No abstract available.
Amputees* ; Energy Metabolism* ; Humans ; Lower Extremity*

PURPOSE: Vitamin D dependent rickets (VDDR) is a rare, autosomal recessively transmitted disorder characterized by hypocalcemia, hypophosphatemia, increased alkaline phosphatase, secondary hyperparathyroidism and many other clinical features. Type l VDDR arises from primary deficiency in the renal 1alpha-hydroxylase that produces 1,25 (OH)2D3. So patients with type I VDDR require life long administration of vitamin D. METHODS: There had been 6 children (4 boys and 2 girls) who were diagnosed as type I VDDR in the Department of Pediatrics, Seoul National University Children's Hospital from March 1983 to May 1997. The medical records, Clinical findings, laboratory, radiologic findings, and response to therapy of these children were analyzed retrospectively. RESULTS: The median age at diagnosis was 19.5 month, and 2 families (33.3%) had family history of rickets. The major presenting symptoms were bowing leg (100%), short stature (100%), and hypocalcemic tetany (67%). Serum levels of 1,25 (OH)2D3 7.0 3.06pg/mL (normal : 20-76pg/mL), respectively. Pretreatment serum levels of calcium (6.9 1.67mg/mL), phosphate (6.9 1.67mg/mL) and alkaline phosphatase (1892 966.4IU/L) were returned to normal levels after treatment (P<0.01). The height standard deviation scores (Z scores) were increased significantly, also (P<0.01). The side effects detected during vitamin D ttherapy were hypercalcemia (33%), hypercalciuria (67%) and nephrocalcinosis (50%). CONCLUSION: This is the first report of type I VDDR in our country. All patients revealed the characteristic clinical, laboratory and radiologic findings, and one third of patients had positive family history. The treatment improved all the clinical, laboratory and radiologic findings significantly including growth. However, complications developed in some patients during the long- term therapy of vitamin D.
Alkaline Phosphatase ; Calcium ; Child ; Diagnosis ; Humans ; Hypercalcemia ; Hypercalciuria ; Hyperparathyroidism, Secondary ; Hypocalcemia ; Hypophosphatemia ; Leg ; Medical Records ; Nephrocalcinosis ; Pediatrics ; Retrospective Studies ; Rickets* ; Seoul ; Tetany ; Vitamin D* ; Vitamins*

BACKGROUND: The emergency physician(EP)'s interpretation of the electrocardiogram(ECG) is important in determining the disposition of patients evaluated in an emergency department(ED) for chest pain o other cardiac complaints. This particularly important in life-threatening ECG findings. When the cardiologist's final interpretation was defined as the correct one, the concordance compared with the EP was reported to be 50-60%, while the missed diagnosis of acute myocardial infarction(AMI) was reported as 0.6-8.0%, which could be deleterious to the patient. METHOD AND MATERIAL : One hundred and twenty eight ECGs were interpreted by two residents from each year residency. ED records of the study patients were reviewed, and the EP's and cardiologist's ECG interpretations were compared. The ECGs were classified by severity according to the following system: class I, normal or minor abnormalities only; class II, abnormalities with potential to alter case management; and class III, potentially life-threatening abnormalities. RESULTS: The overall concordance between EP's and cardiologist's ECG interpretations was 59.3% and the concordance comparing each year residency showed no statistical significant difference (p value less than 0.05). The underdiagnosed rate was 48.4%, 32.0%, 23.4%, 22.7% for first, second, third and fourth year residency respectively, and 2.3%, 5.5%, 10.9%, 5.5% respectively for the overdiagnosed rate. CONCLUSION: Although the overall concordance showed a relatively high result in our study, the concordance of class III ECG resulted a much lower rate. Therefore, additional studies are needed to identify variables that contribute to ED ECG misinterpretation and to develop methods to resolve these difficulties. Assessment of department ECG misinterpretation would be useful in focusing on resident and staff education.
Case Management ; Chest Pain ; Diagnosis ; Education ; Electrocardiography* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Internship and Residency

OBJECTIVE: The purpose of this study is to determine the prevalence of sinus disease and abnormalities in patients scheduled for dental implant in maxillary posterior area using cone beam CT. PATIENTS AND METHOD: One hundred five maxillary sinuses in eighty-seven patients who underwent cone beam CT for dental implant in maxillary posterior area were included. Any patients who had previous history of sinus operations were not included. The sinus abnormalities were classified as follows ; normal (membrane thickness <2 mm), mucosal thickening (membrane thickness > or = 2 mm and <6 mm), partial opacification (membrane thickness >6 mm but not full), full opacification and mucous retention cyst. The relationship between the remaining bone height, sinus symptoms and maxillary sinus abnormality was statistically surveyed. RESULTS: Of 105 maxillary sinuses in 87 patients, 80 (76%) maxillary sinuses showed abnormalities ; 4 of 4 symptomatic patients and 76 of 101 asymptomatic patients. Mucosal thickening was the most common sinus abnormality. Only 3 (4%) of 80 maxillary sinus abnormalities were caused by the odontogenic origin. The prevalence of maxillary sinus abnormalities was higher in the symptomatic group than asymptomatic one (p<0.05). CONCLUSION: Maxillary sinus abnormalities were very common in the patients who were planning implantation in maxillary posterior areas. This result supports that thorough evaluation for maxillary sinus is recommended when implant treatment is planned for those areas.
Cone-Beam Computed Tomography ; Dental Implants ; Humans ; Maxillary Sinus ; Prevalence ; Retention (Psychology)

