BACKGROUND: After surgery for degenerative spinal disease by the anterior approach, the degree of soft tissue swelling can be assessed simply using plain radiographs. However, there are little studies according to the surgical methods or extent of surgery, and no study had addressed the clinical meaning of swelling determined by plain radiography. The purpose of this study was to evaluate the clinical significance of prevertebral soft tissue swelling (PSTS) after anterior cervical fusion with plate fixation for the treatment of degenerative cervical spinal disorders. METHODS: One hundred and thirty-five patients that underwent anterior cervical fusion with plate augmentation for degenerative cervical spondylosis were included in this study. PSTS differences were analyzed with respect to numbers of fusion segments and location of fusion. Cases were divided into two groups based on the amount of PSTS, and incidences of dyspnea, dysphagia, dysphonia were evaluated. RESULTS: PSTS increments were significantly greater in patients that had undergone multi-level or high-level fusion. Complications of dyspnea, dysphagia and dysphonia were found more frequently in patients with marked PSTS group. CONCLUSIONS: Increments of PSTS after anterior cervical fusion for degenerative spinal disorders are greater and incidences of complications are higher in patients that undergo multi-level or high-level fusion. Thus, measurement of PSTS using consecutive cervical lateral radiographs after anterior cervical surgery is clinically meaningful procedure.
Adult ; Aged ; Aged, 80 and over ; Cervical Vertebrae/surgery ; Deglutition Disorders/etiology ; Diskectomy/*adverse effects ; Dysphonia/etiology ; Dyspnea/etiology ; Edema/etiology/*radiography ; Female ; Humans ; Male ; Middle Aged ; Neck Injuries/etiology/*radiography ; Soft Tissue Injuries/etiology/*radiography ; Spinal Fusion/*adverse effects ; Spondylosis/*surgery

BACKGROUND: After surgery for degenerative spinal disease by the anterior approach, the degree of soft tissue swelling can be assessed simply using plain radiographs. However, there are little studies according to the surgical methods or extent of surgery, and no study had addressed the clinical meaning of swelling determined by plain radiography. The purpose of this study was to evaluate the clinical significance of prevertebral soft tissue swelling (PSTS) after anterior cervical fusion with plate fixation for the treatment of degenerative cervical spinal disorders. METHODS: One hundred and thirty-five patients that underwent anterior cervical fusion with plate augmentation for degenerative cervical spondylosis were included in this study. PSTS differences were analyzed with respect to numbers of fusion segments and location of fusion. Cases were divided into two groups based on the amount of PSTS, and incidences of dyspnea, dysphagia, dysphonia were evaluated. RESULTS: PSTS increments were significantly greater in patients that had undergone multi-level or high-level fusion. Complications of dyspnea, dysphagia and dysphonia were found more frequently in patients with marked PSTS group. CONCLUSIONS: Increments of PSTS after anterior cervical fusion for degenerative spinal disorders are greater and incidences of complications are higher in patients that undergo multi-level or high-level fusion. Thus, measurement of PSTS using consecutive cervical lateral radiographs after anterior cervical surgery is clinically meaningful procedure.
Adult ; Aged ; Aged, 80 and over ; Cervical Vertebrae/surgery ; Deglutition Disorders/etiology ; Diskectomy/*adverse effects ; Dysphonia/etiology ; Dyspnea/etiology ; Edema/etiology/*radiography ; Female ; Humans ; Male ; Middle Aged ; Neck Injuries/etiology/*radiography ; Soft Tissue Injuries/etiology/*radiography ; Spinal Fusion/*adverse effects ; Spondylosis/*surgery

OBJECTIVE: The parturient with hypertensive disorders usually has multiple organ alterations, which may affect on the anesthetic care during cesarean delivery. The present study purposed to determine the optimal anesthesia method for the cesarean section of the patients with hypertensive disorders through clinical examination and to support adequate patient management. METHODS: We conducted a retrospective survey of medical records of the patients with hypertensive disorders of varying severity delivered by cesarean, between January 1999 and December 2003 at Gangnam CHA Hospital. According to anesthesia method, the patients were divided into the general anesthesia group and the epidural anesthesia group, and the clinical outcomes were compared statistically. RESULTS: Estimated intraoperative blood loss and the frequency of complications such as anemia and pulmonary edema were significantly lower in the epidural anesthesia group. However, there was no major complications with either general or epidural anesthesia CONCLUSION: Epidural anesthesia is considered allowable as the primary anesthesia method for the caesarean section of the parturient with hypertensive disorders.
Anemia ; Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Cesarean Section* ; Female ; Humans ; Medical Records ; Pregnancy ; Pregnancy* ; Pulmonary Edema ; Retrospective Studies

