No abstract available.
Cesarean Section* ; Female ; Pregnancy

Fractures significantly involving the weight-bearing articular surface and the overlying metaphysis of the distal tibia have deserved notoriety as a severe and challenging subject of ankle injuries. It was not until 1963 that the AO group developed principles for open reduction and internal fixation of pilon fracture. But recently, limited internal fixation of the joint surface combined with external fixation may avoid the soft tissue complications associated with formal open reduction and internal fixation. We have treated 22 cases of tibial pilon fracture with biologic principle. The mean follow-up period was two years ranging from one to three years. According to the Riiedi and Allgower classification, three cases were type I, five cases were type II, and fourteen cases were type III Biologic treatment includes combination of internal and external fixation, external fixation alone, or plating was done with careful soft tissue dissection, limited stripping of fracture fragments, and indirect reduction technique. Radiographic results were assessed by Burwell and Charnley criteria. Three cases of type I, three cases of type II and seven cases of type III pilon fractures obtained good anatomic radiographic results. We also assessed the functional results by Mast and Teipner criteria. Three cases of type I, three cases of type II, six cases of type III pilon fractures obtained good functional outcome. We believed that combination of internal and external fixation provides the patient who has a markedly displaced pilon fracture and diaphyseal comminution with the best chance of good clinical result and minimal risks. As such, we believe biologic treatment is excellent for these injuries.
Ankle Injuries ; Classification ; Follow-Up Studies ; Humans ; Joints ; Tibia ; Weight-Bearing

Osteoid Osteoma occurs anywhere in skeleton. They are most common in lower extremity, particularly femur about 40%. Two-thirds of femoral lesions is in the intertrochanter or intracapsular regions of the hip. The lesion is usually cortical and may extend into the periosteal or endosteal surface of the bone. It is rare in the cancellous bone. We experienced a case of osteoid osteoma in intertrochanteric cancellous portion of the femur in 50 year old man. Many complained right hip pain worsend three weeks before his visit. Radiograph shows sclerosis around a lucent nidus in cancellous portion. The lesion did not extend to the endosteal surface. We have removed nidus and surrounding reactive portion completely with curettage. Follow up radiographic results after 20 weeks, showed no evidence of recurrence.
Adult* ; Curettage ; Femur* ; Follow-Up Studies ; Hip ; Humans ; Lower Extremity ; Middle Aged ; Osteoma, Osteoid* ; Recurrence ; Sclerosis ; Skeleton

BACKGROUND: There are only a few studies regarding the causes of treatment failure for tuberculosis. Therefore, this study aimed to determine the causes of intractable tuberculosis. METHODS: M.tuberculosis, differentiated MOTT (Tycobacterium Other Than Tuberculosis) were isolated, and the RFLP (Restriction fragments length polymorphisms) pattern was analyzed from 204 patients with pulmonary tuberculosis and 53 suffering from neck tuberculosis. The IL-1β, IL-12, *1 IFNγ and *2 TNFαblood levels were measured. All patients were regularly followed for 18 months after treatment. RESULTS: There was no correlation between the RFLP patterns of M.tuberculosis treatment failure. From the 204 cases, 31.9% were intractable. The characteristics of patients with intractable tuberculosis were old age, being male and recurrent cases. The causes of treatment failure were identified as follows ; a decrease in the IL-12(59.4%) concentration, drug resistant strain(54.7%), irregular medication(15.4%), MOTT(6.2%) and a heavy infection(4.6%). The causes of all cases of intractable tuberculosis could be investigated. The IL-12 concentration in the blood was significantly lower in the intractable cases, where it disclosed a maximum sensitivity(64.7%) and specificity(75.4%) at 165.0 pg/ml. Most of the 53 cases on neck node tuberculosis were treated successfully. Therefore, we were unable to analyze the cause of treatment failure. CONCLUSION: A decrease in the blood IL-12 concentration and drug resistant strains were identified as the most significant causes of treatment failure for tuberculosis. In Korea, infection by clusters were prevalent, but no difference in the clinical course between clusters and non-clusters could be found.
Humans ; Interleukin-12 ; Korea ; Male ; Neck* ; Polymorphism, Restriction Fragment Length ; Treatment Failure* ; Tuberculosis* ; Tuberculosis, Pulmonary

