This study was carried out for evaluating the usefullness of pressure pain threshold as an objective test on shoulder muscles in VDT workers. Subjective symptoms, frequency and intensity of pain complaint were investigated by questionnaire method and objective tests, trigger point and pressure pain threshold of 14 shoulder muscles of dominant and nondominant side each, were performed by physical examination and using pressure algometer on 44 VDT workers (more than 2hrs a day) and 20 controls. And work status including work duration, daily work hours and continuous work hours per one time was also surveyed by questionnaire method. The relations among these items were analysed. Results were as follows; 1. The prevalences of shoulder pain in VDT workers and controls were 72.7% and 50.0%. The mean of pain frequency category scale was not significantly different between 2 groups, while the mean of pain intensity category! scale in VDT workers was higher than that in controls. The trigger point in VDT workers showed the highest frequency in the upper trapezius muscle which followed by the levator scapular muscle. And pressure pain thresholds of VDT workers were significantly lower than those of controls in all 14 shoulder muscles. 2. In VDT workers, the category scales of pain frequency and intensity during last one week in shoulder pain complaint group at the time of investigation were significantly higher than those in non complaint group. And the pressure pain thresholds of nondominant levator scapular, bilateral lower trapezius, nondominant posterior deltoid and nondominant pectoralis major muscles were significantly lower in complaint group. 3. The pressure pain thresholds of bilateral upper trapezius, levator scapular and lower trapezius muscles in VDT workers with trigger point at shoulder muscles were significantly lower than those in VDT workers without trigger point. 4. In terms of work duration, the pain frequency category scale during last one week of '5 years and more' group was significantly higher than that of 'less than 5 years' group, while pain intensity category scale. and pressure pain threshold were showed no significant difference. 5. In terms of daily work hour, pressure pain thresholds of bilateral upper trapezius, nondoininant levator scapular, dominant anterior deltoid, dominant posterior deltoid, dominant supraspinatus, and nondominant pectoralis major of 4 hours and more' group were significantly lower than those of 'less than 4 hours group, while category scales of pain frequency and intensity during last one week were showed no significant difference. 6. In terms of continuous work hour, the frequency and intensity category scale was significantly higher and pressure pain thresholds of dominant upper trapezius, bilateral levator scapular and dominant lower trapezius muscles were significantly lower in 2 hours and more' group than 'less than 2 hours' group. In conclusion, in order to evaluate more objectively the musGuloskeletal. impairment by VDT work it is recommended that objective tests such as trigger point and pressure pain threshold are performed in addition to survey of subjective symptoms. And also more consideration on daily work hour and continuous work hour than total work duration is required.
Muscles* ; Pain Threshold* ; Physical Examination ; Prevalence ; Questionnaires ; Shoulder Pain ; Shoulder* ; Superficial Back Muscles ; Trigger Points ; Weights and Measures

Combination chemotherapy and radiation therapy have contributed to the successful treatment of various cancer patients. But the development of second malignancies is an inevitable complication of long-term cytotoxic treatment. The most serious and frequent of such complications is acute myelogenous leukemia (AML). Therapy-related leukemia is generally fatal. Since the number of patients exposed to chemotherapy is increasing each year, the clinical significance of this entity cannot be underestimated. There have been many investigations of therapy-related leukemia, but in Korea published reports are rare. We describe four such cases, involving one older female with lung cancer and three children with acute lymphoblastic leukemia (ALL) and malignant lymphoma. Alkylating agents were used for chemotherapy, and in one case, topoisomerase II inhibitor. Irrespective of the causative agents, the latency periods were relatively short, and despite induction chemotherapy in two, all survived for only a few months. During the follow-up of patients treated for primary malignancies, the possibility of therapy-related leukemia should always be borne in mind.
Adolescence ; Aged ; Antineoplastic Agents, Alkylating/therapeutic use* ; Antineoplastic Agents, Alkylating/adverse effects ; Carcinoma, Small Cell/radiotherapy ; Carcinoma, Small Cell/drug therapy ; Case Report ; Child ; DNA Topoisomerase (ATP-Hydrolysing)/antagonists & inhibitors ; Fatal Outcome ; Female ; Human ; Leukemia, Lymphocytic, Acute, L1/drug therapy ; Leukemia, Monocytic, Acute/etiology ; Leukemia, Myelocytic, Acute/etiology* ; Leukemia, Myelomonocytic, Acute/etiology* ; Lung Neoplasms/radiotherapy ; Lung Neoplasms/drug therapy ; Lymphoma, B-Cell/radiotherapy ; Lymphoma, B-Cell/drug therapy ; Male ; Neoplasms, Second Primary/etiology*

