BACKGROUND: Infiltration of the skin and subcutaneous tissue with local anesthetic solutions may cause transient pain and discomfort. Heating local anesthetic solutions to body temperature has been suggested as a way of reducing the pain associated with injection. We designed a double blind crossover volunteer study to investigate the effect of warming lidocaine on the pain associated with subcutaneous injection. METHODS: Participants were 40 healthy adult volunteers,22 years of age and older, and they were the medical, nursing stay and medical students. They underwent 1ml subcutaneous injections of the study agent through 25-gauge needles. Following a standard crossover protocol, 'room temperature' lidocaine(20degrees C ) was injected into one midvolar forearm and body temperature' lidocaine(37degrees C ) into the opposite arm. Pain assessed by visual analogue pain scores and 'volunteer's comparison of pain on injection. RESULTS: Twenty-six volunteers thought that lidocaine at 20degrees C was more painful and four thought that lidocaine at 37degrees C was more painful, ten volunteers did not express a difference. Median pain score for injection at 20 degrees C was 37 and at 37 degrees C was 35.5. Difference of two median scores was 6.5. CONCLUSION: The simple procedure of warming to body temperature reduced the pain associated with subcutaneous injection of lidocaine. It is an inexpensive and practical method That should be considered for routine use in the ED.
Adult ; Arm ; Body Temperature* ; Forearm ; Heating ; Hot Temperature ; Humans ; Injections, Subcutaneous ; Lidocaine ; Needles ; Nursing ; Skin ; Students, Medical ; Subcutaneous Tissue ; Volunteers

To investigate MR artifacts induced by metallic implants, scans were obtained using both the ferromagnetic Drake lip and the non ferromagnetic Yasargil clip. Scan were taken through the area of clips using geometrical phantom. The MRI was performed by spin echo technique and gradient echo technique on both 2.0T and 0.5T MR unit. The luthors evaluated the nature and differences of artifacts in each sequence and parameter. Artifacts induced by both lips were noted in the direction of frequency encoding gradient, and consisted of region of signal loss abutted in one side by survilinear region of bright signal. Geometric distortion of image was marked in the Drake clip, out was minimal in the Yasargil clip under both 2.0T and 0.5T. Artifacts were more pronounced in the gradient echo technique than those of the spin echo technique on both 2.0T and 0.5T. Although there were no differences n the nature of artifacts induced by the Drake clip among each parameter in the spin echo technique under 2.0T, artifacts were slightly more pronounced on T2 weighted image under the 0.5T field, but no differences were found in the nature of artifacts induced by the Yasargil clip in the spin echo technique under, both the 2.0T and 0.5T fields. Marked artifacts were induced through the small area of the Drake clip which were included in the scan plane, but induced artifacts were small when a small area of the Yasargil clip was included in the scan plane. It seemed likely hat artifacts were slightly more pronounced in the 2.0T than the 0.5T field in both clips, but objective evaluation of the difference was difficult, In conclusion, these results can be an essential basis for the interpretation of MR images or patents with metallic inplants.
Aneurysm* ; Artifacts* ; Lip ; Magnetic Resonance Imaging* ; Magnets

The superficial sural artery flap is supplied by the superficial sural artery that accompanies the sural nerve. The superficial sural artery connects distally with a peroneal artery septocutaneous perforator via a suprafascial network of vessels that permits the flap to be raised on its distal pedicle. We treated 10 patients who showed soft tissue defect of the lower third of the leg, around the ankle and the hindfoot with this flap. The causes of the soft tissue defect were trauma in 6 cases, pressure sore in 2 cases, squamous cell carcinoma in 1 case and osteomyelitis in 1 case. The sites of the soft tissue defect were the lower third of the leg in 5 cases, around the ankle in 2 cases and the hindfoot in 3 cases. The size of the soft tissue defect was from 5x6 cm to 8xl2 cm. All 10 flaps survived. Two flaps showed slight venous congestion which cleared in a few days. The time for flap dissection was 15 minutes in average. The results of our cases show that the distally based superficial sural artery flap is useful for the soft tissue coverage of the lower third of the leg, around the ankle and the hindfoot. The advantages of the flap are that the blood supply is reliable, elevation is easy and quick, the major arteries are not sacrificed and the donor site morbidity is negligible.
Ankle ; Arteries* ; Carcinoma, Squamous Cell ; Humans ; Hyperemia ; Leg ; Lower Extremity ; Osteomyelitis ; Pressure Ulcer ; Sural Nerve ; Tissue Donors