The technique of computer-assisted continuous infusion (CACI) has revolutionised the administration of drugs by intravenous infusion. A stable blood concentration is achieved rapidly with CACI, allowing the anesthesiologist to monitor therapeutic effect and titrate drug concentrations accordingly. Propofol and opioids can be administered by CACI for the induction and maintenance of anesthesia in adult patients. Also, the ability to maintain a constant blood concentration of drugs is also extremely important for studying the pharmacodynamic interactions of drugs, and research in the area has increased with advent of CACI. We experienced a case of total intravenous anesthesia which was totally conducted by CACI, using a Master TCI for propofol and Stelpump program for fentanyl infusion.
Adult ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Intravenous* ; Fentanyl ; Humans ; Infusions, Intravenous ; Propofol

PURPOSE: Cancer has become the major cause of deaths in Korea. Planning care for patients with terminal cancer is difticult. The prediction of length and prognostic factors of survival in the terminal cancer can facilitate the planning of a supportive care program aimed at patients need. The aim of this study was to identify length and those related factor of survival in the patients with terminal cancer. MATERIALS AND METHODS: This retrospective study was performed on 271 patients, who were diagnosed as terminal cancer in Seoul National University Hospital from March 1991 to February 1996. For getting the further informations about the patient, we interviewed with surviving relatives by telephone, and we requested administrative helps in order to take the informations about date of death. We examined the relations of 10 factors with survival in patients with terminal cancer. RESULTS: We could confirm 229 patients' death(84.5%) in 271 subjects. The median length of survival in patients with terminal cancer was 11 weeks(95%CI 10.0~14.0). By univariate analysis, history of surgery(p<0.01), performance(p<0.05), severity of pain(p <0.001), and dyspnea(p<0.05) were clinical factors in predicting survival. According to Cox's proportional hazard model including sex, age, history of surgery, performance, severity of pain, and dyspnea as variables, absence of surgery history(RR 1.398, 95%CI 1.038~1.882) and severity of pain(RR 1.398, 95%CI 1.044 ~1.872) showed independent prognostic value. CONCLUSION: The median survival was 11 weeks, and absence of surgery history and severity of pain were the independent prognostic factors for patients with terminal cancer.
Cause of Death ; Cohort Studies* ; Dyspnea ; Humans ; Korea ; Proportional Hazards Models ; Retrospective Studies ; Seoul ; Telephone

Individual identification procedure is one of the most improtant part in medicolegal fields. Recently, radiolegal investigation methods have been widely applicated to the medicolegal field for the purpose of individual identification. So authors attempted to determine sex and calculate stature by using roentgenographic findings of long bones of 248 subjects the living materials. In orthoscanographic study for long bones, we measured total length, midshaft width, epiphyseal width, cortical width, head diameter of each bones The total length, midshaft width, cortical width, condylar breath, horizontal & vertical head diameter of femur show statistically significant differentiation between two sexes, in tibia, total length, midshaft, cortical width, proximal and distal epiphyseal width show statistically significant. In fibula, Humerus, radius and ulna, total length is only statistically significant. And other wresults are statistically insignificant. Using femoral and fibial lengths (mm) with "Regression Analysis method" in SAS program, we derived the following fomulae. Height (cm)=95.62±0.148×Total length of Femur. (mm) Height(cm)=82.07±0.22×Total length of Tibia. (mm). In conclusion, radiologic measurement of long bone might be one of the useful methods in individual identification of unknown subject in Korea.
Femur ; Fibula ; Head ; Humerus ; Korea ; Radius ; Tibia ; Ulna

