Prevalence of Fructose Malabsorption in Patients With Irritable Bowel Syndrome After Excluding Small Intestinal Bacterial Overgrowth

BACKGROUND/AIMS: Fructose malabsorption (FM) mimics symptoms of irritable bowel syndrome (IBS), and its prevalence has increased. Diagnosing FM in IBS is challenging because of its overlap with small intestinal bacterial overgrowth (SIBO). We assessed the prevalence of FM by comparing patients with IBS with asymptomatic control individuals after excluding SIBO using the glucose hydrogen breath test (HBT). METHODS: Patients diagnosed with IBS and asymptomatic control individuals were enrolled prospectively. Dietary habits were assessed with the Food Frequency Questionnaire. After excluding SIBO, participants underwent HBTs with both 15 g and 25 g of fructose. RESULTS: Thirty-five patients with IBS and 35 age- and sex-matched asymptomatic control individuals were enrolled. The 15-g fructose HBT yielded positive results in 7 of the 35 (20.0%) patients with IBS and in 2 of 35 (5.7%) controls (P = 0.070). The 25-g fructose HBT was positive in 16 of the 35 (45.7%) patients with IBS and in 8 of the 35 (22.9%) controls (P = 0.040). Analysis of the Food Frequency Questionnaire responses showed no significant differences between the 2 groups in dietary intake, although patients with IBS showed a significantly higher mean fiber intake than controls (21.24 ± 11.35 g vs 15.87 ± 7.07 g, respectively, P = 0.040). CONCLUSIONS: The 25-g fructose HBT identified FM in a significantly higher percentage of SIBO-negative patients with IBS than in asymptomatic control individuals, suggesting that FM may correlate with IBS. Education regarding dietary control of foods containing fructose may be useful for the management of patients with IBS.

Predictors of Resilience in Adolescents with Cancer

PURPOSE: The purpose of this study was to identify the predictors influencing on resilience in adolescents with cancer. METHODS: The participants consisted of 107 parents and 107 adolescents who aged ten and eighteen diagnosed with cancer more than six months and currently receiving outpatient treatment or further management after off-therapy. Data was collected using self-report questionnaires and analyzed by descriptive statistics, t-test, ANOVA, Pearson's correlation, and multiple regression. RESULTS: Resilience was significantly different by religion (t=2.472, p=.045) and number of cancer treatment regimens (F=3.155, p=.047). Family problem-solving communication was also significant by number of cancer treatment regimens (F=3.582, p=.031). The higher social support showed the stronger family hardiness and the better family problem-solving communication. In addition, a positive relationship was found between Family Hardiness Index (FHI) (r=.193, p=.046), Family Problem Solving Communication (FPSC) (r=.226, p=.019) and resilience of adolescents with cancer. FPSC (beta=.356, p=.045) and religion (beta=.441, p=.002) were predictive factors at ages 10-12, FHI (beta=.509, p=.029) and FPSC (beta=.503, p=.037) were predictive factors at ages 13-15 on resilience of adolescents with cancer that explained 16.0% and 24.3% respectively. CONCLUSION: The findings suggest that nursing interventions should focus on enhancing family resilience and resilience of adolescents with cancer.

