BACKGROUND: The external jugular vein (EJV) is a useful intravenous (IV) cannulation site for anesthesiologists, although it has a relatively high failure rate. Unlike other central veins, visualization of the EJV is important during IV cannulation, and the Valsalva maneuver distends the jugular venous system. However, the relationship between the maneuver and EJV visibility remains unknown. This study compared EJV visibility before and after the Valsalva maneuver. METHODS: This was a prospective observational study that included 200 participants. After the induction of anesthesia, EJV visibility grade, depth from the skin to the EJV superficial surface (EJV depth), and EJV cross-sectional area (CSA) before the Valsalva maneuver were measured. The same parameters were measured after the Valsalva maneuver was performed. The EJV visibility grade was defined as grade A: good appearance and good palpation, grade B: poor appearance and good palpation, and grade C: poor appearance and poor palpation. RESULTS: Patient body mass index and EJV depth affected the EJV visibility grade before the Valsalva maneuver (p < 0.05), although EJV CSA did not. The Valsalva maneuver distended EJV CSA and reduced EJV depth, although these changes were not correlated with EJV visibility grade. With regard to EJV visibility, 34.0% of grade B cases and 20.0% of grade C cases were improved by the Valsalva maneuver. CONCLUSIONS: Although the Valsalva maneuver improved EJV CSA and EJV depth, it did not greatly affect EJV visibility grade.
Anesthesia ; Body Mass Index ; Catheterization ; Humans ; Jugular Veins* ; Observational Study ; Palpation ; Prospective Studies ; Skin ; Ultrasonography ; Valsalva Maneuver* ; Veins

Finger injuries are becoming more common with the increasing use of mechanical industrial and household appliances. Among the hand injuries, amputation is the serious disaster to the patient. Recently, application of microsurgical technique to the reattachment of amputated digits has been common clinical procedures. We performed microsurgical replantation to the 75 patients with 102 digits from March in 1986 to February in 1988. The following results were obtained. 1. The most common age distribution was third decade and male to female ratio was about 5:1. 2. The ratio of right to left hand was about 1:1 but the dominant to non-dominant hand was about 2:1. 3. The index finger was most commonly injured and the next was middle finger. 4. The most common type of the injuries was the crushing injury and the most common vector was a kind of pressor. 5. The anesthesia was performed in equal ratio between the general and regional anesthesia. 6. The survival rate of micro-replantation to the injuries of the zone II was 77.8% and zone III was 80%. 7. The functional result after replantation at zone II was better than zone III. 8. Micro-replantation was performed in any case of the type of the injury, the severity of crushing and the ischemic time, and the patients requirement was an important factor.
Age Distribution ; Amputation* ; Anesthesia ; Anesthesia, Conduction ; Disasters ; Family Characteristics ; Female ; Finger Injuries ; Fingers ; Hand ; Hand Injuries ; Humans ; Male ; Replantation ; Survival Rate

Spinal intramedullary cysticercosis is a rare manifestation of neurocysticercosis and may present as a isolated lesion. We report a case of cervical intramedullary cysticercosis in a 57-year-old man. The patient presented with weakness, numbness of the right upper extremity, and urinary difficulty. Magnetic resonance images demonstrated a round cystic lesion at the C4-5 level. We performed C4-5 laminectomy with total removal of intramedullary cystic lesion. Diagnosis was confirmed by histopathological examination. The patient was given albendazole(15mg/kg/day for 30 days) along with corticosteroid.
Albendazole ; Cysticercosis* ; Diagnosis ; Humans ; Hypesthesia ; Laminectomy ; Middle Aged ; Neurocysticercosis ; Spinal Cord ; Upper Extremity

Since a nationwide childhood vaccination with tetanus toxoid, tetanus has become a rare disease in Korea. However, we recently experienced 17 cases of adult tetanus in a university hospital during a 21-month period. Seventy percent of the patients were female, and the mean age was 63 yr (range, 29-87). The majority (88.2%) of the patients did not get primary vaccinations for tetanus and decennial tetanus-diph-theria toxoid booster. Most patients (88.2%), who sustained acute injury, did not seek medical care for their wounds or did not receive the prophylaxis for tetanus. Tetanus was found most frequently among farmers. Tetanus was diagnosed initially only in 53% of patients. The case-fatality ratio was 23.5%. These cases show that recently occurring tetanus in Korea is a disease, affecting the elderly and the female who may have a lower immunity against tetanus, and the farmers who are likely to be exposed to Clostridium tetani. In addition, diagnosis of tetanus is often delayed in area where cases are seen infrequently. Therefore, improved education among patients and physicians, emphasis of anti-tetanus immunization and awareness of tetanus respectively, may be essential for the prevention of disease and the reduction of its mortality.
Adult ; Aged ; Aged, 80 and over ; Agricultural Workers' Diseases/epidemiology ; Diagnostic Errors ; Diphtheria-Tetanus-Pertussis Vaccine ; Emergency Service, Hospital ; Health Education ; Health Knowledge, Attitudes, Practice* ; Human ; Immunization, Secondary/psychology ; Immunization, Secondary/utilization* ; Korea/epidemiology ; Middle Aged ; Tetanus/diagnosis ; Tetanus/epidemiology* ; Tetanus/prevention & control ; Tetanus/therapy ; Tetanus Antitoxin/therapeutic use ; Tetanus Toxoid ; Treatment Outcome ; Vaccination/utilization* ; Wounds, Penetrating/complications

