The purpose of this study was to investigate that there was any differences of uptake ratio of Tc99-m-MDP during the healing process related to fracture level in tibia. Thirty mature rabbits were devided into three groups and each group consisted of ten rabbits. The osteotomy was performed at the proximal third of tibia in group I, at the middle third in group II and at the distal third in group III, respectively. After fracture was reduced, the fractured tibia was fixed with K-wire and immobilized with long leg cast. Serial Tc-99m-MDP scintigraphy with pixel counting method was performed in thirty cases of tibial shaft fracture from one day to eight weeks after fracture. The results obtained were as follows: l. In group I, the mean uptake ratio of Tc-99m-MDP at fracture site was 1.40±0.45 at two days after fracture, 3.34±1.21 at two weeks and increased rapidly to a maximal value of 7.51%1.01 at three weeks and decreased thereafter to 4.530.83 at eight weeks. 2. In group II, the mean uptake ratio was 1.10±0.10 at three days, 3.931.±10 at three weeks and increased rapidly to a maximal value of 7.37±2.21 at four weeks and decreased thereafter to 4.54±0.96 at eight weeks. 3. In group III, the mean uptake ratio was 1.13 ± 0.11 at three days, 3.95±0.93 at three weeks and increased rapidly to a maximal value of 7.43±1.72 at four weeks and decreased thereafter to 4.69±0.93 at eight weeks. These experiments suggest that the changes of Tc-99m-MDP scintigraphy in the proximal third fractures of tibia was earlier than middle or distal third fractures and there was no differences between middle and distal third fractures of the tibia.
Leg ; Methods ; Osteotomy ; Rabbits ; Radionuclide Imaging ; Tibia

BACKGROUND: The purpose is to determine the efficacy of additional intravenous patient-controlled analgesia (IV-PCA) by comparing the analgesic effects between interscalene block (ISB) combined with IV-PCA and single ISB after arthroscopic shoulder surgery. METHODS: A total of 213 patients who underwent arthroscopic shoulder surgery were divided into two groups based on the type of perioperative anesthesia. The single ISB group included 100 patients, while the IV-PCA group included 113 patients. The visual analogue scale for pain (VAS pain) scores were assessed at 12, 24, and 48 hours postoperatively in accordance with shoulder pathology. Postoperative narcotics-related complications and consumption of additional non-steroidal anti-inflammatory drugs between the two groups were compared. RESULTS: VAS pain showed no significant difference between the two groups at most points of the postoperative timeline, regardless of shoulder pathology, except in patients with rotator cuff repair at postoperative 24 hours. Although the IV-PCA group showed a statistically lower VAS pain score than the ISB group at postoperative 24 hours (p=0.04), the difference in the VAS pain score was only 9.0 mm in patients with rotator cuff repair. Narcotics-related complications were observed more frequently in the IV-PCA group than in the ISB group for patients with rotator cuff repair. CONCLUSIONS: Additional IV-PCA demonstrated no booster effect for immediate pain control in patients undergoing arthroscopic shoulder surgery with preoperative single ISB. Furthermore, patients with IV-PCA experienced greater narcotics-related complications.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia ; Arthroscopy ; Humans ; Pathology ; Prospective Studies* ; Rotator Cuff ; Shoulder*

BACKGROUND: The purpose of this study is to assess the range of shoulder motion using an indirect evaluation method without physical examinations of patients based on questionnaires regarding several specific arm postures referenced by patient's own body parts. METHODS: Nine criteria of specific shoulder motion including 4 forward flexion, 2 external rotation, and 3 internal rotation were decided as reference position which can represent a certain shoulder motion. Flexion contains postures such as lifting arm to waist-height, shoulder-height, eye-height, and raising arm above head with arm touching ears. External rotation comprises grasping ears and placing hands on back of the head. Vertebral height in internal rotation is determined by calculating the samples' motions, which are holding on to trouser belts, opposite-elbow, and scapula. These postures are included in questionnaires for patients to evaluate the validity and effectiveness of this indirect method. RESULTS: The range of flexion was 77degrees (60degrees to 100degrees), 96degrees (87degrees to 115degrees), 135degrees (115degrees to 150degrees), and 167degrees (150degrees to 175degrees) when arms go up to waist, shoulder, eye, and high vertically. Range of external rotation was 39.6degrees (30degrees to 50degrees) when grasping ears and 69.2degrees (60degrees to 80degrees) with the hands on the back of the head. Range of internal rotation was L4 when placing trouser belts, T12 for holding opposite elbow, and T9 for reaching scapula. The mismatch rates of flexion, external rotation, and internal rotation were 11.6%, 9.6%, and 7.8%. CONCLUSIONS: The range of shoulder motion using this method is expected to be applied to an established shoulder scoring system which included shoulder motion evaluation item.
Arm ; Ear ; Elbow ; Hand ; Hand Strength ; Head ; Human Body* ; Humans ; Lifting ; Physical Examination ; Posture ; Range of Motion, Articular ; Scapula ; Self-Assessment ; Shoulder Joint ; Shoulder* ; Telephone ; Surveys and Questionnaires

