The paint gun is an industrial instrument which ejects paint through a small opening with pressure of l,500 to 3,000 Ib/inch. In case of the paint-gun injury, the paint penetrates through a tiny wound of skin and spreads widely along the fascial plane or tendon sheath. It destroys the tissues rapidly. Moreover, the toxicity of the paint material evokes acute inflammatory reaction which is accompanied by localized swelling, erythema, heat and sometimes generalized symptoms (i.e fever). Local toxic reaction leads to swelling, circulatory disturhance and foIlowed hy gangrene of the tissue. Sometimes tissue condition is too desperate to survive and bring about amputation unfortunately. Authors treated eleven patients of the paint gun injury f'rom March 1988 to April 1995. The paint materials were removed thoroughly via large skin incision as immediately as possible after the injury. Usually the wound is left to be open for seven to ten days and is followed by delayed primary wound closure. In our experience of three cases of delayed removal( two, five and seven days after injury), the outcomes were poor with problems of pain, sensory disturhance, limitation of finger motio, and two cases of digit amputation. On doing paint gun injection, right hand was used to hold the paint-gun and left hand was used to hold the cable. Our study showed right hands were injured mainly(nine cases). It means the paint gun injury is caused by inattention of work partner.
Amputation ; Erythema ; Fingers ; Gangrene ; Hand ; Hot Temperature ; Humans ; Paint* ; Skin ; Tendons ; Wounds and Injuries

Solitary plasmacytoma, in contrast to the disseminated neoplastic proliferation of plasma cells with marked infiltration of multiple organ system in multiple myeloma, is plasma cell neoplasm of a single focus occuring either in bone or soft tissue. The association between a solitary plasmacytoma and peripheral neuropathy is rare, and it is a progressive sensorimotorneuropathy, with a raised CSF protein and mixed demyelination and axonal loss in nerve biopsy. Localized radiotherapy indeed proves to be effective of not only arresting the progress of the neuropathy but also allowing a degree of recovery. We experienced a 55-year-old male with a solitary plasmacytoma and peripheral neuropathy confirmed by the radiologic studies, immunohistochemical stain of nasopharyngeal mucosa biopsy and sural nerve biopsy, which has loss of myelinated fiber and axonal degeneration. Until now, the reported cases are very rare in Korea, so we presented a case of solitary plasmacytoma associated with peripheral neuropathy.
Axons ; Biopsy ; Demyelinating Diseases ; Humans ; Korea ; Male ; Middle Aged ; Mucous Membrane ; Multiple Myeloma ; Myelin Sheath ; Neoplasms, Plasma Cell ; Peripheral Nervous System Diseases* ; Plasma Cells ; Plasmacytoma* ; Radiotherapy ; Sural Nerve

The brachial plexus block is a valuable method of providing anesthesia for the surgery of forearm and hand. Common technique for brachial plexus block include axillary, supraclaviculer, and interscalene approaches. The supraclavicular brachial plexus block offers adventages, ie, high success rate, rapid onset of action and relatively complete block over axillary and interscalene approach, but may be associated with pneumothorax. We marked the P point which was placed on the upper margin of clavicle that crossed the first rib on the chest PA film and marked on the skin of the patient and inserted 23G scalp needle at that point to the first rib. We performed this modified technique of supraclavicular brachial plexus block using chest PA film in 20 patients and there was no incidence of pneumothorax after this block but general anesthesia was sdministered in one case because of incomplete block. We recommend that this modified technique guided by chest PA film for supraclavicular block is simple, reliable and may reduce the incidence of pneumothorax and to increase the success rate in difficult case such as patient with extremely obesity.
Anesthesia ; Anesthesia, General ; Brachial Plexus* ; Clavicle ; Forearm ; Hand ; Humans ; Incidence ; Needles ; Obesity ; Pneumothorax ; Ribs ; Scalp ; Skin ; Thorax*