Objective: To present new classification methods of knee osteoarthritis (KOA) using machine learning and compare its performance with conventional statistical methods as classification techniques using machine learning have recently been developed. Methods: A total of 84 KOA patients and 97 normal participants were recruited. KOA patients were clustered into three groups according to the Kellgren-Lawrence (K-L) grading system. All subjects completed gait trials under the same experimental conditions. Machine learning-based classification using the support vector machine (SVM) classifier was performed to classify KOA patients and the severity of KOA. Logistic regression analysis was also performed to compare the results in classifying KOA patients with machine learning method. Results: In the classification between KOA patients and normal subjects, the accuracy of classification was higher in machine learning method than in logistic regression analysis. In the classification of KOA severity, accuracy was enhanced through the feature selection process in the machine learning method. The most significant gait feature for classification was flexion and extension of the knee in the swing phase in the machine learning method. Conclusion The machine learning method is thought to be a new approach to complement conventional logistic regression analysis in the classification of KOA patients. It can be clinically used for diagnosis and gait correction of KOA patients.

Pharmacologic treatment of the detrusor hypocontractility(hyporeflexia) remains controversial issues. Clean intermittent self catheterization(CIC) alone, or combination with bethanechol chloride has been generally accepted as treatment modality. Until presently, bethanechol chloride is the only pharmacologic agent commonly used for bladder emptying without significant complication. However, the effectiveness of bethanechol seem to be episodic. The present study compared the contractile response of various pharmacologic agents including bethanechol chloride, ATP, PG E1, E2, F2-alpha on the smooth muscle strips of male rabbit bladder. In addition, effect of the gastrointestinal motility agents such as cisapride and metoclopramide on the contraction of rabbit bladder were assessed. Each bladder was divided into bladder body and bladder base for comparison of pharmacologic effects. FS at basal tension elicited a frequency dependent contraction which was greater in bladder body strips than in bladder base strips. The contractile responses to bethanechol, ATP, PG E1, E2 and PG F2-alpha were greater in bladder body than in bladder base.In the bladder body,magnitude of the contractile responses by ATP and PG F2-alpha were approximately 1/3 of those by bethanechol or FS.PG F2-alpha was consistently more potent to produce contraction than PG E1, E2. ATP induced contraction only consisted of initial phasic rise of tension. The contraction induced by PG developed slower than those caused by bethanechol. Cisapride(10uM) induced weak contractile responses comparable to those by PG E1 Metoclopramide had no contractile effects in this studies. Conclusively, differences exist in the response of the bladder body and base to FS and various pharmacologic agents. ATP, PG E2 and PG F2-alpha exhibited some notable contractile responses to the bladder body that were approximately 1/3 of those by bethanechol. Gastrointestinal motility agents were not shown to be effective in the mediation of contraction of rabbit bladder.
Adenosine Triphosphate ; Bethanechol ; Cisapride ; Gastrointestinal Motility ; Humans ; Male ; Metoclopramide ; Muscle, Smooth* ; Negotiating ; Urinary Bladder*

OBJECTIVES: This study was planned to compare the epidemiological features such as radiological and clinical features between coal worker's pneumoconiosis and manufacturing pneumoconiosis in connection with their age and dust exposure duration. METHODS: For the study, detailed examination records of those workers who had been confirmed to have pneumoconiosis in coal mining and manufacturing industries by the Ministry of Labour during two year period of 1991 and 1992. Total number of study subjects was 895 pneumoconiosis cases; 504 from coal mining and 391 from manufacturing industries. Information variables for the data analysis were sex, age, dust exposure duration, work position as the independent variables and radiological pneumoconiosis category, pulmonary function test results and pulmonary tuberculosis complication status as the dependent study variables. RESULTS: There was a significant difference in distribution of radiological categories of both pneumoconiosis groups. The proportion of suspicious and category 1 pneumoconiosis was higher in manufacturing pneumoconiosis group than in coal mine pneumoconiosis group whereas category 2 and large opacity pneumoconiosis was higher in coal mine pneumoconiosis group than in manufacturing pneumoconiosis group. Major ventilatory indices such as FVC and FEV1 were significantly lower in coal mine pneumoconiosis group than in manufacturing pneumoconiosis group even after other variables such as age and smoking history were statistically adjusted for. CONCLUSIONS: It is suggested that some selected outcome variables such as radiological category of pneumoconiosis, ventilatory impairment, and pulmonary tuberculosis complication rate were significantly different between coal mine pneumoconiosis and manufacturing pneumoconiosis.
Anthracosis ; Coal ; Coal Mining ; Dust ; Korea* ; Mining* ; Pneumoconiosis* ; Respiratory Function Tests ; Smoke ; Smoking ; Statistics as Topic ; Tuberculosis, Pulmonary

