ObjectiveTo compare the outcome of an early application of neuromuscular electrical stimulation (NMES) combined with traditional dysphagia therapy (TDT) versus traditional dysphagia therapy only in acute/subacute ischemic stroke patients with moderate to severe dysphagia by videofluoroscopic swallowing study (VFSS).MethodsFifty-seven dysphagic stroke patients were enrolled in a VFSS within 10 days after stroke onset. Patients were randomly assigned into two treatment groups. Thirty-one patients received NMES combined with TDT (NMES/TDT group) and 26 patients received TDT only (TDT group). Electrical stimulation with a maximal tolerable intensity was applied on both suprahyoid muscles for 30 minutes, 5 days per week during 3 weeks. The swallowing function was evaluated at baseline and 3, 6, and 12 weeks after baseline. Outcomes of the VFSS were assessed using the Functional Oral Intake Scale (FOIS).ResultsThe mean ages were 63.5±11.4 years in the NMES/TDT group and 66.7±9.5 years in the TDT group. Both groups showed a significant improvement on the FOIS after treatment. The FOIS score was significantly more improved at 3 and 6 weeks after baseline in the NMES/TDT group than in the TDT group (p<0.05).ConclusionAn early application of NMES combined with TDT showed a positive effect in acute/subacute ischemic stroke patients with dysphagia. These results indicated that the early application of NMES could be used as a supplementary treatment of TDT to help rehabilitate acute/subacute dysphagic stroke patients by improving their swallowing coordination.

Both peripheral neuropathy and distal myopathy are well-established inherited neuromuscular disorders characterized by progressive weakness and atrophy of the distal limb muscles. A complex phenotype of peripheral neuropathy, myopathy, hoarseness and hearing loss was diagnosed in a large autosomal dominant Korean family. A high density SNP-based linkage study mapped the underlying gene to a region on chromosome 19q13.3. The maximum multipoint LOD score was 3.794. Sequencing of 34 positional candidate genes in the segregating haplotype revealed a novel c.2822G>T (p.Arg941Leu) mutation in the gene MYH14, which encodes the nonmuscle myosin heavy chain 14. Clinically we observed a sequential pattern of the onset of muscle weakness starting from the anterior to the posterior leg muscle compartments followed by involvement of intrinsic hand and proximal muscles. The hearing loss and hoarseness followed the onset of distal muscle weakness. Histopathologic and electrodiagnostic studies revealed both chronic neuropathic and myopathic features in the affected patients. While mutations in MYH14 have been shown to cause nonsyndromic autosomal dominant hearing loss (DFNA4), the peripheral neuropathy, myopathy, and hoarseness have not been associated with MYH14. Therefore, we suggest that the identified mutation in MYH14 significantly expands the phenotypic spectrum of this gene.

L iving donor liver transplantation (LDLT) was initially introduced to overcome organ shortage for pediatric patients and as a possible solution for the persistent shortage of cadaveric organs. Because of donor safety considerations, originally the left lobe was most often used for the graft. However, size mismatch has been a major obstacle to the extension of LDLT to larger-sized recipients because a left lobe graft can be insufficient for them. LDLT using an extended right lobe graft was first advocated as a means to treat adult patients who could not receive a timely cadaveric graft.' Donor safety is of utmost importance in LDLT. In this article, we summarize our initial experience Seoul, with the right lobe transplantation procedure and evaluate its safety and feasibility.The goal of this study is to investigate the safety and effectiveness of right lobectomy in LDLT from the standpoint of living donor safety. Materials and MethodsFrom January 1999 to January 2002,100 cases of LDLT were performed in the Department of Surgery, Seoul National University Hospital. Of a total of 100 cases of donor hepatectomy, there were 45 cases of right lobectomy (K), 17 cases of extended left lobectomy (ELL), 37 cases of left lateral segmentectomy (LLS), and 1 case of right posterior segmentectomy. In R L , the middle hepatic vein was left in the remnant liver of the donor. The living donors consisted of 20 mothers, 16 fathers, 18 sons, l 0 spouses, 8 daughters, 7 nephews, 5 brothers, 3 uncles, 6 cases of other relatives, and 7 unrelated but acquainted neighbors (Table 1). The age and weight of the donors ranged from 17 to 49 years (29.5 ? 7.6 years) and from 40 to 87 kg (64.9 2 10.6 kg), respectively. The follow-up period for the 100 donors who underwent donor hepatectomy was 24.6 2 7.8 months, with a range from 3.0 to 38.5 months. Types of donor hepatectomy were determined according to a detailed preoperative imaging and volumetric study (ultrasonography or computerized tomography) of the vascular and biliary anatomy and computed tomographic volumetry. In K, the transection plane was drawn after transient clamping of hepatic artery and portal vein of the right side of the liver. In LLS, the transection plane was the right side of the umbilical portion of the left portal pedicle. In ELL, the transection plane was just the right side of middle hepatic vein. These planes were determined by intraoperative ultrasonography. Liver parenchymal transection was carried out with strict adherence to a meticulous surgical technique using an ultrasonic aspirator and bipolar coagulator without vascular inflow occlusion to either side of the liver.The fibrin glue was applied to the cut surface of the liver after resection. Neither oxidized cellulose nor micronized collagen was used. The residual liver volume always exceeded 30% of the total liver volume.Preoperative, intraoperative, and postoperative data were gathered and analyzed. We retrospectively reviewed the safety of our donor operation in relation to the amount of blood loss, ope...

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In a rabbit model of collagenase-induced osteoarthritis, the additive effects of intra-articular recombinant human growth hormone (GH) administration to hyaluronic acid (HA) were evaluated. After intra-articular collagenase injection, mature New Zealand white rabbits (n=30) were divided into 3 groups. Group 1 (control rabbits) received once weekly intra-articular saline injections for 4 weeks. Group 2 rabbits received 6 mg HA injections, and group 3 rabbits were injected with 6 mg HA and 3 mg recombinant human GH. These injections were initiated 4 weeks after collagenase injections. Lameness was observed for 9 weeks after collagenase injections. Macroscopic and histopathological knee joint findings were also evaluated at the end of 9 weeks after collagenase injections. Although all animals had lameness after collagenase injections, the duration and severity of lameness were significantly shorter and less severe in group 3 than group 1 and 2 (P<0.01). Macroscopic scores showed that femoral condyles of group 3 rabbits received significantly less cartilage damage than those of groups 1 and 2 rabbits (P<0.01). Histopathological score was also the lowest in group 3 (P<0.01). These results suggest that co-injection of intra-articular HA and recombinant human GH is more effective than HA injections alone in an osteoarthritis model.