Lambert-Eaton myasthenic syndrome (LEMS) is characterized clinically by fluctuating muscular weakness; presentation with ocular symptoms is unusual. A 60-year-old man had developed diplopia and ptosis 2 years previously. The findings of a neurologic examination were normal except for bilateral ptosis and ophthalmoplegia. The amplitude of compound muscle action potentials recorded on the abductor digiti minimi increased (by more than 500%) during 50-Hz stimulation. This case demonstrates that LEMS should be included in the differential diagnosis of myasthenic symptom confined to the ocular muscles.
Action Potentials ; Diagnosis, Differential ; Diplopia ; Humans ; Lambert-Eaton Myasthenic Syndrome ; Middle Aged ; Muscles ; Neurologic Examination ; Ophthalmoplegia

Prompt malaria diagnosis is crucial so antimalarial drugs and supportive care can then be rapidly initiated. A 15-year-old boy who had traveled to Africa (South Africa, Kenya, and Nigeria between January 3 and 25, 2011) presented with fever persisting over 5 days, headache, diarrhea, and dysuria, approximately 17 days after his return from the journey. Urinalysis showed pyuria and hematuria. Blood examination showed hemolytic anemia, thrombocytopenia, disseminated intravascular coagulation, and hyperbilirubinemia. Plasmapheresis and hemodialysis were performed for 19 hospital days. Falciparum malaria was then confirmed by peripheral blood smear, and antimalarial medications were initiated. The patient's condition and laboratory results were quickly normalized. We report a case of severe acute renal failure associated with delayed diagnosis of falciparum malaria, and primary use of supportive treatment rather than antimalarial medicine. The present case suggests that early diagnosis and treatment is important because untreated tropical malaria can be associated with severe acute renal failure and fatality. Physicians must be alert for correct diagnosis and proper management of imported tropical malaria when patients have travel history of endemic areas.
Acute Kidney Injury* ; Adolescent ; Africa ; Anemia, Hemolytic ; Antimalarials ; Delayed Diagnosis* ; Diagnosis ; Diarrhea ; Disseminated Intravascular Coagulation ; Dysuria ; Early Diagnosis ; Fever ; Headache ; Hematuria ; Humans ; Hyperbilirubinemia ; Kenya ; Malaria* ; Male ; Nigeria ; Plasmapheresis ; Plasmodium falciparum ; Pyuria ; Renal Dialysis ; Renal Insufficiency ; Thrombocytopenia ; Urinalysis

BACKGROUND: P300 component of the long latency auditory evoked potentials (LLAEPs) provides information on conscious and cortical funtion. The P300 wave occures only for stimuli that somehow capture the patients attention. Therefore LLAEPs implys a degree of cognitive processing. We studied sedation scale and P300 wave to determine if LLAEPs could be utilized as electrophysiologic predictors of sedation. METHODS: The P300 component of LLAEPs from vertex was recorded from 10 ASA physical status I and II patients undergoing elective surgery while they listened via headphones to a series of clicks which were interrupted unpredictably by a tone burst (2 KHz) before and after diazepam 0.04 mg/kg and 0.08 mg/kg IV. The patients were asked to concentrate on the clicks and to press a button whenever they detected a 2 KHz tone. And sedation scale also was measured. RESULTS: Amplitude of P300 was decreased and latency of P300 was increased in a dose-dependent manner with IV diazepam. Amplitude was greatest and latency was shortest in awake. And sedation scale also was increased according to increased IV diazepam adminstration. CONCLUSIONS: Both amplitude and latency may be highly related to the sedation scale with progressively increasing dose of diazepam. Therefore we conclude that P300 component of LLAEPs can be utilized as an electrophysiologic predictor of awareness and sedation.
Diazepam* ; Event-Related Potentials, P300* ; Evoked Potentials, Auditory* ; Humans