulder and knee joints. CONCLUSION: These data and knowledge of physical parameters of the elderly can aid in design of living environment and assistive devices for elderly.

Validity on the Activity Index in the Functional Assessment of Stroke Patients

OBJECTIVE: The purpose of this study was to determine the validity and the reliability of the Activity Index to ascertain its value in the functional evaluation of stroke patients. METHOD: The Activity Index consists of sixteen variables divided into three main parts(mental capacity, motor activity, and ADL function) with a total value ranging from 16 to 92 points. A group of 96 stroke patients were included in this study. To determine the validity, kappa statistics between the Functional Independence Measure and the Activity Index were measured. RESULTS: In the validity study, the kappa statistics between the Functional Independence Measure and Activity Index were 0.79 and 0.84 for an initial total score and a discharge total score respectively, indicating a reasonable agreement between the two tests. In the reliability study, the Cronbach's alpha coefficient was 0.97 for the total score indicating a good internal consistency. CONCLUSION: The Activity Index demonstrated an acceptable validity and reliability for the evaluation of functional capacity of stroke patients in clinical practice.

Low Back Pain Caused by Discitis of Lumbar in Aplastic Anemia Patient: A case report

No abstract available.

Normal Values of R3 Response of Blink Reflex

OBJECTIVE: To determine the normal data of R3 component of blink reflex in normal adults. METHOD: Subjects included 17 healthy males and 16 healthy females. Five trials of blink reflex were recorded from each side. The shortest latency of R3 response was the shortest among the 5 consecutive trials was selected. RESULTS: Mean onset latency of R3 was 79.8 ms, mean duration 31.0 ms, mean amplitude 399.5 V and a side-to-side difference of latency was 2.3 ms. The amplitude of R3 decreased with age. The latencies and durations of R1 and R2 were not related to those of R3. The amplitude of R2 was correlated with that of R3. CONCLUSION: This data will be useful for the localization of brainstem and cervical spinal cord lesions.

Basic Survey of Low Back Pain during Pregnancy

No abstract available.

Traumatic Knee Contracture after Operation

Traumatic knee contracture is a common complication after an operative procedure. It occurs mainly due to an intraarticular adhesion and results in a significant knee dysfunction and disability. Patients with a contracture have different ways of recovery, however there is no reliable clinical data regarding a recovery to the full range of motion after knee injury. A proper therapeutic plan is needed to the physiatrists during a rehabilitation of the traumatic knee contracture. The purpose of this study was to obtain a clinical insight into the course of recovery to the normal range of motion after a traumatic knee contracture. One hundred and fourty-seven cases of traumatic knee contracture patients who underwent an operative treatment at the Department of Orthopedic Surgery, St. Mary's Hospital between the years of 1992 to 1996, were reviewed. Knee contractures were most frequent in the second and third decades with a traffic accident being the most common cause. A factor that influenced regaining a normal range of motion was the injury type with an earlier recovery in the order of an injury to the meniscus, cruciate ligament, collateral ligament, a complex injury, and a bone fracture. Persistent contracture groups showed a higher incidence of bone fractures around the knee and open surgeries, while there was no discrepancy in sex, age, and operation time. In conclusion, the results of this study are expected to give some insights to clinicians and to help them in treating patients with the traumatic knee contracture after operation.

Assessment of Autonomic Function in Diabetic Patients

Dysfunction of the autonomic nervous system is reported to occur at an incidence of 20% to 40% in diabetes. The clinical symptoms include orthostatic hypotension, vomiting, diarrhea, bladder dysfunction, male impotence, sweating, etc. Two simple noninvasive tests, sympathetic skin response (SSR) and R-R interval variation (RRIV), were used to assess autonomic functions. We performed SSR and RRIV on the diabetic patients and controls. The patients were classified into 4 groups (group I: without peripheral neuropathy or dysautonomia, group II: with dysautonomia only, group III: with peripheral neuropathy only, group IV: with both peripheral neuropathy and dysautonomia). We also tried to correlate their clinical dysautonomic symptoms and the results of nerve conduction studies (NCS) and of SSR and RRIV. The subjects of this study were 82 diabetic patients, 20 to 73 years old with the mean age of 53, and 12 controls. Latency, amplitude, and loss of SSR all showed a significant difference in relation to the dysautonomic symptoms. The loss of SSR in the foot showed a remarkable difference in group I. In groups III and IV, three RRIVs (Valsalva ratio, E:I ratio, 30 : 15 ratio) showed a significant decrease compared with the control group, and in group II, only the 30:15 ratio showed a statistically significant decrease. In conclusion, the changes in SSR and RRIV were significantly associated with the dysautonomia. Among these, loss of SSR in the foot and decrease in the 30 : 15 ratio were useful parameters for early detection of diabetic autonomic neuropathy without peripheral neuropathy.