Pennig wrist fixator (Orthofix) is a dynamic external fixator which allows wrist motion in applied state in the treatment of distal radius fracture. The authors have treated unstable distal radius fracture with Orthofix external fixator and additional percutaneous K-wire fixation from January 1990 to June 1996. Among these cases, the authors analysed the clinical result of 40 cases which were available for follow-up for more than one year. The analysis was performed on the basis of the change of radiographic findings and modified Gartland & Werley criteria. The results were as follows; 1. According to Frykmann classification, 3 cases were Type I; 1 case, Type II; 4 cases, Type III; 2 cases, Type IV; 4 cases, Type V; 5 cases, Type VI; 20 cases, Type VII; 1 case, Type VIII. 2. We could get the improved values after operation as radial inclination 22.6degrees, radial length 10.7mm and volar tilt 8.8degrees. 3. There were little differences in value between at the immediate postoperative roentgenogram and at the last follow up one; radial inlclination decreased 1.2degrees, radial length shortened 2.5mm, volar tilt decreased 2.3degrees. 4. In 3 cases, the level of the ball joint of the fixator was not adjusted appropriately, so the initial satisfactory reduction was disrupted. 5. According to modified Gartland & Werley criteria, 34 cases (85%) were excellent and good. Pennig dynamic wrist fixator (Orthofix) allows the wrist motion earlier than the static external fixator without disturbing the initial reduction state, so it could be suggested as one of the good fixation devices for the treatment of the unstable distal radius fracture.
Classification ; External Fixators* ; Follow-Up Studies ; Joints ; Radius Fractures* ; Radius* ; Wrist

PURPOSE: The purpose of this study is to develop a practical method for determining accurate marker positions for prostate cancer radiotherapy using CT images and kV x-ray images obtained from the use of the on-board imager (OBI). MATERIALS AND METHODS: Three gold seed markers were implanted into the reference position inside a prostate gland by a urologist. Multiple digital image processing techniques were used to determine seed marker position and the center-of-mass (COM) technique was employed to determine a representative reference seed marker position. A setup discrepancy can be estimated by comparing a computed COMOBI with the reference COMCT. A proposed algorithm was applied to a seed phantom and to four prostate cancer patients with seed implants treated in our clinic. RESULTS: In the phantom study, the calculated COMCT and COMOBI agreed with COMactual within a millimeter. The algorithm also could localize each seed marker correctly and calculated COMCT and COMOBI for all CT and kV x-ray image sets, respectively. Discrepancies of setup errors between 2D-2D matching results using the OBI application and results using the proposed algorithm were less than one millimeter for each axis. The setup error of each patient was in the range of 0.1+/-2.7~1.8+/-6.6 mm in the AP direction, 0.8+/-1.6~2.0+/-2.7 mm in the SI direction and -0.9+/-1.5~2.8+/-3.0 mm in the lateral direction, even though the setup error was quite patient dependent. CONCLUSION: As it took less than 10 seconds to evaluate a setup discrepancy, it can be helpful to reduce the setup correction time while minimizing subjective factors that may be user dependent. However, the on-line correction process should be integrated into the treatment machine control system for a more reliable procedure.
Axis, Cervical Vertebra ; Humans ; Prostate ; Prostatic Neoplasms ; Radiotherapy

OBJECTIVE: The aim of this study was to determine whether fetuses delivered prematurely because of pregnancy complications had a different neonatal outcomes than that of those bom after either spontaneous preterm labor or after premature rupture of membrane. METHODS: The study design was a retrospective analysis of 150 very low birthweight(<1500 grams) infants and their mothers who delivered preterm neonates at Samsung Medical Center. Only singleton infants without major congenital anomalies were included. The primary reason for delivery was categorized as preterm delivery because of pregnancy complications(indicated preterm delivery) or spontaneous preterm delivery. Selected neonatal outcomes were compared between infants born to women in each of these groups. RESULTS: There were some survival benefits in infants born to women who underwent indicated preterm delivery from univariate analyses. In the multiple logistic regression analysis, however, selected neonatal outcomes did not differ between the groups. CONCLUSION: We concluded that a "stressed" pregnancies confer negligible survival advantage to the very low birthweight infants.
Female ; Fetus ; Humans ; Infant ; Infant, Newborn ; Logistic Models ; Membranes ; Mothers ; Obstetric Labor, Premature ; Pregnancy Complications ; Pregnancy* ; Retrospective Studies ; Rupture

Myokymic discharge is a train of motor unit potentials that occur spontaneously, recur regularly, and sometimes may be associated with clinical myokymia. We report a 39-years-old male with progressive muscle weakness and atrophy of right upper extremity, who revealed focal myokymic discharges in the intrinsic hand muscles where no denervation was evident on EMG study. The cervical CTMM and MRI study showed a large cervical cord tumor at C3-C6 spine level. Postoperative pathological diagnosis of the tumor was anaplastic astrocytoma.
Astrocytoma ; Atrophy ; Denervation ; Diagnosis ; Hand* ; Humans ; Magnetic Resonance Imaging ; Male ; Muscle Weakness ; Muscles* ; Myokymia ; Spine ; Upper Extremity

