PURPOSE: To determine the plain film findings of acute neuropathic joint in diabetic foot. MATERIALS AND METHODS: Acute neuropathic joint in diabetic foot was considered when fragmentation of the articular ends of bone and subluxation of the affected joint developed within eight weeks after clinical onset of diabetic gangrene. Eight toes of six diabetics were satisfactory to our criteria. We analyzed plain radiographic findings of the affected joint and soft tissue, interval changes in follow-up radiographs, and deformities after healing. RESULTS: The time interval between clinical onset of gangrene and bone destruction ranged from 2 weeks to 4 weeks(mean 2.6 weeks). Plain radiographs showed fragmentation of the articular ends, subluxation, and soft tissue swelling of the metatarsophalangeal joint or interphalangeal joint. The significant feature of these patients was rapid progression of the lesions. Clinically, all patients had diabetic gangrene in affected toes, however, there was no evidence of osteomyelitis in our series. Amputation was done in 2 cases, and lesions in 3 of the remaining 4 cases were repaired spontaneously with regression of gangrene, leaving radiological residua such as pointed-end, tapered-end, and ball and socket deformity. CONCLUSION: Rapid disorganization of the joint with associated evidence of soft tissue gangrene in plain radiograph is believed to be valuable for the diagnosis of diabetic osteoarthropathy.
Amputation ; Congenital Abnormalities ; Diabetic Foot* ; Diagnosis ; Follow-Up Studies ; Gangrene ; Humans ; Joints* ; Metatarsophalangeal Joint ; Osteomyelitis ; Toes

PURPOSE: To assess the spinal canal and neural foraminal stenosis associated with spondylolisthesis on MR imaging. MATERIALS AND METHODS: We retrospectively analysed MR findings of 63 cases of spondylolisthesis(degenerative type:23 cases, isthmic type:40 cases) regarding the type and grade of spondylolisthesis, prensence or absence of associated spinal canal stenosis, and the severity of associated neural foraminal stenosis. RESULTS: Central canal stenosis were more frequent in degenerative type(91%) than isthmic type(33%), and more frequent in grade II spondylolisthesis of degenerative type(100%) and isthmic type(89%) than in grade spondylolisthesis of degenerative type(45%) and isthmic type(20%). There was positive correlation between the severity of neural foraminal stenosis and the grade of spondylolisthesis, whereas there was no significant difference between degenerative and isthmic types. CONCLUSION: Degenerative spondylolisthesis were frequently associated with central canal stenosis more than isthmic type. When the grade of spondylolisthesis was higher, it was more frequently associated with central canal stenosis and severe neural foraminal stenosis.
Constriction, Pathologic* ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Canal ; Spondylolisthesis*

OBJECTIVE: To determine whether the somatostatin analogue, octreotide, given concunently with human menopausal gonadotropin (HMG) affects ovarian response, ovulation induction outcome, and serum levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) in infertile patients with polycystic ovarian syndrome (PCOS) resistant to clomiphene citrate (CC). METHODS: From August 1996 to June 1998, 42 infertile patients with PCOS urresponsive to CC were enrolled in the present study. Women who had other infertility factors were excluded from this study. Patients were randomly allocated either to combined HMG and octreotide treatment (treatment group) (n=21) or HMG alone (control group) (n=21). In the treatment group, 100 micrograms of octreotide were administered daily concomitantly with HMG from the 3rd day of menstrual cycle to the preceding day of human chorionic gonadotropin (HCG) injection. RESULTS: Patient's characteristics were comparable in both groups. One cycle in the control group was abandoned because of excessive follicular development. However, none of the cycles in the treatment group was abandoned. There were no differences in the number of HMG ampules required and the duration of HMG administration between the two groups. The number of follicles > 14mm diameter on the day of HCG injection was significantly less in the treatment group than that in the control group (p<0.01). The serum estradiol level on the day of HCG injection was also significantly lower in the treatment group, with 1391.0 +/- 695.5 pg/ml compared with 2217.5 +/- 811.6pg/ml in the control group (p<0.001). The incidence of severe ovarian hyperstimulation syndrome seemed to be lower in the treatment group, but the difference did not achieve significance (4.9% vs 23.8%). There were no differences in the clinical pregnancy rate, miscarriage rate and multiple pregnancy rate between the two groups. Although serum GH levels were comparable between the two groups, serum IGF-1 level on the day of HCG injection was significantly higher in the treatment gmup than that in the control group (p<0.001). CONCLUSION: This study suggests that the combined octreotide and HMG treatment could improve hormonal milieu and folliculogenesis compared to HMG alone, and therefore may be effective in ovulation induction for patients with PCOS resistant to CC.
Abortion, Spontaneous ; Chorionic Gonadotropin ; Clomiphene ; Estradiol ; Female ; Gonadotropins ; Growth Hormone ; Humans ; Incidence ; Infertility ; Insulin-Like Growth Factor I ; Menstrual Cycle ; Octreotide ; Ovarian Hyperstimulation Syndrome ; Ovulation Induction* ; Ovulation* ; Polycystic Ovary Syndrome* ; Pregnancy ; Pregnancy Rate ; Pregnancy, Multiple ; Somatostatin*