Action Mechanism of Chamaecyparis obtusa Oil on Hair Growth

This study was carried out to examine the action mechanism of Chamaecyparis obtusa oil (CO) on hair growth in C57BL/6 mice. For alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (gamma-GT) activities in the skin tissue, at week 4, the 3% minoxidil (MXD) and 3% CO treatment groups showed an ALP activity that was significantly higher by 85% (p < 0.001) and 48% (p < 0.05) and an gamma-GT activity that was significantly higher by 294% (p < 0.01) and 254% (p < 0.05) respectively, as compared to the saline (SA) treatment group. For insulin-like growth factor-1 (IGF-1) mRNA expression in the skin tissue, at week 4, the MXD and CO groups showed a significantly higher expression by 204% (p < 0.05) and 426% (p < 0.01) respectively, as compared to the SA group. At week 4, vascular endothelial growth factor (VEGF) expression in the MXD and CO groups showed a significantly higher expression by 74% and 96% (p < 0.05) respectively, however, epidermal growth factor (EGF) expression in the MXD and CO groups showed a significantly lower expression by 66% and 61% (p < 0.05) respectively, as compared to the SA group. Stem cell factor (SCF) expression in the MXD and CO groups was observed by immunohistochemistry as significant in a part of the bulge around the hair follicle and in a part of the basal layer of the epidermis. Taking all the results together, on the basis of effects on ALP and gamma-GT activity, and the expression of IGF-1, VEGF and SCF, which are related to the promotion of hair growth, it can be concluded that CO induced a proliferation and division of hair follicle cells and maintained the anagen phase. Because EGF expression was decreased significantly, CO could delay the transition to the catagen phase.

Nutritional Status and Dietary Change after Gastrectomy of Gastric Cancer Patients / 대한지역사회영양학회지

The purpose of this survey is to investigate the nutritional status and dietary intake of gastrectomized cancer patients in Asan Medical Center. The subjects were 98 patients, who underwent a gastrectomy due to gastric cancer and were admitted to the General Surgery Department during March 2007 to December 2007. We examined general characteristics (sex, age, clinicopathological stage, type of operation), anthropometric data (height, weight change), biochemical data (red blood cell RBC, hemoglobin HGB, hematocrit HCT, mean corpuscular volume MCV, total lymphocyte count TLC, albumin, total cholesterol), dietary intake and dietary intake related symptoms. Weight loss of gastrectomized patients was 9.0 +/- 4.3% from preillness weight to visiting out-patient department (OPD) weight. Biochemical data (RBC, HGB, HCT, MCV, TLC, albumin, total cholesterol) significantly deteriorated after gastrectomy. However, outpatient visits were all restored to the normal range. Postoperative energy intake was 785.0 +/- 164.2 kcal, which corresponds to 41.6 +/- 9.6% of daily energy requirement. The cause of poor oral intake is mostly fear, abdominal pain and abdominal discomfort. Therefore, to control pre-or post-operative weight change in the future requires, focusing on the body weight to maintain a normal or usual nutrition by interventions and increased caloric intake during hospitalization for the development of nutrient-dense meals. In addition, as the main reason of the lack of intake of meals after the gastrectomy was fear, the patients should be actively encouraged to consider the importance of eating proper meals.

Neuromuscular Electrical Stimulation Therapy for Dysphagia Caused by Wilson's Disease

Wilson's disease is an autosomal recessive disorder of abnormal copper metabolism. Although dysphagia is a common complaint of patients with Wilson's disease and pneumonia is an important cause of death in these patients, management of swallowing function has rarely been reported in the context of Wilson's disease. Hence, we report a case of Wilson's disease presenting with dysphagia. A 33-year-old man visited our hospital with a complaint of difficulty in swallowing, since about last 7 years and which had worsened since the last 2-3 months. He was diagnosed with Wilson's disease about 13 years ago. On the initial VFSS, reduced hyoid bone movement, impaired epiglottic movement and moderate amount of residue in the valleculae during the pharyngeal phase were noted. After 10 sessions of neuromuscular electrical stimulation for 1 hour per day, decreased amount of residue was observed in the valleculae during the pharyngeal phase on the follow-up VFSS.

Neuromuscular Electrical Stimulation Therapy for Dysphagia Caused by Wilson's Disease

Wilson's disease is an autosomal recessive disorder of abnormal copper metabolism. Although dysphagia is a common complaint of patients with Wilson's disease and pneumonia is an important cause of death in these patients, management of swallowing function has rarely been reported in the context of Wilson's disease. Hence, we report a case of Wilson's disease presenting with dysphagia. A 33-year-old man visited our hospital with a complaint of difficulty in swallowing, since about last 7 years and which had worsened since the last 2-3 months. He was diagnosed with Wilson's disease about 13 years ago. On the initial VFSS, reduced hyoid bone movement, impaired epiglottic movement and moderate amount of residue in the valleculae during the pharyngeal phase were noted. After 10 sessions of neuromuscular electrical stimulation for 1 hour per day, decreased amount of residue was observed in the valleculae during the pharyngeal phase on the follow-up VFSS.

