Injury of the ankle ligaments is one of the most common sports-related injuries. Although there are some debates as to the best initial treatment for an acute tear of a lateral ligament, persistent functional instability of the ankle develops in approximately 20% of patients regardless of the type of initial treatment. In these patients, late reconstruction of the lateral ankle ligaments may become necessary. Among 13 cases which have been operated with Larsen procedure using peroneus brevis tendon from March 1991 to February 1993, the 11 cases followed up over 1 year were examined clinically and radiologically. We introduced the clinical analysis and results with the brief review of the literatures. 1. The indication of surgical treatment was the ankle instability which had differences over 10° in talar tilting angle or over 3mm in anterior displacement compared wit the uninjured site. 2. The postoperative results were 5 cases in excellent and 4 in good. 3. The Larsen procedure was considered a good method to anatomically and simply stabilize both the ankle and subtalar joint and to fix tendon depending on the type of instability.
Ankle ; Collateral Ligaments ; Humans ; Ligaments ; Methods ; Subtalar Joint ; Tears ; Tendons

PURPOSE: There were no accurate data of hematologic changes in the high school students in Korea since 1980'. Because of rapid growing of Korean students recently, it is necessary to reevaluate Korean data. So we compared hematologic changes in the students of general (GHS) and athletic high school (AHS) in Seoul city. METHODS: We reassured red cell count (RBC), hemoglobin (Hb), hematocrit (Hct), and related hematologic factors in the 452 GHS (male 290, female 162) as control group and the 138 AHS (male 70, female 68) as exercised group. Hematologic comparisons were performed between the students of AHS and GHS and the male and female students with t-test. RESULTS: 1) Values of RBC, Hb, Hct, MCHC, RDW were 4.6+/-0.3x1012/L, 13.4+/-1.2g/dL, 41.5+/- 3.4%, 32.2+/-0.5g/dL, 12.1+/-0.9% respectively in the male AHS and 5.2+/-0.3x1012/L, 15.2+/- 1.0g/dL, 46.7+/-3.0%, 32.5+/-0.5g/dL, 12.3+/-0.6% respectively in male GHS, and there were significant between compared data. 2) Values of RBC, Hb, Hct MPV were 4.5+/-0.3x1012/L, 13.6+/-1.2g/dL, 40.5+/-3.2%, 9.0+/- 0.6fl respectively in the female AHS and 5.0+/-0.5x1012/L, 14.9+/-1.3g/dL, 44.8+/-3.4%, 8.7+/- 0.8fl respectively in the female GHS, and significance were between compared data. 3) Values of MCH, MCHC, RDW, MPV were 30.1+/-1.8pg, 33.6+/-1.1g/dL, 12.8+/-1.1%, 9.0+/-0.6fl respectively in the female AHS and 29.3+/-1.8pg, 32.2+/-0.5g/dL, 12.1+/-0.9%, 8.7+/-0.9fl respectively in the male AHS, and there were significant between compared data. 4) Values of RBC, Hct, MCH, MCHC, RDW, PLT were 5.0+/-0.5x1012/L, 44.8+/-3.4%, 30.0+/-2.1pg, 33.4+/-1.1g/dL, 12.7+/-1.0%, 29.8+/-5.8x104/mm3 respectively in the female non-AHS, and 5.2+/-0.3x1012/L, 46.7+/-3.0%, 29.4+/-1.4pg, 32.5+/-0.5g/dL, 12.3+/-0.6%, 28.7+/- 5.8x104/mm3 respectively in the male non-AHS, and there were significant between compared data. CONCLUSIONS: Among the high school students, exercise caused several hematologic changes that were significant decline of the values of RBC, hemoglobin, hematocrit compared to control group regardless of sex. In female students, their values of MCH, MCHC, RDW were significantly increased compared to male students regardless of exercise.
Cell Count ; Female ; Hematocrit ; Humans ; Korea ; Male ; Seoul ; Sports

