Acute bacterial infection of bone and joint presents a real challenge to orthopedist because early diagnosis and treatment are difficult and also essential. In almost all practices, fever and erythrocyte sedimentation rate(ESR) are widely used for monitoring the course, for estimating the effectiveness of treatment, and for the recovery of such illnesses. However, interpreting body temperature is difficult and ESR is nonspecific, is not not sensitive, normalizes slowly. Otherwise, C-reactive protein(CRP) is very sensitive and normalizes fast. CRP, body temperature, and ESR were sequentially measured until a normal value was reached in twenty seven patients in whom acute osteomyelitis (17 patients), acute exacerbation of chronic osteomyelitis(4 patients), and septic arthritis(6 patients) had been diagnosed by positive bacterial culture at Kyungpook National University Hospital from June 1984 to May 1985. The results were as follows: 1. CRP normalized within 8.8 days on average. 2. Fever lasted 4.5 days on average. 3. ESR normalized within 41.6 days on average. 4. Initial mean value of CRP was 4.2 positive in acute in acute osteomyelitis and septic arthritis and 3.5 positive in acute exacerbation of chronic osteomyelitis, therefore CRP can be considered as a very sensitive indicator for early detection of acute bacterial infection of bone and joint. Also sequential CRP determination can be used for monitoring the course, for estimating the effectiveness of treatment, and for the recovery of such illnesses.
Arthritis, Infectious ; Bacterial Infections ; Blood Sedimentation ; Body Temperature ; C-Reactive Protein ; Early Diagnosis ; Fever ; Gyeongsangbuk-do ; Humans ; Joints ; Osteomyelitis ; Reference Values

PURPOSE: To evaluate the dose under lung block as a function of depth and the effectiveness of a block as a function of block width. MATERIALS AND METHODS: Field size of mantle field was 22.8 x 32.4 cm2 . Dose distribution of the mantle field was measured with two dimensional water phantom system. To analyze the effectiveness of the lung block, central axis plane, 5cm off-axis plane, and 10cm off-axis plane were studied. RESULTS: The dose under the lung block was recorded with maximum at the depth between , 5cm and 10cm . In the central axis plane, dosimetric block width was 10-15% les than physical block width. In the 5cm off-axis plane. Dosimetric block width was 4-9% less than physical block width. In the 10cm off-axis plane, dosimetric block width was 2% less than physical block width. CONCLUSION: Depth dependence of the dose under the lung block was founded. Also, block width dependence of the lung block was founded. To induce the accurate relation between the physical block width and the "effective" block width, it needs more detailed understanding of the variables involved.
Axis, Cervical Vertebra ; Lung* ; Water

No abstract available.
Cervix Uteri* ; Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization in Vitro* ; Follicular Fluid* ; Humans* ; Spermatozoa* ; Spouses*

A rare case of chronic pain of entrapment neuropathy of the sciatic nerve successfully relieved by surgical decompression is presented. A 71-year-old male suffered a chronic right buttock pain of duration of 7 years which radiating to the right distal leg and foot. His pain developed gradually over one year after underwenting drainage for the gluteal abscess seven years ago. A cramping buttock and intermittently radiating pain to his right foot on sitting, walking, and voiding did not respond to conventional treatment. An MRI suggested a post-inflammatory adhesion encroaching the proximal course of the sciatic nerve beneath the piriformis as it emerges from the sciatic notch. Upon exploration of the sciatic nerve, a fibrotic tendinous scar beneath the piriformis was found and released proximally to the sciatic notch. His chronic intractable pain was completely relieved within days after the decompression. However, thigh weakness and hypesthesia of the foot did not improve. This case suggest a need for of more prompt investigation and decompression of the chronic sciatic entrapment neuropathy which does not improve clinically or electrically over several months.
Abscess ; Aged ; Buttocks ; Chronic Pain ; Cicatrix* ; Decompression* ; Decompression, Surgical ; Drainage ; Foot ; Humans ; Hypesthesia ; Leg ; Magnetic Resonance Imaging ; Male ; Muscle Cramp ; Pain, Intractable ; Sciatic Nerve* ; Thigh ; Walking

No abstract available.
Embryonic Structures* ; Fluorescence* ; Humans* ; In Situ Hybridization* ; Preimplantation Diagnosis*

