PURPOSE: To evaluate dysphagia objectively and quantitatively, and ta clarify the effect of neck position and viscosity changes in patients with aspiration and laryngeal penetration. MATERIALS AND METHODS: We studied 35 patients with dysphagia and 21 normal controls using videofluoroscopy and scintigraphy. Videofluoroscopy was performed with barium with three different viscosity, and scintigraphy was done, with water, yogurt, and steamed egg mixed with Tc-99m tin colloid. 1f aspiration was found during videofluoroscopic examination, patients neck position was changed and study repeated. Videofluoroscopy was analyzed qualitatively. We calculated 7 quantitative parameters from scintigraphy. According to the videofluoroscopic findings, we divided patients into 3 subgroups; aspiration, laryngeal penetration, and no-aspiration group. RESULTS: The result of videofluoroscopy revealed that the most cornmon finding was the delay in triggering pharyngeal swallow. Pharyrigeal transit time (PTT) and pharyngeal swallowing efficiency(PSE) in patients with aspiration were significantly different from other groups. After neck position change, aspiration could be reduced in all of 7 patients, and laryngeal penetration reduced hy about 82%. PTT ancl PSE were also improved after position change. Aspiration and laryngeal penetration occurred more frequently in thin liquid swallowing than in thick liquid and solid swallowing. CONCLUSION: PTT and PSE were useful for the evaluation of dysphagia. Aspiration and laryngeal penetration could be reduced when appropriate position assumed, We could decrease the chance of aspiration by changing the patient diet consisIency. Scintigraphy might be useful tool to quantitate and follow up these changes.
Barium ; Colloids ; Deglutition ; Deglutition Disorders* ; Diet ; Evaluation Studies as Topic* ; Follow-Up Studies ; Humans ; Neck ; Ovum ; Radionuclide Imaging* ; Steam ; Tin ; Viscosity ; Water ; Yogurt

No abstract available.
Adult* ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Humans

STUDY DESIGN: Thirteen patients with cervical interlocked facets dislocation in whom closed reduction by skull traction was failed were evaluated about the patterns of ruptured disc fragment. Objects : To evaluate the causes of failure at closed reduction, and the relation between ruptured discs and interlocked facets, and the treatment results through an anterior approach. SUMMARY OF LITERATURE REVIEW: In traumatic dislocation of the cervical facet joints, spinal cord or nerve roots injury associated with the ruptured disc fragment has been reported. However, there is few report evaluating the patterns of ruptured disc fragment as a cause of reduction failure. MATERIALS AND METHODS: Between 1988 and 1997, thirteen patients were treated by anterior fusion with plate after complete removal of the intervertebral disc through anterior approach and reduction of interlocked facets by O1iveira method. They have been followed for an average of 36 months(range : 12-96 months). The interlocking was bilateral in seven cases and unilateral in six cases. We assessed the types of ruptured disc fragment by preoperative MRI and CT and the clinical and radiological results. RESULTS: Ruptured disc fragment was found in all thirteen patients with interlocked facets dislocation. The patterns of ruptured discs were within the uncovertebral joints in 5 cases, posterioly under the posterior longitudinal ligament in 3 cases, anteriorly under intact anterior longitudinal ligament in 3 cases and combined under the anterior and posterior longitudinal ligament in 2 cases. The displacement of ruptured disc fragment were seemed to be the cause of failure in closed reduction. CONCLUSIONS: Intervertebral disc injury should be evaluated carefully with MRI and CT in the lower cervical interlocked facet dislocations before trial of reduction or decision makings of treatment.
Dislocations* ; Humans ; Intervertebral Disc ; Joints ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Skull ; Spinal Cord ; Spine* ; Traction ; Zygapophyseal Joint

The anterior discectomy is widely accepted method for removal of the herniated disc material of cervical spine due to direct visualization of the lesion site. In addition, it is believed to prevent recurrence of herniation, progression of degenerative change, and to preserve normal cervical lordosis after the fusion. For more effective anterior fusion and early postoperative ambulation without prolonged external support, internal fixation technique was introducsuspected to influence the result of operation, the type of bone graft and age of the patient may be the effective factors to the late result. ed. Authors reviewed 36 patients with cervical disc herniation and evaluated the result of anteior discectomy and fusion with plate fixation. With a mean follow up of 34 months, there were remarkable symptomatic improvement at most instances and bony union in situ within 3 months in all cases after the operation. Disclosed complications were 2 cases of hoarseness which was improved spontaneously, and 1 case of dysphagia. At the comparison of the effect of the factors which were suspected to influence the result of operation , the type of bone graft and age of the patient may be the effective factors to the late result.
Animals ; Deglutition Disorders ; Diskectomy* ; Follow-Up Studies ; Hoarseness ; Humans ; Intervertebral Disc Displacement ; Lordosis ; Recurrence ; Spine ; Transplants ; Walking