OBJECTIVE: This study was designed to evaluate the effect of epidural analgesia on the course of labor and delivery mode. METHOD: Three hundred eighteen term pregnant women with singleton fetus in vertex presentation were admitted for vaginal delivery at the Department of Obstetrics and Gynecology, medical center Chung-ju hospital from January 1, 1998 to December 31, 1998. They were divided into two groups: epidural analgesia group and non-epidural analgesia group. Epidural analgesia group was 106 women (79 primiparas and 27 multiparas). Non-epidural analgesia group was 212 women (138 primiparas and 74 multiparas). Course of labor and delivery mode were compared between the two groups. RESULTS: 1. The duration of the first stage of labor was not significantly different between two groups (primiparas: 672+/-110 min vs 625+/-134 min, multiparas: 458+/-152 min vs 422+/-184 min), and that of the second stage of labor in the primiparas was significantly longer in epidural analgesia group than non-epidural analgesia group (62+/-25 min vs 42+/-20 min, p=0.03), but did not differ significantly in the multiparas groups (36+/-12 min vs 31+/-20 min).2. Cesarean delivery rates were not significantly different between two groups (19.8% vs 15.1%).3. Cesarean delivery rates due to failure to progress were not significantly different between two groups (85.7% vs 78.1%).4. Oxytocin augmentation rates were significantly higher in epidural analgesia group than in non-epidural analgesia group (primiparas: 42.3% vs 20.1%, p=0.008, multiparas: 38.5% vs 19.7%, p=0.01).5. The newborn birthweight, Apgar score and the incidence of meconium-stained amnionic fluid were not significantly different between two groups.6. The complication of the epidural analgesia were back pain (10.4%), shivering (7.5%), nausea and vomiting (1.3%), hypotension (0.9%), and voiding difficulty (0.9%). CONCLUSION: Though epidural analgesia prolonged second stage of labor in the primiparas and increased oxytocin augmentation rates but did not increased the cesarean delivery rates. So intrapartum epidural analgesia provided safe and effective pain control without undesirable effects on labor outcomes.
Amnion ; Analgesia ; Analgesia, Epidural* ; Apgar Score ; Back Pain ; Cesarean Section ; Chungcheongbuk-do ; Female ; Fetus ; Gynecology ; Humans ; Hypotension ; Incidence ; Infant, Newborn ; Nausea ; Obstetrics ; Oxytocin ; Pregnancy ; Pregnant Women ; Shivering ; Vomiting

Macrophage activation syndrome (MAS) is a rare complication in systemic lupus erythematosus (SLE) that can be triggered by infections. Due to the fact that MAS may mimic clinical features of underlying rheumatic disease, or be confused with an infectious complication, its detection can prove challenging. This is particularly true when there is an unknown/undiagnosed disease; and could turn into an even greater challenge if MAS and SLE are combined with a viral infection. A-14-year-old female came to the hospital with an ongoing fever for 2 weeks and a painful facial skin rash. Hepatomegaly, pancytopenia, increased aspartate aminotransferase, elevated serum ferritin and lactate dehydrogenase were reported. No hemophagocytic infiltration of bone marrow was reported. The patient was suspected for hemophagocytic lymphohistiocytosis. Her skin rashes were eczema herpeticum, which is usually associated with immune compromised conditions. With the history of oral ulcers and malar rash, positive ANA and low C3, C4 and the evidence of hemolytic anemia, she was diagnosed as SLE. According to the diagnostic guideline for MAS in SLE, she was diagnosed MAS as well, activated by acute HSV infection. After administering steroids and antiviral agent, the fever and skin rash disappeared, and the abnormal laboratory findings normalized. Therefore, we are reporting a rare case of MAS triggered by acute HSV infection as the first manifestation of SLE.
Anemia, Hemolytic ; Aspartate Aminotransferases ; Bone Marrow ; Exanthema ; Female ; Ferritins ; Fever ; Hepatomegaly ; Humans ; Kaposi Varicelliform Eruption ; L-Lactate Dehydrogenase ; Lupus Erythematosus, Systemic* ; Lymphohistiocytosis, Hemophagocytic ; Macrophage Activation Syndrome* ; Macrophage Activation* ; Macrophages* ; Oral Ulcer ; Pancytopenia ; Rheumatic Diseases ; Steroids

Constipation is a prevalent, often chronic, gastrointestinal motility disorder. Bisacodyl, a stimulant laxative, is widely used to treat constipation in adults and children. This drug is usually safe, but it has some side effects including diarrhea, abdominal pain, colitis, and proctitis. There have been reports that rectal administration of bisacodyl could cause injury to the rectal mucosa by mechanical and chemical mechanisms. However, there has been no report of severe proctitis with rectal ulcers in patients taking oral bisacodyl. In this report, we describe the case of an 80-year-old woman with severe rectal ulcers and proctitis after taking oral bisacodyl for several days, and review the literature.
Abdominal Pain ; Administration, Rectal ; Adult ; Aged, 80 and over ; Bisacodyl* ; Child ; Colitis ; Constipation ; Diarrhea ; Female ; Gastrointestinal Motility ; Humans ; Mucous Membrane ; Proctitis* ; Rectum ; Ulcer*