Since 1980, 18 patients(12 males, 6 females) with intractable perineal and perianal pain caused by uncontrolled malignant neoplastic disease, were surgically treated with sacral rhizotomy. Patients ranged in age from 33 to 74 years ; the duration of symptoms ranged from 2 months to 17 months. The primary site of the malignancies were as follows : prostate cancer(3 cases), cervix cancer(5), colorectal cancer(10). All patients underwent preoperative psychological test, drug assessment, cystometry and trial block. The present criteria for selection were : 1) All patients should have uncontrolled malignant disease with metastasis. 2) The pain should be limited to the perineal or the perianal region. 3) The pain should be severe and refractory to medical and psychological management. 4) The pain should be of least 3 months. 5) Estimated life expectancy should be at least 3 months. 6) All patients should have had a previous colostomy. 7) The operative modification should be made according to the urinary disturbance. If there is no voluntary urination, the operation should include both S2 roots ; but, if the bladder is still functioning normally, the S2 root should be preserved in the least painful side. Postoperative results of pain control were no pain in 14 patients(78%), good in three(16%), and poor in one(6%). After reviewing the results, the authors believe that if the patients are selected properly, according to the criteria outlined, sacral rhizotomy is worthwhile, simple and relatively successful method of treating intractable perineal and perianal cancer pain.
Cervix Uteri ; Colostomy ; Female ; Humans ; Life Expectancy ; Male ; Neoplasm Metastasis ; Prostate ; Psychological Tests ; Rhizotomy* ; Urinary Bladder ; Urination

The treatment of pathologic aerophagia has rarely been discussed in the literature. In this retrospective study, the authors investigated the effects of clonazepam on the management of pathologic childhood aerophagia (PCA) with psychological stresses (PS), but not with mental retardation. Data from 22 consecutive PCA patients with PS (aged 2 to 10 yr), who had been followed up for over 1 yr, were reviewed. On the basis of videolaryngoscopic views, the authors observed that the pathology of aerophagia was the result of reflex-induced swallowing with paroxysmal openings of the upper esophageal sphincter due to unknown factors and also observed that these reflex-induced openings were subsided after intravenous low dose benzodiazepine administration. Hence, clonazepam was administered to treat paroxysmal openings in these PCA patients with PS. Remission positivity was defined as symptom-free for a consecutive 1 month within 6 months of treatment. The results of treatment in 22 PCA patients with PS were analyzed. A remission positive state was documented in 14.3% of PCA patients managed by reassurance, and in 66.7% of PCA patients treated with clonazepam (p=0.032). Thus, clonazepam may produce positive results in PCA with PS. Future studies by randomized and placebo-controlled trials are needed to confirm the favorable effect of clonazepam in PCA.
Treatment Outcome ; Stress, Psychological/*complications/*drug therapy ; Retrospective Studies ; Male ; Injections, Intravenous ; Humans ; Female ; Clonazepam/*administration & dosage ; Child, Preschool ; Child ; Anticonvulsants/administration & dosage ; Aerophagy/*complications/*prevention & control

Tsutsugamushi disease is one of the acute febrile diseases caused by Orientia tsutsugamushi that is transmitted to human by the bite of larval-stage trombiculid mite (chigger). The clinical illness is characterized by abrupt onset of fever, headache, rashes, myalgia and eschar. Chest radiologic findings show reticulonodular infiltration, cardiomegaly, lymphadenopathy and in a minority, pleural effusion. About pleural effusion, it is supposed to be caused by tsutsugamushi disease itself in most cases and no case has been reported that the pleural effusion confirmed by pleural biopsy and revealed granulomatous lesions. We experienced a case of tsutsugamushi disease with pleural effusion which was also confirmed to granulomatous lesion by pleural biopsy. So we report this case with a brief review of literatures.
Biopsy ; Cardiomegaly ; Exanthema ; Fever ; Granuloma ; Headache ; Humans ; Lymphatic Diseases ; Myalgia ; Orientia tsutsugamushi ; Pleural Effusion* ; Scrub Typhus* ; Thorax ; Trombiculidae