No abstract available.
Evoked Potentials, Motor*

Due to an increasing interest in esthetics and concerns about toxic and allergic reactions to certain alloys, patients and dentists have been looking for metal-free tooth-colored restorations. Recent improvement in technology of new all-ceramic materials and composite materials has broadened the options for esthetic single crown restorations. The aim of this investigation was to study the fracture strength of the metal-free posterior single crowns fabricated using two recently introduced systems, Empress 2 ceramic and Targis-Vectris. Forty premolar-shaped stainless steel dies with the 1mm-wide circumferential shoulder were prepared. Ten cylindrical crowns having a diameter of 8.0mm and total height of 7.5mm were fabricated for each crown system respectively (PFM, Empress staining technique, Empress 2 layering technique, and Targis-Vectris). The crowns were filled with cement and placed on the stainless steel dies with firm finger pressure. The crowns were then stored in distilled water at room temperature for 24 hours before testing. The crowns were tested for fracture strength in an Instron universal testing machine (Instron 6022). With a crosshead speed of 1mm/min the center of the occlusal surface of the crown was loaded using a 4mm-diameter stainless steel ball until fracture occurred. The fracture surfaces of the crowns were gold coated and examined using scanning electron microscopy (Jeol JSM-840 Joel Ltd., Akishima, Tokyo, Japan). Within the parameters of this study the following conclusions were drawn: 1. The mean fracture strength for PFM crowns was 5829(+/-906)N; for Empress staining technique the fracture strength was 1697(+/-604)N; for Empress 2 Layering technique the fracture strength was 1781N(+/-400)N, and the fracture strength for Targis-Vectris was 3093(+/-475)N. 2. The fracture strength of the PFM crowns was significantly higher than that of the Empress 2 and the Targis-Vectris crowns (P<0.05). 3. The fracture strength of the Targis-Vectris crowns was significantly higher than that of the Empress 2 crowns (P<0.05). 4. No statistical difference was found when Empress staining technique was compared with Empress 2 layering technique. 5. The SEM image of fracture surface of Empress 2 crown showed a very dense microstructure of the lithium disilicate crystals and the SEM image of fracture surface of Targis-Vectris crown showed indentations of Vectris and some fibers torn off from Vectris.
Alloys ; Ceramics* ; Crowns* ; Dentists ; Esthetics ; Fingers ; Humans ; Hypersensitivity ; Lithium ; Microscopy, Electron, Scanning ; Shoulder ; Stainless Steel ; Water

Chronic osteomyelitis is refractory because of the characteristics of bone. The soft tissues of bone are surrounded by hard walls, and inflammation of the contained tissues causes circulatory disturbances which can readily read to necrosis of various parts of the bone. Since it is impractical to deliver antibiotics to the target tissue at a sufficiently high concentration by the intravenous route, local administration is considered to be essential. There are many materials for drug delivery system. Antibiotic-containing cement beads qualify as a drug delivery system. The distance to which the effective concentration of an antibiotic extends from the carrier material is of clinical importance in evaluating a drug delivery system. We evaluated the concentration of gentamicin released from gentamicin mixed bone cement in bone marrow and bactericidal activity of released gentamicin according to time. Female albino rats weighing approximately 350 grams were used. Beads were made to gentamicin mixed Palacos PMMA bone cement. Three rats in each group were killed on 1st, 3rd day and 1st, 2nd, 3rd, 4th, 5th and 6th week. Extracted bone marrow was homogenized with 5ml of phosphate buffer saline (PBS) and removed beads with 5ml of PBS were incubated for 24 hours in 37degrees C. Gentamicin concentration from bone marrow and elution fluid from removed bead was measured using TDX machine and bactericidal activity of released gentamicin was measured by bactericidal broth dilution method using Bacillus subtilis ATCC 21008. Gentamicin sulfate gave a maximum concentration within the 1st week, which gradually decreased but was still effective at 6th week. Gentamicin concentration from removed bead gave a maximum concentration at 1st day, which gradually decreased to 6th week.
Animals ; Anti-Bacterial Agents ; Bacillus subtilis ; Bone Marrow ; Drug Delivery Systems ; Female ; Gentamicins* ; Humans ; Inflammation ; Necrosis ; Osteomyelitis ; Polymethyl Methacrylate* ; Rats

