Traumatic anterior shoulder dislocation combined with scapular fracture in elderly patients is relatively rare. In this case, a patient visited Emergency Room of Dong-A University Hospital for shoulder pain after falling off a ladder. Radiographs demonstrated anterior shoulder dislocation with displaced Ideberg type IIb scapula (glenoid fossa) fracture combined with a large rotator cuff tear on magnetic resonance imaging. We performed arthroscopic rotator cuff repair, but a large fragment in the inferior glenoid was left untreated. At the 1 year follow-up visit, the pain visual analogue scale of the patient was 2, the American Shoulder and Elbow Society score was 88 and the patient had gained nearly full range of motion without any apprehension.
Accidental Falls ; Aged ; Elbow ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Range of Motion, Articular ; Rotator Cuff* ; Scapula* ; Shoulder Dislocation* ; Shoulder Pain ; Shoulder* ; Tears*

No abstract available.
Hand* ; Humans

PURPOSE: This study was conducted to identify and compare the stressors and coping behaviors of high school students who experienced suicidal ideation vs those who do not. METHOD: The data were collected from 1,441 high school students living in the middle region of Korea. Researchers collected the data using Adolescent Stress Inventory and Adolescent Coping questionnare from February to May of 1999. Data were analyzed using X2, T-test. RESULT: A significant proportion (31.9%) of subjects had thought about suicide during the past 6 months, 297 girls (35.3%) and 163 boys (27.2%). Major stressors of subjects who experienced suicidal ideation were academic problems, conflicts between family members, and changes in sleeping or eating patterns. Conflicts with family members contributed to have suicidal ideation. There was no significant difference in helpful coping behaviors between the two groups. The group who experienced suicidal ideation had lower scores and fewer coping behaviors. Boys perceived more stressors and had fewer helpful coping behaviors than girls. CONCLUSION: It is necessary to develope school-based suicide prevention programs. Our findings suggest that the program should focus on problems related to studying and conflicts within the family.
Adaptation, Psychological* ; Adolescent ; Eating ; Female ; Humans ; Korea ; Suicidal Ideation* ; Suicide

BACKGROUND: Elements of informed consent including capacity, disclosure, understanding, voluntariness, and permission of the participant, are all crucial for clinical trials to be legally and ethically valid. During the informed consent process, the patient information leaflet is an important information source which prospective research subjects can utilize in their decision-making. In the adequate provision of information, KGCP guideline necessitate 20 specific items, as well as the use language that individuals can understand. This study measures the vocabulary level of patient information leaflets in an effort to provide an objective evaluation on the readability of such material. METHODS: The word difficulty of 13 leaflets was quantitatively evaluated using Kim kwang Hae's vocabulary grading framework, which was compared to the difficulty level of words found in the 6th grade Korean textbook. The quantitative outcomes were statistically analyzed using chi-squared tests and linear by linear association for ordinal data. RESULTS: There was a statistically significant difference between the vocabulary level and frequency of words in leaflets and the 6th Korean textbook. The leaflets were on average 260 sentences and about roughly 15 pages long, including lay language (easier or equal to language used in primary school) of around 12% less; technical language of around 4.5% more. As the vocabulary grades increase, there was a distinct difference in vocabulary level between Korean textbook and each information leaflet (p < 0.001). CONCLUSION: Patient information leaflets may fail to provide appropriate information for self-determination by clinical trial subject through the difficulty level of its wording. Improvements in the degree of patients' understanding and appropriate use of information leaflets are collaboratively equipped to strengthen patient's autonomy and therefore guaranteeing participant's rights.
Comprehension* ; Disclosure ; Human Rights ; Humans ; Informed Consent ; Prospective Studies ; Research Subjects ; Vocabulary