Management of Cervical Myelopathy in Athetoid Cerebral Palsy: Case report

We present two patients with a cerebral palsy who developed cervical myelopathy long from term involuntary movements. Frequently instability with a premature onset of spondylosis of the cervical spine is found in an athetoid cerebral palsy patient. These structural abnormalities appear to be related to the athetoid motion of neck in a cerebral palsy. The combination of a disk degeneration and listhetic instability with a narrow canal predisposes these patients for the relatively rapid progression to a devastating neurological defect. Early surgical management is a treatment of choice for the cervical myelopathy associated with an athetoid cerebral palsy.

Congenital Insensitivity to Pain with Anhidrosis: Follow-up of 1 case

Congenital insensitivity to pain with anhidrosis (CIPA: a hereditary sensory and autonomic neuropathy, HSAN IV) is a rare disease characterized by the self-mutilation, bone fracture, multiple scars, osteomyelitis, joint deformities and anhidrosis. The pathophysiologic mechanism remains unknown. This is the report of a twelve years old boy who had been diagnosed as the CIPA at his age of five. Loss of unmyelinated and small myelinated nerve fibers have been noted in an abdominal skin biopsy. On follow up studies, no significant changes were noted in the clinical manifestations and in the findings of laboratory, radiologic and electrophysiologic studies when compared to the initial studies except for the minimally progressed neuropathic ankle joints. Long term follow up study including the sequential electrophysiologic examination and biopsy of nerve and muscle might be necessary to establish the natural course of the disease. Prevention of the injury should be emphasized for the good prognosis.

Analysis of Upper Extremity Motion during Drinking Using Virtual Reality Motion Analysis System(VRMAS)

Currently the evaluations of upper extremity motion have relied on a task-oriented approach to gain an accurate clinical picture of the functional capacities. As it is, an adequate and objective system to estimate upper extremity function is yet to be developed. Authors used the virtual reality motion analysis system(VRMAS) which was developed by us for the purpose of investigating the kinematics of upper extremity motion during drinking a cup of water. Four healthy male adult subjects were recruited from the hospital personnels. After each subject sat down on a chair resting against the backrest in a neutral position, in front of a table he was instructed to drink the content of the cup from the table. The data was analized and showed the following results. While drinking, the hand movements were smooth and linear. There were six distinct stages during drinking a cup of water; a reaching for the cup(stage 1), picking up the cup and carrying the cup to the mouth(stage 2), extending neck and drinking from the cup(stage 3), flexing neck(stage 4), replacing the cup to the table(stage 5), and returning to the start position(stage 6). During the stage 1 and 2, of all joint motions, the shoulder adduction and elbow flexion were most prominent. The stage 3 showed the most complex movements in shoulder flexion, forearm pronation, and wrist extension which were simultaneous. Remaining stages were the reversal of the first three stages. We could observe the ranges of motion of neck, shoulder, elbow, and wrist joint as well as the relationships of these joints at the same time. In conclusion, VRMAS could be a very useful evaluation tool for the upper extremity motion and for obtaining the kinematic data from the upper extremity motion analysis.

Findings of Semiquantitative Analysis of 99mTc-HMPAO Brain SPECT in Cerebral Palsy

It is often difficult, on the basis of clinical examination and conventional investigations, to evaluate the functional impairment of brain in children with cerebral palsy in which early detection remains a challenge. This study was designed to know the usefulness of single photon emission tomography(SPECT) of the brain with technetium-99 m hexamethylpropyleneamineoxime (99mTc-HMPAO) as a semiquantitative method of determination of right-left asymmetries in tracer uptake and a change in antero-posterior regional cerebral blood flow(rCBF) distribution. We investigated 33 children with cerebral palsy aged from 4 months to 48 months(mean 19.3 months). The results were as follows: right to left ratio and regional index of a transverse view were useful to quantify the decrease of tracer uptake in left hemiplegia, but not in right hemiplegia who were all mild in severity, and in tetra- and diplegia in which cerebral lesions were found bilaterally; cortico-cerebellar ratios of a sagittal view were found useful to detect a decrease of rCBF distribution in tetra- and diplegia ,which was not distinct by means of right to left ratio and regional index on transverse view. The results suggest that semiquantitative analysis of 99mTc-HMPAO Brain SPECT would be a valuable complementary tool for determination of topographical involvement in cerebral palsy.