Laparotomy performed for resection of hepatoma in 34 cases at Seoul National University Hospital for 3 .5years since Oct. 1978. Resection of hepatoma was done in 21 cases, ligation with or without canulation of hepaticartery was performed in 12 cases, and open and closure was made in 1 case. Angiographic findins were analyzed forresectability of hepatoma. The results of hte analysis were as follows; 1. Most reliable signs for resectablehepatoma were peripheral location and confinement in one hepatic lobe. Most reliable signs for non-resectablehepatoma were presence of tumor thrombus in portal vein, bilateral hepatic arterial feeding. 2. Less reliablesigns for resectable hepatoma were absence of portal vein invasion, less than 10cm in size and absence of findingsof liver cirrhosis. Less reliable signs for non-resectable hepatoma were right or left massive type. 3. Presenceof arteriovenous fistula, more than 10cm in size, and presence of findings of liver cirrhosis were no reliablecriteria for resectability of hepatoma. 4. Predictability for resectability with those reliable signs ofangiography was around 80%. 5. In addition to routine celiac angiography, oblique celiac angiography or superiormesenteric arteriography for portal vein opacification will be helpful in order to obtaine highly reliable signsfor resectability of hepatoma.
Angiography ; Arteriovenous Fistula ; Carcinoma, Hepatocellular ; Laparotomy ; Ligation ; Liver Cirrhosis ; Portal Vein ; Seoul ; Thrombosis

Dislocation of the clavicle at its sternal end is relatively rare, as compared with acromioclavicular dislocation. Among them, the posterior dislocation of the sternoclavicular joint was extremely rare. So, not more than fifty cases had been reported in the literature. Of these three main typesanterior, superior, and posterior-the anterior one is by far the most common. Most authors have stressed the difficulty in confirming the diagnosis with routine radiographs. We experienced a case of traumatic posterior dislocation of the sternoclavicular joint treated successfully by manipulative reduction. So, we report it with review of literature.
Clavicle ; Diagnosis ; Dislocations ; Sternoclavicular Joint

Osteopetrosis is a very rare bone dysplasia characterized by failure of resorption and persistence of calcified chondroid and primitive bone. In 1904 Albers-Schonberg first described the radiological appearance of marble bone. This is named osteopetrosis by Karshner in 1926. A fulminating form is manifested from birth in which fractures and deformity, hydrocephalus and cranial nerve palsies lead to early death from intractable anemia and intercurrent infection. In other cases the stigmata are delayed until later childhood, when retardation of growth and of mental and sexual development occurs, and not infrequently accompanied by rickets, dental caries and osteomyelitis. We have experienced a familial osteopetrosis, father and three siblings, which was thought to be a autosomal dominant inheritance. One of those family, 20 years old man, has been complained of anemia and low back pain without radiating pain to the lower extremities. The other 3 patients has not been complained of any other clinical symptoms. But X-Ray examination of the entire skeletal survey of those members of the family have revealed the uniform opacity of long bones and flat bones.
Anemia ; Bone Diseases, Developmental ; Calcium Carbonate ; Christianity ; Clothing ; Congenital Abnormalities ; Cranial Nerve Diseases ; Dental Caries ; Fathers ; Humans ; Hydrocephalus ; Low Back Pain ; Lower Extremity ; Osteomyelitis ; Osteopetrosis ; Parturition ; Rickets ; Sexual Development ; Siblings ; Wills

No abstract available.
Lymphocyte Subsets* ; Lymphocytes*