In recent years, it has been common to use bupivacaine for prolonged operation because of its long duration of action but, besides of this benefits, we always are cautious of using bupivacaine for its possible systemic, toxicity, such as convulsion, myocardial depression. We experienced a case of asthmatic attack right after injection of 0.5% bupivacaine 125 mg for BPB(brachial plexus block) in a 26 year old male patient with chronic renal failure for the revision of a-v fistula. With the administration of aminophylline and oxygen by mask the patient was anounced about delaying operation and the symptoms were gone. Next day with local infiltration of 2% lidocaine operation was done uneventfully.
Adult ; Aminophylline ; Bupivacaine ; Depression ; Fistula ; Humans ; Kidney Failure, Chronic ; Lidocaine ; Male ; Masks ; Oxygen ; Seizures

It is common for patient undergoing cesarean section under epidural anesthesia to have lower blood pressure because of not only supine hypotension syndrome but vasodilation due to sympathetic blockade. So it is necessary to give large volume of fluid before perfarming epidural anesthesia to prevent hypotension. When we use the dextrose containing fluid for that purpose, newborn baby could have a high blood glucose at delivery and low blood glucose level due to high insulin level after birth. The authors examined the blood glucose level at delivery and two hours after birth following use of 5% dextrose in lactated Ringers solution(HD group, n=24) or lactated Ringers solution (HS group, n=24) for prevention of hypotension during epidural anesthesia for cesarean section The results were as follows; I) The total amount of fluid was 789.6+/-264.2 ml in HD group and 741.1+/-253.5 ml in HS group. 2) The glucose level of mother at delivery was 300.9+/-76.3 mg/dl in HD group and 98.7+/-24.6 mg/dl in HS group and there was statistical significance(p< 0.01). 3) In HD group, the glucose level of newborn baby was 212.2+/-57.2 mg/dl at delivery and 465.+/-20.3 mg/dl at 2 hours after birth. The change of amount during 2 hours after birth was highly related to the glucose level at birth. Higher level of glucose at birth, larger amount of change during 2 hours after birth. 4) In HS group, the glucose level of newborn baby was 66.8+/-10.2 mg/dl at birth and 67.0+/-12.1 mg/dl at 2 hours after birth. There was no significant change.
Anesthesia, Epidural* ; Blood Glucose* ; Blood Pressure ; Cesarean Section* ; Female ; Glucose ; Humans ; Hypotension ; Infant, Newborn* ; Insulin ; Mothers ; Parturition ; Pregnancy ; Vasodilation

In a double-blind randomized study of five groups of fifty patients scheduled for gynecologic lower abdominal surgery the analgesic efficacy and side effects of epidurai buprenorphine were tested and compared to epidural morphine. Single epidural injeetion of 0.15mg of buprenorphine in group B 0.15, 0.30 mg of buprenorphine in group B D.3, 0.45 mg of buprenorphine in group B 0.45, 3 mg of morphine in group M 3 or 6 mg of morphine in group M 6 mixed with 10 ml of normal saline was done when the patients complained of postoperative pain after general anesthesia with enflurane-N2O-O2. The results were as follows; 1) The onset of analgesia was the most rapid in group B 0.45(20.7+/-3.2 minutes), and appeared as following order: group M 6(29.3+/-14.3 minutes), group M 3(37.5+/-6.7 minutes), group B 0.3(39.3+/-8.7 minutes), and group B 0.15(60.7+/-20.2 minutes). 2) Additional requirement of analgesics during first 24 hours after epidural injection was more frequent in group B O.IS(70%) than in any other four groups. 3) The lowest pain score during 24 hours after epidural injection was the lowest in group M 6(1.6+/-0.5) and group B 0.45(1.8+/-0.4) and the increasing order of the lowest pain score were as follows; 2.2+/-0.4 in group M 3, 2.3+/-0.5 in group B 0.3 and 2.6+/-0.5 in group B 0.15. 4) The pain score measured 24 hours after epidural injection was significantly lower in group B 0.45(2.0+/-0.0) than in any other four groups. 5) Subjective rating of well-being for first 24 hours following epidural injection was better in group B 0.45(good in 60% of patients) than in group M 6(good in 10% of patients). 6) Subjective rating of sleep at the first postoperative night showed no significant differences among five groups. 7) Disturbance of micturition after removal of catheter was noted in group B 0.45 and group M 6(30% each) and spontaneous urination after removal of catheter was significantly delayed in group B 0.45(9.1+/-10.2 hours) and in group M 6(7.2+/-7.8 hours) comparing to other three groups. 8) Pruritus was noted only in the groups with epidural morphine(in group M 3 & M 6; 70% each) and there was no statistieal difference between group M 3 and group M 6. 9) The frequency of nausea or vomiting was the lowest in group B 0.45(30%) and the highest in group M 3(90%), and no significant differences were noted among other three groups. 10) Dizziness was noted in group B 0.45 and in group M 6(30% each), but there was no statistical significances among five groups. I I) No signs of respiratory depression were noted.
Analgesia ; Analgesics ; Anesthesia, General ; Buprenorphine* ; Catheters ; Dizziness ; Humans ; Injections, Epidural ; Morphine* ; Nausea ; Pain, Postoperative* ; Pruritus ; Respiratory Insufficiency ; Urination ; Vomiting