OBJECTIVE: To analyze the efficacy of intracytoplasmic sperm injection (ICSI) for totally unfertilized oocytes by the conventional insemination during in vitro fertilization and embryo transfer (IVF-ET) METHODS: From March 1996 to April 1998, 15 couples who experienced total fertilization failure after conventional IVF without severe male factor infertility in semen analysis were evaluated. Fertilization were assessed by the presence of 2 pronucleus (PN) after 14-16 hours of conventional insemination. All unfertilized oocytes were reinseminated by ICSI and checked for signs of fertilization between 6-10 hours after ICSI. The embryos with fertilization and development were transferred to the uterine cavity and the outcome was analyzed. RESULTS: Total numbers of unfertilized oocytes were 120, and total numbers of oocytes injected on day 1 using ICSI were 102. Total numbers of oocytes with normal fertilization after ICSI were 74 and mean fertilization rate of 71.1 +/- 24.0% was obtained. The numbers of embryos transferred was 3.6 +/- 1.7. The biochemical pregnancy rate was 13.3% (2/15) and the clinical pregnancy rate was 6.7% (1/15) per cycle. CONCLUSION: ICSI to totally unfertilized oocytes by conventional insemination technique during IVF-ET on the next day of oocyte retrieval seems to be a relatively successful mean and afford a chance of pregnancy to the infertile couples whom the ET could not perfomed to because of total fertilization failure."
Embryo Transfer ; Embryonic Structures ; Family Characteristics ; Fertilization ; Fertilization in Vitro ; Humans ; Infertility ; Insemination ; Male ; Oocyte Retrieval ; Oocytes* ; Pregnancy ; Pregnancy Rate ; Semen Analysis ; Sperm Injections, Intracytoplasmic*

'I'he adult form of myasthenia gravis (MG) is an autoimmune disorder characterized by the presence of anti-acetylcholine receptor immunoglobulin G antibodies (anti-ACHRIgG) which blocks the formation of acetylcholine at the motor end plate and causes anatomic deterioration of this structure. 'I'he end result is defective neuromuscular transmission manifested by progressive skeletal muscle weakness. We have experienced a full term pregnancy complicated with the myasthenia gravis. We experienced a case of myathenia gravis associated with pregnancy who underwent cesarean section. The case is presented here with a brief review of literatures concerned.
Acetylcholine ; Adult ; Antibodies ; Cesarean Section ; Female ; Humans ; Immunoglobulin G ; Motor Endplate ; Muscle, Skeletal ; Myasthenia Gravis ; Pregnancy*

To evaluate the usefulness of MR in the osteomyelitis, we reviewed MR examinations of 14 patients with pyogenic osteomyelitis of the long bone. All 14 patients were confirmed to have osteomyelitis either surgically (13/14) or by aspiration (1/14). MRI was performed with 0.5R (n=8) or 2.0T (n=6) SE technique, and Gd-DTPA enhanced T1WI was obtained in 10 examinations. Anatomic location of lesions were femur (8/14), tibia (5/14),m and fibula (1/14). The marrow cavity and soft tissue were involved in 13/14, 12/14 respectively. The signals of both intraosseous and extraosseous infected area were iso to low signal intensity to muscles on T1WI and high signal intensity on PDWI & T2WI. Rim or diffuse enhancement of the marrow cavity and soft tissue were seen in all (10/10) cases. Sequestra, periosteal reaction. And cortical defect were found in 12/14, 10/14, 9/14. MR provided more accurate and detailed anatomic information including extent of disease and possible activity than bone scintigraphy, CT, or conventional radiography. We conclude that MR might be the choice of modality in the diagnosis of osteomyelitis of the long bone.
Bone Marrow ; Diagnosis ; Femur ; Fibula ; Gadolinium DTPA ; Humans ; Magnetic Resonance Imaging ; Muscles ; Osteomyelitis* ; Radiography ; Radionuclide Imaging ; Tibia

Changes of bone turnover with aging are responsible for bone loss and play a major role in osteoporosis. Among the early postmenopausal women, as are known by previous study, there are about 35% ""fast bone losers and bone turnover is more uncoupled in osteoporotic group than in normal control. So, early detection of such fast losers"" and women who have high turnover rate is important to prevent postmenopausal osteoporosis and spontaneous fracture. Dual-energy X-Ray absorptiometry (DEXA), however, cannot reflect current bone loss because changes in bone mineral density (BMD) are only seen after 1 or more years of bone densities declining. In this study, we have measured a battery of new sensitive and specific markers of bone turnover which reflect current bone loss. To investigate the changing pattern of those markers, 674 healthy women including 451 postmenopausal women were classified, according to their menopausal period (less than 5 years, 5-10 years, more than 10 years). Bone formation was assessed by serum osteocalcin (OC), bone-specific alkaline phosphatase (BSAP) and bone resorption by the urinary excretion of deoxypyridinoline (DPD), cross-linked N-telopeptide of type I collagen (NTX). All Biochemical markers, except OC, significantly increased after menopause (p < 0.05). NTX and BSAP remained elevated after 10 years of menopause. These data indicated that the overall rates of both bone formation and bone tesorption increased after menopause and remained high in elderly women.
Absorptiometry, Photon ; Aged ; Aging ; Alkaline Phosphatase ; Biomarkers ; Bone Density ; Bone Resorption ; Collagen Type I ; Female ; Fractures, Spontaneous ; Humans ; Menopause ; Osteocalcin ; Osteogenesis ; Osteoporosis ; Osteoporosis, Postmenopausal

