We analysed 26 cases of pyogenic osteomyelitis of the spine who were treaed at Younsei University Hospital during 25 years from January 1952 to August 1977 by operative or conaervative treatment. The diagnosis of pyogenic osteomyelitis of the spine is not easy and very confused. The cause and entry of the offending organism is mainly by venous drainage from the genitourinary and lower extremity circulation and the next is direct spreading from the adjacent focus. The typical clinical symptom is severe pain and tenderness over the lesion accompanied by febril history and the clinical course is relatively rapid than tuberculosis of the spine. In blood examination leukocytosis is uncommon but it showed relative increase of neutrophils in 62%, and erythrocyte sedimentation rate in 89%. Radiological findings are narrowing of joint space, erosion and/or destuctive change of vertebral body, vertebral marginal sclerotic change, and new bone formation and less frequently abscess shadow. The results obtained from this study were as follows, 1) The incidence of pyogenic osteomyelitis of the spine among total cases of the pyogenic osteomyelitis was 2.5% and the ratio of the pyogenic osteomyelitis of the spine to the spine tuberculosis was 2.8%. 2) The sexual incidence was in 11 and 15 each male and female. and the avrage, prevalent age was 34 years of age. 3) The pathogenic organism was isolated in 20 cases from the diseased focus during surgical procedure; stapyhloccus in 16 cases, pseudomonas in two and in a case of E.coli and proteus each. 4) The lumber vertebrae was mostly involved, i.e.lumbar in 11 cases, cervical in four, thoracic in nine, lumbosacral and sacrum in one each. 5) The operative treatment was performed in 23 cases and conservative in 3 cases with the satisfatory result in all cases. 6) We conclude that the focal curettage with anterior interbody fusion through anterior approach was better than the conservative treatment.
Abscess ; Blood Sedimentation ; Curettage ; Diagnosis ; Drainage ; Female ; Humans ; Incidence ; Joints ; Leukocytosis ; Lower Extremity ; Male ; Neutrophils ; Osteogenesis ; Osteomyelitis ; Proteus ; Pseudomonas ; Sacrum ; Spine ; Tuberculosis

The fractures of the ankle in children are differ from those of adults in terms of the fracture pattern and the possibilities of influence to growth. The injuries of the ankle in children occur mostly at the bony structure rather than ligamentous structure, and some injuries of the growth plate may result in the arrest of entire growth plate or parts of growth plate and these may lead to leg length discrepancy or deformity. Many authors agree that the prognosis of injuries of the growth plate is dependent on the fracture type, the age of the patient at the onset of injuries, the degree of displacement of the fracture fragments, whether the injuries open or closed, and the efficacy of reduction. But the authors can not postulate one uniformed method of classification and treatment of the children's ankle fracture because of the variability of injuries. We have reviewed 35 cases of children's ankle fracture treated at our clinics from Dec. 1979 to Feb. 1984. The results obtained are as follows: l. Over half of the patients were between the ages of 13 and 16 years (54.3%). 2. The incidence of each type as Salter-Harris classification was that of type II(48.6%), type I(20.0%),type III(14.3%),type IV (8.6%). 3. The traffic accidents were the main causes of injury (68.5%). 4. The type I fractures occured mostly under 10 years of age and the type II fractures in adolescents. 5. All the type I fractures were treated conservatively without any complication, and the type II fractures were treated conservatively in 13 cases (76.5%) and operatively in 4 cases (23.5%) with variable results. 6. Overall incidence of complication was 20.0%, consisted with two cases of conservatively treated but not accurately reduced type II fractures, a conservatively treated type III fracture, a triplane fracture, and the others.
Accidents, Traffic ; Adolescent ; Adult ; Ankle Fractures ; Ankle ; Child ; Classification ; Clinical Study ; Clothing ; Congenital Abnormalities ; Growth Plate ; Humans ; Incidence ; Leg ; Ligaments ; Methods ; Prognosis

