The high osteogenic potential in children can lead to the spontaneous regeneration of a significant bone loss, however, the site documented in the previous reports was limited to the diaphysis in long bones. We report an exceptional case of a spontaneous regeneration of the whole lateral malleolus, including epiphysis, physis, and metaphysic, after traumatic loss in a three-year-old boy. This case emphasizes the importance of attempts to save as much of the cartilaginous tissues and the periosteum as possible, which have a great osteogenic potential, in themanagement of open would in childrhood.
Child ; Diaphyses ; Epiphyses ; Follow-Up Studies ; Humans ; Male ; Metaphysics ; Periosteum ; Regeneration

PURPOSE: Many studies have shown that regular exercise produces positive effects on health. The purpose of this study was to examine the differences of health-related quality of life by stage of exercise and the interaction effect of age, sex and stage of exercise. METHOD: A total of 1266 participants were interviewed with structured questionnaire. Stage of exercise was assessed with a single item and respondents were classified with respect to exercise intention and behavior. Health-related quality of life was measured with SF-36 Health Survey Questionnaire. RESULT: Health-related QOL were found to be different by stage of exercise. The subjects who were reached maintenance stage showed significantly higher scores on physical functioning, bodily pain, general health perception, mental health, role limitation due to emotional problems, social functioning, and vitality than those in preparation, contemplation, and precontemplation stage. In addition a significant interaction effect between stage of exercise and age was found on physical functioning, bodily pain, general health perception, mental health, and vitality. CONCLUSION: Perceived health-related QOL varies with stage of exercise. This finding suggests that health is related to both intention and behavior of exercise. Therefore it is important to consider cognitive-motivational and behavioral stage of change for developing exercise programs.
Adult* ; Health Surveys ; Humans ; Intention ; Mental Health ; Quality of Life* ; Social Problems ; Surveys and Questionnaires

Acute arterial occlusion of the extremity may result from obstruction of an artery by embolism or by thrombosis in situ. This results in the sudden cessation of blood flow to an extremity. So immediate managements are required to prevent propagation of the clot and to restore blood flow to the ischemic extremity promptly. We report a case of a acute arterial occlusion which was developed during prolonged fasting. A 59-year-old male was transferred due to severe ischemic pain, coldness and loss of pulse in left lower extremity during fast. The arteriogram shows a complete obstruction of external iliac artery and non-visualization of femoral artery and popliteotibial artery in the left lower extremity. Selective intra-arterial urokinase thrombolytic therapy and percutaneous transluminal angioplasty resulted in recannulation of obstructed artery and relief of symptoms.
Angioplasty ; Arteries ; Embolism ; Extremities ; Fasting* ; Femoral Artery ; Humans ; Iliac Artery ; Lower Extremity* ; Male ; Middle Aged ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator

Congenital scoliosis is a structural deformity due to congenital anomaly of the spine. After Winter's report in 1973, congenital scoliosis is said to be progressive in 75% of cases, and 50% are rapidly progressive, serious and demand treatment. And thus, most of them need more aggressive and early treatment compared with idiopathic scoliosis. The prognosis depends on the type, angle and flexibility of the curvature, and the age of patient. The authors reviewed the results of operative treatment for the congenital scoliosis that had been treated from Jan. 1984 to Dec. 1993 at the orthopedic department of Yonsei University College of Medicine, and the results as follows. 1. The age distribution of the patients was from 2 years to 14 years, and the mean was 8.4 years. Five male patients and two female patients were operated. 2. The involved spinal segments of the primary curve were 2 cases of thoracolumbar, 3 cases of lumbar. There were two cases of double major curves. 3. According to MacEwen's classification, the types of vertebral anomaly were 4 cases of hemivertebra, 2 cases of miscellaneous and one case of wedge vertebra. 4. The levels of apical vertebra were each 1 case of T3, T9, Ll, L2, L4 respectively and each 2 cases of T12, L3 respectively. 5. The methods of operation included 1 case of resection of rib, 4 cases of posterior fusion, 1 case of combined anterior and posterior hemiepiphysiodesis and fusion, and 1 case of hemivertebra excision with spine fusion. 6. The curvature of spine on admission ranged form 10 degrees to 63 degrees, and the mean angle was 35.5 degrees. And, we followed up postoperatively from 1 year to 10 years, and the mean follow up period was 32 months. The final correction angles were from
Age Distribution ; Classification ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Male ; Orthopedics ; Pliability ; Prognosis ; Pseudarthrosis ; Ribs ; Scoliosis ; Spine

