BACKGROUND: The external jugular vein (EJV) is a useful intravenous (IV) cannulation site for anesthesiologists, although it has a relatively high failure rate. Unlike other central veins, visualization of the EJV is important during IV cannulation, and the Valsalva maneuver distends the jugular venous system. However, the relationship between the maneuver and EJV visibility remains unknown. This study compared EJV visibility before and after the Valsalva maneuver. METHODS: This was a prospective observational study that included 200 participants. After the induction of anesthesia, EJV visibility grade, depth from the skin to the EJV superficial surface (EJV depth), and EJV cross-sectional area (CSA) before the Valsalva maneuver were measured. The same parameters were measured after the Valsalva maneuver was performed. The EJV visibility grade was defined as grade A: good appearance and good palpation, grade B: poor appearance and good palpation, and grade C: poor appearance and poor palpation. RESULTS: Patient body mass index and EJV depth affected the EJV visibility grade before the Valsalva maneuver (p < 0.05), although EJV CSA did not. The Valsalva maneuver distended EJV CSA and reduced EJV depth, although these changes were not correlated with EJV visibility grade. With regard to EJV visibility, 34.0% of grade B cases and 20.0% of grade C cases were improved by the Valsalva maneuver. CONCLUSIONS: Although the Valsalva maneuver improved EJV CSA and EJV depth, it did not greatly affect EJV visibility grade.
Anesthesia ; Body Mass Index ; Catheterization ; Humans ; Jugular Veins* ; Observational Study ; Palpation ; Prospective Studies ; Skin ; Ultrasonography ; Valsalva Maneuver* ; Veins

Perigraft seroma is uncommon complication of polytetrafluoroethylene(PTFE) grafts applied as an arteriovenous shunt for hemodialysis. It is a collection of clear, sterile fluid confined to nonsecretory fibrous pseudomembrane, most commonly localized around the middle and distal portion of graft. The possible etiologic factors of perigraft seroma include poor graft incorporation, mechanical graft damage caused by alcohol and povidone-iodine, intraoperative streching of the graft, variations in quality control at the time of manufacture and contributing factors such as anemia and coagulopathy in uremia. The best strategy for management of perigraft seroma is not clear. spiration or drainage alone is not effective, and some authors advocate graft removal. We report a case of perigraft seroma around arterial end of PTFE graft along with a brief review of the literatures.
Anemia ; Drainage ; Humans ; Polytetrafluoroethylene ; Povidone-Iodine ; Quality Control ; Renal Dialysis* ; Seroma* ; Transplants ; Uremia

To elucidate the complex of insulin-like growth factor binding proteins (IGF-BPs) in short stature patients, we carried out a prospective study on three patients who were diagnosed as complete GH deficiency at the department of pediatrics from July 1992 to June 1993. The results were summarized as follows: 1) Two circulating IGFs complexed to specific binding protein existed in normal serum. Binding activity was found to be in the 150,000 molecular weight area (the large complex) and 50~60,000 molecular weight area (the small complex). 2) Binding activity for the large complex was seen to be dependent on advancing age, level of large IGF-BP3 complex peacked at the age of 15~16 years. 3) The binding activity for large complex diminished in three GH deficient patients and increased after hGH injection to near or above normal level. 4) Increased growth rate after GH treatment in GH deficient patient was closely related with increasing level of the large IGF-BP3 complex. Therefore we suggest that the large IGF-BP3 complex is regulated by GH. Estimating its serum level is useful for screening of GH deficiency and the monitoring of response to GH therapy.
Carrier Proteins ; Growth Hormone* ; Humans ; Insulin-Like Growth Factor Binding Proteins ; Insulin-Like Growth Factor I* ; Mass Screening ; Molecular Weight ; Pediatrics ; Prospective Studies