Foreign body aspiration can produce a medical emergency. Obstruction of the airways can be life-threatening, and complications may develop in less-severe cases if it is left untreated. Although it is more prevalent in children by approximately three times, adults can still experience it, and it is more frequently related to healthcare in adults. Objects used in dental treatment are usually placed in the oral cavity and can be ingested or inhaled by accident. Dental treatment has been identified as an important cause of the misplacement of foreign bodies in the airway. However, few reports have been published on dentistry-related foreign body aspiration. This paper discusses the disease course, management, and clinical outcomes of foreign body aspiration, especially those associated with dentistry. The patient must be examined for respiratory distress. If the patient is unstable, urgent airway management and the maneuvers for removal should be performed. Radiographs and computed tomography can help identify and locate the object. The treatment of choice is often bronchoscopy, and both flexible and rigid endoscopes can be used depending on the situation. Preventive measures need to be implemented to avoid inhalation accidents given the potential consequences. Though the incidence is rare, healthcare levels need to be enhanced to avert morbidity and mortality. Radiological evaluation and bronchoscopy are vital for management.

No abstract available.
Child* ; Humans ; Infant* ; Intussusception*

Complications after a median sternotomy incision, which is used currently in most open heart surgery, are serious, although it is infrequent. Reconstruction of the sternal defect resulting from dehiscence of median sternotomy is still big challenge to the most plastic surgeons. Since vascularized greater omentum was transposed to eliminate mediastinal wound problems, many vascularized regional muscle flaps became mainstay in reconstruction of median sternotomy wound. We treated 13 patients with median sternotomy dehiscence between October of 1993 and March of 1998. In two patients, the wound problems were so confined to superficial tissue that debrided and closed primarily. Eleven patients with deep wound infection were managed with vigorous debridement of all necrotic tissues and resultant defects were covered with regional muscle flaps: rectus myocutaneous flap(3) and bilateral pectoralis advancement flap(8). We used the pectoralis major advancement flaps without counter incision at humeral insertion site and the dissections were limited only medial to the anterior axillary line to preserve the axillary fold. In five patients with larger defects, we elevated muscle and cutaneous flaps separately to make these flaps more mobile. Large portion of two rectus abdominis flaps could not survive, whereas pectoralis advancement flaps had mo special wound problems. Only one patient developed fistula due to remained wire, regardless to flap surgery.
Debridement ; Fistula ; Humans ; Omentum ; Rectus Abdominis ; Sternotomy* ; Thoracic Surgery ; Wound Infection ; Wounds and Injuries

