Suppurative arthritis of the hip joint in infants and children is always a serious disease. In management of suppurative arthritis of the hip joint, early diagnosis and treatment is far most important. Authors had treated 22 cases with acute suppurative arthritis of the hip joint in infants and children at the Department of Orthopedic Surgery, St. Benedict Hospital during period from January 1976 to December 1982, and clinically analyzed these 22 cases. The following results were obtained: 1. The incidence of suppurative arthritis of the hip joint was higher in infants and children less than 4 years old, and male predominated by a 2.7:1 ratio. 2. Lag period to diagnosis and treatment in 3 cases was within 4 days, 6 cases within 8 days: usually lag period was long. 3. In general, leukocytosis and elevated ESR were noted, but in infants, these were not always noted. 4. Sometimes, the classic signs of fever, chills, sweats, and prostration were not seen in affected infants. 5. Causative oraganisms were isolated in diseased hip joint: positive cultures were 55%, and most ommon organism was Staphylococ'cus aureus. 6. After diagnosis, immediate arthrotomy, continuous irrigation with normal saline solution, through the irrigation tube, parenteral administration of specific antibiotics, and immobilization with Bucks extension traction were performed in all cases without serious complications. The results were acceptable. 7. Authors concluded as follows: a. Infants and young children are more likely to have poor result than older children. b. When treatment was performed beyond 4 days, more likely to have poor result. c. Associated osteomyelitis of the femoral neck increases the possibility that the patient will have a poor result.
Anti-Bacterial Agents ; Arthritis ; Arthritis, Infectious ; Child ; Chills ; Diagnosis ; Early Diagnosis ; Femur Neck ; Fever ; Hip Joint ; Hip ; Humans ; Immobilization ; Incidence ; Infant ; Leukocytosis ; Male ; Orthopedics ; Osteomyelitis ; Sodium Chloride ; Sweat ; Traction

PURPOSE: Objective measurements of knee of flexor and extensor strength using isokinetic equipment and function after total knee arthroplasty (TKA) were evaluated until postoperative 12 months. MATERIALS AND METHODS: The control group constituted of 15 persons who were of same age and weight without knee problems. Most of the patients (70%) were operated on both knees simultaneously. The patient group consisted of constituted with 20 patients (34 cases). Isokinetic testing (Cybex) of knee flexor and extensor strength of knee and functional evaluation by HSS score was performed preoperatively and at 3, 6, 12 months postoperatively. RESULTS: The peak torque of the knee extensor and flexor muscle in the patient group was decreased by 17-41% compared to the control group. Especially, the peak torque of extensor was more decreased than flexor muscles. At postoperative 12 months, the peak-torque values of hamstring and quadriceps were able to attain the same strength levels of the preoperative knee. According to the grade of the Hospital for Special Surgery knee rating scales by Insall, 28 cases (82 %) in the patient group could obtain good result at postoperative one year. CONCLUSIONS: Exercises to increase the strength of extensor should be emphasized in the rehabilitation programs after TKA
Arthroplasty* ; Exercise ; Humans ; Knee* ; Muscle Strength* ; Muscles ; Rehabilitation ; Torque ; Weights and Measures

The present study was performed to compare maternal and perinatal outcomes in triplet and twin pregnancies with the result of ART(Assisted Reproductive Technology). Each pregnancy of 18 triplet pregnancies with 18 weeks or more was matched for maternal age, EDC(estimated date of confinement), parity, history of preterm delivery, indication of ART with two sets of twin pregnancies. Triplet pregnancies had a significantly shorter gestational age at delivery than twin pregnancies(30.4 versus 34.6 weeks), and a significantly lower mean birth weight(1,514 versus 2,286g). The mean hospital stay was significantly longer in triplets(22.3 versus 10.1 days). The incidences of 5 min Apgar score less than 7, neonatal deaths were significantly more often in triplets than twins; 18(33.3%) vs 6(8.3%), 15(27.8%) vs 7(9.72%), respectively. There were significant differences in the incidence of neonatal complications such as respiratory distress syndrome; 14(25.9%) vs 7(9.72%), ventilatory support; 18(33.3%) vs 5(6.9%), neonatal seizure; 9(16.7%) vs 0, btween the two groups. However, there were no significant differences between the groups in maternal complications or neonatal morbidity such as congenital malformations or hyperbilirubinemia, intraventricular hemorrhage, or bronchopulmonary dysplasia. We suggest that counseling patient regarding the anticipated perinatal outcomes of triplet pregnancies with the result of ART should be conducted with our data.
Apgar Score ; Bronchopulmonary Dysplasia ; Counseling ; Female ; Gestational Age ; Hemorrhage ; Humans ; Hyperbilirubinemia ; Incidence ; Infant, Newborn ; Length of Stay ; Maternal Age ; Parity ; Parturition ; Pregnancy ; Pregnancy, Triplet ; Pregnancy, Twin* ; Reproductive Techniques, Assisted* ; Seizures ; Triplets*

