No abstract available.
Skin Diseases*

PURPOSE: Nerve root compression from spinal stenosis or herniated intervertebral disc(HIVD) may affect bladder function by the disease itself, operation or inappropriate general postoperative care. Preoperative urodynamic study seems to be needed for differential diagnosis of postoperative bladder dysfunction. MATERIALS AND METHODS: Thirty three patients diagnosed as nerve root compression were analysed for urodynamic features prospectively and classified into type I(hyporeflexic, hyposensitive, normal sphincter and hypocontractile, high compliance), type II(hyperreflexic, hypersensitive, normal sphincter and hypocontractile, low compliance), type III(hyperreflexic, hypersensitive, normal sphincter and hypercontractile, low compliance) and normal. Correlation with voiding symptoms, duration of the disease and urodynamic findings was evaluated. RESULTS: The mean age of patients was 56.2 years(29-80 years old), including 21 men and 12 women. Among thirty three patients, 21 had spinal stenosis and twelve patients were diagnosed as HIVD. Urodynamically, there were 16 cases(48.5%) showing type II, 6 cases(18.2%) for type I and 2 cases(6%) for type III. Normal finding was shown in 9 cases(27.3%). No significant difference was shown in mean duration of disease and in urodynamic findings. Patients with voiding symptoms or abnormal urodynamic finding were 20 cases(60.6%) and 24 cases(72.7%), respectively. Among thirteen patients without voiding symptoms, eight patients(61.5%) had abnormal urodynamic findings. CONCLUSIONS: Voiding symptoms and urodynamic findings in patients with nerve root compression were various. Because there is no consistent pattern of dysfunction with any type of nerve root compression disease, preoperative urodynamic study seems to the cornerstone for rational therapy and gives the exact information of bladder function to orthopedic operator.
Diagnosis, Differential ; Female ; Humans ; Male ; Orthopedics ; Postoperative Care ; Prospective Studies ; Radiculopathy* ; Spinal Stenosis ; Urinary Bladder ; Urodynamics*

Osteochondritis dissecans of the knee occurs twice as often in males as in females. The peak incidence is about fifteen years of age, and most patients are first diagnosed before the age of eighteen. The etiology of osteochondritis dissecans is still unknown, but the most accepted theories are trauma, ischemia, abnormal ossification within the physes, constitutional or genetic predisposition, and a combination of these. Osteochondritis dissecans of the knee associated with gout was first reported by Carrabba in 1969. And no additional case has been reported. The purpose of this paper is to present an unusual case of osteochondritis dissecans of the knee associated with gout.
Female ; Genetic Predisposition to Disease ; Gout* ; Humans ; Incidence ; Ischemia ; Knee* ; Male ; Osteochondritis Dissecans* ; Osteochondritis*

PURPOSE: We assessed the clinical significance of suprapubic cystostomy in the treatments of patients with voiding difficulty and analyzed the complications of it and their courses. Also we compared the results with our previous study. PATIENTS AND Methods: We reviewed 30 patients managed with suprapubic cystostomy. The changes in serum Cr, urinary pH and white blood cell values after suprapubic cystostomy were evaluated. We investigated complications of these patient. The stone-free rate after suprapubic catheter insertion was estimated by the Kaplan-Meier method. RESULTS: The original diseases were spinal cord injury in 19 (63.3%), cerebrovascular accident in 3 (10%), inoperable benign prostatic hyperplasia in 2 (6.7%), diabetic cystopathy in 2 (6.7%), recurrent urethral stricture in 2 (6.7%) and prostatic cancer in 2 (6.7%). The most common complication was the formation of the bladder calculi in 8 cases (26.7%). There were no serious complications associated with the procedure and no deterioration of the renal function. The mean serum creatinine level changed from 1.15+/-0.06 mg/dl to 1.13+/-0.07 mg/dl without statistical significance. The stone-free rates 1 and 7 years after the procedure were 96.7% and 73.3%, respectively. The urinary pH of the stone-forming group was significantly higher than that of the stone-free group (p<0.05). CONCLUSION: Suprapubic cystostomy is an alternative method for patients of voiding dysfunction in cases of severe urethral damage or limited activity of upper extremities. In spite of advantage of suprapubic cystostomy, we must make an effort on preventing bladder stone, urinary tract infection in patients with suprapubic catheter.
Catheters ; Creatinine ; Cystostomy* ; Follow-Up Studies* ; Humans ; Hydrogen-Ion Concentration ; Leukocytes ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Spinal Cord Injuries ; Stroke ; Upper Extremity ; Urethral Stricture ; Urinary Bladder Calculi

OBJECTIVE: Applications to extract medical information from electronic medical records(EMRs) confront some serious obstacles such as spelling errors, ambiguous abbreviations, and unrecognizable words. Those obstacles hinder the process of finding medical entities, relations, and events. We present an efficient EMR refinement system for the purpose of medical information extraction from EMRs, not just for traditional text error correction. METHODS: The EMR refinement system has been designed and implemented through following steps: 1) Build domain constrained dictionary database, 2) Correct spelling errors in Korean-English EMR documents, 3) Resolve ambiguous abbreviations in the bilingual documents. The resulting EMR documents are now machine readable and can be applied to various applications including information extraction. RESULT: Precision rate of the refinement system for spelling error correction is 80.4% and for disambiguating abbreviations/acronyms is 94.7%. CONCLUSION: We developed an EMR refinement system to correct spelling errors and resolve ambiguous abbreviations as well as unrecognizable words. Our system can enhance the reliability of medical records and contribute to develop further application systems in the field of text mining and information extraction.
Data Mining ; Electronic Health Records ; Electronics ; Electrons ; Medical Records