PURPOSE: The effects of ball joint location from axis of rotation on postoperative wrist motion in dynamic external fixator for displaced intra-articular fractures in distal radius were evaluated. MATERIALS AND METHODS: 33 patients who had dynamic external fixative surgery after closed reduction within acceptable range and could be followed at least 1 year were reviewed. They were divided into two groups according to distance (5 mm, 10 mm) of ball joint center from axis of wrist rotation which located in proximal cortex of capitate. These groups were compared by clinical results which were evaluated by range of motion of wrist (flexion, extension, radial deviation, ulnar deviation, pronation, supination) and pain evaluation system. They were also divided into two groups according to direction of ball joint migration (proximal, distal) and evaluated by the same methods. RESULTS: No difference in range of motion and pain was observed between distance 0 mm-5 mm group and >5 mm group (p>0.05). Distance 0 mm-10 mm group showed statistically significant more range of motion in extension, supination and pronation than >10mm group (P<0.05). However, there was no significant difference in flexion, radial deviation, ulnar deviation and pain (p>0.05). Also no difference in range of motion and pain was observed between proximal migration group and distal group (p>0.05). DISCUSSION AND CONCLUSION: In retrospective analysis of dynamic external fixator, range of wrist motion should be preserved by decrease of changes of ball joint location within 10mm from center of rotation.
Axis, Cervical Vertebra ; External Fixators ; Humans ; Intra-Articular Fractures ; Joints ; Pronation ; Radius ; Radius Fractures ; Range of Motion, Articular ; Retrospective Studies ; Supination ; Wrist

PURPOSE: This study was undertaken to correlate the CT and histopathologic findings of abscess wall. MATERIALS AND METHODS: The CT findings of 12 patients with pathologically proven brain abscess were retrospectively analyzed with particular attention to the thickness, smoothness and uniformity of enhancing abscess wall, and the results were correlated with histopathologic findings. RESULTS: Two patients with acute cerebritis showed an isodense ring on non-contrast CT(NCCT), but a true capsule formation could not be identified at pathologic examination. Six other patients with isodense ring on NCCT consisted of early to late cerebritis(3 cases), late cerebritis to early capsule(1 case), early capsule(1 case), and late capsule(1 case). These 6 cases showed ring enhancement on contrast enhanced CT(CECT) and true capsule formation pathologically. There was no isodense ring on NCCT in the remaining four patients. They consisted of early to late cerebritis(2 cases), late cerebritis(1 case), and late cerebritis to early capsule formation(1 case). These also showed ring enhancement on CECT and true capsule formation pathologically. CONCLUSION: We found that it is difficult to predict the exact stage of brain abscess on preoperative CT findings. It is suggested that clinical findings and sequential dynamic CT may provide more detailed informations for evaluation of abscess staging.
Abscess ; Brain Abscess* ; Brain* ; Humans ; Retrospective Studies

STUDY DESIGN: In vitro studies using human intervertebral disc for the localization of the type IV collagen. OBJECTIVE: 1) To study the distribution pattern and immunoexpression of type 4 collagen in the intervertebral disc, 2) To study the function of type IV collagen in the intervertebral disc. SUMMARY OF BACK GROUND: The correlations of degeneration changes and collagens in the dics have not been determined. The reports for type IV collagen were few. So far, the histologic analysis for the expression of type IV collagen in the intervertebral disc has not been done. There was no report to study the function of the type IV collagen in the intervertebral disc. METHODS: Fifty-four disc blocks obtained during anterior interbody fusion of the lumbar spine were used to observe the expression pattern of the type IV collagen with immunochemical stain. For the observation of the myxomatous degeneration in the intervertebral disc, the alcian blue stain with periodic acid-schilff was done. For the control group, 22 neonate intervertebral disc blocks were obtained at autopsy. RESULTS: The immunoreactions for type IV collagen were associated blood vessels in the anulus fibrosus in the disc. There was no statistical significant difference of the type IV collagen expression between the control and disease groups. Myxomatous degenerations were observed as the irregular form in the degenerative intervertebral disc. CONCLUSION: The immunoreactions for the type IV collagen were observed in the intervertebral discs and associated with the formation of the blood vessels, especially in anulus fibrosus.
Alcian Blue ; Autopsy ; Blood Vessels ; Collagen ; Collagen Type IV* ; Dacarbazine ; Humans ; Infant, Newborn ; Intervertebral Disc Degeneration ; Intervertebral Disc* ; Spine

