BACKGROUND: Vasoconstrictors have been used as an adjunct to local anesthetics to prolong the duration of spinal anesthesia. Recently, clonidine, an 2-receptor agonist has been shown to prolong the duration of spinal anesthesia following intrathecal administration. Bupivacaine has been used for spinal anesthesia and compared with tetracaine in recent studies. We have undertaken this study to further evaluate the effect of clonidine in hyperbaric 0.5% bupivacaine spinal anesthesia. METHODS: Thirty patients who were scheduled for lower limb or urologic operation were divided into 2 groups: Group A (hyperbaric bupivacaine 13 mg, 2.6 ml + N/S 1 ml), Group B (hyperbaric bupivacaine 13 mg, 2.6 ml + clonidine 150 g, 1 ml). We used standardized techniques and injected above drugs to group A and B intrathecally for spinal anesthesia. We investigated the onset and the duration of spinal anesthesia along with hemodynamic changes (blood pressure and heart rate) in patients. RESULTS: There were no significant differences in the onset of spinal anesthesia and hemodynamic changes between two groups. The time taken to recover from the nerve block was more prolonged in the group B (touch 225, pain 262, foot dorsiflexion 271, knee flexion 290 minutes) than group A (touch 154, pain 188, foot dorsiflexion 198, knee flexion 216 minutes). There were no significant differences in sedation, and in experiencing dry mouth and other side effects between two groups. CONCLUSION: Intrathecal clonidine 150 g has been proved to prolong the duration of hyperbaric 0.5% bupivacaine spinal anesthesia without neurotoxicity or dangerous hemodynamic depression. Therefore, clonidine can be used as an effective adjunct in hyperbaric bupivacaine spinal anesthesia.
Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine* ; Clonidine* ; Depression ; Foot ; Heart ; Hemodynamics ; Humans ; Knee ; Lower Extremity ; Mouth ; Nerve Block ; Tetracaine ; Vasoconstrictor Agents

OBJECTIVE: To evaluate the effect of a transcranial magnetic stimulation on reciprocal inhibition of the human leg. METHOD: Twenty healthy human subjects who showed significant inhibition of soleus H reflex after conditioning electrical stimulation of tibialis anterior at a conditioning-test interval of 2 ms were included in this study. Changes in the amount of reciprocal inhibition by conditioning electrical stimulus were compared after transcranial magnetic stimulation of tibialis anterior. RESULTS: Approximately 12% inhibition of H reflex was produced by motor threshold stimulation, and 14% inhibition by maximum stimulation of common peroneal nerve. When a submotor threshold cortical shock was given with test-conditioning interval 0 ms, this inhibition was not significantly changed. There was no significant change of H reflex amplitude ratio by conditioning electrical stimulation after delivering supramotor threshold cortical shock. Amplitude of H reflex was enhanced by transcranial magnetic stimulation at each same conditioning electrical stimulation. CONCLUSION: We conclude that TMS can produce excitatory effects on spinal motor neurons rather than Ia inhibitory interneuron and there is no evidence for convergence onto Ia inhibitory interneurons from the fiber systems excited by magnetic stimulation over the cortex.
Electric Stimulation ; H-Reflex* ; Humans ; Interneurons ; Leg ; Motor Neurons ; Muscle, Skeletal* ; Peroneal Nerve ; Shock ; Transcranial Magnetic Stimulation*

We examined the associations between thigh muscle area (TMA) and insulin resistance (IR) according to body mass index (BMI) in middle-aged Korean general population.

BACKGROUND: Intertrochanteric fractures of the femur are the most common type of fracture, and are an increasing occurrence due to the aging of the population. The objectives of our study are to predict the fate of intertrochanteric fractures treated with intramedullary hip nails by assessing the postoperative fracture stability utilizing the newly developed scoring system, and to help rehabilitate these patients. METHODS: Eighty-two patients with intertrochanteric fractures that were treated with intramedullary hip nails between December, 2004 and January, 2011 were subjected to this study. The patients who could be followed for a minimum of one year postoperatively were enrolled. The immediate postoperative conditions were determined by radiograms: reduction status (3 parameters/4 points: contact accuracy of posteromedial cortex, severity of angulation, and distraction), fixation status (3 parameters/3 points: tip-apex distance, location of tip of the lag screw, entry point of the intramedullary nail), and fracture type (1 parameter/1 point: stable or unstable type by the Kyle's classification). Postoperative reduction loss and fixation failure were checked by radiograms taken at a minimum 3 months postoperative. RESULTS: Reduction loss and fixation failure were observed in 14 consecutive patients (17%). The fixation failure rate was 100% (2 patients) in score 1, 60% (3 out of the 5 patients) in score 2, 39% (3 out of the 8 patients) in score 3, and 50% (4 out of the 8 patients) in score 4 groups. There were fixation failures only in 1 out of 13 patients with score 5, and in 1 out of 18 patients with score 6. There was no fixation failure in 17 patients with score 7 and 11 patients with score 8. CONCLUSIONS: Maintenance of the fracture reduction by the stable fixation in the patient scores over 5 could be predicted by the postoperative radiograms.
Adult ; Aged ; Aged, 80 and over ; Bone Nails ; Early Ambulation ; Female ; Femur/surgery ; Fracture Fixation, Intramedullary ; Health Status Indicators ; Hip Fractures/classification/rehabilitation/*surgery ; Humans ; Male ; Middle Aged ; Range of Motion, Articular ; Recovery of Function ; Retrospective Studies ; Treatment Outcome