No abstract available.
Scalp*

Bone single photon emission computed tomography(SPECT) of the knees has been shown to be of diagnostic value for the investigation of intemal derangement of knees(IDK). This study compared bone SPECT and magnetic resonance image(MRI) with arthroscopic findings for the diagnosis of IDK. Fifty patients who had been performed arthroscopy in Seoul National University Hospital from January 1997 to September 1997 were studied with both the modalities preoperatively. There were 38 meniscal injuries, 26 cruciate ligament injuries and 8 cases of patellofemoral joint problems. In view of SPECT, the most remarkable results were from meniscal tears. In meniscal tears, the diagnostic values of SPECT were 89.5% of sensitivity, 66.7% of specificity, 84% of diagnostic accuracy, which were comparable to those of MRI, 97.4%, 91.7% and 96%, respectively. But SPECT showed inferior diagnostic values in cruciate ligament injuries. For anterior knee pain, SPECT was more sensitive than MRI for the detection of pathology. And for functionally related cases, such as ACL impingement to intercondylar notch, SPECT was far more valuable than MRI. Bone SPECT will not provide the anatomical detail of MRI but seems to be a useful tool for the detection of wide range of knee disorders including IDK. Further research is justified to investigate the precise role of bone SPECT in clinical practice and its value in relation to MRI.
Arthroscopy ; Diagnosis ; Humans ; Knee* ; Ligaments ; Magnetic Resonance Imaging* ; Patellofemoral Joint ; Pathology ; Sensitivity and Specificity ; Seoul ; Tomography, Emission-Computed, Single-Photon*

Brachial plexus block is frequently used for surgery on the upper extremity. Unsuccessful brachial plexus block is usually caused either by injection outside the neurovascular sheath or by incomplete blockade inspite of injection within the neurovascular sheath. Studied by Winnie and Collines suggested that the extent of blockade following injection in the sheath surrounding the brachial plexus also should be directly proportional to the volume of local anesthetic injected. We therefore investigated the extent of blockade using different volume of bupivacaine with supraclavicular approach. The results were as follows. 1) Complete analgesia was observed between the group of 15 ml and 30 ml. 2) The interval of complaint of pain after a single injection ranged from 14.3 to 16.4 hours. Insignifi-cant difference was found between the group of 15 ml and 30 ml (p> 0.1) 3) There was no hematoma, shivering, but there was Horner's syndrome in 13, phrenic N.paralysis in 2, pneumothorax in 1 cases. No general seizure or other side effects were observed. Therefore we come to the conclusion that above the volume of 15 ml is sufficient to brachial plexus block with supraclavicular approach.
Analgesia ; Brachial Plexus ; Bupivacaine* ; Hematoma ; Horner Syndrome ; Pneumothorax ; Seizures ; Shivering ; Upper Extremity

Objectives: This study analyzed the clinical outcomes of remdesivir treatment in coronavirus disease 2019 (COVID-19) patients in South Korea. Methods: This retrospective cohort study involved the secondary analysis of epidemiological data. Among patients diagnosed with COVID-19 from July 2, 2020 to March 23, 2021 (12 AM), 4,868 who received oxygen therapy and were released from isolation after receiving remdesivir treatment were assigned to the treatment group, and 6,068 patients who received oxygen therapy but not remdesivir were assigned to the untreated group. The study subjects included children under the age of 19. The general characteristics and severity were compared between the groups. Differences in the time to death and mortality were also compared. Results: In the untreated group, the hazard ratio [HR] for mortality was 1.59 (95% confidence interval [CI], 1.40–1.80) among patients aged ≥70 years and 2.32 (95% CI, 2.00–2.69) in patients with severe disease in comparison to the treatment group. In a comparison of survival time among patients with severe disease aged ≥70 years, the HR for mortality before 50 days was 2.09 (95% CI, 1.77–2.46) in the untreated group compared to the treatment group. Conclusion Patients with remdesivir treatment showed better clinical outcomes in this study, but these results should be interpreted with caution since this study was not a fully controlled clinical trial.

PURPOSE: Total prolapse of internal hemorrhoids around the entire anal circumference still remains as a challenging problem. Whitehead's circumferential hemorrhoidectomy is one of the surgical options. To elucidate efficacy of Whiteheads operation, we analyzed the surgical outcomes of Whiteheads operation. METHODS: The medical records of 165 consecutive patients who underwent Whiteheads operation for end-stage hemorrhoids were retrospectively reviewed. The mean operation time, the mean blood loss, and the mean hospital stay were examined. Also the types of complications were identified. All patients were followed for extended periods and in May 2003 they were asked to appraise their satisfaction (mean follow-up duration was 45.5 months, 12~93 month range). RESULTS: The mean operation time was 21.5+/-5.3 minutes, the mean blood loss was 50.5+/-22.0 cc, and the average hospital stay was 5.5+/-1.5 days. Early postoperative complications were fecal incontinence (60.6%) and voiding difficulty (53.3%). These problems were spontaneously resolved within 2 weeks. Pain was the most difficult problem, and all patients required a parenteral opioid for relief of pain. The only late complication was anal stenosis. Objectively, anal stenosis was found in 66 patients; however, 22 patients (13.3%) complained of defecation difficulty. Among them, only 4 patients required surgical treatment. The average score of satisfaction according to the patients themselves was 4.0+/-2.2, 0 being no satisfaction and 5 being complete satisfaction. CONCLUSIONS: The Whitehead operation, if performed properly for the selected patients, still remains as one of the best surgical options for end-stage hemorrhoids.
Constriction, Pathologic ; Defecation ; Fecal Incontinence ; Follow-Up Studies ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Length of Stay ; Medical Records ; Postoperative Complications ; Prolapse ; Retrospective Studies