PURPOSE: To evaluate the urodynamic findings in diabetics complaining of urinary voiding symptoms, the retrospective study was performed. MATERIALS AND METHODS: For 5 years, from Jan. 1992 to Dec. 1997, urodynamic findings on 76 diabetics(49 males and 27 females) with voiding dysfunction were assessed and classified into; 1, detrusor instability, 2, impaired detrusor contractility, 3, detrusor areflexia, 4, indeterminate, 5, normal. Diabetic patients who had diseases of influential potentiality on bladder function were excluded out. A detailed history of diabetes, past and present medical history were reviewed. In addition, a thorough voiding history, urine culture, blood chemistry and physical examination were determinate. Ophthalmic examination by ophthalmologist and sacral reflex arc examination by urologist were also examined. Those with abnormal sacral reflex arc(absent bulbocavernous reflex, lax anal sphincter tone and control) were deemed sacral cord signs positive, and those with intact sacral reflexes were deemed sacral cord signs negative. RESULTS: The urodynamic findings of 76 diabetic patients were distributed into 25(32.9%) detrusor instability 23(30.3%) impaired detrusor contractility, 21 (27.8%) detrusor areflexia, 6(7.9%) indeterminate and 1 (1.3%) normal. Thirty six(47.4%) of them had retinopathy and 27(35.5%) had positive sacral cord sign, those complications took place most frequently in diabetics with detrusor areflexia. CONCLUSIONS: Diabetic cystopathy revealed various patterns of bladder dysfunction, and detrusor areflexia patients showed high incidence of retinopathy and positive sacral cord sign. It is necessary that urodynamic studies should be done in diabetic cystopathy to characterize the treatment of voiding dysfunction.
Anal Canal ; Chemistry ; Humans ; Incidence ; Male ; Physical Examination ; Reflex ; Retrospective Studies ; Urinary Bladder ; Urodynamics*

No abstract available.
Child* ; Heart* ; Humans

The main purpose of this study was to examine factors related to exercise behavior of civil airmen. The subjects for the study were 200 civil airman including pilots, flight officers and flight engineers working for "A" airline in South Korea. The data was collected from April, 1 to 30, 1996 using a questionnaire that was developed for this study, and analyzed using SPSS(Statistical Package for Social Science). The subjects consisted of 200 males. The average age was 42 years old and the majority(82.5%) were married. The large proportion of subjects had received four years of college education or more(86%), and reported having a religion(71%). The average height and weight were 171.7cm and 69.4kg respectively. The average working period and total flight time were 8 years and 6002 hours respectively. Ninety-five percent of sample exercised regularly. As for the frequency of the exercise, 4% of the sample never exercised and 26% of the sample exercised less than once per week, while 44.5% and 24.5% of the sample exercised once or two times, and more than three times per week respectively. The type of exercise was strengthening (30.0%) and aerobic exercise such as jogging(54%), mountain climbing(37.5%) and golf(33.0%). Nearly three fourths of the sample were involved in more than the "light heavy" level of intensity(72.5%) and the average duration was 74.9 minutes. The following factors are related to the exercise behavior. 1) Age and marriage were positively related to exercise behavior(p<.05). 2) The cognitive/perceptual factor is related to exercise behavior. Those who perceived that their health was poor, that health was out of their control exercised less frequently. Also those who showed low self efficacy, and those who valued their health less exercised less frequently. 3) Among environmental factors, social support such as peers, spouse and media influenced exercise behavior. Also the use of a health center was related to a higher level of exercise behavior compared to self-regulated home exercise. Irregular duty was the higher barrier to exercise. 4) The type and intensity of exercise were related to exercise behavior, but not duration. Those who have been jogging or mountain climbing regularly, and those who exercised rather intensely showed a higher frequency of exercise. However, there was no difference in duration 5) The results of stepwise multiple regression analysis showed that the variables which were related to exercise behavior were exercise intensity, exercise place and whether the subject was married. These three factors accounted for 37% of the variance.
Adult ; Education ; Exercise ; Fibrinogen ; Humans ; Jogging ; Korea ; Male ; Marriage ; Self Efficacy ; Spouses ; Surveys and Questionnaires