A case of severe aseptic meningitis with communicating hydrocephalus following iotrolan myelography is presented. The patient's condition improved very quickly after corticosteroid therapy. Rapid improvement and absence of pathogenic organisms in the CSF culture strongly favor an aseptic meningitis. This is the first reported case of aseptic meningtis with the secondary development of hydrocephalus caused by iotrolan myelography.
Hydrocephalus* ; Meningitis, Aseptic* ; Myelography*

A case of severe aseptic meningitis with communicating hydrocephalus following iotrolan myelography is presented. The patient's condition improved very quickly after corticosteroid therapy. Rapid improvement and absence of pathogenic organisms in the CSF culture strongly favor an aseptic meningitis. This is the first reported case of aseptic meningtis with the secondary development of hydrocephalus caused by iotrolan myelography.
Hydrocephalus* ; Meningitis, Aseptic* ; Myelography*

Nonunion of fractures of forearm bone occurs frequently. These patients usually suffer from pain and functional disturbance of the hand and forearm. With the introduction of compression plate for the treatment of nonunion at the Campbell Clinic in 1959, a modification of the Nicoll graft was advised. The authors analysed 23 cases of the nonunion of forearm bone, in which military injured patients were admitted and treated by bone graft with internal fixation using various devices in Department of Orthopaedic Surgery of Korea Veterans Hospital from Sep. 1983 to Aug. 1988.
Forearm ; Hand ; Hospitals, Veterans ; Humans ; Korea ; Military Personnel ; Transplants

External fixation was improved in its material, design and techniques as a specific method of open fracture treatment. Seventy-three, tibial open fracture, patients were treated with external fixator in Korea Veterans Hospital from January 1983 to April 1988. Each fixation method was divided into two types;one-plane unilateral frame and one-plane bilateral frame. 1. The duration of external fixation was 14.3 weeks in averge, 15.4 weeks in one plane unilateral frame and 13.2 weeks in one plane bilateral frame. 2. Secondary operation for bony union was performed 19 cases in one plane unilateral frame and 8 cases in one plane bilateral frame. 3. The union time was 23.6 weeks in average, 26.8 weeks in one plane unilateral frame and 21.4 weeks in one plane bilateral frame. 4. The common complications were delayed union and nonunion (7 cases) and pin tract infection (5 cases) in one plane unilateral frame, and pin tract infection ( 9 cases), joint stiffness (4 cases) and delayed union and nonunion (3 cases) in one plane bilateral frame. 5. External fixation gave rigid fixation and easy wound access, but did not give excellent bony union. 6. One plane bilateral frame showed more or less better result than one plane unilateral frame except some complications.
External Fixators ; Fractures, Open ; Hospitals, Veterans ; Humans ; Joints ; Korea ; Methods ; Wounds and Injuries

Since the rectangular rod had been used by Eduardo R. Luque in 1979, many authors reported good results by this technique in low back arthrodesis. The advantages of this device are that the technique is relatively easy, the cost is cheaper than the other devices, and no special instruments are needed for application of this device. On the other hand, it has the disadvantage of possible neurologic damage while passing sublaminar wires. The rectangular rod functions fundamentally as a tension band that although it is strong in flexion, it is relatively weak in lateral bending or axial loading on the spine. From June, 1984 to June, 1988, the authors experienced 41 cases of rectangular rod instrumentation with sublaminar wiring in various low back conditions. And 30 cases of spondylolisthesis which could be followed for more than one year were analyzed. And the results obtained were as follows. l. Of 30 patients of spondylolisthesis, 7 cases(23.3%) were male and 23 cases(76.7%) were female. 2. 21 cases(70.0%) were isthmic type and 9 cases(30.0%) degenerative type. 3. 23 cases(76.7%) were in Grade I, 6 cases(20.0%) in Grade II and 1 cases(3.3%) in Grade III, according to Meyerding's classification. 4. At follow up examination, 18 cases(60.0%) were in excellent group, 8 cases(26.6%) in good, 2 cases(6.7%) in fair, according to Gill's criteria. Two cases(6.7%) of pseudoarthrosis were noted and these cases were classified in unsatisfactory group. 5. Rectangular rod with sublaminar wiring was not a good device for reduction of spondylolisthesis
Arthrodesis ; Classification ; Female ; Follow-Up Studies ; Hand ; Humans ; Male ; Pseudarthrosis ; Spine ; Spondylolisthesis