No abstract available in English.
Tibia

Many difficult problems are encountered in the treatrnent of infected nonunion of long bone. To solve these difficult fractures, authors adopted an active approach-thorough debridement of the infected and necrotic soft tissue and bone, rigid internal fixation with autogenous cancellous bone graft and opening of the wound to ensure continuous drainage until union of the fracture. Authors treated 28 cases of infected nonunions with this method from Mar. 1980 to Feb. 1989, and the results are as follows ;1. Femur(54%) and tibia(43%) were most frequently involved sites. 2. Most of the cases(86%) were treated by rigid internal fixation and cancellous bone graft. 3. In most cases(64%), infection was controlled spontaneously by the time of bony union, but in 5 cases which showed persistent drainage, implant removal controlled the problem, and residual soft tissue and bony defect were solved by Papineau's technique or musculocutaneous flap. 4. Revision was required in 5 cases(18%) because of insercure fixation. 5. Union could be obtained in average 4.8 months, and infection could be controlled in all except 1 case.
Debridement ; Drainage ; Methods ; Myocutaneous Flap ; Transplants ; Wounds and Injuries

The epidural injection of corticosteroid reduces the inflammatory process of the neural structure and its neighbor structures. Morphine, also injected epidurally, has been reported to alleviate severe pain with the short-acting property. In attempt to prolong the effectiveness of pain relief, we have studied the effect of the epidural injection of the morphine and steroid frorg May 1987 to Oct. 1987, and compared with the effect of the epidural injection of the steroid and local anesthetics from Jan. 1986 to Oct. 1987. In this study, we obtained following results; 1. The major causative diseases were herniated necleus pulposus in 34 cases(48.5%), spinal stenosis in 16 cases(22.9%) and spondylolisthesis in 9 cases(12.9%). 2. In morphine-injected group, 100% of acute group and 92.3% of chronic group was improved. In non-morphine injected group, there was no significant difference between the acute and chroinc groups. 3. The effect of epidural morphine and steroid was as follows; Complete relief 14 cases (63.6%), marked improvement 5 cases(22.7%), moderate improvement 2 cases(9.2%) and no relief 1 case(4.6%). The overall improvement was resulted in 21 cases(95.4%). 4. The effect of epidural steroid and local anesthetics was as follows; Complete relief 10 cases(20.8%), marked improvement 14 cases(29.2%), moderate improvement 12 cases(25%~ and no relief 12 cases(25%). The overall improvement was resulted in 36 cases(75%). 5. The average duration of pain relief was 2.5 months in morphine injected group and 1.3 months in non-morphine injected group. 6. The side effects associated with opiate, such as generalized pruritus, nausea, vomiting and urinary retention were reported in 16 cases(72.7%), but responded readily to Naloxone injection and subsided within 24 hours. It is considered that epidural injection of morphine and steroid prolong the effect and duration of pain relief for low back pain and sciatica when compared with the epidural injection of steroid and local anesthetics.
Anesthetics, Local ; Injections, Epidural ; Low Back Pain ; Morphine ; Naloxone ; Nausea ; Pruritus ; Sciatica ; Spinal Stenosis ; Spondylolisthesis ; Urinary Retention ; Vomiting

Ninety cases of meniscus injury were treated by arthroscopic meniscetomy between March, 1988 and March, 1992. Eighty four cases were treated by arthroscopic partial, 5 cases by subtotal, and 1 case by total meniscectomy. All cases were followed up for more than 1 year. The results were as follows. 1. The ratio of male to female was 57 to 31, and that of right to left was 52 to 38. 2. There were 41 cases of medial meniscus and 49 cases of lateral meniscus. Longitudinal tears were 35 cases (39%), oblique tears were 20 cases (22%), horizontal tears were 15 cases (17%), and radial tears were 9 cases (10%). There was no difference in the shape of tear between medial and lateral meniscus. 4. The most common associated injury was anterior cruciate ligament tear. 5. The Tapper and Hoover scale was used to record the clinical results, and satisfatory results (exellent and good)were in 86% of cases.
Anterior Cruciate Ligament ; Clinical Study ; Female ; Humans ; Knee ; Male ; Menisci, Tibial ; Tears

Deep vein thrombosis(DVT) after joint arthroplasty in tbe lower extmmity has been one of the major causes of death in postoperative complications. But, there is little information on incidence and clinical risk factors of DVT in Korea. Fifty-eight patients (sixty-two cases) who underwent TKR were included in this study for evaluation of the incidence of DVT and correlation with clinical risk factors after total knee replacement(TKR) in Korea. Venography were performed preoperatively and postoperatively, and clinical risk factors were examined. The preoperative venography was performed within seven days before the surgery, and postoperative venography seven to 14days after the surgery. There was no evidence of thrombosis in any patient preoperatively, but thrombi were observed in seven cases (11%) postoperatively. Six cases showed thrombi in the calf vein and one case showed thrombi in the femoral vein. There was no statistically significant difference in incidence rate of DVT according to clinical risk factors such as age, toumiquet time, BMI(body mass index), diastolic blood pressure, operation time and coagulation assay(platelet, PT, aPTT, Anti-thrombin III, fibrinogen).
Arthroplasty ; Arthroplasty, Replacement, Knee* ; Blood Pressure ; Cause of Death ; Femoral Vein ; Humans ; Incidence* ; Joints ; Knee ; Korea ; Phlebography ; Postoperative Complications ; Risk Factors* ; Thrombosis ; Veins ; Venous Thrombosis*

No abstract available.
Thorax* ; Tomography, X-Ray Computed*