The Evaluation of Cardiac Function in Duchenne Muscular Dystrophy

OBJECTIVE: To evaluate the cardiac function and to explore the importance of the evaluation of cardiac function in patients with Duchenne muscular dystrophy (DMD). METHOD: Thirty-nine patients with DMD without any symptoms of heart problems underwent physical examinations and cardiac monitoring including the arterial carbon dioxide (CO2) screening. Thirty one patients underwent pulmonary function test. RESULTS: Among 39 patients 27 showed abnormal electrocardiographic findings such as ventricular hypertrophy, ischemic change, atrial hypertrophy, T wave inversion, sinus tachycardia and ST elevation. 24 patients showed abnormal echocardiographic findings such as abnormal ejection fraction, dilated cardiomyopathy (DCMP), filling abnormality of left ventricle, global hypokinesia and reduced systolic function. 17 patients showed low ejection fraction (below 59%) and 4 of them were diagnosed as DCMP. There were significant correlations between age and ejection fraction (r= 0.552, p<0.01), between functional level and ejection fraction (r= 0.607, p<0.01) and between vital capacity and ejection fraction (r=0.547, p<0.01). However, ejection fraction showed no significant correlations with arterial CO2. CONCLUSION: Routine evaluation of the cardiac function, at least from 10 years of age, and proper treatment following early diagnosis of heart problems were necessary in patients with DMD, because they possibly have been severely affected by cardiac problems without any clinical symptoms.

Dose Dependent Changes of Lipid Profiles, IL-6 and CRP in Unstable Angina Patients after Simvastatin Therapy

BACKGROUND AND OBJECTIVES: The beneficial effects of statins in preventing cardiovascular events may depend, in part, on their anti-inflammatory action. We previously reported that low dose statin therapy has cholesterol lowering effects, but no effect on inflammation, and proposed that a sufficient dose of therapy might be needed to achieve anti-inflammatory action. The aims of this study were to confirm the suggestions made in our previous study. SUBJECTS AND METHODS: Fifteen unstable angina patients who were enrolled in our previous study were evaluated. The usual dose (20 mg) of simvastatin was administrated for 26 weeks, blood samples collected following the administration and tested for their lipid profiles and inflammatory markers (IL-6, CRP). The changes in the lipid profiles and inflammatory markers, from baseline levels, to the usual and low doses of statin therapy were evaluated. RESULTS: The changes in the IL-6 and hsCRP levels after the usual dose simvastatin therapy compared with the baseline levels were -72.8 and -59.6% (p< 0.05), respectively. The changes in the IL-6 and hsCRP levels after the usual dose simvastatin therapy compared with a 5 mg dose were -77.2 and -47.1% (p< 0.05), respectively. There was statistically significant correlation between the change in the levels of IL-6 and hsCRP during statin therapy. CONCLUSION: Our data confirmed the preliminary result of Chung et al, which suggested the usual dose of simvastatin is required to inhibit the inflammation of unstable plaque in patients with unstable angina associated with hypercholesterolemia.

Stretching Therapy of Neurogenic Bladder in Patients with Spinal Cord Injury

OBJECTIVE: To evaluate the effect of stretching therapy of neurogenic bladder in spinal cord injured patients. METHOD: Twelve spinal cord injured patients who had neurogeic bladder manifested with urinary incontinence resistant to oral and intravesical anticholinergic instillation treatment were selected. Oxybutynin solution was instillated via foley catheter and the catheter was clamped until incontinence occur. This was performed twice a day for 7 days. The urodynamic studies were compared before and after therapy. Total volume of daily incontinence and total volume of daily fluid intake were also monitored. RESULTS: After stretching therapy, median maximal bladder capacity increased from 190.08 to 457.17 ml (p<0.01), mean bladder compliance increased from 8.46 to 18.85 ml/cmH2O (p<0.01), mean reflex volume increased from 148.75 to 252.17 ml (p<0.05), mean maximal detrusor pressure decreased from 52.17 to 28.29 cmH2O (p<0.01), mean clinical maximal capacity increased from 277.50 to 537.50 ml (p<0.01), and mean daily incontinent volume decreased from 508.33 ml to 20.83 ml (p<0.01). No significant correlation was found between the duration since onset of injury and the urodynamic finding. CONCLUSION: This study proved that stretching therapy of bladder was an effective method in spinal cord injured patients who had neurogenic bladder with uncontrolled incontinence with conventional therapy.