OBJECTIVES: The Korean government in January 2006 instigated an exemption policy for hospitalized children under the age of six years old. This study examines how this policy affected the utilization of medical care in Korea. METHODS: A total of 1,513,797 claim records from the Health Insurance Review Agency were analyzed by complete enumeration methods. The changes of medical utilization were compared from 2005 to 2006. In addition, the changes of medical utilization between 2004 and 2005 were compared as a pseudocontrol group. RESULTS: The admission rate increased 1.14-fold from 15.20% in 2004 to 17.32% in 2005, and this further increased 1.08-fold to 18.65% in 2006. The increase of patients with a common cold (1.2-fold) was higher than that of both the general patients (1.08-fold) and the patients with the top 10 fatal diseases (0.91-fold). The average length of stay per case for clinics showed the highest increase rates (1.06-fold). The rates of patients with the common cold showed a higher increase (1.05-fold) than that of the general patients. The average medical expense per case was increased by 1.10-fold from 2005 to 2006, which was higher than that from 2004 to 2005 (1.04-fold). The increase rate for patients with the common cold was higher at 1.18-fold than that of the general patients. CONCLUSIONS: The cost exemption policy has especially led to an increase in the utilization of clinics and the utilization by patients with a common cold.
Child, Preschool ; Cost Sharing/*legislation & jurisprudence ; *Health Policy ; Health Services/*utilization ; Hospitalization ; Humans ; Insurance Claim Review ; Korea ; Length of Stay

BACKGROUND: Medication adherence is important for hypertension management but still stay low level. It is reasonable method to classify medication nonadherence into intentional nonadherence and unintentional nonadherence and manage it according to this categories. This study aimed to explore medication adherence and its predictors in community patients with hypertension, especially dividing into intentional nonadherence and unintentional nonadherence. METHODS: Study subjects included 1,988 patients who were prescribed hypertension drugs among 2012 community health survey subjects of 10 cities in Gyeongsangnamdo and we analyzed medication adherence with hypertension and its predictors. We conducted chi-square test for nominal variable and ANOVA test for continuous variable and use multinominal regression to analyze independent predictors of intentional nonadherence and unintentional nonadherence in contrast to medication adherence. RESULTS: Of the 1,988 patients, 49.7% were adherent, 26.1% were unintentionally nonadherent and 24.2% intentionally nonadherent. Independent predictors of unintentional nonadherence were depressive symptoms (odds ratio [OR]=1.696, P=0.047) and arthritis (OR=1.319, P=0.030) and independent predictors of intentional nonadherence were cardiocerebrovascular disease (OR=1.464, P=0.044), self-efficacy (OR=0.984, P=0.007), beliefs about medications questionnaire (necessity [OR=0.834, P<0.001] and concern [OR=1.236, P<0.001]). CONCLUSIONS: In order to manage hypertension in community, improvement in medication adherence is needed. Depressive symptom and self-efficacy need to be managed, but especially patients'beliefs about their medication need to be considered to improve intentional nonadherence.
Aged* ; Arthritis ; Depression ; Gyeongsangnam-do ; Health Surveys ; Humans ; Hypertension* ; Intention ; Medication Adherence*

BACKGROUND: Diffusion-perfusion mismatch (DPM) on MRI has been considered an ischemic penumbra. However, several reports have demonstrated limitation of DPM on MRI as a predictable marker of the ischemic penumbra. In this study, we investigated the relationship between DPM and the clinical progression in acute ischemic stroke patients. METHODS: We consecutively recruited fifty-seven patients showing acute ischemic stroke (within 24 hours) in the middle cerebral artery (MCA) territory. The clinical outcomes were determined by serial measurement of National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) during 30 days after their ischemic event. We also evaluated the relationship among the parameters of perfusion MRI and the clinical worsening in patients with DPM on initial MRI. RESULTS: Nineteen (33.3%) patients had DPM on MRI within 24 hours after stroke onset. Even though the frequency of clinical worsening for 30 days after stroke onset was higher in DPM group (26%) than in non-DPM group (11%), it did not reach statistical significance (p=0.143). However, extent of MCA stenosis (p<0.001) and time to peak (TTP) delay on MRI (p<0.001) were significantly greater in patients with DPM than in those without DPM. Among several parameters of the perfusion MRI, only relative cerebral blood volume (rCBV) was significantly related to the clinical worsening (62.9+/-24.7% vs 96.1+/-19.2%, p=0.007) in patients with DPM. CONCLUSIONS: This study shows that DPM on MRI does not always predict the clinical worsening in acute ischemic stroke. To overcome this problem, we should analyze rCBV map based DPM as well as TTP map based DPM.
Blood Volume ; Brain ; Constriction, Pathologic ; Diffusion ; Humans ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Perfusion ; Stroke ; Thymine Nucleotides

No abstract available.
Edema* ; Humans ; Hydrops Fetalis* ; Infant, Newborn*