Marjolin's ulcer is a malignant degeneration of cicatrical tissue, especially in chronic burn scar. Since the first description by Jean Nicholas Marjolin(1828), many studies for Marjolin's ulcer have been performed and reported. From 1985 to 1997, we experienced 20 cases in 14 patients diagnosed as Marjolin's ulcer clinically, and we analysed malignant transformation rate, induction period of Marjolin's ulcer and prevention of Marjolin's ulcer, etc. The results are summarized as follows. 1) The sex distribution was predominant in male(64.3%). 2) The most common cause of injury was flame burn(78.6%). 3) The mean age at the time of diagnosis was 45.6 years and the average lag period was 20.6 years. 4) The pathologic types of Marjolin's ulcer were squamous cell carcinoma(57.2%), followed by dyspasia(28.6%), acnthosis and hyperkeratosis(14.2%). 5) The locations of ulcers were frequently on the lower extremity(42.9%), followed by upper extremity(35.7%) and trunk (21.4%). 6) The lymph node involvements were 3 patients out of the 8 patients who were confirmed as squamous cell carcinoma. 7) The modalities of treatment were skin graft (18 cases, 12 patients), myocutaneous flap(1 case, 1 patient), fasciocutaneous flap(1 case, 1 patient).
Burns ; Carcinoma, Squamous Cell ; Cicatrix ; Diagnosis ; Humans ; Lymph Nodes ; Sex Distribution ; Skin ; Transplants ; Ulcer*

OBJECTIVE: It is known that normal follicular growth and pregnancy are possible using Follicular stimulating hormon(FSH) alone during controlled ovarian hyperstimulation(COH) for IVF-ET. The purpose of this study was to compare and analize the results of COH for IVF-ET between a group using only FSH-HP and a group using FSH/hMG METHOD: 111 cycle of the total 280 COH for IVF-ET cycles belonged to the FSH-HP group, and the FSH/hMG group accounted for remaining 169 cycles. The amount of gonadotropin administered, the duration of hormonal therapy, the number of embryos transfered, the endometrial thickness, and the pregnancy rate were compared between the two groups and statistically analized using the t-test. p values less than 0.05 deemed statistically significant. RESULT: There were no statistical differences on the amount of gonadotropin administered, the duration of hormone therapy, number of oocytes retrieved, nor the endometrial thickness between the two groups. However,the serum E2 level was significantly lower, and the number of embryos of high quality(GradeIandII) significantly higher in the FSH-HP group. In pregnancy rate, FSH-HP group shows higher than FSH/hMG group(38.8% VS 34.2%). but the difference was not large enough to be considered statistically significant. CONCLUSION: The results of this study show that compared to using FSH/hMG, treatment with FSH-HP alone allowed the retrieval of more embryos of high quality, and although not statistically significant, achieved a higher pregnancy rate, thus indicating that it can be used as an effective method for COH.
Embryo Transfer* ; Embryonic Structures* ; Fertilization in Vitro* ; Gonadotropins ; Oocytes ; Pregnancy ; Pregnancy Rate

BACKGROUND: The potential adverse effects of ketamine in neurosurgical anesthesia have been well established. However, the effects of ketamine on intracranial pressure (ICP) and hemodynamics during general anesthesia remain unclear. The purpose of this study was to assess the effects of ketamine on hemodynamics and ICP in anesthetized, ventilated rabbits. METHODS: Thirty rabbits were divided into three groups: Group 1 (n=10) received 1 ml/kg normal saline iv; Group 2 (n=10) received 0.5 mg/kg ketamine iv; Group 3 (n=10) received 1.0 mg/kg ketamine iv. After induction with thiopental, anesthesia was maintained with isoflurane and nitrous oxide in oxygen. During controlled ventilation, ICP, mean arterial pressure (MAP), cerebral perfusion pressure (CPP) and heart rate (HR) were measured. The ICP was measured using Ladd ICP monitoring system. All variables were evaluated at baseline and for 30 min following ketamine. RESULTS: In group 1, ICP, MAP, CPP and HR were unchanged over the course of the study. In group 2, ICP, MAP and CPP were unchanged. HR increased at 1, 3 and 5 min (p<0.01), 10 and 20 min (p<0.05) after injection. In group 3, ICP, MAP and CPP increased at 1 and 3 min (p<0.01) after injection. HR increased at 1, 3 and 10 min (p<0.01), 5 min (p<0.05) after injection. CONCLUSIONS: These results suggest that 0.5 and 1.0 mg/kg of ketamine don't significantly affect the hemodynamics and ICP in anesthetized, mechanically ventilated rabbits.
Anesthesia* ; Anesthesia, General ; Arterial Pressure ; Heart Rate ; Hemodynamics* ; Intracranial Pressure* ; Isoflurane ; Ketamine* ; Nitrous Oxide ; Oxygen ; Perfusion ; Rabbits* ; Thiopental ; Ventilation

