BACKGROUND: Patients without genuine zygapophysial joint pain exhibit a positive response to uncontrolled diagnostic blocks. We determined the false positive rate of single uncontrolled diagnostic zygapophysial joint block in patients with chronic back pain. METHOD: Thirty-five patients with chronic lower back pain were studied prospectively. All patients underwent a series of medial branch of dorsal rami blocks with lidocaine and bupivacaine starting at the symptomatic level to a maximum of three levels or until the pain was abolished. RESULTS: All patients proceeded with the injections. 16 patients (45%) had a definite or greater response to the initial lidocaine injection at one or more levels but only 5 (14%) had a 50% or greater response to a confirmatory injection of 0.5% bupivacaine. Using the confirmatory blocks as the criterion standard, the false positive rate of uncontrolled diagnostic blocks was 37% and the positive predictive value was only 31%. CONCLUSION: Uncontrolled diagnostic blocks may be unreliable for the diagnosis of lumbar zygapophysial joint pain.
Arthralgia ; Back Pain ; Bupivacaine ; Diagnosis ; Humans ; Joints ; Lidocaine ; Low Back Pain ; Prospective Studies

Cardiac lymphangioma is one of the rarest, primary, benign tumor of the heart. We report a case of cardiac lymphangioma, which was diagnosed with CT and MRI in a 50 years old female. Plain chest film showed minimal enlargement and globular shape of the heart. On CT scan, abnormal fluid density mass lesion was noted within pericardial sac. The signal intensity was lower on T1-weighted image and hgher on T2-weighted image than that of the myocardium and located along the left atrioventricuar groove. Several small low signal spots representing hemorrhage were seen within this lesion.
Female ; Heart ; Hemorrhage ; Humans ; Lymphangioma* ; Magnetic Resonance Imaging ; Myocardium ; Thorax ; Tomography, X-Ray Computed

Renal agenesis is a relatively rare congenital anomaly. The frequent difficulty in establishing a definite diagnosis of renal agenesis is emphasized. Recently we experienced 2 cases of renal agenesis in 24-year-old male patients, so we report these 2 cases of renal agenesis with review of literatures.
Diagnosis ; Humans ; Male ; Young Adult

No abstract available.
Pulmonary Aspergillosis*

The 8 cases of left ventricular thrombus detected by the 2 D echocardiography or left ventriculography, after acute transmural anterior myocardial infarction were effectively lysed by the thrombolytic agents and heparin therapy. The thrombolytic agents were either urokinase or tissue plasminogen activator. Urokinase was infused intravenously at a dose of 1.0 million unit for three days. And tissue plasminogen activator was infused at a dose of 100mg for a day. In all cases, the thrombi were completely lysed. At follow up, no recurrence of left ventricular thrombus was found. We have experienced 2 cases of peripheral embolization in which, left ventricular thrombi were protruding nonmobile type. The one was the embolic cerebral infarction, the other was transient hoarseness and paresthesia on the left foot, which may be transient ischemic attack. These results show that left ventricular thrombi can be treated by intravenous thrombolytic agents without life-threatening complication. However, for the better establishment of the risk and benefit of therapy further investigation is needed.
Cerebral Infarction ; Echocardiography ; Fibrinolytic Agents ; Follow-Up Studies ; Foot ; Heparin ; Hoarseness ; Ischemic Attack, Transient ; Myocardial Infarction* ; Paresthesia ; Recurrence ; Thrombolytic Therapy* ; Thrombosis* ; Tissue Plasminogen Activator ; Urokinase-Type Plasminogen Activator

Adenosine is well known as a safe and effective drug for the termination of paroxysmal supraventricular tachycardia (PSVT), and is also widely used for the termination of both narrow and wide QRS-complex tachycardia of unknown origin in the setting of hemodynamic stability. However, due to a shortening of atrial refractoriness, adenosine can facilitate the induction of atrial fibrillation. A life threatening tachycardia may result from a potential rapid conduction of the atrial fibrillation over an accessory pathway. A case of patient, where the intravenous administration of adenosine, during regular, narrow QRS tachycardia, was followed by atrial fibrillation with rapid conduction over a manifest accessory pathway, is reported.
Adenosine* ; Administration, Intravenous ; Atrial Fibrillation* ; Hemodynamics ; Humans ; Tachycardia ; Tachycardia, Supraventricular* ; Wolff-Parkinson-White Syndrome