BACKGROUND AND OBJECTIVES: Stroke onset is known to vary by several factors. Although it has been known that stroke may develop most frequently in the morning, its association with the type of activity has quite rarely been described. METHODS: We prospectively investigated by interview the time of and the activity during or before the onset of stroke in patients with acute cerebral infarction from Aug. 1995 to Mar. 1996. The activities were subdivided into basal metabolic rate state, sedentary, light, moderate, and heavy movements based on the caloric expenditure. RESULTS: One hundred-twenty five patients were enrolled. The time of day when ischemic stroke most frequently occurred was from 8:00 AM to noon. The type of activity was significantly associated with stroke onset in that it developed most commonly during and just after sleep or resting. The relationship between the onset of stroke and such patterns of onset time and the activity was found only in the atherothrombotic infarction, but not in the other stroke types. CONCLUSION: We demonstrated that stroke has clear diurnal variation. Our observations also suggested that the activity may be significantly associated with stroke onset. These findings may be useful for better understanding of the pathogenesis and prevention of ischemic stroke.
Basal Metabolism ; Cerebral Infarction* ; Health Expenditures ; Humans ; Infarction ; Prospective Studies ; Stroke

Plasma cell balanitis (Balanitis circumscripta plasmacellularis or Zoon's balanitis) is an idiopathic, benign condition of the glans penis or prepuce. It occurs mostly as a solitary, persistent plaque among middle-aged to older uncircumcised males. It is characterized by chronic, shiny, smooth, red-orange plaques with small, dark red stippling. When the plasma cell balanitis is suspected clinically, diagnosis can be readily confirmed by microscopic examinations of the lesion. Differentiating this lesion from similar lesions such as premalignant, infective and other inflammatory penile lesions is important. The current preferred treatment is circumcision and this disorder can be treated relatively easily by circumcision. We, herein, report an interesting case of plasma cell balanitis on preputial mucosa.
Balanitis ; Circumcision, Male ; Female ; Humans ; Male ; Mucous Membrane ; Penis ; Plasma ; Plasma Cells

The purpose of this study is to evaluate the ventricular conduction abnormalities, especially RBBB, observed electrocardiographically after surgical closure of VSD. The present study population consists of 92 patients with VSD who were surgically corrected at the Hanyang University Hospital during 6 years period from Jan. 1985 to Dec. 1990. We reviewed their clinical records including surgical notes and EKG findings before and after operations. The results of the study were as follows: 1) Male to female ratio was 1.1:1 (48:44) 2) Out of a total of 92 cases of VSD, 65cases(70.7%)were perimembranous type and 27 cases (29.3%)were subarterial type. 3) The normal preoperative EKG findings were seen in 22 patients, LVH in 21 patients, BUH in 47patients, and RVH in 3 patiens. 4) A transatrial approach was performed in 55 cases, right ventriculotomy with or without resection of muscles in right ventricle in 13 cases, and pulmonary arteriotomy alone in 24 cases. 5) The right bundle branch block after operation developed in 33 patients out of the 65 patinets with perimembranous defect and 5 patients out of the 27 patients with subarterial defects. Postoperative RBBB developed more frequently in perimembranous defect than in subarterial defect. 6) Postoperative RBBB occured in 31.8% of the patients with normal preoperative EKG findings, 23.8% with preoperative LVH, 52.1% with BVH and 66.7% with RVH. Postoperative RBBB was more frequently observed in the patients group with preoperative BVH or RVH than the patients with normal or LVH. 7) Postoperative RBBB was observed in 84.6% after right wentriculotomy, in 43.6% after right atriotomy and in 12.5% with pulmonary arteriotomy alone.
Bundle-Branch Block* ; Electrocardiography ; Female ; Heart Septal Defects, Ventricular* ; Heart Ventricles ; Humans ; Male ; Muscles

No abstract available.
Epilepsy* ; Video Games*