The purpose of this study was to investigate the arthro-sonographic appearance of the chronic anterior talofibular ligament (ATFL) injury. Twenty-nine patient, who were identified to have partial or complete ATFL tears by conventional ultrasonography were included. Intraarticular injection of 5 mL of fluid (2.5 cc lidocaine+2.5 saline) was performed under ultrasound-guidance, which was followed by arthrosonography. Among 23 patients with partial tear which was detected by the conventional ultrasonography, 11 patients were identified to have complete tear by the arthrosonography. Among 6 patients with complete tear was detected by conventional ultrasonography, all of them identified to have complete tear by the arthrosonography. Arthrosonography is helpful in evaluation the configuration of ATFL complete tear and detecting complete tear by making them appear larger and apparent after instillation of fluid.
Humans ; Injections, Intra-Articular ; Ligaments

PURPOSE: Oxidative stress is the well known causative factor for retinal damage. This study investigated the effects of glutathione on reactive oxygen species(ROS) induced injury in human retinal pigment epithelial(HRPE) cells. OBJECTS AND METHODS: HRPE cells (ATCC:CRL-2302) were cultured with DMEM media and exposed to oxidative stress (paraquat, hydrogen peroxide) and/or glutathione modulator[(buthionine sulfoximine (BSO), glutathione (GSH), 2-oxo 4-thiazolidine carboxylic acid (OTC)] for 2 days. The cell viability was determined by measuring the amount of reduced 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT). RESULTS: The rate of MTT reduction of HRPE cells decreased by either paraquat or hydrogen peroxide treatment. BSO as a inhibitor of glutathione biosynthesis potentiated paraquat- or hydrogen peroxideinduced HRPE cells injury. On the other hand GSH or OTC reduced the rate of decrement of MTT reduction in HRPE cells by paraquat and hydrogen peroxide. CONCLUSIONS: Glutathione seemed to play some role in prevention of ROS-induced HRPE cells injury and OTC may be used as an agents for prevention of free radical induced HRPE cell injury.
Cell Survival ; Epithelial Cells* ; Glutathione* ; Hand ; Humans* ; Hydrogen ; Hydrogen Peroxide ; Oxidative Stress ; Oxygen* ; Paraquat ; Retinaldehyde*

OBJECTIVE: To compare the short-term effects and advantages of transforaminal epidural steroid injection (TFESI) performed using the conventional (CL) and posterolateral (PL) approaches. METHOD: Fifty patients with lumbar radicular pain from lumbar spinal stenosis and herniated lumbar disc were enrolled. Subjects were randomly assigned to one of two groups (CL or PL group). All procedures were performed using a C-arm (KMC 950, KOMED, Kwangju, Kyunggi, Korea). We compared the frequency of complications during the procedure and the effects of the pain block between the two groups at 2, 4, and 12 weeks after the procedure. RESULTS: There were no significant differences in the demographic data, initial VNS (Visual numeric scale), or ODI (Oswestry disability index) between the CL group (n=26) and the PL group (n=24). There was no statistically significant difference in the outcome measures (VNS and ODI) between the groups at 2, 4, or 12 weeks. Symptoms of nerve root irritation occurred in 1 case of the CL group and in 7 cases of the PL group (p<0.05). Pricking of spinal nerve during the procedure and transient weakness after the procedure occurred in 6 cases and 3 cases, respectively in the CL group, but did not occur in the PL group. CONCLUSION: Our findings suggest that the posterolateral approach represents an alternative TFESI method in cases with difficult needle tip positioning in the anterior epidural space, and could lower the risk of target nerve root irritation and nerve penetration.
Epidural Space ; Humans ; Needles ; Outcome Assessment (Health Care) ; Spinal Nerves ; Spinal Stenosis

A 36-year-old female amateur cyclist developed mononeuropathy of the deep branch of the ulnar nerve due to nerve compression adjacent to the ulnar tunnel (type II Guyon’s canal syndrome) caused by prolonged bicycle riding.The patient’s signs and symptoms persisted even after refraining from cycling for 4 weeks; thus, she underwent decompression of the deep branch of the ulnar nerve in the palm and wrist. Three months postoperation, she recovered nearly full power and function of her left hand.

