To compare the efficiency, success rate and abortion time of applications of intravaginal misoprostol versus intravenous Sulprostone(Nalador) for mid-trimester pregnancy termination. Eighty three patients between 17-29 weeks of gestation with medical, obstetric, or genetic reasons for termination of pregnancy were randomized to receive either 50 ug tablets of misoprostol placed in the posterior vaginal fomix or 1,000ug sulprostone intravenously diluted I L of isotonic saline solution given as a 12-h infusion. Among eighty three patients recruited, fourty five patients received misoprostol and thirty eight patients received sulprostone intravenously. The average interval from start of induction to vaginal delivery was 13.35+/-3.34 hours in misoprostol group and 21.14+/-6.64 hours in the sulprostone group. The success rate of complete termination within 12 and 24 hours in misoprostol group were 57.7%, 93.3%, respectively, while in sulprostone group were 15.8%, 92.1% respectively. Oxytocin augumentation was 6.7% in misoprostol group and 7.9% in the sulprostone group. No serious complication occurred. Intravaginal misoprostol appears to be acceptably safe and effective agents for second trimester pregnancy termination. Misoprostol has the advantage of being inexpensive, easily stored and readily available. The regimen of 100 ug misoprostol inserted intracervicovaginally every 8 hours is the optimal method for pregnancy termination.
Female ; Humans ; Misoprostol* ; Oxytocin ; Pregnancy ; Pregnancy Trimester, Second* ; Sodium Chloride ; Tablets

No abstract available.
Ischemia* ; Lower Extremity*

The technique of muscle transposition has gained an accepted place in treating the wide skin defect with bony exposure in which conventional palliative care has rarely been successful. The principle of this procedure, popularized by Ralph Ger and significantly contributed by Bakajian, has been approved by many and now been adapted in the care of similar lesion throughout the entire body regions. This report comprises the results of muscle transposition experienced in 28 patients. The results were as follows: 1. Twenty-four cases of antetibial skin defect with bony exposure, resulted from chronic osteomyelitis, open fracture, chronic ulcer, and burn scar, were successfully managed with the transposition of single muscle or combination of them: medial head of the gastroenemius, the soleus, the flexor digitorum longus and the abductor hallucis. The extent and the level of the defect in each case were the sole indication of selection of the appropriate muscle and the number. 2. Four patients with decubitus ulcer in the sacral region were also managed by transposing the upper half of the gluteus maximus. 3. Subsequent skin coverage over the transposed muscle were uniformly successful in all cases and this technique seemed to afford a definite favorable influence upon the healing of fracture and the eradication of infection.
Body Regions ; Burns ; Cicatrix ; Fractures, Open ; Head ; Humans ; Osteomyelitis ; Palliative Care ; Pressure Ulcer ; Sacrococcygeal Region ; Skin ; Transplants ; Ulcer

BACKGROUND: The relationship between type II diabetes and congnitive function has been explored in several studies. But the result was controversial. The purpose of the study was to determine whether diabetes mellitus in older patients(>or=65 years) is assiciated with cognitive dysfunction and to discover the related factors with th cognitive dysfunction. METHOD: Twenty patients with type 2 diabetes and twenty subjects with non-diabetes are studied with cognitive function test at Hwachun health center and county hospital. Cognitive function was assessed using Mini-Mental State Examination and Clock Drawing test and the score was analyzed. The diabetes groups were subdivided with duration of diabetes, HbAlc, chronic diabetic complications and then analyzed. RESULTS: A total of 6(30%) diabetic subjects scored below 24 on mini-mental state examination, compared with 3(15%) of controls(p=0.2560). The mean socres were 20.1+/-2.7 and 19.0+/-3.5 respectively. Clock drawing test demonstrated that 13(65%) diabetic subjects inconectly placed the numbers and hands, compared with 7(35%) of controls(p=0.0578>0.05). The duration of diabetes mellitus, HbAlc, chronic diabetic com- plications were not associated with cognitive dysfun- ction among diabetic subjects. CONCLUSIONS: The study showed that type 2 diabetes mellitus in the elderly is not associated with cognitive dysfunction, but further study should be done.
Aged ; Diabetes Complications ; Diabetes Mellitus* ; Diabetes Mellitus, Type 2 ; Hand ; Hospitals, County ; Humans