Pulmonary alveolar proteinosis is a rare disorder in which lipoproteinaceous material accumulates within the alveoli. We report a case of pulmonary alveolar proteinosis in a 41 year old female patient. She complained of a dry cough in the preceding 6 months. She presented symptoms of mild hypoxemia and diffuse infiltration at both lower lung fields. A milky fluid was obtained by bronchoalveolar lavage. We confirmed by light microscopic examinations of the lung tissues obtained by transbronchial lung biopsy. Through several follow-ups, the patients symptoms were mild.
Adult ; Anoxia ; Biopsy ; Bronchoalveolar Lavage ; Cough ; Female ; Follow-Up Studies ; Humans ; Lung ; Pulmonary Alveolar Proteinosis

OBJECTIVE: We studied the effects of the age factor in pregnant women who are over the age of 35 on pregnancy, parturition and verified its usefulness in the future managements of the old aged pregnancy. METHODS: Out of 2,526 mothers who delivered in Dongguk university hospital from April 2000 to June 2003, we selected 183 mothers who aged more than 35 years as a study group, and 150 mothers aged between 25 and 29 years as a control group. We then statistically evaluated and analyzed the two groups. RESULTS: Study group consumed up to 7.24%. Placenta previa, male birth delivery, abnormal presentation, low birth weight, iron deficiency anemia and preterm labor was noted more in the study group. Likewise, preterm delivery, pregnancy induced hypertension and cesarean section rates were significantly high in the study group. CONCLUSION: Pregnancy in old age is currently a rising trend. Whlie they might have the tendency to show prenatal complications, neonatal complication and difficult decision making in delivery method, early detection and treatment of presumable complications by adequate antenatal care and appropriate selection of delivery method can reduce the section rates and obtain relatively successful pregnancy outcome.
Age Factors ; Anemia, Iron-Deficiency ; Cesarean Section ; Decision Making ; Female ; Humans ; Hypertension, Pregnancy-Induced ; Infant, Low Birth Weight ; Infant, Newborn ; Male ; Mothers ; Obstetric Labor, Premature ; Parturition ; Placenta Previa ; Pregnancy Outcome ; Pregnancy* ; Pregnant Women*

No abstract available.
Gonadotropin-Releasing Hormone* ; Humans ; Hypogonadism* ; Male*

OBJECTIVE: The purpose of this study is to evaluate the role of cold knife conization in the diagnosis and management of cervical neoplasia. METHODS: Cold knife conization was performed in total 163 patients from January 1992 to December 2003. The results of PAP smear and colposcopy-directed biopsy were compared with the pathologic diagnosis of conization. And we evaluated the rate of positive margin and the presence of residual lesion. And then, we reviewed the pregnancy outcome after conization. RESULTS: The rate of agreement between PAP cytology and conization was 45.4%, and the rate of agreement between colposcopy-directed biopsy and conization was 65.6%. Hysterectomy was done in 102 patients (62.6%). The positive rate of resection margin was 19.6%. The incidence of residual lesion after conization was 31.2% in margin (+) and 1.4% in margin (-). We evaluated 7 cases of pregnancy after conization. CONCLUSION: Cervical conization as surgical treatment was effective in cervical neoplasia patients, especially young patients, with continuous follow-up.
Biopsy ; Conization* ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Incidence ; Pregnancy ; Pregnancy Outcome

PURPOSE: The purpose of this study is to compare the rehabilitation effects between aquatic physiotherapy and land-based physiotherapy after total knee arthroplasty. PARTICIPANTS AND METHODS: The study was performed by patients with TKA caused by knee OA. The participants were divided into two groups based on random sampling method. One group received aquatic physiotherapy while the other received land-base physiotherapy. Each physiotherapy program lasted 40 minutes a day, 5 days a week, for 1 week starting a week after the operation. Pertinent indicators, knee extensor strength, knee flexor strength, walking speed, knee circumference, WOMAC index and Visual analogue scale were recorded before and after the physiotherapy programs, 1 week, 2weeks and 6 weeks after the operation. RESULTS: The aquatic physiotherapy group showed statistically significant improvements in knees circumference and VAS scores, compared to the land-based physiotherapy group between 1week and 2 weeks after the operation, whereas no statistical differences were found in Knee extensor strength, knee flexor strength, walking speed and WOMAC index. CONCLUSION: The aquatic physiotherapy group showed statistically significant improvements in knee circumference and VAS scores compared to the land-based physiotherapy group between 1 and 2 weeks after the operation. Further studies are required to confirm these findings. We were able to conclude that aquatic physiotherapy is an alternative rehabilitation program for patients with TKA.
Arthroplasty, Replacement, Knee ; Humans ; Knee ; Walking

PURPOSE: The purpose of this study is to compare the rehabilitation effects between aquatic physiotherapy and land-based physiotherapy after total knee arthroplasty. PARTICIPANTS AND METHODS: The study was performed by patients with TKA caused by knee OA. The participants were divided into two groups based on random sampling method. One group received aquatic physiotherapy while the other received land-base physiotherapy. Each physiotherapy program lasted 40 minutes a day, 5 days a week, for 1 week starting a week after the operation. Pertinent indicators, knee extensor strength, knee flexor strength, walking speed, knee circumference, WOMAC index and Visual analogue scale were recorded before and after the physiotherapy programs, 1 week, 2weeks and 6 weeks after the operation. RESULTS: The aquatic physiotherapy group showed statistically significant improvements in knees circumference and VAS scores, compared to the land-based physiotherapy group between 1week and 2 weeks after the operation, whereas no statistical differences were found in Knee extensor strength, knee flexor strength, walking speed and WOMAC index. CONCLUSION: The aquatic physiotherapy group showed statistically significant improvements in knee circumference and VAS scores compared to the land-based physiotherapy group between 1 and 2 weeks after the operation. Further studies are required to confirm these findings. We were able to conclude that aquatic physiotherapy is an alternative rehabilitation program for patients with TKA.
Arthroplasty, Replacement, Knee ; Humans ; Knee ; Walking