Recurrent dislocation of the peroneal tendon is infrequent but often the injury is a disabling one, and the result of conservative treatment is unsatisfactory. Dislocation of these tendons may be the result of a congenitally shallow groove in the lateral malleolar or of a complete abscence of the groove and the dislocation may be present at birth or may be caused by trauma. We are reporting one case of bilateral recurrent dislocation of the peroneal tendons with- out any history of trauma in which disturbed superior peroneal retinaculum was reconstructed by transposition of the calcsneofibular ligament to the lateral side of the peroneal tendons. The calcaneal insertion of the calcaneofibular ligament was mobilised with a small bone block and reinserted in its bed after the transposition. After a follow up of 13 months, the result was satisfactory.
Dislocations ; Follow-Up Studies ; Lateral Ligament, Ankle ; Ligaments ; Parturition ; Tendons

Nocturia is usually considered to be just one of the symptoms included with lower urinary tract symptoms (LUTS) and is treated with therapy based on LUTS. Recent research suggests, however, that nocturia is not merely a simple symptom of LUTS but is a multifactorial condition with many contributing etiological factors. The causes of nocturia can be classified into bladder storage problems, increased urine output, sleep disturbance problems, and other potential diseases. The frequency-volume chart (FVC) is very important in evaluating and diagnosing nocturia. Patients usually record the volume and timing of voids for a period of 1 to 3 days on the FVC. The FVC data can provide information on voiding patterns and clues about the etiology and treatment of nocturia. It is doubtful that alpha-blockers will have clinical significance for treatment because the difference in nocturia episodes between treatment with alpha-blockers and placebo is too small. Antimuscarinics also exert no effect on nocturnal polyuria, and the evidence supporting the efficacy of antimuscarinics for the treatment of nocturia is limited. However, several randomized placebo-controlled trials have shown the efficacy of oral desmopressin in the treatment of adults with nocturia. Short-acting hypnotics may be helpful for patients with sleep disturbances. Although surgical or interventional therapy is not indicated for nocturia, transurethral resection of the prostate appears to confer a greater improvement in benign prostatic hyperplasia symptoms including nocturia. The management of nocturia may require a team approach by making optimal use of multidisciplinary expertise.
Adult ; Deamino Arginine Vasopressin ; Humans ; Hypnotics and Sedatives ; Lower Urinary Tract Symptoms ; Muscarinic Antagonists ; Nocturia ; Polyuria ; Prostate ; Prostatic Hyperplasia ; Urinary Bladder

BACKGROUND: The fast EMS helicopter was introduced to Korea in 1996 and from Dec. 1. 1997, it was used far transporting emergent patients. Authors, here upon, report the transporting experiences. METHODS: From Dec. 1, 1996 to Dec. 31,1997, Samsung Medical Centers EMS helicopter was used for air evacuation of critically ill patients. The patients data prospectively analyzed. RESULT: A total of 65 patients were transported. Male to female ratio was 1.95 : 1. The mean transport time was 64.1min(10-160 min). Majority of the evacuated patients was surgical patients (General Surgery'16, Orthopedic surgery : 10, Neurosurgery : 6, Infernal medicine 13, Pediatrics : 3, and others : 3). Twenty-one of the 65 patients transported were admitted to ICU and 31 did not require ICU care. During the air evacuation, one physician and one nurse trained for air evacuation amended The patients. No medical problems or deaths developed during the air evacuation period. CONCLUSION: The first EMS helicopter was introduced to Korea in 1996. From Dec. 1, 1996 to Dec. 31, 1997, Samsung Medical Center's EMS helicopter was used for air evacuation of critically ill patients. The patients data reported.
Aircraft* ; Critical Illness ; Emergencies* ; Female ; Humans ; Korea ; Male ; Neurosurgery ; Orthopedics ; Pediatrics ; Prospective Studies