Pendulum Test Using Video-Based Two Dimensional Motion Analysis Program

The pendulum test, recognized as a reliable measure of spasticity, has been replaced in this study by a video-based two dimensional motion analysis system. Using twenty five patients with spasticity(21 males, 4 females; mean age 46.6 year-old) in their lower legs due to lesions affecting the central nervous system and twenty two persons without any evidence of hypertonia(all males; mean age 23.4 year-old), five parameters such as relaxation index(RI), amplitude ratio(AR), torque at maximal acceleration velocity, number of swing and swing time were obtained for the purpose of documenting the reliability of the video-based two dimensional motion analysis system for the evaluation of spasticity. The values of RI(P<0.05), AR(P<0.01), and swing time(P<0.05) in patients with spasticity were significantly lower than control, whereas the value of torque in patients was significantly higher than control(P<0.01). Spearman's correlation coefficients of the RI(r=+/-0.70894, P<0.001), AR(r=+/-0.71832, P<0.001), number of swing(r=+/-0.59037, P<0.05) and swing time(r=+/-0.59648, P<0.01) showed a statistically significant negative correlation with the modified Ashworth scale, whereas that of torque(r=0.59037, P<0.01) showed a significant positive correlation. In conclusion, a pendulum test using a video-based two dimensional motion analysis system is a simple, and a reliable method for the quantitative evaluation of spasticity.

Measurement of Intervertebral Foramina on the Plain Radiographs of Patients with Cervical Radiculopathy

In this study, we measured the intervertebral foramina on the plain radiographs of cervical spine of fifty three patients who were over forty-year-old, and with single or multiple unilateral cervical radiculopathies on EMG. In order to determine if the foraminal stenosis on plain radiographs can determine the presense of radiculopathy, four parameters such as vertical diameter, mid-transverse diameter, inferior transverse diameter, and area were measured by a digital caliberator(CD-15C, Mitutoyo, Japan) and an image analyzer(VIDAS 2.0, Kontron, Germany) in 194 foramina of both sides(affected and unaffected groups). Another 80 foramina were also measured as control group in ten age-matched patients who did not show any abnormality on EMG. In control group, C4/5 intervertebral foramen showed maximal values of the parameters among foramina, with vertical diameter of 10.55+/-0.35 mm(mean+/-S.D.), mid-transverse diameter of 6.22+/-0.33 mm, inferior transverse diameter of 5.09+/-0.19 mm and area of 0.77+/-0.05 cm2. The minimal values were noted in C6/7 foramen except those of the vertical diameter which were noted in C4/5 foramen. The mid-transverse diameter and area of C7/T1 intervertebral foramen of affected group were significantly smaller than those of control and unaffected groups(p<0.05). The other values in affected group were also smaller among the groups but they did not reach statistical significance. In conclusion, the mid-transverse diameter and area of intervertebral foramen on plain cervical radiographs are somewhat useful to determine the encroachment of nerve root within the intervertebral foramen, especially in the lower cervical spine, in patients with cervical radiculopathy.

Quantitative Analysis of Isotonic Exercise Using Virtual Reality Motion Analysis System(VRMAS)

Isotonic exercise occurs when the tension or torque generated by a muscle is constant throughout the movement. In practice it is very difficult to maintain the tension constant. Evaluation of isotonic exercise should include the works of concentric and eccentric contraction and the changes in tension and torque during joint motion. However, optimal evaluation tools for isotonic exercise has yet to be developed. We authors, used virtual reality motion analysis system(VRMAS) which was codeveloped by us and EMG system(Cardwell Excel). Healthy male adult subjects(n=10) were recruited from hospital personnel. After dominant upper arm and trunk of each subject was fixed with velcro, he was instructed to repeat flexion and extension of his dominant elbow grasping dumbell (9 kg) in hand with maximal velocity as possible as can until the point of exhaustion. We measured the elbow angle, the angular velocity, torque, power, total work and the work of concentric and eccentric contraction during exercise. The results were as follows: there were four distinct elbow flexor muscle contractions during flexion and extension of the elbow with the first and the second contractions during concentric contraction and the third and the fourth contractions during eccentric contraction. Between the peaks of contraction, motion was maintained due to the momentum that was generated. Of the ten subjects, seven had higher concentric work than eccentric work with the eccentric work being higher in the remaining three. But there was no statistic significance between the works of concentric contraction and eccentric contraction(p>0.05). The biggest work was observed in the fourth contraction, while the third contraction showed the least work(p<.05). In conclusion, there were four distinct muscle contractions during elbow isotonic exercise and the works of each muscle contraction were different. This result is contrary to the definition of isotonic exercise. This study also shows that the VRMAS could be a very useful evaluation tool for several types of isotonic exercise.