BACKGROUND: In patients with myocardial infarction, one needs to know the location, extent and severity of wall motion abnormalities to assess prognosis and guide therapy. Thus more precise quantatative estimates of regional ventricular function are required. Regional wall motion has generally been assessed by displaying the multiple cardiac images of RVG as endless-loop movie, but the cinematic display was not objective. We used the usefulness of the phase analysis in evaluating the global left ventricular function and regional wall motion abnormalities of patients with myocardial infarction. The accuracy of the RVG cinematic display in detecting regional wall motion abnormalities in patients with myocardial infarction was also evaluated. METHODS: Studied cases were 97 patients with myocardial infarction and 20 normals with low likelihood of coronary artery disease. Coronary angiography and contrast left ventriculography were performed in all patients with myocardial infarction. The regional wall myocardial infarction(presence) is defined when the EKG presented the evidence of myocardial infarction, left ventriculogram showed RWMA(regional wall motion abnormality) along with stenosis of 50% or greater of the regional supplying coronary artery. Each patient was imaged in 45 left anterior oblique(LAO) view, anterior(Ant) view and left lateral(Lt Lat) view. We evaluated Left ventricular ejection fraction(LVEF) from time-activity curve. We constructed the histogram for the left ventricle and both ventricle separately to obtain the global and total phase angle(GPA, TPA), standard deviation of phase angle(GSDPh, TSDPh), full width half maximum(GFWHM, TFWHM). The left ventricle was divided into 7 segments. LAO projection ; septal, apical, basal lateral, apical lateral, Ant projection ; anterolateral, Lt Lat projection ; inferior, posterior, Phase angle(RPA) and full width half maximum(RFWHM) from the histogram (regional 7 segments) were examined. On the RVG cinematic display, the standard 4 grading system was used, normal, hypokinesia, akinesia, dyskinesia. The observer evaluated regional wall motion abnormality of the 7 segments for all cases. The sensitivity of the above parameters and RVG cinematic display was evaluated. We analyzed the regional parameters among the patents with regional wall myocardial infarction(presence), those without regional wall myocardial infarction(absence) and control group using the t-test. The statistical analysis was done by one way ANOVA between regional phase analysis and RVG cinematic display. RESULTS: The sensitivity of LVEF was lowest(70.1%) and the GFWHM was highest among the global parameters(89.1%). But RFWHM showed even higher sensitivity(96.9%), thus regional phase analysis was also required. The RVG cinematic display was also sensitive(92.7%), but less sensitive than the RFWHM. On regional phase analysis the RPA of septal, apical, inferior, posterior walls of the left ventricle was able to separate presence group from absence group and also presence group from control group and the RPA of the apical lateral wall could separate presence group from absence group. The RPA of basal lateral and anterolateral wall was inaccurate in diagnosing the regional wall myocardial infarction, because basal lateral wall was overlapped by adjacent vascular structures, and the area of anterolateral wall dose not correlate completely beteen the RVG & the left ventriculogram, also the anterolateral wall can be supplied by the obtuse marginal branch of left circumflex artery. The RFWHM of all regional walls of left ventricle could separate presence group from absence group and presence group from control group. We found good correlation between regional phase analysis & left ventriculogram for detection of regional wall myocardial infartion. On RVG cinematic display, the RPA of the normal group was different from that of dyskinesia, akinesia and hypokinesia groups. The RPA of the dyskinesia group was also different from that of skinesia and hypokinesia groups by oneway ANOVA(p<0.05). The RFWHM of the dskinesia group was different from that of the normal group and hypokinesia group. RVG cinematic display correlated well with regional phase analysis and also quantitation of wall motion. CONCLUSIONS: Thus RVG cinematic display was useful and can not be replaced by phase analysis. But the regional phase analysis was sensitive and objective in diagnosing the wall motion abnormality in myocardial infarction.
Ants ; Arteries ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Dyskinesias ; Electrocardiography ; Heart Ventricles ; Humans ; Hypokinesia ; Myocardial Infarction* ; Prognosis ; Radionuclide Ventriculography ; Ventricular Function ; Ventricular Function, Left

PURPOSE: After delivery, eating brown seaweed soup is a typical Korean tranditional habit. But, excessive intake of iodine transiently inhibits biosynthesis and secretion of thyroid hormones if a certain threshold of iodine is reached in the serum. The aim of our study was to demonstrate whether the observed the elevations of TSH level in the breast fed neonatal infants was caused by mother's eating brown seaweed soup or not. METHODS: We performed neonatal TSH test by enzyme linked immunosorbent assay(FRELISA Screenig TSH) and cheked TSH level for 178 newborns with a appropriate gestational age. We divided the study subject into 3 groups, the group used breast feeding, mother had taken brown seaweed soup and blood sampled at 6th day after birth was categorized Group A, formular feeding, blood sampled at the 4th days after birth was categorized Group B, breast feeding and had taken brown seaweed soup and blood sampled at the 19th day after birth was categorized Group C. RESULTS: 1) The mean TSH level was 1.5+/-1.3 uU/ml in Group A, 3.3+/-2.5uU/ml in Group B, 1.7+/-l.3uU/ml in Group C(Group A vs Group B: p<0.05, Group A vs Group C: p<0.05). 2) There was no statistical significances between the TSH levels and the amount of brown seaweed soup which mother had one day, the duration which mother had brown seaweed soup and duration of breast feeding. CONCLUSIONS: Mother had taken brown seaweed soup about 3 times a day in korea at present days, There was no significant changes of TSH levels in the beast fed newborn infants after the korean mother had taken brown seaweed soup.
Breast Feeding* ; Breast* ; Eating* ; Gestational Age ; Humans ; Infant ; Infant, Newborn* ; Iodine ; Korea ; Mothers ; Parturition ; Seaweed* ; Thyroid Hormones