Ventricular premature beats(VPB) are the most common cardiac arrhythmia and frequently found in apparently normal healthy persons as well as in various heart diseases. Postectopic potentiation of ventricular contraction has widely reported by electrocardiography. In this study, the authors performed comparative assessment of the left ventricular function at the preextrasystolic, extrasystolic and postextrasystolic beats by M-mode echocardiography and electrocardiography. The results obtained were as followings; 1) Among 22 patients of isolated, unifocal ventricular premature beats with fully compensatory pause, male were 6 and female 16, mean age being 47.2 years. 2) Hypertensive heart disease was the most common underlying disease of ventricular premature beats(5 patients) and the others were valvular heart diaeases(3), ischemic heart diseases(3), cardiomyopathy(2), intracerebral hemorrhagy(1), atrial septal defect of secundumtype(1), cor pulmonale(1), pericarditis(1), 1degree A-V block(1) and enteric fever(1). In 3 patients the causes were not clarified. 3) R wave amplitude was higher in the postextrasystolic beat(2.02+/-0.79cm) than preestrasystolic beat(1.86+/-0.66cm) 4) PEP/LVET ratio showed more decrease(18%) in postextrasystolic beat than that of preextrasystole. 5) Diastolic filling time of mitral valve was more reduced in the extrasystole than preextrasystole, but that of postextrasystole exceeded the preextrastystole. 6) Aortic cusps separation was more decreased in the extrasystole than preextrasystole and slightly more increased in the postextrasystole than preextrasystole. 7) LVID, LSa, ENa, DeltaEN/Deltat, LVEDV, SV and LV mass showed more decrease in extrasystole compared with those in pre-and postextrasystole, which was higher than preextrasystole. But LVESV was slightly lower in extrasystole than preextrasystole. 8) In extrasystolic beat, LVEDV, LVESV, stroke volume, and ejection fraction of ventri cular premature beat were 15.77%, 0.18%, 24.05% and 12.21% lower, respectively, than those of preextrasystole. And in the postextrasystole, LVEDV, LVESV, stroke volume and ejection fraction were 23.35%, 2.42%, 28.51% and 10.4% higher, respectively, than these of preextrasystole.
Arrhythmias, Cardiac ; Cardiac Complexes, Premature* ; Echocardiography* ; Electrocardiography ; Female ; Heart ; Heart Diseases ; Heart Septal Defects, Atrial ; Humans ; Male ; Mitral Valve ; Stroke Volume ; Ventricular Function, Left*

No Abstract Available.

A multiple regression analysis using ordinary least square (OLS) is frequently used for the projection of healt expenditure as well as for the identification of factors affecting health care costs. Data for the analysis often have mixed characteristics of time series and cross section. Parameters as a result of OLS estimation, in this case, are no longer the best linear unbiased estimators (BLUE) because the data do not satisfy basic assumptions of regression analysis. The study theoretically examined statistical problems induced when OLS estimation was applied with the time series cross section data. Then both the OLS regression and time series cross section regression (TSCS regression) were applied to the same empirical data. Finally, the difference in parameters between the two estimations were explained through residual analysis.
Health Care Costs ; Health Expenditures*

The mirtazapine is a relatively new antidepressant that has noradrenergic and specific serotonin antagonist action(NaSSAs). This has been known as one of the most safest drugs because of its few side effects. Until now, there have been only one case report that mirtazapine causes a EPS side effect(restless leg syndrome). But the peculiar mechanism of this drug makes it impossible to explain the exact reasons why the mirtazapine could induce EPS symptoms. Authors obseved three cases of mirtazapine indeced akathisia. We could not explain the phenomenon the other way except akathisia. So here we presents the three case of mirtazapine induced akathisia and a few possible hypothesis of this phenomenon.
Leg ; Psychomotor Agitation* ; Serotonin