To evaluate geriatric anesthetic experiences, the clinical record of 970 cases out of total 13,324 anesthetic cases perfomed at Korea university Anam hospital from January 1991 to December 1992 were reviewed according to age, sex, department, operation site, preoperative physical status, preoperative chest X-ray findings, preoperative electmcardiography readings, preoperative pulmonary function test, preoperative concurrent disease, type of anesthesia, duration of operation, intraoperative event, postoperative complication, and mortality. The result were as follows; 1) The number of the cases older than age 65 years was 970 accounting for 7.3% of 13,324 anesthetic cases from the year 1991 to 1992. 2) There were 566 (58.4%) males and 404 (41.6%) females. 3) There were 417 (43.0%) cases between the age of 65 and 69; 323 (33.3%) between the age of 70 and 74; 133 (13.7%) between the age of 75 and 79; 73 (7.6%) between the age of 80 and 84; 15 (1.5%) between the age of 85 and 89; 7 (0.7%) between the age of 90 and 94; 1 (0.1%) between the age of 95 and 100; 1 (0.1%) cases was 103 years of age. 4) In preoperative physical status according to the calssification of American Society of Anesthesiologist, 34 (3.5%) cases were class I, 471 (48.9%) class II, 465 (48.6%) class III, and 10 (1.0%) calss IV. 5) Emergency operation was performed in 107 (11.0%) cases. 6) There were 365 (37.6%) general surgery, 156 (16.1%) orthopedic surgery, 153 (15.8%) genitourinary surgery, 101 (10.4%) otolaryngologic surgery, 66 (6.8%) neurosurgery, 59 (6.1%) chest surgery, 40 (4.1%) gynecologic surgery, and etc. 7) The most frequent operation site was upper abdominal region in 242 cases (24.9%) and lower abdominal region in 184 (19,0%), upper and lower extremities in 165 (17.0%), head and neck in 126 (12.9%) and so on. 8) The findings of preoperative chest X-ray revealed that 502 (51.7%) cases were within normal limits. The most frequent abnormal finding was hypertensive heart changes in 128 (13.2 %). Another findings were arteriosclerotic changes in 72 (7.4%), inactive pulmonary tuberculosis in 37 (3.8%), emphysematous changes in 34 (3.5%), bronchiectasis in 19 (2.0%) and so on. 9) The preoperative electrocardiographic findings revealed that 452 (46.6%) cases were within normal limits. The abnormal findings were as follows ; left ventricular hypertrophy in 113 (11.6%), sinus bradycardia in 67 (6.9%), myocardial infarction in 45 (4.6%), myocardial ischemia in 32 (3.3%), and so on. 10) Preoperative pulmonary function test was performed in 702 (72.6%) cases. Two hundred sixity five cases (37.5%) showed abnormal results consisting of obstructive type in 34.7%, restrictive type in 24.9%, mixed type in 21.5%, and small air way disease in 18.9%. 11) Three hundred sixty one (37.3%) of the total cases had preoperative concurrent illness consisting of hypertension in 158 (16.3%), chronic obstructive pulmonary diseases in 66 (6.8%), myocardial infarction in 37 (3.8%), myocardial ischemia in 34 (3.5%), diabetes mellitus in 32 (3.3%), and so on. 12) The type of anesthesia used in these case were 678 (69.9%) general anesthesia, 96 (9.9%) spinal anesthesia, 84 (8.7%) combined anesthesia, 82 (8.4%) epidural anesthesia, and 30 (3.1%) brachial plexus block. 13) The duration of operation was 1~2 hours in 329 (33,9%) cases, 2~3 hours in 267 (27.5%), 3~4 hours in 126 (13.0%), and so on. 14) The most frequent intraoperative envent was hypertension in 155 (16.0%) cases. And hypotension in 72 (7.4%), premature ventricular contraction in 12 (1.2%), ohguria in 9 (0.9%), bradycardia in 8 (0.8%), myocardial ischemia in 8 (0.8%), myocardial ischemia in 7 (0.7%), and hyperglycemia in 7 (0.7%) were noted, 15) One hundred six cases (10.9%) were sent to intensive care unit for postoperative care. 16) The most frequent postoperative complication was hypertension in 154 (15.9%) cases. Hypotension in 21 (2.2%), myocardial ischemia in 13 (1.3%) and etc, were noted. 17) Overall mortality rate was 1.2%. The mortality rate was 0.2% in elective cases, and 9.3% in emergency ones.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal ; Brachial Plexus ; Bradycardia ; Bronchiectasis ; Diabetes Mellitus ; Electrocardiography ; Emergencies ; Female ; Gynecologic Surgical Procedures ; Head ; Heart ; Humans ; Hyperglycemia ; Hypertension ; Hypertrophy ; Hypertrophy, Left Ventricular ; Hypotension ; Intensive Care Units ; Korea ; Lower Extremity ; Lung Diseases, Obstructive ; Male ; Mortality ; Myocardial Infarction ; Myocardial Ischemia ; Neck ; Neurosurgery ; Orthopedics ; Postoperative Care ; Postoperative Complications ; Reading ; Respiratory Function Tests ; Thorax ; Tuberculosis, Pulmonary ; Ventricular Premature Complexes