BACKGROUND: Mesenchymal stem cells can be expanded rapidly in vitro and differentiated into multiple mesodermal cell types. This study was planned to isolate human adipose tissue stromal cells (hATSCs) from human liposuction tissues and to investigate the changes of tactile threshold after hATSC transplantation in animal neuropathic pain models. METHODS: hATSCs were grown under control conditions in alpha-MEM/10% FBS. To prepare neuropathic pain model rats, thirty male Sprague-Dawley rats that had the average body weight of 208 +/- 5 g, had an experimental nerve injury by cutting or clamping of sural and tibial nerves. The tactile threshold was measured by von Frey hair filament at preinjury and postoperative day (POD) 1, 2, 3, 7, 14. Transplantation of hATSCs was performed after measurement of tactile threshold at POD3. RESULTS: hATSCs grew as a monolayer of large, flat, and spindle-shaped cells. The tactile threshold after spared nerve injury was significantly decreased since one day after cutting or clamping of nerves (P < 0.01). The percent changes of a tactile threshold in clamping and hATSC group were decreased to 59.8 +/- 7.1% (POD7) and 52.6 +/- 5.1% (POD14) (P < 0.05). CONCLUSIONS: This results was suggested that hATSCs could be isolated from human adipose tissue easily. Althogh it needs more long-term investigation hATSCs might be used as a method of therapy for neuropathic pain.
Adipose Tissue ; Animals ; Body Weight ; Constriction ; Hair ; Humans ; Lipectomy ; Male ; Mesenchymal Stromal Cells ; Mesoderm ; Neuralgia* ; Rats* ; Rats, Sprague-Dawley ; Stem Cells ; Stromal Cells ; Tibial Nerve

We report two cases of porphyric peripheral neuropathy in a 19-year-old male with variegate porphyria and in a 39 year-old male with intermittent acute prophyria. Clinically, there were sensory, motor disturbance and autonomic symptoms including decreased sweating, urinary and sphinctor distrubances. Variegate porphyria showed facial diplegia and positive family history inherited by autosomal dominent trait. Intermittent acute porphyria was combined-with SIADH. Both cases were expired due to respiratory failure. Nerve conduction studies were carried out in two cases and both cases showed slow motor, sensory nerve conductlon velocity ,and significant low CMAPs(Compound Muscle Action Potentials). Sural nerve biopsy was carried out in a variegate prophyria compared with one normal control. Decreased large myelinated fibers was found. In nerve fiber teased study. 8.5% of nerve fibers showed axonal degenration and only 2.3% of the segmental demyelination. There findings are suggesting that the porphyric neuro might be the axonal type.and severe neuropathy in a sign of poor prognosis.
Adult ; Axons ; Biopsy ; Demyelinating Diseases ; Humans ; Inappropriate ADH Syndrome ; Male ; Myelin Sheath ; Nerve Fibers ; Neural Conduction ; Peripheral Nervous System Diseases ; Porphyria, Acute Intermittent ; Porphyria, Variegate ; Prognosis ; Respiratory Insufficiency ; Sural Nerve ; Sweat ; Sweating ; Young Adult

BACKGROUND: There were several studies for the incidence of gastroesophageal reflux associated with the laryngeal mask airway(LMA), but the results of those studies were much different from one another. The authors of this study measured the intraesophageal pH at 5cm above lower esophageal sphincter(LES) to compare the incidence of gastroesophageal reflux associated with the LMA and the endotracheal tube(ETT) in positive pressure ventilated patients during long surgical procedures. METHOD: Ninety patients scheduled for elective orthopedic surgery with a standardized general anesthetic technique were randomly allocated to receive either a LMA(n=49) or a ETT(n=41) for airway management. The esophageal manometry was carried out for the exclusion of esophageal motility disorders and a probe with a pH electrode was passed nasally into the esophagus and positioned at 5 cm above LES one day before the operation. After that, recordings of pH for the diagnosis of gastroesophageal reflux disorder and for the detection of reflux episodes during and immediate after anesthesia were performed. RESULTS: There was no significant difference in the incidence of reflux(pH< or =4) between groups; only two patients in LMA and three patients in ETT had reflux episodes in the removal or arousal phase. All of them had experiences such as a coughing or straining during those phases. There was no clinical evidence of aspiration of gastric contents in either group. CONCLUSION: In comparison with ETT, use of LMA does not appear to result in increased incidence of reflux in positive pressure ventilated patients during long surgical procedures.
Airway Management ; Anesthesia ; Arousal ; Cough ; Diagnosis ; Electrodes ; Esophageal Motility Disorders ; Esophagus ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration ; Incidence* ; Laryngeal Masks* ; Manometry ; Orthopedics