62 cases of the fracture of the pelvis admitted to the orthpedic department of Wonju Christian Hospital during past 5 years from 1975 to 1979 were reviewed and clinical results were obtained as follows: 1. Males were frequent than females and almost 3rd to 4th decades of life. 2. The causes of injury were traffic accident, coal minor accident, and falling. 3. Stable type is the most common in this series and among the unstable types, lateral compression type is the most common and then straddle type and vertical shear type. 4. The most common complication is uro-genital injury. 5. The residual complications at the end of treatment remained in some cases, Arthritis of sacroiliac joint, Impotence, Urethral stricture, Low back pain, etc. 6. All of the cases were treated conservatively and their results were somewhat good except 4 cases. 7. Surgical treatment would be considered, if necessory, to decrease the complications and reduce hospital days.
Accidental Falls ; Accidents, Traffic ; Arthritis ; Coal ; Erectile Dysfunction ; Female ; Gangwon-do ; Humans ; Low Back Pain ; Male ; Pelvic Bones ; Pelvis ; Sacroiliac Joint ; Urethral Stricture

Torsade de pointes is a life-threatening, polymorphic ventricular tachycardia associated with prolongation of the QTc interval. Although torsade de pointes is found in many clinical settings, it is mostly drug induced. Similar problems have been described with nonsedating H1-selective antihistamines like terfenadine and astemizole. The increased risks of both H1-antihistamines were associated with exposure to supratherapeutic doses or concomitant exposure to the cytochrome P-450 inhibitors, ketoconazole, erythromycin and cimetidine. We report a 51-year-old woman with torsade de pointes and a long QTc interval caused by the combined use of terfenadine and itraconazole. After discontinuation of these drugs and treatments with electrical cardioversion and magnesium sulfate, torsade de pointes and prolonged QTc interval were no longer observed and she was discharged in good condition with a normal ECG. In conclusion, physicians should be aware that terfenadine and astemizole can cause torsade de pointes in rare cases.
Astemizole ; Cimetidine ; Cytochrome P-450 Enzyme System ; Electric Countershock ; Electrocardiography ; Erythromycin ; Female ; Histamine Antagonists ; Humans ; Itraconazole* ; Ketoconazole ; Magnesium Sulfate ; Middle Aged ; Tachycardia, Ventricular ; Terfenadine* ; Torsades de Pointes*

PURPOSE: To evaluate the characteristics of the bronchiectasis in diffuse panbronchiolitis using HRCT. MATERIALS AND METHODS: We retrospectively studied 12 HRCT scans and two bronchography of 12 patients with diffuse panbronchiolitis(DPB). According to Akira et al., DPB was classified into four types: small nodules around the end of bronchovascular branchings(CT type I), small nodules in the centrilobular area connected with small branching linear opacities(CT type II), nodules accompanied by ring-shaped or small ductal opacities connected to proximal bronchovascular bundles(CT type III), large cystic opacities accompanied by dilated proximal bronchi(CT type IV). We compared the type and the extent of bronchiectasis, CTtypes of DPB, and pulmonary function test. RESULTS: Bronchiectasis was defined in 12 cases with the tubular type predominantly involving small and medium-sized bronchi. These bronchiectasis involved the proximal bronchi of the centrilobular lesions of DPB. Among eight cases of advanced DPB(CT type III & IV) which extended to both upper lobes, seven showed tubular bronchiectasis at the same area. Cystic bronchiectasis was shown in eight cases predominantly involving right middle lobe(n=7). There was no linear correlation between the values of pulmonary function test and CTtypes of DPB. CONCLUSION: Characteristic feature of the bronchiectasis in DPB is the tubular ectasis predominantly involving the small and medium-sized bronchi. DPB with associated tubular bronchiectasis can involve whole lung field in advanced cases. HRCT is useful not only to depict the findings of DPB but also to demonstrate the extent of lesion.
Bronchi ; Bronchiectasis* ; Bronchography ; Humans ; Lung ; Respiratory Function Tests ; Retrospective Studies

