Background. Ultimate goal for the treatment of the deformities in the lower extremities is to minimize the energy requirement and conserve the energy on walking and daily living. The normal energy saving mechanism is usually broken down in the patients with the deformities in the lower extremity, and they need more energy consumption. This is the reason why they feel fatigue frequently. It is well known that the deformity in the lower extremity cause excessive energy consumption. Objectives. There is no report that compared the energy consumption according to the deformities of the lower extremity. When we decide the priority of the treatment in cases of multiple deformities, it will be important to understand the energy demand according to each deformity. Therefore, it is the purpose of this study that assess the energy consumption according to the various types of lower extremity deformities. Method. We induced the multiple deformities in ten normal adults with the brace artificially. The induced deformities are as follows: Equinus deformity; mild (10degrees), moderate (20degrees), severe (30degrees), Knee flexion deformity; mild (10degrees), moderate (20degrees), severe (30degrees), Hip flexion deformity; mild (10degrees), moderate (20degrees), severe (30degrees). For the control group, same braces were applied without any deformity. Oxygen consumption was measured for the energy consumption with the Oxygen Consumption Meter (Morgan Oxylog II, Morgan Ltd. England). Heart rate was checked with the Telemonitor (Dynascope, Fukuda Ltd, Japan). We evaluated the inspired volume, oxygen rate, oxygen cost, and heart rate in each group and compared the data among the groups. Result. Energy consumption was higher in the hip deformity group, in the knee deformity group, and in the ankle deformity group in that order. Conclusion. When there are concomitant deformities in hip, knee and ankle, the priority of treatment may be hip, knee and ankle, in that order in terms of energy consumption.
Adult ; Ankle ; Braces ; Congenital Abnormalities* ; Equinus Deformity ; Fatigue ; Heart Rate ; Hip ; Humans ; Joints* ; Knee ; Lower Extremity* ; Oxygen ; Oxygen Consumption ; Walking

PURPOSE: We estimated scattered radiation doses to the patients and medical practitioneer and revealed risk factors associated with increasing radiation doses during extracorporeal shock wave lithotripsy(ESWL). MATERIALS AND METHODS: At first, we measured radiation doses 2 times using thermoluminescence dosimeter to simulative patients and medical practitioneer without any shield during 10 minutes of ESWL and determined mean radiation dose/minute. From June to August 2007 at our institution, we prospectively measured radiation exposured time during respective ESWL for treatment of urinary stones. Thereafter, we calculated practical radiation doses to patients and medical practitioneer from respective mean radiation dose/minute. We also analyzed which factors were associated with increasing radiation doses. RESULTS: A total of 50 ESWL were analyzed from 38 patients. Mean radiation dose/minute to simulative patients and medical practitioneer was 16.20, 0.006mSv respectively. At 1 time ESWL, median radiation exposured time was 360 seconds(130-980), therefore, median radiation dose to patients and medical practitioneer was calculated as 97.20mSv(35.10-264.60), and 0.04mSv(0.01-0.08) respectively. Larger stone size had a correlation with increasing radiation dose and additional pain control group had higher radiation dose than otherwise. CONCLUSIONS: During ESWL, patients were relatively exposed to high radiation which were roughly corresponded to that of 3 times of computed tomography. But the radiation dose to medical practitioneer was insignificant consider international guideline. Medical practitioneer should be aware of radiation hazard and try to minimize radiation dose to the patients at the time of ESWL.
Humans ; Lithotripsy ; Prospective Studies ; Risk Factors ; Shock ; Urinary Calculi

Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.
Adult ; Amniotic Fluid* ; Anaphylaxis ; Anoxia ; Cardiopulmonary Bypass ; Cesarean Section ; Cognition ; Embolism, Amniotic Fluid* ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Peripartum Period ; Pregnancy ; Pregnant Women ; Pulmonary Circulation ; Shock