Effect of Tracheostomy Tube on Swallowing in Patients with Stroke

OBJECTIVE: To investigate the characteristics and severity of swallowing difficulties among stroke patients with a tracheostomy tube, compared to those without. METHOD: A retrospective study was performed on two groups of 17 stroke patients with a tracheostomy tube (58.8 years) and without a tracheostomy tube (69.8 years) fed by Levine tube or a gastrostomy tube. There were no differences in the FIM (functional independence measure) score and brain lesions between the two groups. We evaluated the functional dysphagia scale (FDS) and aspiration; classified before, during, and after swallowing aspiration and silent aspiration. The swallowing task consisted of 2 ml of fluid and a videofluoroscopic swallowing study. RESULTS: There were no significant differences between the oral preparatory, oral and pharyngeal phase for the two groups in FDS. However, frequency of silent aspiration (p=0.007) and the total frequency of aspiration (p=0.038) were significantly higher in patients with tracheostomy. CONCLUSION: Patients with stroke who underwent tracheostomy showed no meaningful difference in FDS. However, there were significant differences in terms of silent aspiration and the total frequency of aspiration; caused by laryngopharyngeal desensitization and the anterior tethering effect on the tracheostomy tube. We have to pay more attention to the treatment and care of patients with tracheostomy tubes.

Endoscopic Balloon Dilatation for the Treatment of Cricopharyngeal Dysfunction with Dysphagia

Primary cricopharyngeal dysfunction is a rare, idiopathic, functional disorder of the upper esophageal sphincter (UES) characterized by dysphagia, frequent aspiration, and functional narrowing at the level of UES. It is caused by failure or partial relaxation of the sphincter, lack of pharyngoesophageal coordination, or reduced compliance of the muscular of the UES. We saw a 62-year-old man who presented with dysphagia and UES narrowing on videofluoroscopy swallowing study (VFSS). Physical, neurologic, and laboratory evaluations revealed no abnormal findings. Radiologic evaluation looking for any abnormalities that might provoke dysphagia was within normal limits. VFSS showed laryngeal aspiration, residue in vallecular and pyriform sinuses, and cricopharyngeal narrowing. Balloon catheter dilatation under endoscopic guidance was performed twice, after which, the dysphagia improved. Here, we describe the results of treatment with balloon dilatation in a patient with primary cricopharyngeal dysfunction.

A Clinical Study of 263 Patients with Childhood Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo is an acquired pigmentary disorder and half of these patients experience disease onset during childhood. The psychosocial complications of vitiligo can be substantial, and especially for children. There has been no study that has compared the clinical features according to the symmetry of the vitiligo lesions of patients with childhood vitiligo. OBJECTIVE: The purpose of this study is to evaluate the clinical aspects and distribution of the vitiligo lesions according to the symmetry in patients with childhood vitiligo. METHODS: The clinical characteristics and distribution of the vitiligo lesions according to the symmetry were investigated in the 263 childhood patients who were diagnosed with vitiligo at the Dermatology Department of our University Hospital from January 1991 to August 2008. RESULTS: Of the 263 patients, 133 (50.6%) had the asymmetric vitiligo lesions, 76 (28.9%) had the symmetric lesions and 54 (20.5%) had the multiple lesions. Of the patients with asymmetric vitiligo lesions, 91 (34.6%) had the localized lesions and 42 (16.0%) had the segmental lesions. The most common site of the vitiligo lesions was the face (54.8%). In case of the vitiligo lesions on the scalp, face and neck, the asymmetric type was predominant. The lesions on the scalp and the face showed a lesser tendency to spread to other sites. CONCLUSION: Childhood vitiligo showed the higher prevalence of asymmetric vitiligo lesions. It is expected that the asymmetric type of childhood vitiligo, and especially that on the scalp and the face, may have a favorable clinical course.

