After the stabilization using unreamed intramedullary interlocking nails for the management of fractures of the tibial shaft, a large percentage of patients whose fractures would proceed to delayed bony union may be subject to secondary surgical procedure. The purpose of this study is to determine whether ultrasound, through its potential early assessment of the presence or absence of callus at the fracture site, can be used to predict the need for secondary surgical procedure. Fourteen tibial fractures (5 open, 9 closed) were treated with unreamed interlocking intramedullary nailing. Radiographs were obtained to monitor the maintenance of reduction and fracture healing. The results of ultrasound studies were obtained at two-week intervals for 10 weeks postoperatively and read by a radiologist. In prospective study of 14 patients, tibial fractures treated with unreamed interlocking intramedullary nailing were analyzed from June 1995 to February 1997 and following results were obtained. 1. Ultrasound correctly predicted fracture healing in all 10 fractures that subsequently progressed to fracture union. 2. Of the 4 fractures that did not heal, ultrasound was able to predict delayed union before it was radiographically evident. 3. Ultrasound predicted fracture healing at an average of 42 days (range, 22-70 days). In comparison, the plain radiographs showed fracture healing at an average of 126 days (range, 70 - 180 days). In conclusion, the tibia was ideal for ultrasound study because of the thin overlying soft tissue. Furthermore, the presence of the intramedullary nail facilitated evaluation of the intervening tissue. And there were several advantages of ultrasound over other imaging modalities. It was noninvasive, easy to use, and painless method of evaluation that does not use ionizing radiation.
Bony Callus ; Fracture Fixation, Intramedullary ; Fracture Healing* ; Humans ; Prospective Studies ; Radiation, Ionizing ; Tibia* ; Tibial Fractures ; Ultrasonography*

Clinical characteristics of papular-purpuric gloves and socks syndrome consist of a purpuric erythema affecting the hands and feet in a gloves and stocking distribution. It is sometimes associated with fever and oral lesions. The disease is self-limiting and resolves within 1 to 2 weeks. Serological studies have shown that there is an association with parvovirus B19 infection in most patients affected by this syndrome. We report a case of gloves and socks syndrome in a 21-year-old female. She had a 4-day history of papular-purpuric eruptions of the hands and feet in a gloves-and-socks distribution. She also complained of fever(up to 39C) during the first 2 or 3 days of clinical onset. The oral mucosa was normal and there were no palpable lymph nodes. Laboratory and histopathological findings were non-specific. However, human parvovirus B19 DNA was detected in the serum by a polymerase chain reaction. Systemic manifestations were transient and disappeared within a few days, whereas the skin lesions resolved gradually over a period of 2 weeks.
DNA ; Erythema ; Female ; Fever ; Foot ; Hand ; Humans ; Lymph Nodes ; Mouth Mucosa ; Parvovirus ; Parvovirus B19, Human ; Polymerase Chain Reaction ; Skin ; Young Adult

In 1952, Zoon described eight cases of benign circumscribed chronic balanitis characterized by an extensive infiltration of plasma cells with no evidence of dysplasia of the overlying epidermis. Plasma cell balanitis can often be confused clinically with other conditions, such as erythroplasia of Queyrat, fixed drug eruptions, secondary syphilis, candidiasis and Reiters disease. We report a case of plasma cell balanitis in a 65-year-old man. He complained of a single, red, shiny and smooth patch involving the glans penis and adjacent prepuce. This patch was unresponsive to systemic and topical steroid treatment. Laboratory studies were negative or within the normal range. Histopathological findings showed a band-like mainly plasmacytic inflammatory infiltrate of the upper dermis. This patient was treated once daily with 2% fusidic acid cream topically for 5 weeks. The lesions resolved and no recurrence was observed during 2 years of follow-up.
Aged ; Arthritis, Reactive ; Balanitis* ; Candidiasis ; Dermis ; Drug Eruptions ; Epidermis ; Erythroplasia ; Follow-Up Studies ; Furosemide* ; Fusidic Acid* ; Humans ; Male ; Penis ; Plasma Cells* ; Plasma* ; Recurrence ; Reference Values ; Syphilis