Benzodiazepine derivatives, chlordiazepoxide(Librium), diazepam(Valium), nitrazepam(Mogadon) and oxazepam(Serenid-D) are mainly used as hypnotics at present. Diazepam has been used mainly for premedication in anesthesia and as an intravenous anesthetic agent. The pharmacological actions of these drugs are tranquilizing effects for central nervous system, slight depression on the cardiovascular and respiratory system, anticonvulsant, anxiolytic and antidepressant effects. A new benzodiazepine derivative, Flunitrazepam(Ro 5-4200) has strong hypnotic action, is anticonvulsant and antidepressant in spite of slight depression of the cardiovascular and respiratory systems. Furthermore the onset and duration of this drug are shorter than the others. In our clinical study, flunitrazepam in the dosage of 0.005mg/kg was administered intravenously, as an intravenous anesthetic induction agent, for 22 surgical adult patients. In each patient, the blood pressure, pulse rate, respiratory rate, minutes volume and arterial gas study were done, before and after administration of the Ro 5-4200. The results are as follows; 1. Dosage of this flunitrazepam is not constant as other benzodiazepines. 2. The effects of flunitrazepam on the cardiovascular system showed slight depression but no effect by one hour post-operation. 3. In respiratory system, the minute volume was depressed slightly and the respiratory rate was increased but negligibly. 4. Undesirable side effects attributed to this drug were not found, except the developing of cough (one case).
Adult ; Anesthesia ; Benzodiazepines ; Blood Pressure ; Cardiovascular System ; Central Nervous System ; Clinical Study* ; Cough ; Depression ; Diazepam ; Flunitrazepam ; Heart Rate ; Humans ; Hypnotics and Sedatives ; Premedication ; Respiratory Rate ; Respiratory System ; Tranquilizing Agents

With the advent of intracytoplasmic sperm injection (ICSI), the fertiliution and pregnancy have been reported even in complete asthenozoospermia. However, the results of ICSI in men with totally immotile sperm was still disappointing. The reasons for the total lack of sperm movement are not yet determined. The immotility of ejaculated spermatozoa is probably caused by sperm degeneration during epididymal transport, therefore higher viable spermatozoa can be obtained by testicular sperm recovery in some cases with low viability and total lack of movement of ejaculated spermatozoa. Recourse to testicular spermatozoa for ICSI is thus an alternative treatment possibility in this kind of pathology. This clinical study was performed to investigate the efficacy of ICSI employing testicular and ejaculated spermatozoa. From December 1995 to March 1998, 35 couples with totally immotile spermatozoa were included in the study. In 14 patients, the ejaculated spermatozoa were used whereas in 21 patients the spermatozoa were recovered from the testis. There were no significant differences in the fertilization and cleavage rates between the testicular sperm group with 62.6%, 52.7% and the ejaculated sperm group with 56.1%, 74.3%. Two pregnancies were achieved, one in the testicular spnm poup and the other in the ejaculated group. A healthy child was delivered at term in the ejaculated sperm group, but a clinical abortion occurred in a pregnancy in the testicular sperm group. In conclusion, it was suggested that ICSI using ejaculated sperm might be a primary treatment in cases with totally immotile spermatozoa and, if failed, testicular sperm could be used as an alternative mode of heatment.
Asthenozoospermia ; Child ; Family Characteristics ; Fertilization ; Humans ; Male ; Pathology ; Pregnancy ; Pregnancy Rate ; Sperm Injections, Intracytoplasmic* ; Spermatozoa* ; Testis

Congenital diaphragmatic hernia (CDH) is caused by a failure of fusion of the muscular diaphragm and results in herniation of abdominal viscera into the thorax, It occurs in appoximately 1 in 2,200 to 5,000 live births, and most cases are probably multifactorial, but they can be also associated with chromosomal abenation. Due to the improvement of sonography, it can be diagnosed more accurately. However, the mortality associated with CDH is extremely high. It is well known that the incidence of congenital anomaly in infants after in vitro fertilization and embryo transfer (IVF-ET) is not increased copared with that of general population, and CDH that occurred following IVF-ET has not been reported. A case of CDH that occurred following IVF-ET is presented with brief review of literatures.
Diaphragm ; Embryo Transfer* ; Embryonic Structures* ; Fertilization in Vitro* ; Hernia, Diaphragmatic* ; Humans ; Incidence ; Infant ; Live Birth ; Mortality ; Thorax ; Viscera