OBJECTIVE: Our purpose was to compare the expression of endothelial nitric oxide synthase in the placenta and umbilical cord of preeclamptic placenta with that of the normotensive placenta. METHOD: We compared placental endothelial nitric oxide synthase expression in preeclamptic (n=5) with in normal (n=5) pregnancies. Frozen sections of umbilical cords, chorionic plate vessels, and terminal villi were immunostained with a monoclonal endothelial nitric oxide synthase antibody. RESULTS: The age revaled no difference between control (28.1+4.2 years). and study group (26.1+4.7 years). The gestational age was statistically different between control (38.9+1.7 weeks) and study group (34.9+3.5 weeks). The neonatal body weight and placental weight were also statistically different between control (3060+528 g) and study group (2160 417 g). No difference in endothelial nitric oxide synthase immunostaining in the endothelium of the umbilical vessels and stem villous vessels was found between preeclamptic and normotensive pregnancies. In contrast, in the preeclamptic placental endothelial nitric oxide synthase immunostaining was seen in the terminal villous vessels. In the syncytiotrophoblast endothelial niric oxide synthase immunostaining appeared primary basal in location and diffuse in distribution in the preeclamptic placentas but primary apical in the normotensive placentas. CONCLUSION: Differences in endothelial nitric oxide synthase expression in terminal villous vessels and syncytiotrophblast may be a result of vascular alterations or damage that take place in the placenta in preeclampsia.
Body Weight ; Chorion ; Endothelium ; Frozen Sections ; Gestational Age ; Nitric Oxide Synthase Type III ; Nitric Oxide Synthase* ; Nitric Oxide* ; Placenta ; Pre-Eclampsia* ; Pregnancy* ; Trophoblasts ; Umbilical Cord

The significance of the physical examination is controversial since Slocum and Larson first described the concept of rotatory instability of the knee. The findings of the physical examination of the 101 knees of 95 patients from 1982 to 1985 were compared with the operative findings. The results were as follows. 1. Valgus stress test a) The valgus stress test c the knee in extension was positive in 1) combined tear of medial collateral ligament, posterior oblique ligament, either anterior or posterior cruciate ligament, 2) avulsion fracture of medial collateral ligament and 3) extensive tear of medial capsular ligament. But the test was negative when the posterior oblique ligament was intact although the medial collateral ligament and the anterior cruciate ligament were torn. b) The valgus stress test c the knee in 30° flexion was positive in all cases of torn medial collateral ligament, But it was severer in cases of positive test in full extension. 2. The varus stress test in extension was positive when the anterior or posterior cruciate ligament was torn in addition to lateral collateral ligament and posterolateral capsule. 3. The Slocum test was negative, or positive only in neutral rotation in isolated tear of the anterior cruciate ligament. 4. The Ritchey-Lachman test was positive in all cases of torn anterior cruciate ligament. 5. The posterior drawer test could be positive in cases of intact posterior cruciate ligament. 6. The pivot shift test was negative in cases of torn medial collateral ligament and posterior oblique ligament although there was associated tear of the anterior cruciate ligament. 7. The flexion rotation drawer test was positive in all cases of torn anterior cruciate ligament although there was associated tear of the medial collateral ligament. The positive test didn't always mean anterolateral rotatory instability, 8. The reversed pivot shift test was positive in cases of posterolateral rotatory instability but it was negative in cases of associated tear of posteromedial capsule. 9. The drawback of external rotation drawer test was that it depended on subjective evaluation. 10. The rotation test was very good for the rotatory instability but it could not be used in bilateral injury and the anterolateral rotatory instability of isolated tear of anterior cruciate ligament.
Anterior Cruciate Ligament ; Collateral Ligaments ; Exercise Test ; Humans ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Physical Examination ; Posterior Cruciate Ligament ; Tears