Mycosis fungoides palmaris et plantaris is an uncommon expression of mycosis fungoides that manifests primarily on the palms and the soles. The lesions may be quite hyperkeratotic and mimic various inflammatory palmoplantar dermatoses. A biopsy is recommended in the evaluation of recalcitrant palmoplantar dermatoses. We report a case of mycosis fungoides palmaris et plantaris in a 36-year-old woman presented with hyperkeratotic plaque on her palms and soles.
Adult ; Biopsy ; Female ; Humans ; Mycosis Fungoides* ; Skin Diseases

BACKGROUND: Left ventricular thrombus is a common complication after acute myocardial infarction. Methods and RESULTS: To Study the incidence of left ventricular thrombosis (LVT) after acute myocardial infarction, we performed serial two-dimensional echocardiography (2D-Echo) in 35 consecutive patients with acute myocardial infarction prospectively ; 10 patients had inferior wall myocardial infarction, 25 patients had anterior wall myocardial infarction. 2D-Echo was obtained within 3 days of acute myocardial infarction, at 4-10 days after symptom onset, and 2-4 weeks after symptom onset serially in each case. 19 out of 35 patients received thrombolytic therapy with urokinase. Left ventricular thrombi were identified in 9(25.7%) of the 35 study patients. The location of myocardial infarction was anterior and apical in all cases with left ventricular thrombi. The shape of thrombi was mural in 6 cases and protruding in 3 cases. The incidence of left ventricular thrombi in patients who received urokinase was not significantly different from that in patients who didn't(31.9% vs 18.8%,p=0.22). Wall motion score was significantly higher in patients who developed left ventricular thrombi than in patients who had no left ventricular thrombus(8.2+/-1.9 vs 5.8+/-2.6, p<0.005). All thrombi appeared within 10 days after myocardial infarction. CONCLUSIONS: Thus left ventricular thrombi develops within 10 days following myocardial infarction with large anterior and apical location. The thrombolysis therapy has no effect in the incidence of left ventricular thrombi in this study. But because of confounding effect of thrombolysis and location of myocardial infarction and extent of myocardial infarction, further investigation is needed.
Anterior Wall Myocardial Infarction ; Echocardiography ; Humans ; Incidence* ; Inferior Wall Myocardial Infarction ; Myocardial Infarction* ; Prospective Studies ; Thrombolytic Therapy ; Thrombosis* ; Urokinase-Type Plasminogen Activator

No abstract available.
Blood Glucose ; Diabetes Mellitus, Type 2 ; Humans

OBJECTIVE: To investigate whether the findings of wrist magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA) is representative of their disease activity. METHODS: MRI and plain radiographs were performed on the wrists of 15 patients with RA. Four MRI techniques were used; T1 weighted spin echo image (T2WI), chemical fat suppression T2 weighted image (FS-T2WI) and Gadolinium-DTPA contrast enhanced T1 weighted image (CE-TIWI). Erosion scores used as radiologic index were calculated from total counts of bone erosion in all coronal planes of wrist MRI and .plain radiographs. This erosion score was compared with the clinical indices (Ritchie index, grip strength, visual analogue pain scale) and laboratory indices (ESR, CRP, hemoglobin, immunoglobulins). RESULTS: MRI erosion score of the wrist in patients with RA significantly correlated with ESR and serum IgG level, but did not correlate with global clinical indices such as grip strength and Ritchie index. MRI was especially useful in early detection of erosive bone change. Special MR images such as fat suppres-sion and Gd-DTPA enhanced images were superior to plain radiographs and conventional MR images in detecting the erosive lesion of carpal bones. CONCLUSIONS: Wrist MRI is useful in early detection of erosive bone change and may be an important tool for the measurement of disease activity in RA. We prospect that it could be used to assess the progression of the disease and the response of drug therapy.
Arthritis, Rheumatoid ; Carpal Bones ; Drug Therapy ; Gadolinium DTPA ; Hand Strength ; Humans ; Immunoglobulin G ; Magnetic Resonance Imaging* ; Wrist*