Pneumoperitoneum caused by acute gastric dilatation (AGD) is a very rare complication. We report a case of pneumoperitoneum and acute pulmonary edema caused by AGD in a patient with Parkinson's disease. A 78-year-old woman presented with pneumonia and AGD. We inserted a nasogastric tube and administered empirical antibiotics. We performed an endoscopy, and perforation or necrosis of the stomach and pyloric stenosis were not observed. Thirty-six hours after admission, the patient suddenly developed dyspnea and shock, and eventually died. We suspected the cause of death was pneumoperitoneum and acute pulmonary edema caused by AGD during the conservative treatment period. Immunocompromised patients with chronic illness require close observation even if they do not show any symptoms suggestive of complications. Even if the initial endoscopic or abdominal radiologic findings do not show gastric necrosis or perforation, follow-up with endoscopy is essential to recognize complications of AGD early.
Aged ; Anti-Bacterial Agents ; Cause of Death ; Chronic Disease ; Dyspnea ; Endoscopy ; Female ; Follow-Up Studies ; Gastric Dilatation* ; Humans ; Immunocompromised Host ; Necrosis ; Parkinson Disease ; Pneumonia ; Pneumoperitoneum* ; Pulmonary Edema* ; Pyloric Stenosis ; Shock ; Stomach

BACKGROUND: Cardiac tamponade is associated with the expiratory increase and the expira-tory decrease in left ventricular filling flow. With Doppler echocardiography, we analyzed the respiratory variations of mitral and tricuspid inflows, and pulmonary and hepatic venous flows in patients with cardiac tamponade. METHODS: Respiratory hemodynamic changes in mitral and tricuspid inflows and pulmonary and hepatic venous flows were evaluated using Doppler echocardiography in 13 patients (6 men and 7 women; mean age 51+/-13 years) with large pericardial effusion and clinical cardiac tamponade, and compared the results with those of 11 control subjects (3 men and 8 women, mean age 53+/-13 years). Doppler examination was repeated after pericardiocentesis in 6 patients. RESULTS: Peak velocity of early diastolic mitral inflow (E velocity) decreased during inspiration compared with expiratory increase; the mean percentage change was 40%. Peak velocity of late diastolic mitral inflow (A velocity) decreased 13% during inspiration. E/A ratio decreased 31% during inspiration. Deceleration time (DT) and isovolumic relaxation time (IVRT) increased by 26% and 44%, respectively, during inspiration. But respiratory variations of tricuspid inflow were opposite to those of mitral inflow. Tricuspid E velocity increased during inspiration and decre-ased during expiration. The mean percentage change was 123%, which was larger than thte 40% of mitral inflow. The most characteristic findings of pulmonary venous flow during respiration were the expiratory increases of peak diastolic velocity (DV) and diastolic time-velocity integral (D-TVI). The mean percentage changes of peak systolic velocity (SV), DV and D-TVI during respiration were 27%, 45% and 53% respectively. In contrast, the SV and DV of hepatic venous flow increased during inspiration and decreased during expiration. The respiratory variations of peak systolic reverse flow velocity (SR) and peak diastolic reverse flow velocity (DR) were opposite to those of SV and DV. DR notably increased during expiration, and the mean percentage change was 61%. The ratio of RFI (Inspiratory reverse flow integral) to FFI (forward flow integral) of the tamponade group was 270%. The mean percentage changes of each parameters decreased after pericardiocentesis. CONCLUSION: Patients with cardiac tamponade showed inspiratory increases of diastolic tri-cuspid filling flow and hepatic forward flow. Expiratory increases included diastolic mitral filling flow, pulmonary venous systolic and diastolic flow, and hepatic venous reverse flow. Such res-piratory variations decreased after pericardiocentesis.
Cardiac Tamponade* ; Deceleration ; Echocardiography* ; Echocardiography, Doppler ; Female ; Hemodynamics ; Humans ; Male ; Pericardial Effusion ; Pericardiocentesis ; Relaxation ; Respiration