Neuroendocrine tumor (NET) of the colon and rectum has been reported to have a low incidence and aggressive progression; it is frequently misdiagnosed and its treatment is not well documented. Four NET cases were collected at our hospital during the previous year of a colon cancer survey. Endoscopic mucosal biopsy of the colon was done for each case and all the cases proved to be adenocarcinomas. Curative surgery was conducted after the preoperative diagnostic and staging evaluation was completed. The locations of the primary lesions of the patients were all different; cecum, ascending colon, splenic flexure colon and sigmoid colon. The disease was advanced in all cases and the first postoperative diagnosis was poorly differentiated adenocarcinoma. Immunohistochemical tests followed and all the cases were positive for chromogranin A staining. A retrospective study was then conducted.
Adenocarcinoma ; Biopsy ; Cecum ; Chromogranin A ; Colon* ; Colon, Ascending ; Colon, Sigmoid ; Colon, Transverse ; Colonic Neoplasms ; Diagnosis ; Humans ; Incidence ; Neuroendocrine Tumors* ; Rectum ; Retrospective Studies

Spinal anesthesia with hyperbaric tetracaine has short action duration, therefore it is inappropriate to long term operation. Clonidine has been shown to stimulate central and peripheral alpha two adrenergic receptors. By these central adrenergic action, clonidine decreases the MAC of anesthetics. Clonidine also has analgesic property following intrathecal administration. These properties may make clonidine as a useful adjunct to extend anesthesia time with spinal anesthesia. This study was undertaken to evaluate the effects of clonidine in spinal anesthesia. Thirty healthy adult patients who were scheduled for orthopedic operation below knee were divided into 3 groups: Group1 (hyperbaric tetracaine 10 mg(2 ml)+N/S 1 ml), Group2I (hyperbaric tetracaine 10 mg with clonidine 75 ug(0.5 ml)+N/S 0.5 ml) and Group3 (hyperbaric tetracaine 10 mg with clonidine 150 ug(1 ml). We investigated the onset and duration of spinal anesthesia and hemodynamic changes (blood pressure and heart rate). The results were as follows 1) There were no significant changes between groups in hemodynamic data. 2) The onset of spinal anesthesia was more rapid in the group 2 (knee flexion 2.9+/-0.7, foot dorsiflexion 4.6+/-0.8 minutes) and 3 (knee flexion 2.0+/-0.4, foot dorsiflexion 4.1+/-0.7 minutes) than group I (knee flexion 4.9+/-1.6, foot dorsiflexion 9.1+/-3.4 minutes). 3) The time to recovery of nerve block was more prolonged in the group 2 (touch 256, pain 295, foot dorsiflexion 276, knee flexion 300 minutes) and 3 (touch 295, pain 312, foot dorsiflexion 339, knee flexion 385 minutes) than group 1 (touch 143, pain 176, foot dorsiflexion 178, knee flexion 195 minutes). 4) There were more sedation and dry mouth in group 2 and group 3. From the above results, clonidine can be used as an effective adjunct in hyperbaric tetracaine spinal anesthesia to make rapid onset and prolonged anesthesia without significant hemodynamic changes.
Adult ; Anesthesia ; Anesthesia, Spinal* ; Anesthetics ; Clonidine* ; Foot ; Heart ; Hemodynamics ; Humans ; Knee ; Mouth ; Nerve Block ; Orthopedics ; Receptors, Adrenergic ; Tetracaine

Several reports have described the usefulness of tumor markers detected in pancreatic juice for diagnosis of pancreatic cancer. We performed this study to evaluate the usefulness of tumor markers in pure pancreatic juice collected by duodenoscopic cannulation of pancreatic duct before and after injection of secretin. From April 1993 to July 1995, 8 cases of pancreatic cancer, 5 cases of benign pancreatic lesions, and 5 cases of benign biliary diseases without pancreatic lesion were involved. CEA and CA 19-9 immunoreactivity were measured by radioimmunoassay. Concentrations of CA 19-9 in pure pancreatic juice were significantly higher in patients with pancreatic cancer(median value; 3582, range 88.4-10410 IU/ml) than in control patients(median value 231, range 30.4-682 IU/ml)(p<0.05). Concentrations of CEA in pure pancreatic juice were not significantly different between patients with pancreatic cancer(median value: 6,5, range 1.0-152ng/ml) and control patients(median value: 4.0, range 1-17.2 ng/ml)(p>0.05). There was no significant correlation between levels of CA19-9, CEA in pancreatic juice and those levels in serum. The amounts of juice collected by duodenoscopic cannulation in patients with pancreatic cancer were 1.5+/- 0.9ml during 5 minutes before infusion of secretin, 11.3+/- 3.9ml, 10.8+/- 4.0ml, 10.6+/- 4.0ml in 5 minute interval after infusion of secretin. These results indicated that measurement of CA19-9 in pure pancreatic juice may be used as a marker for pancreatic cancer. Adequate amount of pancreatic juice was collected by duodenoscopic cannulation for evaluation of tumor marker, enzyme studies and cytology.
Catheterization ; Diagnosis ; Humans ; Pancreatic Diseases ; Pancreatic Ducts ; Pancreatic Juice* ; Pancreatic Neoplasms ; Radioimmunoassay ; Secretin ; Biomarkers, Tumor