Total Surface Bearing Socket for a Transtibial Prosthesis: Preference, Satisfaction, and Clinical Implications

OBJECTIVE: To evaluate the preference of transtibial amputees for the total surface bearing (TSB) socket versus the patellar tendon bearing (PTB) socket, to examine the reasons for their preferences and to determine the clinical indications of each socket. METHOD: We investigated fifty five subjects who could walk with the TSB silicon liner socket and had already used the PTB socket with supracondylar suspension. The subjects responded to a questionnaire of the 19 items. RESULTS: 67.3% (37/55) of the subjects preferred the TSB silicon liner socket over the PTB socket. More than 60% of the respondents regarded the wearing, appearance, donning & doffing, weight and noise positively. However, knee flexion, walking on an uneven surface, amount of perspiration, heating and odor were regarded negatively by more than 50% of respondents. When we compared the satisfaction scores of 37 respondents who preferred TSB socket and 18 respondents who did not, the two groups showed significant differences in the level of satisfaction for wearing appearance, walking, pistoning, donning & doffing, adaptation, perspiration, heating, odor, skin disorder, stump pain, tightening feeling, and noise (p<0.05). CONCLUSION: The TSB silicon liner socket was preferred by many transtibial amputee patients. TSB silicon liner socket showed positive effects on comfort, donning & doffing and cosmesis. Also it improved prosthetic suspension as a decrease in pistoning compared to the PTB socket with supracondylar suspension. However the TSB silicon liner socket has some problems such as causing excessive perspiration, heating and odor etc.

Quality of Life of Alopecia Areata Patients / 대한피부과학회지

BACKGROUND: Hair constitutes an integral part of our self and our self-identity, which is why hair loss may cause a broad range of psychological problems related to our identity. However, the association between quality of life (QOL) in alopecia areata (AA) patients and their clinical characteristics has not yet been investigated in Korea. OBJECTIVE: The purpose of this study is to compare the QOL in patients with AA and healthy controls by using Hairdex scale. The relationship between their QOL and their clinical characteristics will be investigated. METHODS: 102 AA patients and 82 healthy controls were recruited in this study and compared by use of Hairdex. Correlation analysis was performed to examine the relationship between the QOL and the clinical characteristics of patients with AA. RESULTS: The total Hairdex scores and all domain scores, except those of the symptomatic domain, of the Hairdex scales in AA were higher than those of the healthy controls. Clinical characteristics, including the age, disease duration, AA type, AA area, treatment satisfaction, treatment history, anxiety and depression, showed significant correlation with QOL. Of these characteristics, the depression and treatment satisfaction showed strong association with QOL. CONCLUSION: AA can a impair patient's quality of life and has a significant psychological impact.

The Clinical Significance of Symmetry in the Distribution of Vitiligo Lesions / 대한피부과학회지

BACKGROUND: Vitiligo is an acquired disease that causes depigmented patches of various sizes. The most widely used method of classification is by the distribution, which is categorized into four types: localized, segmental, universal, and generalized vitiligo. In addition, vitiligo can be divided into segmental and non-segmental, according to its relation to dermatomes. However, few studies have compared the clinical features and prognosis with the symmetry of the vitiligo lesions. OBJECTIVE: We examined 690 vitiligo patients to investigate the clinical significance of symmetry in the distribution of vitiligo lesions. METHODS: The clinical characteristics, distribution, and lesion sizes were investigated in 690 patients who were diagnosed with vitilgo at the Dermatology Department of Chungnam National University Hospital from January 1991 to August 2006. RESULTS: Of the 690 vitiligo patients, 369 (53.3%) had symmetric vitiligo lesions and 321 (46.5%) had asymmetric lesions. Patients with symmetric lesions had an older age of onset, longer duration of disease, wider distribution area, and greater tendency of the lesions to enlarge with time. CONCLUSION: Our clinical classification method, based on the the symmetry of the vitiligo lesions, may help physicians to predict the course and prognosis of the disease. Therefore, the dissemination of new vitiligo lesions in symmetric vitiligo patients should be observed closely.