Glycogen Storage Disease Type II: A Case Report

Glycogen Storage Disease Type II is caused by the deficiency of acid maltase resulting in lysosomal accumulation of glycogen. There are two major clinical syndromes, a severe generalized and invariable fatal disease of infancy, and a myopathy starting in juvenile or adult life. The clinical and laboratory findings of a patient with Glycogen Storage Disease Type II are presented. The patient, a 17-year-old male, experienced slowly progressive weakness of muscle of the pelvis shoulder girdles and trunk. Muscle biopsy showed vacuolar myopathy and electromyograph showed features of myopathy with fibrillation potentials, positive sharp waves, myotonic discharges, without clinical myotonia at rest, and polyphasic potentials on volition. Clinical features, histopathologic and electrophysiologic findings of this disease and differential diagnosis were reviewed.

Brachial Plexopathy Associated with Thoracoscopic Sympathectomy for Treatment of Primary Hyperhidrosis: A Case Report

Brachial plexus is vulnerable to injury because it is close to shoulder joint of which the range of motion is very large and it is surrounded by many complex structures. Iatrogenic injuries are commonly associated with surgeries such as procedures in the posterior neck or in the shoulder and open thoracotomy, during regional anesthetic blocks, and during other procedures that use needles and cannulas. Radiation therapy can cause brachial plexus injury. A case of brachial plexus injury after thoracoscopic sympathectomy for treatment of primary hyperhidrosis is discussed in this report. Twenty eight years old male patient developed motor and sensory paralysis of Rt. upper extremity shortly after thoracoscopic sympathectomy performed with hyperabduction position of Rt. upper extremity for 2 hours and 30 minutes. Electrodiagno stic study was performed on the 11th day after paralysis. Electrodiagnostic findings from the which was compatible with showed abnormal spontaneous activities at rest and decreased numbers of MUAPs on volition sampled muscles innervated by brachial plexus. The motor power of these muscles was trace or fair grade. On the 14th day after paralysis the patient recoverd the motor power to near nomal on muscle testing. The reason of this complication is not clear, but it might have occurred most likely in association with tension and traction forces applied to patient's brachial plexus while hyperabducting the arm for a long period of time during surgery. In this study we have reviewed perioperative brachial plexus injuries and their possible mechanisms, of injury hoping to decrease the occurrence of perioperative brachial plexus injuries.

Measurement of Thoracolumbar Range of Motion by Motion Analyzer in Low Back Pain: Preliminary Study

Measurement of spinal range of motion(ROM) can be effectively used in guiding the direction of therapy, determining the patient's response to rehabilitation treatment and functional assessment. However for a method of measurement to be commonly used in clinical and research settings, it must be easy to perform, rapid and highly reliable. The purpose of this study was to determine the possibility of clinical application of 2-dimensional motion analysis system to measure spinal ROM in patients with low back pain(LBP). Subjects included 10 healthy males and 10 patients with LBP. Using Electronic Digital Inclinometer (EDI 320) and 2-dimensional motion analysis system, thoracic, lumbar and pelvic ROMs were measured for trunkal flexion, extension, lateral flexion and rotation. Also proportions of decreased ROMs in LBP patients relative to healthy subjects and movement patterns of each spinal segment according to time sequence were investigated. LBP patients compared to normal subjects showed significantly low spinal ROM(P<0.05) except thoracic and pelvic ROM for extension. When looking at the change of each spinal ROM in respect to time with motion analysis system, normal subjects showed synchronized and sigmoid motion curve time from the initiation to the end of motion in all areas of spine during 4 motions. LBP patients took longer time from the initiation to the end of each motion, and showed smaller initial change and fluctuation in spinal ROM during each motion compared to normal subjects. The results of this preliminary study suggest that 2-dimensional motion analysis system can be effectively used for measuring spinal ROM in patients with LBP.

Brain MRI findings in children with developmental motor delay

No abstract available.