Hip subluxation and dislocation are common orthopaedic problems in children with cerebral palsy. Selective posterior rhizotomy(SPR) is a neurologic procedure aimed in reducing spasticity. Several recent studies have indicated a decrease in spasticity and functional improvement after SPR, and also decrease the tendency toward hip subluxation in children with cerebral palsy. This is a retrospective study to examine whether SPR halts hip subluxation. Between May 1994 and July 1996, 22 children below age of 5 underwent SPR. Twenty children were spastic diplegic types and 2 were mixed type and quadriplegic type respectively. Approximately 50-80% of L2-Sl level dorsal roots was cut, and 13 children had 50% of both Ll roots cut. Migration percentage score (MP) was used to determine progression of hip subluxation during the follow up period (12 36 mos.; Average 15 mos.). Of the total 44 hips in 22 patients, 45.5% (20 hips) improved, 34% (15 hips) remained unchanged, and 20.5% (9 hips) were worsened after SPR. Radiographic stability was achieved in 79.5%. Ll root cut rate (Ll SPR) was 55.5% for improved hips, 67% for unchanged hips, and 50% for worsened hips. Two patients had undergone orthopaedic procedure for progressive hip migration. Most patients experienced postoperative hip stability after SPR, but 20.5% were worsened and 2 patients had orthopaedic procedure. Also it is unlikely that Ll root involvement prevents progression of hip migration.
Cerebral Palsy* ; Child ; Dislocations ; Follow-Up Studies ; Hip* ; Humans ; Muscle Spasticity ; Retrospective Studies ; Rhizotomy* ; Spinal Nerve Roots

OBJECTIVES: In order to establish prevalence and characteristics of tinnitus and hearing thresholds according to tinnitus, this study was carried out. METHODS: Nine hundred and thirty two subjects, undergone human dock or general health check-up and been in college, were surveyed to the questionnaire on the general characteristics, past medical histories, life styles, subjective symptoms about hearing, taking ototoxic drugs and were conducted on the hearing thresholds by pure tone audiometry. RESULTS: Of the total population, 98 reported tinnitus, giving an overall prevalence of 10.5%, prevalence of tinnitus in the subjects with the factors infuencing hearing thresholds were 17.4 %, prevalence without the factors influencing hearing thresholds were 7.5 %. Frequency of tinnitus of the total population was the highest in 'once per several months'(39.6 %) and followed by' once per several days'(29.7 %), 'all day long'(16.5 %) and' several times per day'(14.3 %). Complaint site of tinnitus was 41.8 % in left ear or right ear 39.6 % in both ear and 18.7 % in head. The 13.6% of the total subjects complained sleep disturbance. Hearing thresholds in the subjects without the factors influencing hearing thresholds tended to increase or decrease in 20 and 30 years old according to tinnitus, but those with, tinnitus tended to increase more than chose without tinnitus in 40 and 50 years old. CONCLUSIONS: Results also provide evidence that reports of tinnitus at the time of annual audiometric testing may be useful in identifying workers at greater risk for developing significant shifts in hearing thresholds. Awareness of the possible occurrence of tinnitus may encourage worker to cooperate more actively in a company hearing conservation programme.
Adult ; Audiometry ; Ear ; Head ; Hearing* ; Humans ; Life Style ; Middle Aged ; Prevalence* ; Questionnaires ; Tinnitus*

BACKGROUND: Pulse wave velocity (PWV) and pulse transit time (PTT) are influenced by the arterial wall stiffness and compliance. Also, the PTT is dependent on blood pressure changes that can be accompanied by the anesthesia. The simply measured PTT has difficult to discriminate the arterial compliance changes from blood pressure changes. Therefore, we investigated that the differences of PTT between toe and finger as an independent parameter on blood pressure. METHODS: Eighteen patients scheduled for elective lower abdominal gynecologic surgery were studied. General anesthesia was achieved with sevoflurane and epidural block was done with 0.2% ropivacaine and fentanyl 100microgram via epidural catheter inserted into L1 - L2 epidural space. PTT was measured in a finger (PTTf) and a toe (PTTt) by the time difference between the ECG R wave and the pulse wave of PPG. Blood pressure and PTT was measured at three instances such as preinduction (Pre), 5 minutes after intubation (Int5) and 30 minutes after injection of epidural dose (Epi). The time delay of PTT between toe and finger (PTTt-f) was measured. RESULTS: PTTf and PTTt was prolonged at Int5 and Epi. But the PTTt-f was not different between the Int5 and Epi because of prolonged PTTf caused by the blood pressure decrement after the epidural block. CONCLUSIONS: PTTf, PTTt and PTTt-f can be a one of the convenient measurement of the arterial compliance but it was suggested that there need to be a parameter less dependent on the blood pressure changes.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Blood Pressure ; Catheters ; Compliance ; Electrocardiography ; Epidural Space ; Female ; Fentanyl ; Fingers* ; Gynecologic Surgical Procedures ; Humans ; Intubation ; Photoplethysmography ; Pulse Wave Analysis* ; Toes*