Ecologic studies are widely used in all fields of public health on account of accesibility of data. However, two problems related to these studies have been brought up. The first is ecological fallacy occurred in the course of interpreting the ecologic level of exposure-disease associations into individual level. The second is exposure isclassification which leads to serious bias. Nevertheless there is few methodologic study dealing joint effects of the two problems in ecologic study. This study was conducted to suggest an ecologic model not having an ecologic fallacy due to model linkage failure and a methodology for correcting the misclassification bias due to exposure-confounder misclassification. Finally, we suggest a criteria for the ecologic model selection. Main results are as follows: 1. A linear ecologic regression model has a serious ecological fallacy due to model linkage failure and the misclassification bias due to the exposure-confounder misclassification. 2. An interaction ecologic regression model has no ecological fallacy due to model linkage failure, but it is affected seriously by the exposure misclassification. However misclassification bias could be removed mathematically if the information related to the misclassification was known. 3. A log-linear ecologic regression model has an ecological fallacy due to model linkage failure. It is seriously biased as the individual risk ratio are increased, but relatively less affected by the exposure misclassification than interaction ecologic regression model. 4. One of the two ecologic regression model-interaction ecologic regression model and log-linear ecologic regression model- would be selected according to the information of individual risk ratio and exposure misclassification. But using a linear ecologic regression model should be avoided in any circumstance. The above results are only valid in case that there is no other source of ecological fallacy except model linkage failure. Also exposure and confounder are independent each other, measured binary, and having nondifferential misclassification. Since the above assumptions are somewhat strong in considering the real situations of ecologic studies, it is necessary to extend the scope of this study.
Bias (Epidemiology) ; Joints ; Odds Ratio ; Public Health

The immunocompetence is important not only to kill the neoplastic cells but also to keep the neoplastic cells from growing further. T lymphocyte is plays the most important role in maintaining the tumor immunity efficiently. T lymphocyte has its specific functions depending in the subset of T lymphocytes. The author analyzed the T lymphocyte subsets in 31 brain tumor patients using anti-CD3, anti-CD4, anti-CD8 monoclonal antibodies and flow cytometry to determine the immunological status of brain tumor patients. All CD3, CD4 and CD8 subsets were reduced in both benign and malignant brain tumor patients but more signigicantly reduced in malignant tumor group. But in benign tumor group, the subtypes of T lymphocytes were not so different from those of normal healthy controls except the pituitary tumor patients, who showed the significant decrease in all the subtypes. In malignant tumor group, each subtype was signigicantly reduced and CD8 subtypes was markedly reduced in metastatic tumor patients, These analyses were considered to have the possibility to be contributable to planning the further immunotherapy and also the possibility to moniter the brain tumor patients clinically.
Antibodies, Monoclonal ; Brain Neoplasms* ; Brain* ; Flow Cytometry ; Humans ; Immunocompetence ; Immunotherapy ; Lymphocytes ; Pituitary Neoplasms ; T-Lymphocyte Subsets* ; T-Lymphocytes*

Disseminated intravascular coagulation (DIC) is a pathological syndrome in which activation of coagulation cascade leads to fibrin clot formation, consumption of platelets and coagulation factors, and secondary fibrinolysis. We report a case of severe postoperative hemorrhagic diathesis due to DIC. A 59-year-old man was scheduled for reduction of tibia fracture and anatrophic nephrolithotomy of staghorn calculi. On the fifth postoperative day, second operation was performed for nephrectomy due to perirenal hematoma. Two days later, third operation was performed for hemostasis because of the continuous bleeding. Coagulation tests showed positive DIC profiles of thrombocytopenia, hypofibrinogenemia, increased fibrin degradation products, and prolonged prothrombin time and thrombin time. The patient recovered uneventfully and discharged on the 59th postoperative day.
Blood Coagulation Factors ; Calculi ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Fibrin ; Fibrin Fibrinogen Degradation Products ; Fibrinolysis ; Hematoma ; Hemorrhage* ; Hemorrhagic Disorders ; Hemostasis ; Humans ; Middle Aged ; Nephrectomy ; Postoperative Complications ; Prothrombin Time ; Thrombin Time ; Thrombocytopenia ; Tibia

A case of multiple trichilemmal cysts (TC) is presented. TC is known to be a kind of keratinous cyst with lining cells showing trichilemmal keratiniration. A 63-year-old female patient presented with a 30 year duration of increasing in size and number of twenty five nodular lesions on the scalp. All twenty five TC on the scalp were totally excised and examined microscopically. However, the evidence of proliferation or malignant change like the previous case reports was not found in our case.
Female ; Humans ; Middle Aged ; Scalp