Six patients with twenty histologically proven neurilemmomas of the extremities were studied using magnetic resonance(MR) imaging. The size, number, signal intensity on spin-echo T1WI(TR 500-650ms/TE 14-25ms)and gradient -echo (TR 200-600ms/TE 14-20ms; flip angle 25-30)image, enhancement pattern, detectability of nerve of origin, nerve-lesion relationship, and presence of a capsule were analyzed. The masses ranged from 1 to 12cm in longitudinal diameter and originated from the median nerve, ulnar nerve, sciatic nerve, radial nerve, and tibial nerve. All the nerve tracts except for those of 5 lesions, which could not be detected due to their small diameter, were visualized as low intensity tubular structures. All visible nerve tracts were situated along the periphery of the lesion and this finding was considered to be specific for neurilemmona. All neurilemmomas were isointense with the surrounding muscle on spin-echo T1WI and hyperintense on gradient-echo image. After a GD-DTPA injection, all masses showed moderate or marked enhancement and more prominent inhomogeneity than that on nonenhanced scan. In 19 out of 20 lesions(95%), a low signal intensity capsule surrounding the masses could be seen. Four of the six patients showed multiple masses, which was unusual as neurilemmoma usually arises as a solitary mass. In conclusion, the MR findings, especially the eccentric location of the mass lesion from the nerve of origin and the presence of a capsule, were useful in making a diagnosis of neurilemmoma of the extremity and that multiple neurilemmomas were not uncommon.
Diagnosis ; Extremities* ; Gadolinium DTPA ; Humans ; Median Nerve ; Neurilemmoma* ; Radial Nerve ; Sciatic Nerve ; Tibial Nerve ; Ulnar Nerve

We report the results of field operation of TELEACE system between Kyung-Pook National University Hospital and Ul-Jin Goon Health Care Medical Center from December, 1990 to September, 1991, which had been operated as a kind of Integrated Services Digital Nework projects by KOREA TELECOMMUNICATION Inc. Ul-Jin Goon Health Care Medical Center transmitted 414 plain radiographs to our hospital in speed of 9600BPS. Each image was composed of 1024X1024 pixelsX8 bits/pixel. In our hospital, the image files were displayed on high resolution monitor (1280×1024 pixets). Text files of image interpretations were transmitted to the health care medical center. The two radiologists who had interpreted the transmitted images, went to the health care medical center and read radiographic film with blind test method. We obtained the following results: false negative rate of 6.3%, false postitve rate of 2.4%, mean sensitivity of 81.4%, mean specificity of 96.3%, and mean accuracy of 91.3%. In predictive value of 0.05, there was no significant difference between results of these two types of radiographs. In conclusion, TELEACE system was valuable to the clinicians isolated from services of radiologists.
Delivery of Health Care ; Korea ; Methods ; Sensitivity and Specificity ; Telecommunications ; X-Ray Film

No abstract available.

PURPOSE: Prolonged stay in the emergency department (ED) have been associated with high mortality, but this association remains controversial. We examined the relationship between emergency department length of stay (EDLOS) and the mortality in critically ill patients undergoing traumatic emergency surgery. METHODS: A retrospective cohort study was conducted at an academic medical center with 257 critically ill patients undergoing traumatic emergency surgery from 2003 to 2004. Patients were classified into two groups those spending less than 4 hours in the emergency department and those spending over 4 hours. The groups were compared for hospital-mortality, and the data were entered into multinominal logistic regression, ROC curve, and life table using 12.0 version of SSPS. RESULTS: The overall mortality rate was 16.0%. Average length of stay was 220.1+/-138.5 minutes and 191.3+/-112.9 minutes in the survivors and non-survivor groups, respectively (p=0.212). Hospital-mortality and cumulative survival rate were similar in the group spending less than 4 hours to those in the group spending over 4 hours. The mortality was mainly related to the severity of the patients' condition (SAPS II). CONCLUSION: EDLOS did not affect hospital mortality, and EDLOS of more than 4 hours was not associated with worse prognosis.
Academic Medical Centers ; Cohort Studies ; Critical Illness* ; Emergencies* ; Emergency Service, Hospital* ; Hospital Mortality ; Humans ; Length of Stay* ; Life Tables ; Logistic Models ; Mortality ; Prognosis* ; Retrospective Studies ; ROC Curve ; Survival Rate ; Survivors