PURPOSE: In response to a growing threat of violence in hospitals, we examined a specific educational effort to reduce emergency department (ED) violence in the shortterm. METHODS: Cross-sectional prospective surveys were conducted at Chosun University Hospital Emergency Center during a baseline period from May 26 to Jul. 9. 2003, and during a post-education period from Aug. 7 to Sep. 20. 2003. Questions addressed the degree of violence, the reason for the violence, demographic information about the perpetrator of the violence, the outbreak time of the violence and the response of emergency personnel. RESULTS: After an education program on violence, the rate of violent events in the ED was decreased by 23.5%. A notable change was that ED workers handled the violence more positively during the post-education period by isolating or restraining the aggressor. Almost all of the violence was caused by males, particularly those in their third or fourth decade. The violence occurred mostly on the night shift. Of the violence, 52.4% was caused by the patient while 34.8% was caused by the patient's guardian. The leading causes of violence were drunkenness and delays in laboratory tests and treatment. Verbal abuse and threats were the most concern forms of violence. CONCLUSION: Violent events are frequent in the ED. Education programs may reduce the number of events at least temporarily.
Alcoholic Intoxication ; Education* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Male ; Prospective Studies ; Violence*

OBJECTIVE: To compare the short-term effect and advantage of transforaminal epidural steroid injection (TFESI) performed using the Kambin's triangle and subpedicular approaches. METHOD: Forty-two patients with radicular pain from lumbar spinal stenosis were enrolled. Subjects were randomly assigned to one of two groups. All procedures were performed using C-arm KMC 950. The frequency of complications during the procedure and the effect of TFESI at 2 and 4 weeks after the procedure between the two groups were compared. Short-term outcomes were measured using a visual numeric scale (VNS) and a five-grade scale. Multiple logistic regression analyses were performed to evaluate the relationship between possible outcome predictors (Kambin's triangle or subpedicular approach, age, duration of symptoms and sex) and the therapeutic effect. RESULTS: VNS was improved 2 weeks after the injection and continued to improve until 4 weeks in both groups. There were no statistical differences in changes of VNS, effectiveness and contrast spread pattern between these two groups. No correlation was found between the other variables tested and therapeutic effect. Spinal nerve pricking occurred in five cases of the subpedicular and in none of the cases of the Kambin's triangle approach (p<0.05). CONCLUSION: The Kambin's triangle approach is as efficacious as the subpedicular approach for short-term effect and offers considerable advantages (i.e., less spinal nerve pricking during procedure). The Kambin's triangle approach maybe an alternative method for transforaminal epidural steroid injection in cases where needle tip positioning in the anterior epidural space is difficult.
Constriction, Pathologic ; Epidural Space ; Humans ; Imidazoles ; Injections, Epidural ; Logistic Models ; Needles ; Nitro Compounds ; Spinal Nerves ; Spinal Stenosis