PURPOSE: There were no accurate data of hematologic changes in the high school students in Korea since 1980'. Because of rapid growing of Korean students recently, it is necessary to reevaluate Korean data. So we compared hematologic changes in the students of general (GHS) and athletic high school (AHS) in Seoul city. METHODS: We reassured red cell count (RBC), hemoglobin (Hb), hematocrit (Hct), and related hematologic factors in the 452 GHS (male 290, female 162) as control group and the 138 AHS (male 70, female 68) as exercised group. Hematologic comparisons were performed between the students of AHS and GHS and the male and female students with t-test. RESULTS: 1) Values of RBC, Hb, Hct, MCHC, RDW were 4.6+/-0.3x1012/L, 13.4+/-1.2g/dL, 41.5+/- 3.4%, 32.2+/-0.5g/dL, 12.1+/-0.9% respectively in the male AHS and 5.2+/-0.3x1012/L, 15.2+/- 1.0g/dL, 46.7+/-3.0%, 32.5+/-0.5g/dL, 12.3+/-0.6% respectively in male GHS, and there were significant between compared data. 2) Values of RBC, Hb, Hct MPV were 4.5+/-0.3x1012/L, 13.6+/-1.2g/dL, 40.5+/-3.2%, 9.0+/- 0.6fl respectively in the female AHS and 5.0+/-0.5x1012/L, 14.9+/-1.3g/dL, 44.8+/-3.4%, 8.7+/- 0.8fl respectively in the female GHS, and significance were between compared data. 3) Values of MCH, MCHC, RDW, MPV were 30.1+/-1.8pg, 33.6+/-1.1g/dL, 12.8+/-1.1%, 9.0+/-0.6fl respectively in the female AHS and 29.3+/-1.8pg, 32.2+/-0.5g/dL, 12.1+/-0.9%, 8.7+/-0.9fl respectively in the male AHS, and there were significant between compared data. 4) Values of RBC, Hct, MCH, MCHC, RDW, PLT were 5.0+/-0.5x1012/L, 44.8+/-3.4%, 30.0+/-2.1pg, 33.4+/-1.1g/dL, 12.7+/-1.0%, 29.8+/-5.8x104/mm3 respectively in the female non-AHS, and 5.2+/-0.3x1012/L, 46.7+/-3.0%, 29.4+/-1.4pg, 32.5+/-0.5g/dL, 12.3+/-0.6%, 28.7+/- 5.8x104/mm3 respectively in the male non-AHS, and there were significant between compared data. CONCLUSIONS: Among the high school students, exercise caused several hematologic changes that were significant decline of the values of RBC, hemoglobin, hematocrit compared to control group regardless of sex. In female students, their values of MCH, MCHC, RDW were significantly increased compared to male students regardless of exercise.
Cell Count ; Female ; Hematocrit ; Humans ; Korea ; Male ; Seoul ; Sports

Coronary involvement of polyarteritis nodosa (PAN) is rarely identified at premortem. Herein, we report a case of PAN presenting as acute myocardial infarction (MI). A 66-year-old man without previous history of heart disease presented with excruciating substernal chest pain of 3 hours duration. On admission, cardiac enzyme and ECG changes were compatible with acute MI of inferior wall. Emergency coronary angiography showed multiple aneurysmal dilatations of both left and right coronary arteries (RCA) and total occlusion with large thrombi at mid-RCA. After balloon angioplasty and intracoronary urokinase, huge coronary aneurysm was defined at mid-RCA and coronary flow partially improved. The patient was transferred to coronary care unit and continous intravenous heparin infusion was started. On the 7th hospitalization day, the patient was discharged in good condition. Two months later, follow-up coronary angiography showed no significant luminal narrowings in RCA with multiple aneurysmal dilatation, but abdominal angiography revealed multiple aneurysms in right renal and superior mesenteric arteries. These findings were compatible with the diagnosis of PAN. The patient was started on prednisone 60mg once daily and cytoxan 125mg bid. At follow-up 8 month later, there was no recurrence of symptoms.
Aged ; Aneurysm ; Angiography ; Angioplasty, Balloon ; Chest Pain ; Coronary Aneurysm ; Coronary Angiography ; Coronary Care Units ; Coronary Vessels ; Cyclophosphamide ; Diagnosis ; Dilatation ; Electrocardiography ; Emergencies ; Follow-Up Studies ; Heart Diseases ; Heparin ; Hospitalization ; Humans ; Mesenteric Artery, Superior ; Myocardial Infarction* ; Phenobarbital ; Polyarteritis Nodosa* ; Prednisone ; Recurrence ; Urokinase-Type Plasminogen Activator