In the past, arthrodesjs was a widely used procedure but in recent times, with the development of replacement arthroplasty, decreased in tuberculosis and polio. etc, it is not commonly used by orthopedic surgeons. However, for those in the young age group, people employed in hard labor and patients with acute inflammatory disease, arthrodesis is through to be more appropriate than replacement arthroplasty. From January 1980 to December 1985, 20 cases of arthrodesis of the knee joint were carried out. The results were follows.; 1. Methods of arthrodesis used were Charnley compression arthrodesis in 10 cases, Hoffman compression arthrodesis in 2 cases, cross pinning in 3 cases and and cross pinning with patella graft in 5 cases. 2. Bone union was seen in all 12 cases of compression arthrodesis at an average of 21.3 weeks while bone union was seen in 7 out of 8 cases of non-compression arthrodesis at an average 25 weeks. 3. Among the 20 cases, complication were pseudoarthrthrosis in one case, pin tract infection in 2 cases and skin necrosis in 5 cases. 4. Inconclusion of the above results, bone union was carried out in 19 cases out of total 20 cases, and compression arthrodesis showed faster bone union at an average of 3.7 weeks earlier than non-compression arthrodesis.
Arthrodesis ; Arthroplasty, Replacement ; Humans ; Knee Joint ; Knee ; Necrosis ; Orthopedics ; Patella ; Poliomyelitis ; Skin ; Surgeons ; Transplants ; Tuberculosis

The method of ankle arthrodesis is variable but compression arthrodesis has been widely used because of better results than non-compression arthrodesis. Twenty-one cases of ankle arthrodesis were carried out at department of orthopaedic surgery of Korea Veterans Hospital from January 1980 to June 1986, and were analysed clinically. The results obtained were as follows; l. Among 11 cases of compression arthrodesis, Charnleys method was done in 8 cases and Monofixateur in 3 cases. 2. Among 10 cases of non-compression arthrodesis, Chuinard-Peterson method was done in 7 cases and anterior 'sliding graft in 3 cases. 3. The average duration of immobilization after ankle arthrodesis was 11.7 weeks, and average 4.2 weeks were less needed in the compression arthrodesis than non-compression arthrodesis. 4. The postoperative complications were developed in 8 cases (38%): wound infection in 4 cases,skin necrosis in 3 cases and incisional neuroma in 1 case. 5. Bony union was obtained in 20 cases(95.2%) out of 21 cases at average 15.7 weeks, and in the non-compression arthrodesis and in the cnmpression arthrodesis, respectively, 90% at 17.7 weeks and 100% at 13.9 weeks.
Ankle Joint ; Ankle ; Arthrodesis ; Hospitals, Veterans ; Immobilization ; Korea ; Methods ; Necrosis ; Neuroma ; Postoperative Complications ; Transplants ; Wound Infection

Injuries to the tarsometatsrsal joint are not common, and the results or treatment are often unsatisfactory. Whatever the severity of the initisl injury, prognosis depends on accurate reduction and its maintenance. 5 cases of fracture and dislocation of the tarsometatarsal joint were treated at Department of Orthopaedic Surgery, Capital Armed Forces General Hospital. The length of follow-up period ranged from 12 months to 18 months, with a mean of 15 months.
Arm ; Dislocations ; Follow-Up Studies ; Hospitals, General ; Joints ; Prognosis

The intramedullary nailing for the fractured tibia has been used in selected cases of fresh diaphyseal fracture and non-union. However, with modern technical improvements, the indications could be expanded considerably. With interlocking nailing technic we can treat various types of tibia fracture, which were unsuitable for intramedullary nailing previously. Stability can be achieved with transverselyinserted bolts which anchor the implant directly to the cortical bone, thereby controllinglength, alignmentandrotation of the fracture as well as permitting early joint motion and weight bearing. Between May 1985 and Feb. 1988, interlocking nailings were performed for 54 cases oftivial fractures, of which 40 cases were acute fracture and 10 were non-union and 4 weremalunion. We obtained the following results ; 1. Closed nailing technic was accomplished in 40 cases and 14 cases were opened. 2. Dynamic and static interlocking nailings were done in 8 and 46 cases respectively. 3. Full weight could be borne on 5th postoperative day in transverse or short oblique fracture cases, 2 weeks in nonunion and malunion cases and 4 weeks in comminuted or segmental fracture cases. 4. The mean fracture healing period was 11.5 weeks in dynamic interlocking cases and 13 weeks in static nailing cases. 5. According to the functional classification of Klemm and Borner, out of 54 cases 36 were excellent, 14 were good, 3 were fair and one was poor.
Classification ; Fracture Fixation, Intramedullary ; Fracture Healing ; Joints ; Tibia ; Weight-Bearing