Anesthesia for cesarean section involves consideration of Loth maternal and fetal welfare. The choice of anesthesia for cesarean section is controversial. Regional analgesic techniques may be least harmful to the fetus, but suffer definite drawbacks; they are time-consuming, and therefore not always applicable when urgent surgery is indicated; are associated with a definite failure rate even in skilled hands, and require considerable technical ability and practice. Recently there has been progressive increase in the use of balanced anesthesia for cesarean section, it produces little or no hemodynamic and acid-base disturbance in the mother and infant if administered skillfully. The value of muscle relaxants to facilitate endotracheal intubation and pulmonary ventilation and to permit the use of light general anesthesia. From November, 1971 to October, 1973 there were 1,432 deliveries, of which 1,284 were delivered vaginally and 148 (10.3%) by cesarean section. Of the cesarean section group, 139 were performed under general anesthesia and 9 were performed under regional anesthesia. The characteristic difference for our series was that most of all cases were emergency cesarean section (71.6%). The major indication for surgery was that of a previous cesarean section (45.3%), the second most common cause was dystocia (42.9%), and the others are as following order; Hemorrhage (5.4%), toxemia (3.4%), and others (3.4%). In our study, we adopted two different general anesthetic techniques for cesarean section. Patients were randomly assigned to two groups: Group I: 112 patients, thiopental-succinylcholine-nitrous oxide-oxygen (67:33) anesthesia. Group II: 25 patients, thiopental-succinylcholine-nitrous oxide-oxygen (50:50) supplemented with 0.5~1.0% of halothane anesthesia. All patients were pre-oxygenated for 3 5 minutes and anesthesia was then induced with thiopental sodium 125~250mg, followed by succinylcholine 40~50 mg to facilitate intubation. Pressure was maintained on the cricoid cartilage to prevent regurgitation following loss of consciousness. After the affects of succinylcholine showed signs of wearing off, relaxation was maintained with 0.1% succinylcholine drip or 40~80 mg of gallamine. Anesthesia was maintained with nitrous oxide 4 l/min. and oxygen 2 l/min. and/or nitrous oxide 2 l/min. and oxygen 2 l/min. supplemented with 0.5~1.0% of halothane. Respiration was carefully controlled by manually so as not to producing hyperventilation. The clinical condition of newbron infant in general anesthesia series of 135 cases, mean minute apgar score were good (7~10) in 91.8 percent, fair (4~6) in 6.7 per cent, and poor (1~3) in 1.5 per cent. And 90.4 per cent of babies born within 10 minutes of induction to delivery time interval (IDI) had mean apgar score of 8. 8, 5.8 per cent were delivered after 11 to 15 minutes of IDI with decreased mean apgar score of 7.6, and 3.7 per cent were delivered after over 15 minutes of IDI had mean apgar score of 7. 6. A short IDI appears to be advantageous from the standpoint of the newborn. Of the 144 infants, 6. 9 per cent of newbron infants(10) received intermittent positive pressure breathing by face mask and 3.5 per cent(5) received oxygen through an endotracheal tube for the resuscitation. Neonatal death occurred only 1(0.69%) case out of 144 infants, which caused by severe fetal. distres associated with toxemia of pregnancy. There were no maternal death or anesthetic complication.. At the conclusion, the technique of general anesthesia with thiopental-succinylcholine-nitrous oxide-oxygen and/or supplemented with 0.5~1.0% of halothane was proved to be safe for mother and child, and showing a wide acceptance of general anesthesia for cesarean section(94%) at the Kyung Hee University Hospital.
Anesthesia* ; Anesthesia, Conduction ; Anesthesia, General ; Apgar Score ; Balanced Anesthesia ; Cesarean Section* ; Child ; Clinical Study* ; Cricoid Cartilage ; Dystocia ; Emergencies ; Female ; Fetus ; Gallamine Triethiodide ; Halothane ; Hand ; Hemodynamics ; Hemorrhage ; Humans ; Hyperventilation ; Infant ; Infant, Newborn ; Intermittent Positive-Pressure Breathing ; Intubation ; Intubation, Intratracheal ; Masks ; Maternal Death ; Mothers ; Nitrous Oxide ; Oxygen ; Perinatal Death ; Pre-Eclampsia ; Pregnancy ; Pulmonary Ventilation ; Relaxation ; Respiration ; Resuscitation ; Succinylcholine ; Thiopental ; Toxemia ; Unconsciousness