BACKGROUND: Video assisted thoracic sympathectomy or sympathicotomy is a safe and effective therapy for the treatment of palmar hyperhidrosis with immediate symptomatic imporvement. However the degree of satisfaction may diminish with time due to cmpensatory sweating or excessive hand dryness. Therefore by comparing and assessing the degree of symptomatic improvement or compensatory sweating following sympathectomy or sympathicotomy at various levels we aim to determine the optimal level of sympathetic nerve block which will result in minimal side effects and maximal benefit. MATERIAL AND METHOD: Among 194 patients having undergone video assisted thoracic sympathectomy or sympathicotomy between January 1996 and June 1999, 137 patients who responded to either telephone interview or questionnaire were included in the current study. The patients were divided into three groups. Group I(n=61) ; patients having undergone T2,3,4 sympathectomy group II(35) ; patients having undergone T2 sympathicotomy and group III(41) ; patients having undergone limited T2 sympathicotomy which consist of block of interganglionic neuronal fiber on the third rib. The parameters studied comprised of pre- and post-operative palmar temperature change treatment satisfaction the degree of compensatory sweating or discomfort from palmar dryness postoperative complication and changes in plantar sweating. RESULT: There was no difference in age and sex among the groups and the mean postoperative elevation in palmar temperature was 21.59degrees C without any differences among the groups. Patients expressing satisfaction were 65.6%, 62.9% and 90.24% in groups I, II and III, respectively(p<0.05) Moderate to severe compensatory sweating was present in 65.6% 51.4%, and 24.39%, in group I, II, and III, respectively (p<0.05) Slight but comfortable amount of palmar humidness was expressed in decreasing order group III(41.6%) group I(24.6%) and group II(5.7%) (p<0.05) Ineffectiveness or recurrence was present in 5patients in group I(8.2%) 1 patient in group II(2.9%) and none in group III. With regards to plantar sweating decrease in sweating was expressed in 43 patients(31.4%) while similar degree of sweating in 61 patients(44.5%) and increase in sweating in another 33 patinets(24.1%). CONCLUSION: Limited T2 sympathicotomy resection of the lower interganglionic neuronal fiber of the second sympathetic ganglion on the third rib showed immediate effect in palmar hyperhidrosis and caused lesser compensatory sweating and hand dryness.
Autonomic Nerve Block ; Ganglia, Sympathetic ; Hand ; Humans ; Hyperhidrosis* ; Interviews as Topic ; Neurons ; Postoperative Complications ; Surveys and Questionnaires ; Recurrence ; Ribs ; Sweat ; Sweating ; Sympathectomy

BACKGROUND: The purpose of this study was to analyze the endotracheal intubation cases performed in the emergency department. METHODS: We investigated retrospectively 326 cases of endotracheal intubation performed in the emergency department of a tertiary care center from April 1, 1998 to March 31, 1999. We focused on operators, medications used, its success rate and immediate complications, and the relationship between its success rate and medications. RESULTS: Of 326 consecutive intubations, 193 patients(59.2%) were done by emergency medicine residents or attending physician. While 320 patients(98.2%) were successfully intubated, 6 patients could not be intubated and 2 patients underwent tracheostomy. Of 50 cases of intubations(15.3%) attempted with paralyzing agents, 48 cases were done with succinylcholine and 46 cases underwent by emergency physicians. Intubations with neuromuscular paralysis resulted in high success rates at the first attempt. Of 55 immediate adverse events were encountered in 47 patients(desaturation=17, bronchial intubation=15, hypotension=8, bradycardia=4, cardiac arrest=2, others=5). CONCLUSION: At this institution, paralyzing agents were used infrequently, but almost all of them were used by emergency physicians.
Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Humans ; Intubation ; Intubation, Intratracheal* ; Paralysis ; Retrospective Studies ; Succinylcholine ; Tertiary Care Centers* ; Tertiary Healthcare* ; Tracheostomy

The azygous anterior cerebral artery (ACA) is a rare type of ACA anomaly. In the conventional angiography, cognition of its realm is difficult without considerable reading. Clinically, misreading its nature causes confusion during the surgical approach to its associated cerebral aneurysm. We report this rare clinical experience with an angiographic and surgical review.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Cerebral Angiography ; Cognition ; Intracranial Aneurysm

This article was inadvertently omitted Acknowledgments section for grant support.