The ultraviolet radiation (UVR) is known to be a potent modulator of many host immune functions and the exposure of experimental animals to the inflammatory effects of UVR induces depressions in their ability to initiate and effectuate various types of cellular immune responses. In this study, the effects of UV-B (280 320 nm) radiation on resistance to a facultative intracellular bacterium, Listeria monocytogenes (LM), were examined at the cellular level. The numbers of cultivable LM recovered from the spleens of UV-B-irradiated mice were decreased at 2 days postinfection compared with those of untreated control mice. However, the acquired immunity, developed 7 days after immunization with streptomycin (SM)-sensitive LM, in either UV-irradiated, LPS- or IL-1-pretreated mice was less stronger than that developed in untreated, control mice. To elucidate the possible mechanisms underlying the observation that UVR did increase innate immunity but decreased acquired immunity of mice to the infection with LM, the effects of UVR of mice on the production of IFN-r by activated splenocytes and TNF-a by peritoneal macrophages were assessed. Activated splenocytes from UV-irradiated mice exhibited a reduced capacity to produce IFN-r and cultured peritoneal macrophages produced more TNF-a in the presence of LPS during 24 hours after UV radiation. Though TNF-r activity was not detected in the sera of LM-infected mice, intravenous LPS injection induced TNF-r production and UVR decreased TNF activity in sera obtained from LM-infected mice with LPS induction 9 days after irradiation. Although Ia-negative macrophages were predominant in the peritoneal macrophages from untreated control mice, the infection of mice with LM caused a marked increase in Ia expression on peritoneal macrophages. However, UVR resulted in decreased expression of Ia molecule on the peritoneal macrophages during the LM infection. These findings suggest that the dual effects of UVR on the innate and acquired immunity of mice to the LM infection may be associated with altered capacities of splenocytes and peritoneal macrophages of the mice to produce cytokines, in addition to decrease of la molecule expression on the macrophages.
Adaptive Immunity ; Animals ; Cytokines ; Depression ; Immunity, Cellular ; Immunity, Innate ; Immunization ; Listeria monocytogenes* ; Listeria* ; Macrophages ; Macrophages, Peritoneal ; Mice* ; Spleen ; Streptomycin ; Tumor Necrosis Factor-alpha*

BACKGROUND: Lidocaine or verapamil are used as an antiarrhythmic agent or agent blunting the cardiovascular changes induced by intubation or extubation during anesthesia. After recovery from general anesthesia with muscle relaxants, most patients remained in a residual paralytic state, hence it might develop easily recurarization by factors that affect neuromuscular transmission. Lidocaine and verapamil are well known as agents to potentiate the neuromuscular block. We investigated the effects of lidocaine or verapamil on neuromuscular transmission in vitro. METHODS: Square wave, 0.2 ms duration at a frequency of 0.1 Hz supramaximal or train of four stimuli was applied and the twitch height response was recorded mechanomyographically on rat phrenic nerve hemidiaphragm preparations. Dose responses of rocuronium, lidocaine, verapamil, rocuronium pretreated with lidocaine or verapamil, lidocaine pretreated with rocuronium, and verapamil pretreated with rocuronium were observed by cumulative method, and effective doses (Lag dose, ED50 and ED95) between a pretreated and nonpretreated agent were compared statistically. TOF ratios were observed at 80, 70, 40 and 30% of the control twitch height value during the observation of dose responses. RESULTS: Lag dose, ED50 and ED95 of rocuronium were reduced significantly after pretreatment of lidocaine, verapamil or their mixture, and the dose response of lidocaine, verapamil or their mixture were also reduced significantly by rocuronium pretreatment. TOF ratios at the point of each twitch height decreased significantly after pretreatment. CONCLUSIONS: Lidocaine or verapamil itself did not affect the neuromuscular transmission but might have potentiated the neuromuscular blocking effect induced by rocuronium. However, in excessive doses, these agents produced neuromuscular blockade. Consequently, in the residual neuromuscular block induced by rocuronium, lidocaine or verapamil may enhance recurarization.
Anesthesia ; Anesthesia, General ; Animals ; Humans ; Intubation ; Lidocaine* ; Neuromuscular Blockade* ; Phrenic Nerve ; Rats ; Verapamil*

There is an evidence that onset time and potency of the non-depolarizing neuromuscular blocking agents are related. However the relationship between onset time and the recovery has not been investigated yet. In this experiment, the onset times of six neuromuscular blocking agents have been compared with their recovery times. The neuromuscular transmission of mivacurium 0.15 mg/kg, atracurium 0.4 mg/kg, vecuronium 0.08 mg/kg, pipecuronium 0.08 mg/kg, pancuronium 0.1 mg/kg and succinylcholine 1 mg/kg were studied in 58 adult healthy patient (ASA I and II) during O2-N2O-isoflurane anesthesia using train-of-four stimulation with Relaxograph. It has been demonstrated that there is a close relationship between onset time and recovery in depolarizing neuromuscular blocking agent but not in non-depolarizing agents. Consequently, it is proposed that the relationships between the onset time and the recovery may hardly expected in clinical practice following systemic administration of non-depolarizing neuromuscular blocking agents.
Adult ; Anesthesia ; Atracurium ; Humans ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents ; Pancuronium ; Pipecuronium ; Succinylcholine ; Vecuronium Bromide