Object of this study was to to evaluate the laterality of local cerebral cellular metabolism in various locations of the brain related to the symptomatic side of patients with clinically diagnosed idiopathic Parkinson's disease (IPD) and to verify GABA-related pathophysiology in IPD by comparing postoperative changes in (GABA+Glutamate)/Cr ratio from patients with IPD after stereotactic pallidotomy and thalamotomy. Fourteen patients with IPD(10 males and 4 females: age range 39-67 years) participated in the study. The patients were classified into two disease subgroups, one for tremor dominant group(n=7, T group), and the other bradykinesia and rigidity dominant one(n=7, B&R group). For T group, stereotactic VL(Vop, Vim) thalamotomy and subthalamotomy was performed and for the B&R group, stereotactic posteroventrolateral pallidotomy was selected. In Vivo 1H MRS study was performed on a 1.5 T MRI/MRS system(GE Sigma Advantage, version 4.8) using STEAM sequence after water suppression with CHESS RF pulse and dephasing gradients. After peak areas of creatine/phosphocreatine(Cr), choline-containning compound(Cho), N-Acetyl Aspartate(NAA), r-aminobutyric acid, (GABA) and glutamate(Glu) were calculated and processed, the metabolic ratios of NAA/Cr, Cho/Cr, and (GABA+Glu)/Cr in three different locations were calculated and compared with clinical symptoms and its changes after surgery. For the neuronal laterality in patients with IPD, there was significant differences of NAA/Cr ratio between the right and left sides of substantia nigra, thalamus and pallidum(p=0.00170). The magnitude of difference in NAA/Cr ratios between right and left side were significantly larger in substantia nigra(p=0.0141). Compared to the normal control values(1.82+/-0.52 in ages 27-50, 1.71+/-0.54 in ages 51-70 years), the neuronal loss was generally observed in at least one of three locationsin all patients. Moreover, NAA/Cr ratio was substantially lower in ipsilateral than contralateral substantia nigra of the parkinsonian symptomatic side. For preoperative(GABA+Glu)/Cr ratios of thalamus contralateral to the symptomatic side compared to that of ipsilateral, it was significant larger in thalamus of B&R group and significant smaller in T group. In the pallidotomy group, there was significant increase in the operated pallidum, whereas significant decrease in (GABA+Glu)/Cr ratios were noted in the operated side thalamus. And in the thalamotomy group, there were significant increase in the operated thalamus, whereas in the operated side pallidum, significant decrease in (GABA+Glu)/Cr ratios were noted. Neuronal laterality, pallidal neuronal loss and postoperative changes in GABA activity in patients with IPD were demonstrated on the basis of NAA/Cr and (GABA+Glu)/Cr ratio by In Vivo 1H MRS. The neuronal laterality was detected in the substantia nigra of all the parkinsonian patient, and NAA/Cr ratios in unilateral and bilateral disease were consistently lower in ipsilateral than in contralateral substantia nigra of the Parkinsonian disease side. Our result suggests that there may be another ongoing pathological process of ipsilateral neuronal degeneration with contralateral dopaminergic neuronal loss. The result of neuronal loss in pallidum supports with the previous reports concerning striatal degeneration in IPD. Our results concerning postoperative changes of (GABA+Glu)/Cr ratio suggests that separate pathophysiologic mechanisms may be involved in the development of two dominant symptom groups of IPD. That is, for the B&R group, pallidal overinhibition to the thalamus by the GABA-ergic system as previously noted, but for T group, a process other than GABA inhibitory mechanism with or without it may be involved.
Brain ; Dopaminergic Neurons ; Female ; gamma-Aminobutyric Acid ; Humans ; Hypokinesia ; Male ; Metabolism ; Neurons* ; Pallidotomy ; Parkinson Disease ; Steam ; Substantia Nigra ; Thalamus ; Tremor ; Water

PURPOSE: Cranial fasciitis is a rare type of benign tumor that occurs mostly in children younger than 6 years. It arises from the deep fascia, periosteum, or fibromembranous layer that covers fontanelles. The etiology is unknown, although prior trauma has been postulated to be an underlying cause. There is a 2:1 male predominance. Despite its rapid growth, this tumor has a benign clinical course and can be cured by total excision. METHODS: A 16-year-old male presented with a 3 cm-sized palpable mass in the left lateral eyebrow region that he first noticed 4 months before presentation. The mass had grown rapidly since it was first noticed. Preoperative brain computed tomography showed a well-demarcated mass approximately 3 cm in size extending from the subcutaneous layer to the periosteum. Preoperatively, the presumed diagnosis was a dermoid cyst. An operation was performed with the patient under general anesthesia. The subcutaneous mass was completely excised by periosteal dissection. RESULTS: Histological diagnosis revealed the presence of cranial fasciitis. After 20 months of follow-up, there have been neither complications nor evidence of local recurrence besed on clinical examination. CONCLUSION: Although cranial fasciitis is quite rare, it should be considered in the differential diagnosis for lytic skull lesions in patient whose clinical presentation suggests this possibility. This condition could be occasionally mistaken for malignant or locally aggressive lesions. To prevent local recurrence, curettage of the underlying bone is recommended for patients with bone involvement.
Adolescent ; Anesthesia, General ; Brain ; Child ; Curettage ; Dermoid Cyst ; Diagnosis, Differential ; Eyebrows ; Fascia ; Fasciitis ; Follow-Up Studies ; Humans ; Male ; Periosteum ; Recurrence ; Skull