PURPOSE: To assess the role of contrast-enhanced dynamic Magnetic Resonance Imaging in evaluating disease activity of rheumatoid arthritis. MATERIALS AND METHODS: Forty-seven wrist joints with rheumatoid arthritis were examined prospectively. coronal images of the wrist were obtained using fat-suppression Fast multi-planar spoiled gradient recalled(FMPSPGR) acquisition in the steady state ; TR/TE=102/6.4m sec, flip angle=60.4 slices persequence, FOV=8cm, matrix=256X192 at 1.5 Tesla. Scans were carried out once before and five to eight times after an intravenous Gd-DPTA injection, at 30-second-intervals. The enhancement of synovium were measured, the enhancement ratio was calculated(postcontrast SNR/precontrast SNR) and time-enhancement ratio curves were plotted patients were divided into three groups according to the ratio of inital to peak enhancement: less than 30%; 30-80%; morethan 80%. Differences among the three groups were statistically tested using clinical indices and laboratory data as variables. RESULTS: Comparing one group with another, there were no significant differences in clinical indices and laberatory data except for the parameter of grip strength. CONCLUSION: Enhancement pattern measured in a single wrist joint was not comparable to a clinical index in predicting disease activity in rheumatoid arthritis.
Arthritis, Rheumatoid ; Hand Strength ; Magnetic Resonance Imaging* ; Prospective Studies ; Synovial Membrane ; Wrist Joint* ; Wrist*

BACKGROUND: Opioid based patient-controlled analgesia (PCA) effectively provides adequate pain control after spine surgery, often at the expense of high incidence of postoperative nausea and vomiting (PONV). This study was designed to compare the effect of ramosetron with ondansetron for preventing PONV in highly susceptible patients using PCA following spine surgery under general anesthesia. METHODS: Seventy female patients, aged 18 to 65, scheduled for elective lumbar spine surgery, were randomly allocated into either ondansetron group (Group O, n = 35) or ramosetron group (Group R, n = 35). In patients assigned to group O, ondansetron 4 mg was injected and 12 mg was added to the PCA regimen. In patients assigned to group R, ramosetron 0.3 mg was injected and 0.3mg was added to the PCA regimen. The PCA regimen consisted of fentanyl 25microgram/kg (total volume including saline: 100 ml) and was programmed to deliver 2 ml/hr as background infusion and 0.5 ml per demand with a 15 min lockout. The incidence and severity of PONV, pain score, total amount of administered rescue analgesic and rescue antiemetic were assessed following 48 hrs after surgery. RESULTS: The incidence of PONV showed no significant differences between groups during 48 hrs after surgery. There were no differences in the severity of nausea, pain score, total amount of administered rescue analgesic and rescue antiemetic between groups. CONCLUSIONS: Ramosetron prophylaxis for preventing PONV is as effective as ondansetron in highly susceptible patients using fentanyl based PCA following spine surgery under general anesthesia.
Aged ; Analgesia, Patient-Controlled ; Anesthesia, General ; Benzimidazoles ; Female ; Fentanyl ; Humans ; Incidence ; Nausea ; Ondansetron ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Spine