The Efficacy of Autologous Epidermal Grafting Based on Clinical Types for the Treatment of 320 Stable Vitiligo Lesions / 대한피부과학회지

BACKGROUND: Autologous epidermal grafting was reported by several authors to be successfully used for the treatment of stable vitiligo lesions. However, there have been only a few studies with a sufficient number of cases and long-term follow up. OBJECTIVE: The purpose of this study was to evaluate the long-term efficacy of autologous epidermal grafting for the treatment of stable vitiligo lesions. METHODS: We evaluated 187 patients (320 lesions) after autologous epidermal graftings using suction blistered epidermis. The effects were analyzed based on age, sex, clinical types, recipient sites, the ablative methods for recipient sites and the time after the operation. RESULTS: Autologous epidermal grafting was more effective for younger patients, for asymmetrical types and when the recipient sites were the head and neck. Pigment production increase until about 3 years after the operation was also found for patients who were evaluated regularly for more than 3 years. CONCLUSION: Autologous epidermal grafting is a safe, effective treatment modality for stable vitiligo. In order to determine the long-term efficacy of epidermal grafting, doctors should closely observe for at least 3 years after the grafting.

Assessment of the Quality of Life in Vitiligo Patients / 대한피부과학회지

BACKGROUND: Although vitiligo does not cause direct physical impairment or life-threatening conditions, it can produce significant psychosocial problems. Nevertheless, its effect on the psychosocial well-being of patients has been neglected. OBJECTIVE: This study compared quality of life (QOL) in patients with vitiligo and in healthy controls, and assessed the impact of vitiligo on the patients' QOL using Skindex-29. METHODS: This study recruited 105 vitiligo patients and 105 healthy controls, and the QOL scores of the groups were compared using Skindex-29. Statistical analyses were performed to examine the relationship between QOL and clinical characteristics. RESULTS: The total Skindex-29, emotion, and function scores, but not the symptom scores, were significantly higher in the vitiligo group than in the healthy controls. QOL, including symptom, function, and emotion scores, was significantly impaired in women, the elderly, married patients, and patients with a longer duration of disease, greater area of vitiligo, and lesions appearing on the exposed sites. But, symptom scores generally did not differ significantly. All aspects of QOL were impaired in patients with a previous treatment history, longer duration of treatment, and relatively low levels of satisfaction with treatment. CONCLUSION: Vitiligo can impair a patient's QOL. Therefore, it is important for the dermatologist to recognize and manage psychological problems to improve the QOL of vitiligo patients.

13 Cases of Leukoderma Punctata after Narrowband UVB Therapy in Vitiligo Patients / 대한피부과학회지

BACKGROUND: Leukoderma punctata is a peculiar disorder with punctiform, hypopigmented and achromic spots. Histopathologically, a focal reduction of melanocytes and melanin granules are found in the depigmented macule. The phototoxic effect of phototherapy on melanocytes has been suggested as the most likely cause. This occurs mostly after application of systemic or topical psolaren on photochemotherapy. However, a case following narrowband UVB therapy is very rare. OBJECTIVE: The purpose of our study was to investigate the characteristics of leukoderma punctata patients and find the cause of leukoderma punctata. METHODS: We reviewed the medical records of leukoderma punctata patients, and a skin biopsy was taken from punctiform hypopigmented macules. The tissues were stained with hematoxyline and eosin, Fontana-Masson, and dopa-oxidase. RESULTS: The average age of patients was 51 years old. There was no difference between results of male and female patients. Involvement sites of patients were mostly the arms and legs. 76% of patients did not have preceding subjective symptoms. In eight of nine patients, a marked reduction of melanin and melanocytes was noted with both Fontana-Masson staining and dopa-oxidase staining. The average total period of PUVA therapy was 26 months and average total dose of PUVA irradiation was 351.2 J/cm2 in leukoderma punctata patients. Before leukoderma punctata developed, the average total period of narrowband UVB therapy was 6.9 months and average total dose of narrowband UVB was 22.45 J/cm2. The results suggest that leukoderma punctata developed in very small dose of narrowband UVB, although it did not develop with large doses of PUVA. CONCLUSION: Narrowband UVB (311 nm) is the most likely spectrum for development of leukoderma punctata.