OBJECTIVE: The purpose of this study is to determine the prevalence of sinus disease and abnormalities in patients scheduled for dental implant in maxillary posterior area using cone beam CT. PATIENTS AND METHOD: One hundred five maxillary sinuses in eighty-seven patients who underwent cone beam CT for dental implant in maxillary posterior area were included. Any patients who had previous history of sinus operations were not included. The sinus abnormalities were classified as follows ; normal (membrane thickness <2 mm), mucosal thickening (membrane thickness > or = 2 mm and <6 mm), partial opacification (membrane thickness >6 mm but not full), full opacification and mucous retention cyst. The relationship between the remaining bone height, sinus symptoms and maxillary sinus abnormality was statistically surveyed. RESULTS: Of 105 maxillary sinuses in 87 patients, 80 (76%) maxillary sinuses showed abnormalities ; 4 of 4 symptomatic patients and 76 of 101 asymptomatic patients. Mucosal thickening was the most common sinus abnormality. Only 3 (4%) of 80 maxillary sinus abnormalities were caused by the odontogenic origin. The prevalence of maxillary sinus abnormalities was higher in the symptomatic group than asymptomatic one (p<0.05). CONCLUSION: Maxillary sinus abnormalities were very common in the patients who were planning implantation in maxillary posterior areas. This result supports that thorough evaluation for maxillary sinus is recommended when implant treatment is planned for those areas.
Cone-Beam Computed Tomography ; Dental Implants ; Humans ; Maxillary Sinus ; Prevalence ; Retention (Psychology)

OBJECTIVE: To measure anterior displacement of the humeral head and to observe its relationship with clinical findings in the subluxed hemiplegic shoulders. METHOD: Seventeen hemiplegic patients, having the subluxed shoulder over one finger breadth were subjected. We measured shoulder pain, muscle power of the shoulder abductors, Brunnstrom stage and spasticity in the affected upper extremity. To measure the humeral displacement of the shoulder subluxation, the AP and transthoracic lateral views of simple radiologic picture were taken on both affected and unaffected shoulders, and repeated after donning three kinds of arm slings. RESULTS: Its anterior displacement as well as the inferior displacement occured in all subjects, and was significantly related with the value of shoulder pain and spasticity, and the inferior displacement with Brunnstrom stage and muscle power of the shoulder abductors in the subluxed hemiplegic shoulder (p<0.05). Correction of the humeral displacement occured significantly in anterior direction as well as inferior by use of all tested arm slings. CONCLUSION: Clinical implications of the shoulder subluxation were different according to direction of the humeral displacement, and anterior displacement will be considered for its symptom in hemiplegic shoulder.
Arm ; Fingers ; Hemiplegia ; Humans ; Humeral Head* ; Muscle Spasticity ; Shoulder Pain ; Shoulder* ; Upper Extremity

In order that anesthesiologists may reduce the anesthetic and surgical stress on the heart, they frequently use regional anesthesia in patients with coronary artery disease, even though there is no evidence that it reduce the incidence of myocardial ischemia. We report a case of life-threatening cardiovascular collapse that occurred in a 47 years old male patient at the emergence from regional anesthesia. He underwent open reduction and internal fixation for femur fracture under combined spinal epidural anesthesia.The cause of serious hypotension is suspected of myocardial ischemia on the basis of ST segment elevation on EKG. We considered that these cardiovascular events were due to coronary spasm.The possible inducing factors of coronary spasm were altered autonomic balance and arteriosclerotic change related endothelial dysfunction.
Anesthesia, Conduction ; Coronary Artery Disease ; Electrocardiography ; Femur ; Heart ; Humans ; Hypotension ; Incidence ; Male ; Myocardial Ischemia ; Spasm