Wear of articular cartilage usually occurs at flexion zones (30°–60°) of the femorotibial articulation, which is demonstrable on the 45°posteroanterior (PA) weight-bearing view. The authors measured and evaluated the cartilage space on the non weight-bearing AP view, AP extension weight-bearing view and 45°PA flexion weight-bearing view, comparing operative findings in cases of 18 osteoarthritis, 7 rheumatoid arthritis and 2 spontaneous osteonecrosis of the lateral femoral condyle, who underwent total or hemiarthro plasty (1 case) of the knee. The results were as follows. l. Operative findings of 11 out of 18 osteoarthritis (61.1%) showed cartilage defect of middle 3/4–4/5 of the medial tibial condyle (sparing finger tip sized anterior & posterior edge) and corresponding femoral condyle. The cartilage space on the AP non weight-bearing, AP extension weight-bearing and 45°PA flexion weight-bearing view were normal to 20% decrease (4.1–5.0mm remained), 60–80% decrease (1.1–2.0mm remained) and 80–100% decrease (0–1.0mm remained), respectively, showing one grade increased cartilage space narrowing on the 45°PA flexion weight-bearing view comparing to AP extension weight-bearing view. 2. Uniform cartilage defect of medial compartment was found in 7(38.9%) osteoarthritic knees. The cartilage space on the non weight-bearing AP view were normal. Both AP & PA weightbearing views showed 60–80% decrease (1.1–2.0mm remained) in 3 knees & 80–100% decrease (0–1.0 mm remained) in 4 knees without any difference between the two views. 3. Uniform cartilage space narrowing of both medal & lateral compartment was noted in 7 rheumatoid knees. The cartilage space on the AP non weight-bearing view were 20–40% decrease (3.1–4.0mm remained) in all knees. The AP extension & 45°PA flexion view showed 40–60% decrease (2.1–3.0mm remained) in 2 knees, 60–80% (1.1–2.0mm remained) in 5 knees respectively without any difference between two groups. 4. The anterior horn of menisci was always intact. The presence of menisci didn't affect the radiological cartilage space. 5. The 45°PA flexion weight-bearing view functioned as a tunnel view showing bone defect and less than 20% decrease of cartilage space in cases of the spontaneous osteonecrosis of the lateral femoral condyle. From our results it was concluded that the radiologic cartilage space could be more accurately demonstrated with 45°PA flexion weight-bearing view in addition to the conventional AP extension weight-bearing view.
Animals ; Arthritis, Rheumatoid ; Cartilage ; Cartilage, Articular ; Clothing ; Fingers ; Horns ; Knee ; Numismatics ; Osteoarthritis ; Osteonecrosis ; Weight-Bearing

The effectiveness of alternate flexion and extension splint(splint group) in restoring the range of motion(ROM) following total knee arthroplasty(TKA) was evaluated, comparing with the continuous passive motion(CPM) group. One hundred and twenty knees of 87 patients(21–80 years old:12 males & 75 females) who were followed for 2.7 years(ranging from 1.2 to 5.3 years) were involved in this study. The ROM of following groups were compared each other and the results were analyzed statistically with Wilcoxon rank sum test and the differences between each prosthesis were compared with Kruskal-Wallis test. 1) Splint(51 knees, 42.5%) v.s CPM group(69 knees, 57.5%) 2) RA(43 knees, 35.8%) v.s. OA(77 knees, 64.2%) 3) Various types of prosthesis(PSCK, PCA, Tricon-M, M/G, Oxford Knee, PFC) The results were as follws:1. The ROM of splint group(average 132.2°, ranging from 85–145°) was significantly greater than that of CPM group(average 110.5°, ranging from 50–140°)(p<0.01). 2. The ROM of osteoarthritic knees(average 122.2°) was slightly greater than that of rheumatoid knees(average 115.8°) without statistical significance(p) 0.05). 3. There was statistically significant difference between ROM of the various types of implant(p < 0.01). However this difference seemed due to different methods of rehabilitation rather than different types of prosthesis. From this result it is suggested that the alternate flexion and extension splint following TKA is a useful method in restoring ROM, comparing to gradual ROM exercise with CPM.
Arthroplasty, Replacement, Knee ; Humans ; Knee ; Male ; Methods ; Passive Cutaneous Anaphylaxis ; Prostheses and Implants ; Rehabilitation ; Splints

No abstract available.
Arteriovenous Fistula*

No abstract available.
Colon, Ascending* ; Leiomyosarcoma*