OBJECTIVE: To know the effect of intrathecal baclofen on increased muscle tone, spasm and ambulation. METHODS: Six patients with a severe chronic spasticity were evaluated with 10~75 microgram of intrathecal baclofen infusion. Two patient were infused more than two times (25 microgram, 50 microgram, 75 microgram). After each bolus infusion, an assesment was done for the patient's Ashworth score, spasm score, reflex score, peak eccentric torque by Cybex 6000 system , H/M ratio, subjective feeling of walking and the gait analysis. RESULTS: Spasticity decreased from the mean prebolus Ashworth score of 3.4 to mean postbolus Ashworth score of 1.4 and the pre- and postbolus mean reflex score were 3.9 and 1.6 respectively for a minimum of 4 hours. All patients showed that spasms disappeared, and the peak eccentric torque and H/M ratios also decreased. For the bipedal locomotion, all patients improved in their gait speed, step length, and maximal knee flexion angle, but only two patients improved in their subjective ambulatory functions. These two patients could control the spastic limbs voluntarily and walk independently at the prebolus stage. Four patients had more difficulty in gait because of the subjective weakness of extensor muscles of the lower extremities. CONCLUSION: Intrathecal baclofen decreased the spasticity, and spasm effectively in patients who had failed the conservative treatment with medication and physical therapy.
Baclofen* ; Equidae ; Extremities ; Gait* ; Humans ; Knee ; Locomotion ; Lower Extremity ; Muscle Spasticity* ; Muscles ; Reflex ; Spasm ; Torque ; Walking

OBJECTIVE: To find the characteristics of the nerve stimulator for the peripheral nerve blockade. METHOD: We studied four different nerve stimulators currently available in the clinical setting. The output characteristics(wave shape, voltage and duration of the stimulus impulse) were measured for each stimulator using an oscilloscope. Target current from 0 mA to 5 mA and load resistances from 200 ohm to 10 kohm were selected to model the normal ranges of operating current and tissue impedance when performing peripheral nerve block technique. RESULTS: There was a marked variation in performance of nerve stimulators depending on the target current value and resistances. Measured pulse width was not identical to the target pulse width in three nerve stimulators. Measured voltage with a fixed resistance was smaller in two nerve stimulators than the target voltage which was supposed to be produce in target current value of same resistance. One nerve stimulator showed the differences of calculated current value according to the used resistances. CONCLUSION: For the successful nerve block, it is important for the operator to be aware of the design and functional limitations of the nerve stimulator being used in clinical practice.
Electric Impedance ; Nerve Block ; Peripheral Nerves* ; Reference Values

OBJECTIVE: We compared a few variables such as the type of needle, the direction of bevel, and the effect of stimulation duration in percutaneous peripheral nerve blockade. We also studied the real distribution of injected drug through nerve biopsy. METHOD: The sciatic nerve-tibialis posterior muscle preparation of rabbit was chosen as a model. Experimental rabbits were divided into 3 groups: Group 1 (16 legs), use of insulated needle and 100 microsecond stimulation duration; Group 2 (9 legs), use of insulated needle and 240 microsecond stimul ation duration; Group 3 (6 legs), use of uninsulated needle and 100 microsecond stimulation duration. The mixed solution, 0.1 cc, of 5% phenol and indian ink was injected in 10 legs and the muscles were obtained to observe the spreads of injected solution after 2 weeks. RESULTS: The minimal stimulation currents of group 1, 2, 3 were 0.49 mA, 0.37 mA, 2.07 mA, respectively. The distance between needle and sciatic nerve sheath of group 1, 2, 3 were 0.09 mm, 0.11 mm, 0.20 mm in width, and 1.84 mm, 3.33 mm, 4.50 mm in depth, respectively. The current required to stimulate the nerve increased rapidly as the tip of the insulated needle passed the nerve, and the direction of bevel had no effect on the minimal stimulation current. Injected indian ink was located alongside the perineurium. CONCLUSION: In three methods, the most exact method was the use of insulated needle and 100s stimulation duration. The needle tip was located 1.84 mm past the nerve.
Biopsy ; Ink ; Leg ; Muscles ; Needles ; Nerve Block ; Peripheral Nerves* ; Phenol ; Rabbits ; Sciatic Nerve