The Change of the Frontal Hair Line According to the Treatment for Androgenetic Alopecia / 대한피부과학회지

BACKGROUND: Androgenetic alopecia (AGA) occurs as a result of progressive miniaturization of scalp hair in genetically predisposed individuals. Several effective treatments for AGA are well known. However, there is a paucity of literature about the influence of such treatments on the frontal hair line (FHL). OBJECTIVE: To assess the effectiveness of oral finasteride and/or topical minoxidil on the FHL. METHODS: An assessment of 100 male patients with AGA of grades II to IV was made, based on the Norwood- Hamilton scale after six months of treatment. The patients were divided into three groups. Group 1 received 1 mg of oral finasteride daily. Group 2 exclusively used 5% minoxidil solution 1 ml twice daily. Group 3 received 1 mg of finasteride daily in combination with a topical application of 5% minoxidil solution. We measured the length from the mid-pupillary line to three points of the FHL with calipers; midpoint of the forehead, and right and left temporal recession, respectively. RESULTS: An improvement of the FHL was observed in all of three groups. There was a tendency for patients taking only finasteride to show an overall improvement in the frontal hair line, while patients applying only minoxidil solution showed an improvement in both temporal recession lines. Comparing the three groups at three points of the FHL respectively, at both temporal recession of the FHL, Group 3 showed the best result, followed by Group 2, and finally Group 1. The center of the FHL Group 3 showed the best result, followed by Group 1, and finally Group 2. CONCLUSION: We found that the combination therapy of finasteride and minoxidil had a synergic effect on FHL in the treatment of androgenetic alopecia. In the assessment of treatment efficacy to the FHL of patients with AGA, the method of using calipers in this study was worthwhile.

Late-onset Krabbe's Disease (Globoid Cell Leukodystrophy): A case report

Krabbe's disease is a rare autosomal recessive disorder characterized by hemiplegia, paraplegia, ataxia, cortical blindness, and peripheral neuropathy. This disease is caused by deficiency of the lysosomal enzyme galactocerebroside beta-galactosidase(GALC), resulting in demyelination of white matter of brain and peripheral nerve. We reported a 38-year-old female developed a slowly progressive weakness of lower extremities and gait disturbance since age of 10. Neurological examination revealed spastic weakness of both lower extremities, hyperactive deep tendon reflexes and intrinsic muscle atrophy of both hands and feet. Electrophysiologic study showed uniform demyelinating sensorimotor peripheral neuropathy. T2-weighted brain MRI (magnetic resonance imaging) findings revealed symmetric high signal intensity along the bilateral corticospinal tract. The diagnosis of Krabbe's disease was confirmed by finding of markedly reduced GALC activity in leukocyte. We recommended to consider Krabbe's disease in the diagnosis of patients affecting both central and peripheral nervous system.