No abstract available.
Adult* ; Cytarabine* ; Cytosine* ; Humans ; Leukemia* ; Mitoxantrone*

OBJECTIVE: To define arthrographic findings in patients with frozen shoulder and to evaluate the therapeutic effect of arthrographic capsular distension and rupture. METHOD: Thirty patients who were clinically diagnosed as frozen shoulder were enrolled. During a trial of intra-articular injection of 35 mL of fluid which contained 8 mL of 1% lidocaine, 2 mL of prednisolone (80 mg) and 25 mL of radiocontrast material, arthrographic findings and the occurrence of iatrogenic capsular tear were observed. Passive range of shoulder motion (percent of normal, %) at flexion, abduction, internal rotation, and external rotation was measured at pre- and 1 week post-injection. The therapeutic effect of the procedure was statistically analyzed by paired Student's t-test. RESULTS: Mean age of the subjects was 57-years-old (range: 40~76 years) and mean duration of the symptom was 6 months (2~42 months). A decreased joint volume of less than 10 mL (100%), poor or absent filling of the axillary recess or subscapular bursa (75.9%), nonfill of the biceps tendon sheath (37.9%), and irregularity of capsular insertion (31.0%) were typical abnormal arthrographic findings. In one week after arthrographic distension and rupture, the passive range of shoulder motion was significantly (p<0.05) increased at flexion, abduction and external rotation, of which the range of external rotation was the most remarkably increased (mean, 23.9%). CONCLUSION: Distension arthrography was useful for increasing shoulder motion in frozen shoulder, especially at flexion, abduction and external rotation.
Arthrography* ; Bursitis* ; Humans ; Injections, Intra-Articular ; Joints ; Lidocaine ; Prednisolone ; Rupture ; Shoulder ; Tendons