BACKGROUND: Increased left ventricular mass in patients with essential hypertension, coronary artery disease, chronic renal failure or in general population has been suggested as a useful predictor of increased cardiovascular morbidity and mortality. Many studies have reported that left ventricular mass is correlated postively with body size. Thereafter normalization of left ventricular studies, but it is uncertain which is appropriate. This study was designed to determine the appropriate method for normalization of left ventricular mass to exclude influence of body size in normal adults. METHODS: We measured left ventricular mass 100 normal adults by M-mode echocardiogram using ASE cube method without(Devereux and Reichek's method) and with correction(Devereux and Alonso's method). Left ventricular mass were normalized for body weight, height, body surface area, body surface area1.5, height2.0 and height2.7 RESULTS: 1) Left ventricular mass by Devereux and Reichek's method correlated well with that by Devereux and Alonso's method(r=1.0,p<0.001). 2) Corrected left ventricular mass correlated well with weight(r=0.64, p<0.001), height(r=0.49, p<0.05), body surface area(r=0.53, p<0.01) and body mass index(r=0.58, p<0.001). 3) Correlation coefficients of left ventricular mass/weight with weight, of ventricular mass/height with height, of ventricular mass/height2.0 with height, of ventricular mass/height2.7 with height, of ventricular mass/body surface area with body surface area and of ventricular mass/body surface area1.5 with body surface area were 0.12, -0.05, -0.29, -0.42, 0.13 and -0.11 respectively. 4) Peak systolic wall stress correlated with age and left ventricular mass, but end systolic wall stress did not correlated with left ventricular mass. CONCLUSIONS: The current indexation method of left ventricular mass for height may reduce the variability associated with body size. Furthermore, it could be used reliably in normal Korean adults.
Adult* ; Body Height ; Body Size* ; Body Surface Area ; Body Weight ; Coronary Artery Disease ; Echocardiography ; Humans ; Hypertension ; Kidney Failure, Chronic ; Mortality

Integrase inhibitor is uniquely available as single tablet regimen (STR) in Korea. In this study, the durability until 96 weeks was compared between dolutegravir/abacavir/lamivudine (D/A/L) and elvitegravir/cobicistat/tenofovir/emtricitabine (E/T/E) in treatment naïve human immunodeficiency virus 1 (HIV-1) infected individuals. From 2014 to 2017, 153 and 234 subjects started D/A/L and E/T/E, respectively. During 96 weeks, 73 discontinued initial STR and the reason of discontinuation was typable in 44. The frequency of drug adverse event related discontinuation (AEDC) was higher in D/A/L (13.1% vs. 6.4%, P = 0.023) while most non-AE related discontinuations occurred in E/T/E (8/9), such as drug-drug interaction, meal requirement and virologic failure. AEDC occurred usually within 24 weeks (20/35) and D/A/L to E/T/E AEDC incidence rate ratio was 3.71 (95% confidence interval, 1.36–10.10) in this period. Regarding the durability, D/A/L and E/T/E revealed no significant difference at week 96 (P = 0.138) while durability of D/A/L was worse in the aspect of AEDC (P = 0.013).

OBJECTIVE: The purpose of this study was to investigate the risk factors of adhesive capsulitis and the effect of intra-articular steroid injection in spinal cord injured patients. METHOD: Fifty spinal cord injured patients participated in this study. The risk factors of adhesive capsulitis were compared between fourteen patients with adhesive capsulitis and thirty-six patients without one. Methylprednisolone acetate 40 mg mixed with 0.5% lidocaine 2 ml was given into glenohumeral joint space in adhesive capsulitis group and their pain and range of motion (ROM) were analyzed. RESULTS: 1) The incidence of adhesive capsulitis was higher in patients with higher injury level, older age and delayed start of rehabilitation therapy. 2) 10 cm visual analogue scale scores were significantly decreased after intra-articular steroid injection (p<0.01). 3) The shoulder ROM was increased after intra-articular steroid injection. The shoulder ROM at pre-injection was 126o in flexion, 113o in abduction, 64o in external rotation and 51o in internal rotation. The shoulder ROM at 4 weeks after injection was 138o in flexion, 131o in abduction, 74o in external rotation and 77o in internal rotation. CONCLUSION: There was a trend that the incidence of adhesive capsulitis was higher in patients with higher injury level, older age and delayed start of rehabilitation therapy. Further, it was suggested that intra-articular steroid injection was effective for reducing pain and improving ROM.
Adhesives* ; Bursitis* ; Humans ; Incidence ; Lidocaine ; Methylprednisolone ; Range of Motion, Articular ; Rehabilitation ; Risk Factors ; Shoulder ; Shoulder Joint ; Spinal Cord Injuries ; Spinal Cord*