PURPOSE: Central compartment reoperation for recurrent thyroid carcinoma is challenging to surgeons due to the scar tissues and adhesions and the distortion of the normal anatomic relationships. This study was carried out to investigate the central neck recurrence patterns and the surgical morbidity of reoperation for patients with papillary thyroid carcinoma. METHODS: The study population was comprised 68 papillary thyroid carcinoma patients (15 males and 53 females, median age: 50.8 years [range: 12~78 years]) who underwent reoperation for recurrent tumors in the central compartment of the neck between January 1999 and June 2007. All of the patients had undergone prior total thyroidectomy. RESULTS: Of the 68 patients, 21 recurrences occurred in the proper thyroid tissue of the thyroid bed, 43 in the central neck nodes and 4 in a combination of the central nodes and proper thyroid tissue. The common recurrent site from the proper thyroid tissue were at the berry ligaments and at the level of the upper one-third of the recurrent laryngeal nerves, while the common nodal recurrence sites were the lower-most portion of the paratracheal nodes and the right paraesophageal nodes (the lymph nodes posterior to the right recurrent laryngeal nerve). Eleven cases of transient hypocalcemia (17.5%, 11/63) and 3 cases of permanent hypocalcemia (4.3%, 3/63) were noted after reoperation. Recurrent laryngeal nerve injury occurred in 5 patients (8.1%, 5/62), but three of them were intentionally resected with the recurrent cancers. CONCLUSION: Reoperation for central neck recurrence of papillary thyroid carcinoma is associated with a higher complication rate. Meticulous surgical dissection of the central compartment based on the recurrent patterns is important to reduce injury to the recurrent laryngeal nerves and parathyroid glands.
Carcinoma ; Cicatrix ; Female ; Fruit ; Humans ; Hypocalcemia ; Intention ; Ligaments ; Lymph Nodes ; Male ; Neck ; Recurrence ; Recurrent Laryngeal Nerve ; Recurrent Laryngeal Nerve Injuries ; Reoperation ; Thyroid Gland ; Thyroid Neoplasms

No abstract available.
Cervix Uteri* ; Female ; Uterine Cervical Neoplasms*

OBJECTIVE: This study was conducted to assess the reliability, the validity, the psychological characteristics, and the internal structure of the Negative Acts Questionnaire-Revised (NAQ-R) for nurses for the assessment of the workplace bullying. METHODS: A total of 190 female nurses who worked in a university hospital and who had participated in an annual health surveillance program were recruited into the study. A structured questionnaire was used to evaluate each participant's workplace bullying, job stress, and psychosocial wellbeing. Workplace bullying was assessed using the negative acts questionnaire-revised (NAQ-R), job stress was assessed using the Korean Occupational Stress Scale-Short Form (KOSS-SF) and psychosocial wellbeing was assessed using the Psychosocial Wellbeing Index-Short Form (PWI-SF). Resulting answers from the questionnaires were analyzed by chi-square, ANOVA, correlation analysis, and factor analysis. RESULTS: Victims of workplace bullying of nurses in a hospital is 37(19%) based on operational bullying criteria. The Cronbach's alpha for the negative acts questionnaire-revised (NAQ-R) is 0.9260. By exploratory factor analysis, we conclude that 3 factor are most relevant. Criterion validity was satisfied with that a negative acts questionnaire-Revised (NAQ-R) resulting in a statistically significant and positive relationship with PWI-SF , construct validity was satisfied with that NAQ-R has statistically significant and high positive correlation with the occupational climate of the KOSS results. CONCLUSIONS: The negative acts questionnaire-revised (NAQ-R) is a reliable and valid tool for the assessment of workplace bullying in the hospital nurse. By using this tool, we can imply the prevalence of and the condition of workplace bullying among the nurse.
Bullying ; Climate ; Female ; Humans ; Prevalence ; Questionnaires ; Reproducibility of Results

Acral persistent papular mucinosis (APPM) is a rare subtype of localized lichen myxedematosus, which involves only the extensor surfaces of the hands, wrists and the distal part of forearms. Some subtypes of lichen myxedematosus including APPM have been reported with increased frequency in a patient with human immunodeficiency virus (HIV) infection. We describe a 31 year-old male patient with an HIV infection who presented with discrete, flesh-colored papules on the extensor surfaces of the wrists and the distal part of the forearms. Histopathologic findings revealed focal deposition of mucin in papillary and mid dermis that spared a small grenz zone. The lesions showed spontaneous regression after starting highly active antiretroviral therapy (HAART). We report a rare case of APPM in a patient with HIV infection which showed spontaneous regression with HAART, suggesting that APPM may represent one of the cutaneous markers of HIV infection.
Acquired Immunodeficiency Syndrome ; Adult ; Antiretroviral Therapy, Highly Active ; Dermis ; Forearm ; Hand ; HIV Infections* ; HIV* ; Humans ; Male ; Mucins ; Scleromyxedema* ; Wrist