No abstract available.
Paragonimiasis*

As the incidence of acute myocardial infarction been increasing with prolongation of life spans, improvement in foods and life styles in Korea, rapid diagnosis and treatment is critical in survival of acute myocardial infarction patient. Most of the acute myocardial infarction result from atherosclerotic plaque forming thrombus and occlusion of coronary artery. Because early thrombolytic therapy is important to maintain the left ventricular function and survival rate, there have been many trials to reperfuse the occluded coronary artery. We have studied the many aspects of acute myocardial infarction such as sex, age, infarction site, chief complaints, change of ECG, change of serum enzyme, time delay on emergency room arrival, and compared the effectiveness of thrombolytic therapy. Total number of patient was 212, and males were 141(66.5%) and females were 71(33.5%). The most common infarction site was ant, fuel wall(102 cases,48%)of the heart and the most common chief complaint was chest pain(204 cases,97%). Among the 106 patients who received thrombolytic therapy, 101 patients(95%) had survived and 5 patients(5%) had died. Among the 64 patients who didn't receive thrombolytic therapy, 56 patients (87.5%) were alived and 8 patients(12.5%) were dead.
Ants ; Coronary Vessels ; Diagnosis* ; Electrocardiography ; Emergency Service, Hospital ; Female ; Heart ; Humans ; Incidence ; Infarction ; Korea ; Life Style ; Life Support Care ; Male ; Myocardial Infarction* ; Plaque, Atherosclerotic ; Survival Rate ; Thorax ; Thrombolytic Therapy ; Thrombosis ; Ventricular Function, Left

Basal cell carcinoma is the most common skin cancer, especially on the eyelid and nose. As it rarely invades to a underlying bone or metastasizes an distant site, and is usually found at an early stage, it is regarded as a curative disease. However, basal cell carcinoma on the eyelid and nose may be resected incompletely due to efforts to preserve important structures or as a result of esthetic considerations. We experienced two cases of basal cell carcinoma with local invasion to underlying bone. One was a recurred case on the nasal area extending to the nasal bone arts medial wall of the ethmoid sinus. The lesion was widely resected and covered with a radial forearm free flap. The other was on the eyelid extending to the orbit. It was treated with orbital exenteration and resection of the involved eyelid. The defect was reconstructed with the temporalis muscle flap with split-thickness skin graft. These patients were followed up for 7 months with no evidence of recurrence. Since basal cell carcinoma can invade to the bone and metastasize to a distance site, it should be resected radically in the regions of the eyelid and nose.
Carcinoma, Basal Cell* ; Ethmoid Sinus ; Eyelids ; Forearm ; Free Tissue Flaps ; Humans ; Nasal Bone ; Nose ; Orbit ; Recurrence ; Skin ; Skin Neoplasms ; Transplants

In modem medical industries as in others, it has been emphasized by many experts such as Dr. Mayer and Dr. Donabedean that there should be quality assurance activities applying statistical knowledges in the processes of medical management and medical staff themselves for the better medical care and customer satisfaction. Three of our quality assurance programs for the purpose of shortening the treatment time In the department of emergency medicine in Keimyung University, Dong-San Medical Center had been carried out during the period of June 94 through December 95. Our methodology was mainly the process emphasized ; finding the causes of delaying factors in various processes related to the works of nurses, doctors, laboratory services, radiology services etc. in the emergency room, holding various meetings among the related groups with genuine discussions, notifying the new results in each step, encouraging the positive ones and also applying the new leadership technics. During the period of June 94 through December 95(for 1.5 years), the average E.R. patient treatment time from registrations to dispositions had been reduced by about 2 hours (from 5 hours 3 minutes to 2 hours 5 minutes) and its variations among the different specialities had been narrowed down to significant degree (p<0.05) revealing the preprogram base line standard deviation of 2.43 to 1.28 in post program through continuous quality assurance programs. It was also noted that the successful results of Q/A program have been closely related to the fact that the process should be designed and redesigned repeatly as needed and that all the participants related were actively involved in the planning and redesigning processes.
Emergency Medicine ; Emergency Service, Hospital ; Humans ; Leadership ; Medical Staff ; Modems