PURPOSE: Recognition of impending death is crucial not only for efficient communication with the caregiver of the patient, but also determination of the time to refer to a separate room. Current studies simply list the events 'that have already occurred' around 48 hours before the death. This study is to analyze the predictability of each event by comparing the time length from 'change' to death. METHODS: Subjects included 160 patients who passed away in a palliative care unit in Incheon. The analysis was limited to 80 patients who had medical records for the last week of their lives. We determined 9 symptoms and 8 signs, and established the standard of 'significant change' of each event before death. RESULTS: The most common symptom was increased sleeping (53.8%) and the most common sign was decreased blood pressure (BP) (87.5%). The mean time to death within 48 hours was 46.8% in the case of resting dyspnea, 13.6% in the ease of low oxygen saturation, and 36.9% in the case of decreased BP. The symptom(s) which had the highest positive predictive value (PV) for death within 48 hours was shown to be resting dyspnea (83%), whereas the combination of resting dyspnea and confusion/delirium (65%) had the highest negative PV. As for the most common signs before death within 48 hours, the positive PVs were more than 95%, and the negative PV was the highest when decreased BP and low oxygen saturation were combined. The difference in survival patterns between symptoms and signs was significant. CONCLUSION: The most reliable symptoms to predict the impending death are resting dyspnea and confusion/delirium, and decline of oxygen saturation and BP are the reliable signs to predict the event.
Blood Pressure ; Caregivers ; Dyspnea ; Humans ; Medical Records ; Oxygen ; Palliative Care ; Prognosis ; Terminally Ill

Lipoma rarely occurs in the head and neck region ; it is especially rare to find it in the nasal cavity and paranasal sinus probably because there are few normal adipose tissue. There has been only one case of septal lipoma reported so far, and here we report another case. A 31-year-old female visited our hospital with nasal obstruction. In physical examination, we found 2 cm sized round mass covered with normal hyperemic mucosa on the right anterior part of nasal septum. On computed tomography, this was shown as a low density mass. The mass was completely resected via endonasal approach under general anesthesia. The histopathological diagnosis was lipoma. This case was different from the previously reported one in that this one was located at the anterior septal portion of the septum and had a wide base without stalk.
Adipose Tissue ; Adult ; Anesthesia, General ; Diagnosis ; Female ; Head ; Humans ; Lipoma* ; Mucous Membrane ; Nasal Cavity ; Nasal Obstruction ; Nasal Septum* ; Neck ; Physical Examination

There has been a number of reports recently describing the pathogen potential of irregular asporogenous gram positive rods (IGPR), also referred as coryneforms or diphtheroids. This may be due to a greater number of opportunistic infections occurring in patients who are immunosuppressed or implanted with prostheses. The documentation of endocarditis caused by IGPR is difficult. Because all the result of culture is not always positive and these cultures need long-period incubation, and there are sometimes pseudo-positive cases due to the contamination in blood sampling. An early diagnosis and adequate treatment are important for the better result. We describe the case of bio prosthetic valve endocarditis in a 61-year-old woman who enduring chronic hemodialysis. This is the first case reported of bioprosthetic valve endocarditis by Corynebacterium in Korea.
Corynebacterium* ; Early Diagnosis ; Endocarditis* ; Female ; Gram-Positive Rods ; Humans ; Korea ; Middle Aged ; Opportunistic Infections ; Prostheses and Implants ; Renal Dialysis

Pulmonary artery sling with bridging bronchus is not only rare but also difficult to diagnose unless specially sought. When young infant suffers from prolonged or recurrent wheezing, possibility of underlying anomalies of the tracheobronchial trees or great vessels should be considered, even though bronchiolitis and gastroesophageal reflux are the most common causes. We experienced four cases of pulmonary artery sling with bridging bronchus who presented with dyspnea and recurrent wheezing since infancy. Diagnosis was made using bronchoscopy, three dimensional computed tomography, echocardiography and angiography. Bridging bronchus of three patients (case 1, 2, 3) correspond to type IIA and one patient (case 4) to type IIB by Wells classification. Bronchoscopic examinations on 3 patients showed segmental bronchomalacia and near complete obstruction of bronchus by the posterior left pulmonary artery. These congenital bronchial anormalies should be included in differential diagnosis in pediatric patients with unexplained persistent and recurrent wheezing, or emphysema of unknown etiology on plain chest X-ray.
Angiography ; Bronchi* ; Bronchiolitis ; Bronchomalacia ; Bronchoscopy ; Classification ; Diagnosis ; Diagnosis, Differential ; Dyspnea ; Echocardiography ; Emphysema ; Gastroesophageal Reflux ; Humans ; Infant ; Pulmonary Artery* ; Respiratory Sounds ; Thorax