PURPOSE: The purpose of this study is to determine the left ventricular mass (LVM) and the left coronary artery dimension and to investigate the relationship between the two values in the normotensive group and hypertensive group with using 16-channel multidetector CT (MDCT). MATERIALS AND METHODS: Among the patients who underwent a CT coronary angiogram procedure using 16-channel MDCT at Ajou University Hospital from October 2004 to February 2005, 33 patients became the subjects of this study. These 33 patients showed normal findings without calcification or stenosis of the coronary arteries. The total volume of the left ventricular wall was calculated using work-in-progress cardiac CT reconstruction software. The LVM could then be directly calculated by multiplying the left ventricular muscle volume by the myocardial tissue density, which was assumed to be 1.05 g/cm3. The coronary diameter was measured by a fixed threshold method from the transverse reformation images obtained along the long-axis of each coronary artery. We calculated the cross-sectional area (CSA) of the coronary arteries from the equation of pi D2/4 (D=diameter). Regression analysis was performed for the relationship between LVM and the left coronary artery dimensions with using a linear least-squares method. Comparison between the normotensive group and the hypertensive group was done using the Student t test. RESULTS: The average LVM was 127.9+/-36.2 g (mean+/-standard deviation) and the average left ventricular mass index (LVMI) was 74.7+/-15.5 g in this study population. The average diameter of the coronary arteries was 4.38+/-0.69 mm for the left coronary artery. In all the subjects (n=33, r=0.67, p=0.000) and the normotensive group (n=21, r=0.68, p=0.000), the LVM was significantly correlated with the CSA of the left coronary artery, but not in the hypertensive group (n=12, r=0.57, p=0.062). In the hypertensive group, the CSA of the left coronary arteries per 100 g of muscle mass tended to decrease as the LVM increased. However, no statistical significance was demonstrated (r=-0.51, p=0.087). The end-diastolic left ventricular volume of the hypertensive group was smaller than that of the normotensive group (p=0.039). CONCLUSION: Using 16-channel MDCT, we could determine the LVM and coronary artery dimensions simultaneously in all the subjects. In all the subjects and the normotensive group, the LVM was significantly correlated with the CSA of the left coronary artery. However, the coronary artery dimensions did not increase commensurately with a concomitant increase of the LVM in the patients with hypertension.
Constriction, Pathologic ; Coronary Vessels* ; Heart ; Humans ; Hypertension ; Myocardium

Golf is low demanded activity and becoming more popular. But it often occur problems in back, shoulder, elbow and wrist. Golf injuries in professional golfer are related overuse and frequency, while in amateur are related wrong swing technique. Also muscle activities in swing are different between professional and amateur. We report partial tear of pronator teres in middle aged amateur golfer with literatures.
Elbow ; Golf ; Humans ; Middle Aged ; Muscles ; Shoulder ; Wrist

Ganglioneuroma is generally considered to be the benign mature from of tumor arising from neural crest tissue. The great chain of sympathetic ganglia including the adrenal medulla accounts for the origin of most of ganglioneuroma. Complete surgical excision of adrenal ganglioneuroma is the treatment of choice. Herein we report a cases of adrenal ganglioneuroma in a 17-year-old male which is confirmed by surgical exploration and histopathologic examination.
Adolescent ; Adrenal Medulla ; Ganglia, Sympathetic ; Ganglioneuroma* ; Humans ; Male ; Neural Crest

PURPOSE: Surgical excision of the subcutaneous tissues, with or without skin excision in the axillary hair-bearing area, has been the treatment of choice in treating osmidrosis for several decades. However, long periods of postoperative immobilization of a shoulder joint, partial necrosis of skin flaps or the possibility of hematoma and scars have occurred frequently. So we used XPS(R) microresector(Shaver) in procedure which requires removal of soft tissue for comparing results between surgical excision and the laters. METHODS: From January 2007 to February 2008, a total of 20 patients(8 male and 12 female) underwent XPS(R) microresector(Shaver) assisted aspiration for treating osmidrosis. The mean age of the subjects was 21.9, and we tried to analyze some advantages of XPS(R) microresector(Shaver). RESULTS: The average operation time was 61.6 minutes. This results can show that the patients who received XPS(R) microresector(Shaver) assisted aspiration can accomplish better outcomes than any other procedures in terms of operation time at least. Moreover, no significant postoperative complications occurred in our studies. Subjects have been followed up from 2 months to 1 year and among these patients, no one suffered from critical complications. CONCLUSION: In brief, XPS(R) microresector(Shaver) is able to shorten the time of operation and simplify the procedures relatively and this device has more superiorities in wound healing by maintaining of vascularized dermal skin flaps. It means that XPS(R) microresector (Shaver) can prevent flap necrosis, axillary hair loss and minimalize scarring and bleeding. Thus, we expect that these advantages can lead to better patient's comfort and self-confidence than several previous procedures.
Cicatrix ; Hair ; Hematoma ; Hemorrhage ; Humans ; Immobilization ; Male ; Necrosis ; Postoperative Complications ; Shoulder Joint ; Skin ; Subcutaneous Tissue ; Wound Healing