PURPOSE: The symptoms of female urethral syndrome (FUS) can originate from mechanical or functional obstructions of the bladder neck or urethra. From retrospective reviews of women referred for evaluation of lower urinary tract symptoms (LUTS), 2.7 to 23% had urodynamic evidence of a bladder outlet obstruction (BOO). However, few urodynamic studies (UDS) have been performed on the prevalence of BOO in FUS. This study was aimed at identifying the causative factors of FUS symptoms, including BOO, as evidenced by UDS. MATERIALS AND METHODS: One hundred and sixteen women with FUS were enrolled in our UDS evaluations. An additional 247 patients, presenting for evaluation of stress urinary incontinence (SUI), served as controls. Comparisons of the maximum flow rate (Qmax), voided volume, post-void residual, detrusor pressure at maximum flow rate (PdetQmax), maximum detrusor pressure (Pdetmax) were made between the FUS and SUI cases. By definition, the FUS cases were divided into normal, BOO, detrusor under activity, detrusor instability and low compliance. These sub-groups were compared with controls in a similar way. RESULTS: Women with FUS showed a lower Qmax (15.9 versus 23.8ml/sec, p<0.05), higher post-void residual (86 versus 22ml, p<0.05), PdetQmax (24.0 versus 18.0 cmH2O, p<0.05) and Pdetmax (33.3 versus 27.9cmH2O, p<0.05) compared to those with SUI. The incidence of BOO, detrusor under activity and detrusor instability were 31.9, 25 and 16%, respectively, in the FUS group. Only 22% of women with FUS showed normal UDS findings. CONCLUSIONS: These results indicated the importance of UDS in identifying the causative factors of the symptoms of FUS. Treatment of a BOO will help provide new treatment modalities for FUS.
Classification* ; Compliance ; Female* ; Humans ; Incidence ; Lower Urinary Tract Symptoms ; Neck ; Prevalence ; Retrospective Studies ; Urethra ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Incontinence ; Urodynamics*

PURPOSE: The symptoms of female urethral syndrome (FUS) can originate from mechanical or functional obstructions of the bladder neck or urethra. From retrospective reviews of women referred for evaluation of lower urinary tract symptoms (LUTS), 2.7 to 23% had urodynamic evidence of a bladder outlet obstruction (BOO). However, few urodynamic studies (UDS) have been performed on the prevalence of BOO in FUS. This study was aimed at identifying the causative factors of FUS symptoms, including BOO, as evidenced by UDS. MATERIALS AND METHODS: One hundred and sixteen women with FUS were enrolled in our UDS evaluations. An additional 247 patients, presenting for evaluation of stress urinary incontinence (SUI), served as controls. Comparisons of the maximum flow rate (Qmax), voided volume, post-void residual, detrusor pressure at maximum flow rate (PdetQmax), maximum detrusor pressure (Pdetmax) were made between the FUS and SUI cases. By definition, the FUS cases were divided into normal, BOO, detrusor under activity, detrusor instability and low compliance. These sub-groups were compared with controls in a similar way. RESULTS: Women with FUS showed a lower Qmax (15.9 versus 23.8ml/sec, p<0.05), higher post-void residual (86 versus 22ml, p<0.05), PdetQmax (24.0 versus 18.0 cmH2O, p<0.05) and Pdetmax (33.3 versus 27.9cmH2O, p<0.05) compared to those with SUI. The incidence of BOO, detrusor under activity and detrusor instability were 31.9, 25 and 16%, respectively, in the FUS group. Only 22% of women with FUS showed normal UDS findings. CONCLUSIONS: These results indicated the importance of UDS in identifying the causative factors of the symptoms of FUS. Treatment of a BOO will help provide new treatment modalities for FUS.
Classification* ; Compliance ; Female* ; Humans ; Incidence ; Lower Urinary Tract Symptoms ; Neck ; Prevalence ; Retrospective Studies ; Urethra ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Incontinence ; Urodynamics*