PURPOSE: As a baseline study for clinical application, we investigated MRI findings of normal cruciate ligaments in the knee being flexed as compared to those in the knee being extended. MATERIALS AND METHODS: Seven asymptomatic volunteers were studied. Knee MRI was performed with a 1.5 Tesla unit using a dual 3 inch coil. Inthe decubitus position, sagittal scanning was performed with the knee in extension, and subsequently, in flexion. We observed the shape and signal intensity of both cruciate ligaments, and measured the angles between the longaxis of the femur and ligaments, and the ligament dimensions in extension and flexion images. RESULTS: As flexionand extension images were compared, cruciate ligaments differed both in their appearance and dimensions. With flexion, joint space was widened, PCL became straightened and the signal intensity of ACL became homogeneously low; both cruciate ligaments became longer and thinner. These MRI findings were statistically significant except forthinning of PCL. CONCLUSION: MRI appearance and the dimensions of cruciate ligaments were different in the flexed knee as compared to those in the extended knee.
Femur ; Joints ; Knee* ; Ligaments* ; Magnetic Resonance Imaging* ; Volunteers

The pulmonary recruitment and activation of inflammatory cells, in particular, neutrophils is thought to contribute to lung injury resulting from dust exposure. MIP-2 (macrophage inflammatory protein-2) which is a member of C-X-C chemokine plays a key role in neutrophil recruitment to sites of tissue injury. Especially, mineral fiber induced pulmonary response is as a model for the neutrophil recruitment. Therefore, we evaluated the distribution of MIP-2 expression in lung tissue of mineral fiber exposed rat using immunohistochemical study and the relationship between degree of inflammation of lower respiratory tract and MIP-2 expression. Total cell counts in bronchoalveolar lavage (BAL) fluid in mineral fiber-exposed group were markedly increased compared with each control group even not in ceramic fiber group. Number of neutrophil in BAL fluid in mineral fiber-exposed group were markedly increased compared with each control group until 4th week but except ceramic fiber group. In chrysotile group, number of neutrophil in BAL fluid were markedly increased compared with control group at 8th week. Lung tissue instilled with all kinds of mineral fibers showed remarkable developments of bronchus associated lymphoid tissue (BALT) and small multiple granulomas but not for ceramic fiber group. In chrysotile group, multiple granuloma and inflammatory change were more profuse response compared with other groups. MIP-2 was predominently expresses in epithelial cells of bronchioles and bronchus and was express also found in macrophages with lung section at 1 week after fiber instillation. Small amount of epithelial cell associated MIP-2 was present in chrysotile at 8 week group. But MIP-2 was not seen in epithelial cells and macrophages in the lung tissue instilled with crocidolite, ceramic fiber and glass fiber at 8 weeks. Our finding suggest that MIP-2 is predominantly expressed in bronchial epithelial cells of lung from mineral fiber-exposed rat and correlated with inflammatory cell, especially neutrophil, recruitment and tissue reaction. And we documented that MIP-2 expression and neutrophil recruitment in man-made vitreous fiber-exposed rat, especially glass fiber, less than chrysotile.
Animals ; Asbestos, Crocidolite ; Asbestos, Serpentine ; Bronchi ; Bronchioles ; Bronchoalveolar Lavage ; Cell Count ; Ceramics ; Dust ; Epithelial Cells ; Glass ; Granuloma ; Inflammation ; Lung ; Lung Injury ; Lymphoid Tissue ; Macrophages ; Mineral Fibers ; Neutrophil Infiltration ; Neutrophils ; Rats ; Respiratory System