The Effect of Vertebral Endplate Area and Shape in the Patients with Lumbar Herniated Intervertebral Disc

OBJECTIVE: To determine whether the area and the shape of the vertebral body endplate in the magnetic resonance image (MRI) findings were risk factors for the development of symptomatic herniated lumbar intervertebral disc. METHOD: Sixty patients of low back pain with the age below 60 were enrolled. They didn't have spondylolisthesis or the history of spine surgery. MRI films of these patients were reviewed. Anteroposterior and transverse diameter of endplates, height of vertebral body and intervertebral discs were measured. The relation of these data and intervertebral disc herniation, body weight, height, body mass index (BMI) were statistically studied. RESULTS: Patients' weight, BMI, the vertebral body area and the shape of the endplate were related to disc herniations. Furthermore, the larger and circular vertebral body was observed in the patients with disc herniation. In the patients with lower back pain, men were diagnosed disc herniations of the MRI finding more than women. CONCLUSION: In anatomical aspect, the area and the shape of the vertebral body at the endplate level were important factors contributing to the development of disc herniations at L4-L5 and L5-S1.

Assessment of Colonic Motility and Nutrients Intake in Children with Spastic Cerebral Palsy

OBJECTIVE: To evaluate the colonic motility and nutrients intake in children with spastic cerebral palsy (CP) and to compare the results with those of normal children. METHOD: Thirty-eight children with spastic CP were participated in this study. They took the radioopaque markers for 3 successive days. Then, abdominal X-ray was taken on the fourth day. Total and segmental colon transits were estimated by the simplified assessment of a single-film technique by Metcalf et al. The amounts of nutrients intake for 3 days were recorded and nutritional factors were analyzed by ESHA Food Processor. Then, daily intakes of the nutrients were compared with Recommended Dietary Allowance of the Korean Nutrition Society. RESULTS: Total and segmental colon transit time were more than 2 times delayed in children with spastic CP as compared with those of normal controls. Total colon transit time was significantly prolonged in quadriplegic and non-ambulatory children (p<0.05). On the evaluation of daily nutrients intake, most of nutritional factors were inadequate in children with spastic CP. CONCLUSION: The children with spastic CP had the problems in colonic motility and nutritional intake. Also, delayed colon transit time was significantly related with poor mobility. Therefore, early intervention for these problems will be required in spastic CP, especially quadriplegic and non-ambulatory children.

Kinematic and Kinetic Comparison between Stair Climbing and Level Walking

OBJECTIVE: The aims of this study were to investigate the characteristics of stair climbing through the comparison between the stair climbing and level walking, and to present the standard values of stair climbing. METHOD: Twenty healthy young adults were recruited. The kinematic and kinetic data of level walking and stair climbing on the specially designed stair were obtained through 3 dimensional motion analyzer (Vicon 370 system) with the force plate. RESULTS: The sagittal range of motion of all examined joints at stair climbing was significantly increased compared as at level walking (p<0.05). The maximal flexion angle at swing phase of all examined joints were significantly increased at stair climbing compared than at level walking (p<0.05). At loading response, the kinetic data showed the significant differences between stair climbing and level walking. The time when the maximal extensor moment of knee developed was significantly earlier than when that of hip developed (p<0.05). CONCLUSION: As a results, we found that stair climbing was different from level walking and had the unique pattern in the kinematic and kinetic aspect. The motion analysis of stair climbing may be useful to the further studies.