BACKGROUND: This study was conducted to evaluate the effects of fentanyl and midazolam when used as adjuvant in a supraclavicular brachial plexus block. METHODS: 100 adult patients with an ASA status of I-II that were scheduled to undergo upper extremity surgery performed under a supraclavicular brachial plexus block were prospectively evaluated in this study.The patients were randomly divided into 4 study groups:Group 1, which received 40 ml of 1.5% lidocaine, Group 2, which received 3 mg of midazolam with 40 ml of 1.5% lidocaine, Group 3, which received 100microgram of fentanyl with 40 ml of 1.5% lidocaine, and Group 4, which received 3 mg of midazolam and 100microgram of fentanyl with 40 ml of 1.5% lidocaine.The onset time, as well as the duration of analgesia and motor blocks, proportion of successful blocks, hemodynamic parameters, and adverse events were then noted. RESULTS: The incidence of successful block was higher in group 4 (92%) than in any other groups (68-72%) (P = 0.185). In addition, the mean duration of analgesia was longer in groups 2 and 4 (165 min and 175 min) than in groups 1 and 3 (114 min and 131 min) (P < 0.05).Furthermore, the mean duration of motor block was longer in groups 2 and 4 (169 min and 180 min) than in groups 1 and 3 (123 min and 126 min) (P < 0.05).No significant difference was observed in the onset time of the sensory block and motor block when the groups were compared. CONCLUSIONS: Although the addition of 3 mg of midazolam and 100microgram of fentanyl to lidocaine in a supraclavicular brachial plexus block does not affect the onset of sensory or motor block, it does prolong the duration of analgesia and motor block.
Adult ; Analgesia ; Brachial Plexus ; Fentanyl ; Hemodynamics ; Humans ; Incidence ; Lidocaine ; Midazolam ; Prospective Studies ; Upper Extremity

OBJECTIVE: To evaluate the clinical and radiological results and to compare the results of posterolateral lumbar fusion in rheumatic and non-rheumatic disease. METHODS: A retrospective review of results was carried out in 20 patients who had posterolateral lumbar fusion with rheumatic disease from Jul. 1996 to Aug. 2002. And same cases of non-rheumatic disease were compared. The diagnosis of rheumatic disease was confirmed by the ARA revised criteria. Bony union was evaluated by Lenke's criteria and the clinical results by Katz's satisfaction degree. Statistical analysis was performed by paired T-test and ANOVA test. RESULTS: In rheumatic disease group, there were 7 males and 13 females. Mean age was 56.6 (20~68) years and mean fused segments were 2.7 (1~7). Mean follow-up period was 41 months (12~80) after surgery. In non-rheumatic group, there was 6 males and 14 females. Mean age was 57.1 (35~71) years and mean fusion segments were 2.9 (1~4), Mean follow-up period was 40.2 (12~88) months. In age and fusion segments between two group, there was no statistical difference. In rheumatic disease group, the diagnosis were rheumatoid arthritis in 18 patients, ankylosing spondylitis in 1, and systemic lupus erythematosus in 1 patient. The other operations for combined disease were 8 total knee arthroplasty and 3 total hip arthroplasty. There were no statistical differences in operation time (p=0.527), perioperative bleeding (p=0.653) and postoperative (p=0.830) bleeding between two group. In radiological bony union, all patients of two groups showed A and B grade by Lenke's criteria. Bony union was complete at 5.5 (5~8), 5.1 (4~7) months after surgery. There was no significant difference in clinical satisfaction (p=0.756). CONCLUSION: There were no significant differences in clinical and radiological results between the rheumatic and non-rheumatic patients with disease of the lumbar spine.
Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Diagnosis ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Knee ; Lupus Erythematosus, Systemic ; Male ; Retrospective Studies ; Rheumatic Diseases* ; Spinal Fusion* ; Spine* ; Spondylitis, Ankylosing

OBJECTIVE: To evaluate the safety of nasogastric tube (NGT) removal and change to oral feeding with a food thickener for acute stroke patients in whom a videofluoroscopic swallow study (VFSS) confirmed thin liquid aspiration. METHODS: We retrospectively examined data of 199 patients with first stroke who were diagnosed with dysphagia from 2011 to 2015. Swallowing function was evaluated using VFSS. Patients included in this study were monitored for 4 weeks to identify the occurrence of aspiration pneumonia. The penetration-aspiration scale (PAS) was used to assess VFSS findings. The patients were divided into thin-liquid aspiration group (group 1, n=104) and no thin-liquid aspiration group (group 2, n=95). RESULTS: The feeding method was changed from NGT feeding to oral feeding with food thickener (group 1) and without food thickener (group 2). The PAS scores of thin and thick liquids were 6.46±0.65 and 1.92±0.73, respectively, in group 1 and 2.65±0.74 and 1.53±0.58, respectively, in group 2. Aspiration pneumonia developed in 1.9% of group 1 and 3.2% of group 2 (p=0.578), with no significant difference between the groups. CONCLUSION: We concluded that removing the NGT and changing to oral feeding with a food thickener is a safe food modification for acute stroke patients with thin liquid aspiration. Therefore, we recommend that VFSS should be conducted promptly in acute stroke patients to avoid unnecessary prolonged NGT feeding.
Deglutition ; Deglutition Disorders ; Feeding Methods ; Humans ; Pneumonia, Aspiration ; Retrospective Studies ; Stroke*