PURPOSE: To assess the long-term outcomes of tension-free vaginal tape (TVT) for stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD) and to identify influencing factors for failure in these cases. METHODS: A total of 136 women who underwent TVT procedures with minimum follow-up duration of 3 years were included in the study. Patients were divided into two groups (non-ISD and ISD groups) based on preoperative urodynamic studies. Patient outcomes were assessed from retrospective chart review and telephone research. Cure was defined as the subjective resolution of SUI in any circumstances. Improvement was defined as the subjective improvement of SUI without complete resolution. Failure was defined as the subjective lack of improvement of SUI. Patients in ISD group were subdivided into two subgroups (cure and non-cure groups) and were compared to identify influencing factors for TVT procedure failure. RESULTS: Eighty-nine patients were in non-ISD group, and 47 in ISD group. The mean follow-up durations were 50.3+/-9.2 and 49.7+/-9.7 months, respectively. Subjective cure rate was 75.3% for non-ISD group, and 76.7% for ISD group (P>0.05). Improvement rate was 6.7% for non-ISD group, and 2.1% for ISD group (P>0.05). Satisfaction scores was 3.8+/-1.2 points in the non-ISD group, and 3.5+/-1.2 points in ISD group (P>0.05). In ISD subgroups, VLPP was 41.9+/-12.0 cmH2O for non-cure group, and 50.5+/-8.6 cmH2O for cure group, and was the only factor that showed significant statistical difference between the two subgroups (P=0.011). CONCLUSIONS: With our long-term results, TVT is an effective treatment even in women with ISD. However, ISD patients with low VLPP should be counseled carefully about TVT outcome.
Female ; Follow-Up Studies ; Humans ; Retrospective Studies ; Suburethral Slings ; Telephone ; Urinary Incontinence ; Urodynamics

OBJECTIVE: Few studies on the clinical spectrum of automated pressure-controlled discography (APCD)-defined positive discs have been reported to date. Thus, the present study was undertaken to analyze clinical parameters critical for diagnosis of discogenic pain and to correlate imaging findings with intradiscal pressures and pain responses in patients with APCD-positive discs. METHODS: Twenty-three patients who showed APCD-positive discs were selected for analysis. CT discogram findings and the degrees of nuclear degeneration seen on MRI were analyzed in comparison to changes of intradiscal pressure that provoked pain responses; and clinical pain patterns and dynamic factors were evaluated in relation to pain provocation. RESULTS: Low back pain (LBP), usually centralized, with diffuse leg pain was the most frequently reported pattern of pain in these patients. Overall, LBP was most commonly induced by sitting posture, however, standing was highly correlated with L5/S1 disc lesions (p < 0.01). MRI abnormalities were statistically correlated with grading of CT discogram results (p < 0.05); with most pain response observed in CT discogram Grades 3 and 4. Pain-provoking pressure was not statistically correlated with MRI grading. However, it was higher in Grade 3 than Grade 4. CONCLUSION: APCD-positive discs were demonstrated in patients reporting centralized low back pain with diffuse leg pain, aggravated by sitting and standing. MRI was helpful to assess the degree of nuclear degeneration, yet it could not guarantee exact localization of the painful discs. APCD was considered to be more useful than conventional discography for diagnosis of discogenic pain.
Humans ; Intervertebral Disc ; Leg ; Low Back Pain ; Posture

BACKGROUND/AIMS: The spectrum of clinical features of chronic liver disease bas wide range from asymptomatic cases to hepatic failure, The natural course and long-term prognosis of chronic liver disease also varies greately, and this diversity makes it diflicult to predict the clinical course of individual patient. The two majar approaches to the treatment of chronic liver disease are 1) directed toward the eradication of the virus and 2)designed to modulate cellular and humeral immunity. Progress has been made in the development of antiviral chernotherapeutic agents for hepatitis. But as yet no safe and reliably effective treatment or combination of treatrnents is available. In tkis study, we performed trial of diphenyl-dimethyl-dicarboxylate to evaluate the therapeutic effect and safety of it. METHODS: The ciinical trials of DDB(complex capsule of diphenyl dimethyl dicarboxylate 7.5mg and polysorbate 80 1,5mg and polyethylene glycol 6000 66mg) were carried out in 30 patients with chronic liver disease for 6 months. All patients had abnormal liver function test ouer a period of 6 months. RESULTS: In selected groups mean serum aspartate aminotransferase and alanine aminotrans- ferase dropped from pretreatment level of' 115.9+/-74.1 IU/L and 201.6+/-173.0 1U/L to posttreatment level of46.6+/-21.6 UU/L and 28.7+/-15.4IU/L, respectively(p<0.01). There was no significant hernatological and biochemical change after administration of DDB. Untoward side effects were easily controlled by discontinuing the drugs. CONCLUSIONS: Administration of DDB(for 6 months) appears to be effective for decrement of transaminase level and safe for the treatment of patients with chronic liver disease.
Alanine ; Aspartate Aminotransferases ; Hepatitis ; Humans ; Liver Diseases* ; Liver Failure ; Liver Function Tests ; Liver* ; Polyethylene Glycols ; Polysorbates ; Prognosis