BACKGROUND: The associations between angiotensinogen M235T polymorphism and essential hypertension or ischemic stroke are still controversial. The aims of this study were to observe the associations of the angiotensinogen M235T polymorphism with hypertension or ischemic stroke, and to elucidate whether angiotensinogen M235T polymorphism was related to ischemic stroke itself or to hypertension. METHODS: We analyzed a particular polymorphysm in exon 2 of the angiotensinogen gene, a threonine to methionine substitution at position 235 (M235T), by a polymerase chain reaction in sixty patients with symptomatic ischemic stroke, one hundred patients with hypertension, and one hundredcontrol subjects without cardiovascular risks. Cardioembolic stroke was excluded. RESULTS: The three groups differed with respect to age and sex, but not total cholesterol, low-density lipoprotein, triglyceride, or body mass index. However, the distribution of angiotensinogen M235T genotypes was not different among the ischemic stroke group, hypertensive group, and control subjects. The TT genotype of angiotensinogen M235T was not significantly associated with ischemic stroke or hypertension (adjusted odds ratio (OR) = 1.02, 95% confidence interval (CI), 0.44 to 2.41, adjusted OR = 0.74, 95% CI=0.41 to 1.33, respectively), adjusting for age and sex. CONCLUSIONS: We found no significant associations between the angiotensinogen 235T alleles and hypertension or ischemic stroke in the Korean population. (J Korean Neurol Assoc 19(1):24~28, 2001
Alleles ; Angiotensinogen* ; Body Mass Index ; Cholesterol ; Exons ; Genes, vif ; Genotype ; Humans ; Hypertension ; Lipoproteins ; Methionine ; Odds Ratio ; Polymerase Chain Reaction ; Stroke* ; Threonine ; Triglycerides

PURPOSE: To determine the usefulness of cerebral perfusion computed tomography (CT) in patients with acute cerebral ischemic infarction. MATERIALS AND METHODS: Twelve patients with acute middle cerebral artery infarction underwent conventional CT and cerebral perfusion CT within 25 hours of the onset of symptoms. For each patient, perfusion CT scans were obtained at the levels of the basal ganglia and 1 cm caudal to them. Using special imaging software, perfusion imaging maps for cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time to peak (TTP) were created, and the infarcted lesion was evaluated on each map. MTT and TTP delay times were measured in the perfusion defect lesion and symmetric contralateral normal cerebral hemisphere. Lesion size on each perfusion map was determined and compared with the value obtained by diffusionweighted MR imaging (DWMRI). RESULTS: In all patients, perfusion CT maps depicted the perfusion defect lesion, for which the MTT and TTP delay was remarkable. A comparison of lesion size between each perfusion map and DWMR images showed that the closest correlation involved CBF maps (8/12, 67%). On MTT maps, the lesion was larger than at DWMRI, suggesting that MTT mapping can be used to evaluate ischemic penumbra. CONCLUSION: Perfusion mapping facilitates the evaluation not only of the ischemic core and ischemic penumbra, but also of hemodynamic status in the area of the perfusion defect. This finding demonstrates that perfusion CT can be useful for the diagnosis and treatment of patients with acute cerebral ischemic infarction.
Basal Ganglia ; Blood Volume ; Cerebrum ; Diagnosis ; Hemodynamics ; Humans ; Infarction* ; Infarction, Middle Cerebral Artery ; Magnetic Resonance Imaging ; Perfusion Imaging ; Perfusion* ; Tomography, X-Ray Computed

PURPOSE: Authors pursuit the meaningful guide for doing arthroscopic meniscetomy in the treatment of symptomatic discoid meniseus of the knee by determining the needed resection margin(partial or total) from the schematic diagram of degeneration and tear which is based on pre-operative MRI. MATERIALS AND METHODS: We analyzed the findings of MRI and operation retrospectively for 32 knees. At first, we designed authors own schematic diagram of discoid meniscus and divided it into 6 x 6 block. The radiologists draw the pattern of degeneration and tear on diagram from pre-operative MRI and the orthopedic surgeons draw the status of degeneration, tear and remaining meniscus after meniscetomy by retrospective analysis of video documentation. Two diagrams were compared for analysis. RESULTS: We had used morselization technique to save meniscus as much as possible on doing meniscetomy. The resected margin of cases were as follows; 9 cases were partial, 21 cases were subtotal and 2 cases were total meniscetomy. But in this study, 19 cases were requested total resection margin on pre-op MRI evaluation. Among these 19 cases, 17 cases of partial or subtotal meniscetomized were reviewed again on video documentation to determine the remained meniscus would be removed completely or not. In 13 of 17 cases, remaining menisci have advanced horizontal tear and rims were not stable that would be rather cases of total meniscetomy. CONCLUSION: Use of diagram of degeneration and tear on the basis of pre-op MRI would be valuable guide to determine appropriate resection margin and moreover the technique of the meniscetomy in the treatment of symptomatic discoid meniscus.
Knee ; Magnetic Resonance Imaging* ; Orthopedics ; Retrospective Studies