OBJECTIVE: The purpose of this study was to evaluate the occurrence of the suicidal ideation and associated factors with self-reported suicidal ideation within the last 12 months among Korean high school students. METHODS: A total of 697 adolescents were recruited from high schools (age range: 15-16 years) in Jeju area. According to existence of suicidal ideation, they were divided into two groups-suicidal ideation group and non-suicidal ideation group, and the differences between groups in terms of various sociodemographic and clinical characteristics, including depression (Beck Depression Inventory), and health related conditions. RESULTS: A total of 187 (26.8%) high school students reported suicidal ideation, and the rate of suicidal attempt was 4.9% (n=34). The associated factors of suicidal ideation were depression [odds ratio (OR)=2.42, p< or =0.001], short sleep duration (OR=1.84, p=0.009), current alcohol use (OR=4.94, p< or =0.001), self reported poor health (OR=2.10, p=0.004), and school bullying (OR=3.06, p=0.002). CONCLUSION: These results may have important implications for the strategies and specified intervention in preventing suicidal ideation in Korean high school students.
Adolescent ; Bullying ; Depression ; Humans ; Risk Factors ; Self Report ; Suicidal Ideation*

OBJECTIVE: This study evaluated the occurrence and associated factors with self-reported suicidal ideation within the last 12 months among Korean elementary school students. METHODS: In a school-based cross-sectional survey, a total of 657 students were recruited from elementary schools (age range: 11??2 years) in Jeju area. They filled out self-completing questionnaires on suicidality (suicidal ideation and suicidal attempt), depression (Kovacs' Children's Depression Inventory), and sociodemographic characteristics, including school and family factors. RESULTS: A total of 192 (29.2%) students reported suicidal ideation, and the rate of suicidal attempt was 6.1% (n=40). Logistic regression analysis identified factors associated with recent suicidal ideation. Female had higher rates of suicidal ideation than male [odds ratio (OR)=1.81, p=0.005], and students with depression (OR=3.23, p<0.001) and experience of abuse in the home (OR=6.77, p<0.001) were at high risk for suicidal ideation. CONCLUSION: These results suggest that suicidal ideation and actions are relatively common in Korean elementary school students, and have implications for prevention and intervention.
Cross-Sectional Studies ; Depression ; Female ; Humans ; Logistic Models ; Male ; Surveys and Questionnaires ; Risk Factors ; Suicidal Ideation*

Complex Physical Therapy (CPT) is one of the variable conservative methods of lymphedema and recently used in many countries with great success. The main concept of CPT is to improve central lymph flow by opening non-functioning lymphatic pathway and by stimulating collateral lymphatic channels to drain the swollen area into adjacent areas where lymph flow is normal. CPT consists of 4 main parts; 1. meticulous skin care, 2. manual lymph drainage, 3. multilayered non-stretching compression bandages and compression garments, 4. special exercise. We tried to assess the immediate and maintenance effects of CPT in patients with lymphedema. CPT was used on 25 patients (male 5, female 20) with 10 upper and 15 lower extremity edemas for 2weeks such as 5 days per week, 1.5 hours per day at out-patient clinic. Immediately, the reduction of edema volume was 25.5+/-13.8% at the upper extremity and 27.5+/-15.5% at lower extremity in 2 weeks after treatment. All these were well maintained following 3 months without any significant variation. In comparison between proximal and distal parts, there was no significant difference except the immediate post-treatment result of the lower extremity. But the maintenance of volume reduction of distal part was better than proximal part through 3 months after treatment. We also found the reduction of skin subcutaneous thickness according to the volume reduction. In conclusion, CPT is a effective treatment method for patients with lymphedema but follow up study will be needed for identifying long term maintenance effect.
Compression Bandages ; Drainage ; Edema ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; Lymphedema* ; Outpatients ; Skin ; Skin Care ; Upper Extremity

OBJECTIVE: This study examined the prevalence and correlates of depressive symptoms in North Korean defectors who have been living in South Korea for more than one year. METHODS: We used questionnaires developed by the authors to collect sociodemographic data in addition to the Center for Epidemiologic Studies Depression Scale (CES-D), the Psychosocial Well-being Index to measure stress, and a social support scale. A total of 367 subjects were included in this study. RESULTS: The results showed that 30.5% of the men and 34.7% of the women reported depressive symptoms, and 33.1% of the men and 36.1% of the women exhibited signs of severe distress. Correlates of depressive symptoms were lack of occupation [odds ratio (OR)=2.198, 95% confidence interval (CI), 1.247-3.873], having escaped without family (OR=1.725, 95% CI, 1.006-2.959), and a poor subjective sense of health status (OR=3.111, 95% CI, 1.591-6.085). CONCLUSION: Continuing vocational training and career management, psychological support programs, and intensive physical health services are needed to improve the mental health of this population.
Depression ; Epidemiologic Studies ; Female ; Health Services ; Humans ; Male ; Mental Health ; Occupations ; Prevalence ; Surveys and Questionnaires ; Republic of Korea ; United Nations