PURPOSES: The respiratory tract infection is one of the most prevalent and serious complications following hematopoietic stem cell transplantation (HSCT). Reports not only for the respiratory tract infection but, unlikely for bacteria or fungi, for the infections caused by the respiratory viruses have been rarely reported in Korea. During the winter of 2000~2001, authors wanted to know the prevalence rate of the respiratory tract infection and the kinds of causative microorganisms, especially the community respiratory viruses (CRV). Based on these data, we attempted to evaluate the clinical courses and prognosis of the patients. METHODS: From October 2000 to February 2001, specimens were collected from the patients who visited Catholic hemopoietic stem cell transplantation center, showing symptoms and signs of respiratory tract infection after HSCT. Standard methods have been applied to isolate and identify bacterial and fungal species. Measles was diagnosed based on the typical symptoms, rash, fever, and Koplik spot. For the four different CRV (adenovirus, RSV, influenza virus, parainfluenza virus), multiplex PCR and conventional culture method were used for the identification. RESULTS: Eighty-four specimens were collected from 66 patients for 4 month period. Average age of patients was 35+/-8 years. Sixty patients (90%) were received allogeneic HSCT. Sample collection was performed between 10 and 3,740 days (average 370 days, median 215 days) after HSCT. Forty-seven patients (71.2%) have been received immunosuppressants at the time of respiratory tract infection. Forty patients (60.6 %) were suffered lower respiratory tract infection and forty-four patients (66.7%) had community-acquired infection. Sixty microorganisms were identified from 45 patients out of total 66 patients. Identified microoganisms were bacteria accounting for 2 cases (3.4%), fungi for 11 (18.3%), tuberculosis for 5 (8.3%), and viruses for 42 (70.0%). Among viruses, 16 cases were measles (39%), 14 adenovirus (33%), 9 cytomegalovirus (21%), 2 parainfluenza virus (5%), 1 was influenza virus (2%). However, no RSV was identified. Most of patients showed good prognosis without any complications. Ten (15.2%) out of total 66 patients were expired. The direct cause of death for all 8 among 10 patients was pneumonia. CONCLUSION: Of the respiratory tract infection fol-lowing HSCT, most common causative microorganisms were viruses - measles, adenovirus in order. No case of RSV infection was found. No epidemic must be occurred by influenza virus because only 1 case was found. Fourteen patients were infected by more than one microorganisms. Overall mortality rate was 15.2%. This study is still undergoing and once accumulated data for more than 1 year, it might be possible to work out a strategies of treatment and prevention for respiratory tract infections. We also expect that these data might be able to provide the basis of efficient infection control in HSCT unit.
Adenoviridae ; Bacteria ; Bone Marrow Transplantation ; Cause of Death ; Community-Acquired Infections ; Cytomegalovirus ; Exanthema ; Fever ; Fungi ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Immunosuppressive Agents ; Infection Control ; Korea ; Measles ; Mortality ; Multiplex Polymerase Chain Reaction ; Orthomyxoviridae ; Paramyxoviridae Infections ; Pneumonia ; Prevalence ; Prognosis ; Respiratory System* ; Respiratory Tract Infections* ; Stem Cell Transplantation ; Tuberculosis

PURPOSE: This study aimed to investigate the association between skeletal maturation and adrenal androgen levels in obese children and adolescents. METHODS: Fifty-three children and adolescents (aged 7–15 years) diagnosed as obese or overweight were investigated. Anthropometric measurements, bone age (BA) determination, serum biochemical analyses, and hormonal measurements were performed. The difference between BA and chronological age (BA–CA, dBACA) was calculated and used to represent the degree of advanced skeletal maturation. RESULTS: Thirty-one subjects were classified into the obese group and 22 subjects into the overweight group. Insulin resistance as calculated by the homeostasis model assessment of insulin resistance (HOMA-IR) was significantly higher in the obese group than in the overweight group (4.03±2.20 vs. 2.86±1.11, P=0.026). The skeletal maturation of the obese group was advanced, but the dBACA did not differ between the obese and overweight groups statistically (1.43±1.35 vs. 0.91±1.15, P=0.141). Serum dehydroepiandrosterone sulfate (DHEA-S) levels were significantly higher in subjects with dBACA>1 compared to those with dBACA≤1 (104.3±62.2 vs. 59.6±61.0, P=0.014). Correlation analyses demonstrated that dBACA was positively correlated with body mass index standard deviation scores (r=0.35, P=0.010), fasting insulin (r=0.36, P=0.009), HOMA-IR (r=0.30, P=0.031), and insulin-like growth factor-binding protein-3 (r=0.331, P=0.028). In multivariate linear regression analysis, HOMA-IR (P=0.026) and serum DHEA-S (P=0.032) were positively correlated with the degree of advanced skeletal maturation. CONCLUSION: Advanced skeletal maturation is associated with increased insulin resistance and elevated DHEA-S levels in obese children and adolescents.
Adolescent* ; Age Determination by Skeleton ; Androgens ; Body Mass Index ; Child* ; Dehydroepiandrosterone Sulfate ; Fasting ; Homeostasis ; Humans ; Insulin ; Insulin Resistance ; Linear Models ; Obesity ; Overweight