BACKGROUND: The purpose of this study was two fold; first, to determine the incidence and type of withdrawal movement associated with IV injection of rocuronium in pediatric patients; and second, to determine whether pretreatment with IV lidocaine affects the incidence of movement associated with rocuronium administration in pediatric patients. METHODS: Forty-two pediatric patients were randomly assigned to two groups. After general anesthesia was induced with thiopental sodium 5 mg/kg and manual occlusion of venous inflow was performed, one group of patients received 0.1 ml/kg 1% lidocaine IV. A second group received 0.1 ml/kg of normal saline as a placebo control. Venous inflow occlusion was held for 5 seconds, and immediately followed by the injection of rocuronium 0.6 mg/kg IV. The patient's response to rocuronium injection was graded using a 5-point scale. RESULTS: We observed that the incidence of movement was 100% in the placebo group and was significantly decreased to 28.8% in the group pretreated with lidocaine (P<0.001). CONCLUSIONS: Withdrawal movement on injection of rocuronium in pediatric patients can be decreased or prevented by pretreatment with IV lidocaine.
Anesthesia, General ; Child* ; Humans ; Incidence ; Lidocaine* ; Thiopental

Tuberculous spondylitis is a very rare disease, but it can result in bone destruction, kyphotic deformity, spinal instability, and neurologic complications unless early diagnosis and proper management are done. Because the most common symptom of tuberculous spondylitis is back pain, it can often be misdiagnosed. Atypical tuberculous spondylitis can be presented as a metastatic cancer or a primary vertebral tumor. We must make a differential diagnosis through adequate biopsy. A 30-year-old man visited our clinic due to back and chest pain after a recent traffic accident. About 1 year ago, he had successfully recovered from tuberculous pleurisy after taking anti-tuberculosis medication. We performed epidural and intercostal blocks but the pain was not relieved. For the further evaluation, several imaging and laboratory tests were done. Finally, we confirmed tuberculous spondylitis diagnosis with the biopsy results.
Accidents, Traffic ; Adult ; Back Pain ; Biopsy ; Chest Pain ; Diagnosis, Differential ; Early Diagnosis ; Humans ; Rare Diseases ; Spondylitis ; Tuberculosis, Spinal ; Tuberculosis, Pleural

BACKGROUND: Many topical hemostatics are widely applied for bleeding control. They can be classified into two categories according to their mechanism of action on the clotting cascade in a biologically active or passive manner. Passive hemostatics include cellulose and gelatin. We performed an experimental study to compare the effect of passive hemostatics in wound healing by applying them to a rectus abdominis muscle defect of white mice. METHODS: Surgicel is a sterile absorbable knitted fabric prepared by the controlled oxidation of regenerated cellulose. Spongostan is an absorbable hemostatic gelatin sponge. In 30 mice, a 1x1 cm defect was created on the rectus abdominis muscle and the materials were applied in three ways: control group, cellulose (Surgicel) group, gelatin (Spongostan) group. For the histologic analysis, biopsies were performed at 3 and 28 days. RESULTS: After 3 days, the cellulose group showed limited granulation formation with acute inflammatory reactions similar to the control group. At the 28th day, moderate amounts of granulation tissue formation was observed with milder inflammatory reactions than the control group. In the gelatin group, after 3 days, gelatin remnants were observed surrounded by severe inflammatory changes. After 28 days, the same quantity of gelatin remnants could be still observed. CONCLUSIONS: This study suggests that cellulose is associated with minimal morbidity in wound healing, while the use of gelatin shows severe adverse tissue reactions with delayed wound healing. Consequently, cellulose is better than gelatin when considering wound healing.
Animals ; Biopsy ; Cellulose ; Cellulose, Oxidized ; Fibrin Foam ; Gelatin ; Granulation Tissue ; Hemorrhage ; Hemostatics ; Humans ; Mice ; Muscles ; Porifera ; Rectus Abdominis ; Wound Healing