Plasma cholinesterase (ChE), an enzyme produced by the liver, rapidly hydrolizes succinylcholine. In the presence of low enzymatic activity, the rate of destruction of succinylcholine is diminished and it may result in an undesirably long duration of paralysis following succinylcholine administration. There are many reports that a significant fall in plasma ChE activity was shown to occur during pregnancy and in the immediate postpartum period. The present study was designed to compare the plasma ChE activity and the reaction of succinylcholine in 27 healthy nonpregnant women with that in 30 pregnant women undergoing elective caesarean section. Before induction of anesthesia, venous blood was taken for the measurement of plasma ChE activity, which was assayed by a colorimetric method, and the duration of action, recovery index and TOF ratio of succinylcholine were measured using ABM (Anesthesia and Brain activity Monitor, Datex Co.). The results were as follows: 1. Plasma ChE aetivity in pregnant women was lower than in nonpregnant women but was not statistically significant. 2. With respect to the duration of action, recovery index and TOF ratio on the 25 and 75% recovery of first twitch height, there were no significant differences between pregnant and nonpregant women.
Anesthesia ; Brain ; Cesarean Section ; Cholinesterases* ; Female ; Humans ; Liver ; Paralysis ; Plasma* ; Postpartum Period ; Pregnancy* ; Pregnant Women ; Succinylcholine*

Traumatic anterior shoulder dislocation combined with scapular fracture in elderly patients is relatively rare. In this case, a patient visited Emergency Room of Dong-A University Hospital for shoulder pain after falling off a ladder. Radiographs demonstrated anterior shoulder dislocation with displaced Ideberg type IIb scapula (glenoid fossa) fracture combined with a large rotator cuff tear on magnetic resonance imaging. We performed arthroscopic rotator cuff repair, but a large fragment in the inferior glenoid was left untreated. At the 1 year follow-up visit, the pain visual analogue scale of the patient was 2, the American Shoulder and Elbow Society score was 88 and the patient had gained nearly full range of motion without any apprehension.
Accidental Falls ; Aged ; Elbow ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Range of Motion, Articular ; Rotator Cuff ; Scapula ; Shoulder Dislocation ; Shoulder Pain ; Shoulder ; Tears

BACKGROUND: Intravenous anesthetics may modify airway responsiveness. The author investigated the relaxant effect of thiopental, ketamine, and propofol on isolated rat tracheal smooth muscles. METHODS: The trachea of the rat was dissected and cut into 3-mm rings. The rings were mounted in a water-jacked organ bath filled with Krebs solution aerated with 95% O2 and 5% CO2 at 37degreesC. Thiopental, ketamine, and propofol were given randomly to each ring preconstricted with EC50 of acetylcholine from 10(-6) to 10(-3) M. The relaxation response was the tension during anesthetic equilibration, expressed as a percentage of the tension from EC50 of acetylcholine. RESULTS: Thiopental and propofol (10(-5) to 10(-3) M) relaxed acetylcholine-induced contractions in a dose dependent manner (P < 0.05). Ketamine in doses of 10(-5) and 10(-4) M constricted acetylcholine-induced contractions by 3.2% and 16.5% respectively (P < 0.05). But ketamine in a dose of 10(-3) relaxed acetylcholine-induced contractions by 76.4% (P < 0.05). The relaxation of tracheal smooth muscles was greatest in thiopental, and was least in ketamine (P < 0.05). CONCLUSIONS: All three intravenous anesthetics have an excellent relaxation of tracheal smooth muscles in rats, except in doses of 10(-5) and 10(-4) M of ketamine.
Acetylcholine ; Anesthetics, Intravenous ; Animals ; Baths ; Ketamine* ; Muscle, Smooth* ; Propofol* ; Rats* ; Relaxation ; Thiopental* ; Trachea