Prognostic Factors Influencing Therapeutic Effect in Methylprednisolone Pulse Therapy for Alopecia Areata / 대한피부과학회지

BACKGROUND: Many treatments induce remission in patients with alopecia areata. Among them, systemic steroids may be effective in the treatment of severe alopecia areata, however, they have many side effects. To avoid side effects, high doses of a bolus infusion of methylprednisolone have been used to treat severe alopecia areata. OBJECTIVE: To confirm the effect of pulse therapy and to evaluate the prognostic factor associated with pulse therapy. METHOD: The medical records of 60 patients with alopecia areata between 2001 and 2004 at the Department of Dermatology, Chungnam National University Hospital were reviewed. All patients were treated with methylprednisolone pulse therapy. RESULTS: 1. 73.3% (44/60) of patients showed terminal hair growth, and 41.7% (25/60) of patients completely responded to this therapy with a cosmetically acceptable outcome. 2. Prognostic factors that influenced the result of the therapy were type of alopecia areata and disease duration before treatment. 3. Based on these 2 factors (type & duration), we suggest the following indications of methylprednisolone pulse therapy for severe alopecia areata. (1) Absolute indication (1) less than 3 months' duration with any type of alopecia (2) 4-6 months' duration with plurifocal alopecia (2) Relative indication (1) 4-6 months' duration with alopecia totalis and universalis (2) 7-12 months' duration with plurifocal alopecia (3) Borderline indication (1) 7-12 months' duration with alopecia totalis (2) 13-24 months' duration with plurifocal alopecia (4) Hopeless (1) 7-12 months' duration with alopecia universalis (2) 13-24 months' duration with alopecia totalis and universalis (3) more than 25 months' duration with any type of alopecia CONCLUSION: Methylprednisolone pulse therapy appears to be well tolerated and effective in patients with rapidly progressing extensive alopecia areata of any type which is treated within 6 months of disease onset, and the plurifocal type with 7-12 months of disease onset.

Gait Analysis Related to the Level of Lumbosacral Radiculopathy in Patients with Chronic Low Back Pain

OBJECTIVE: To study gait patterns of patients with chronic lumbosacral radiculopathy, and to investigate whether gait parameters can reflect functional deficit in relation to the level of lumbosacral radiculopathy. METHOD: Conventional physical examinations and three- dimensional gait analysis were performed on 24 patients with chronic lumbosacral radiculopathy (twelves with L5 and twelves with S1 radiculopathy) who were diagnosed by electrophysiologic study and magnetic resonance imaging study, and 12 healthy control subjects. Temporospatial, kine matic and kinetic parameters of patients were compared with those of the control group. RESULTS: In patients with lumbosacral radiculopathy, walking velocity, stride length, ratio of single support time to double support time and range of pelvic obliquity were less than control group. Increased double support time, decreased maximal hip extension angle, decreased ankle plantar flexion angle during preswing phase and decreased maximal ankle plantar flexion moment were noted in S1 radiculopathy patients compared with control group. Decreased pelvic rotational range and decreased ankle dorsiflexion moment were specific in L5 radiculopathy patients compared with control group. CONCLUSION: Using three-dimensional gait analysis, we could identify specific gait parameters to reflect functional deficit related to the level of lumbosacral radiculopathy.

Multiple Symmetric Lipomatosis with Peripheral Neuropathy: A case report

Multiple symmetric lipomatosis is a rare disorder characterized by massive fatty deposits arranged symmetrically around the neck, shoulder, abdomen and back. It is typically associated with high alcohol consumption and a high prevalence of peripheral neuropathy. The pathogenesis of the syndrome is still unknown, but mitochondrial abnormality or metabolic abnormalities are occasionally found in the affected patients. In our patient, clinical and electrophysiologic signs of a generalized peripheral sensorimotor neuropathy and a multiple bilateral lumbosacral radiculopathy were observed. Sural nerve biopsy demonstrated many small unmyelinated fibers with complete loss of axoplasm and a extensive loss of myelinated fibers. Lipoma biopsy demonstrated non-capsulated mature adipose cells in the subcutaneous tissue. Serum lipid studies were normal. MERRF point mutation of mitochondrial DNA were negative in blood. We reported a case of multiple symmetric lipomatosis and peripheral polyneuropathy with the review of literature.