The management of fractures of os calcis remains highly controversial. The fractures involving subtalar joint may cause serious and persistent disabilities. Recently, the computed tomography (CT) scan has been shown to he superior in evaluating the intraarticular fractures of calcaneus and the most widely used classification is based on the number of fragments especially seen on. Although the classification of calcaneal fractures hy CT, tongue type and joint depression type fractures hy plain radiographic views have been commonly used. Generally, closed reduction and axial fixation with metallic pin for tongue type fractures and open reduction and internal fixation for joint depression type fractures have been performed. The authors did so. The 13 fractures were tongue types and 17 fractures were joint depression types. The intraarticular calcaneal fractures of 30 feet in 26 patients who were treated at Our Lady of Mercy Hospital were analyzed in clinical and radiological aspects from Mar.1991 to Apr.1996. The results were as follows: 1. Of 30 cases, 16 fractures were treated with closed reduction and pinning, and 14 fractures were treated with open reduction and internal fixation. 2. The preoperative, postoperative and the last follow-up average Bohlers angle were 6.0, 21.0 and 20.5 respectively. 3. The preoperative, postoperative and the last follow-up average Gissanes angle was 106, 129 and 126 respectively. 4. Based on assessment of the criteria of Salama et al 19), excellent results were 5, good results were 14, fair results were 6 and poor results were 5. 5. All the five cases of poor results were tongue type fractures and they were treated with closed reduction and axial pinning. 6. Of 7 fractures using autogenous iliac bone graft, 6 fractures were good, I fracture was fair and there was no poor results. Therefore, open reduction and internal fixation for joint depression type calcaneal fractures was thought to be a good method of treatment. But we must consider whether axial fixation with metallic pin for tongue type calcaneal fractures will be a good method of treatment.
Calcaneus ; Classification ; Depression ; Follow-Up Studies ; Foot ; Humans ; Intra-Articular Fractures ; Joints ; Subtalar Joint ; Tongue ; Transplants

BACKGROUND: The induced hypotension was used to decrease blood loss, thereby decreasing the need for blood transfusion and/or improving operating conditions at the surgical site. It was hypothesized that SNP-induced hypotension with fixed concomitant esmolol infusion(75 ug/kg/min) might prevent side effects such as reflex tachycardia and reduce SNP dose requirement during SNP-induced hypotension. METHOD: The concomitant infusion of 75 ug/kg/min esmolol was used to potentiate hypotension(30% reduction of mean arterial blood pressure) induced with sodium nitroprusside in six dog during halothane(lvo1%)-N2O(50%)-O2(50%) anesthesia. Mean arterial blood pressure, heart rate, cardiac output, mean pulmonary arterial blood pressure, central venous pressure, arterial blood gas analysis, and mixed venous oxygen saturation were measured and systemic vascular resistance was calculated in the each periods. RESULT: The results run as follows; 1) Compared to SNP-induced hypotension, there was significant reduction in SNP dose requirement to maintain a 30% reduction of mean arterial pressure at the concomitant infusion of 75 ug/kg/min esmolol. 2) There were significant reduction in heart rate, mixed venous oxygen saturation and cardiac output, but significant increase in systemic vascular resistance and mean pulmonary arterial pressure at the coneomitant infusion of 75 ug/kg/min esmolol. 3) No rebound hypertension was observed at 30 minute after SNP and esmolol infusions were simultaneously discontinued. CONCLUSION: The result of present study suggests that esmolol infusion is a safe and effective pharmacologic means of potentiating SNP-induced hypotension during halothane-N2O-O2 anesthesia. Probably esmolol may act by counteracting side effects such as acute tolerance during SNP-induced hypotension.
Anesthesia* ; Animals ; Arterial Pressure ; Blood Gas Analysis ; Blood Transfusion ; Cardiac Output ; Central Venous Pressure ; Dogs* ; Halothane* ; Heart Rate ; Hemodynamics* ; Hypertension ; Hypotension* ; Nitroprusside* ; Oxygen ; Reflex ; Sodium* ; Tachycardia ; Vascular Resistance

OBJECTIVE: This study was conducted to evaluate payer-driven medication adherence intervention program from the patient's and counselor's perspectives. METHODS: Target patients for intervention were selected by retrospective adherence measures based on national health insurance claims data for hypertension, diabetes and hyperlipidemia. As a serial intervention for higher risk groups of medication non-adherence, initial direct mailing, the first direct telephone call and the second direct call or a home visit were followed. Interview approach to qualitative inquiry was used to evaluate intervention results. RESULTS: Participants including 4 patients received telephone calls, and 4 National Health Insurance Service staff and 4 pharmacists participated as counselors were interviewed regarding their impression of the intervention program. Three major themes arose: overall perception; necessities; and suggestions for success, of the intervention. Despite short period of intervention, educational intervention by telephone counseling involving pharmacists shows potential to improve self-management of chronic disease, and pharmacist-involvement. But more sophisticated selection of target patients requiring the intervention and complementation of electronic database system would be necessary. In addition, personal disposition of counselor was revealed to be an important factor for achieving successful outcome of intervention. CONCLUSION: The findings suggest that the individualized counseling intervention would be an efficient option for improved medication adherence. Further researches should include longer periods of interventions, a quantitative analysis using adherence measures based on claims data and consideration of clinical benefits associated with the intervention.
Chronic Disease* ; Complement System Proteins ; Counseling* ; House Calls ; Humans ; Hyperlipidemias ; Hypertension ; Medication Adherence ; National Health Programs ; Pharmacists ; Postal Service ; Retrospective Studies ; Self Care ; Telephone

BACKGROUND: The Folstein Mini-Mental State Examination (MMSE) is a well-established and reliable cognitive screening instrument. However, recent investigations have reported limitations in the MMSE as a cognitive screening tool. The Modified Mini-Mental State Examination (3MS) taps a broader range of cognitive abilities by including evaluations of semantic fluency, delayed memory, remote personal information, and abstraction as well as those areas included in the MMSE. We report age- and education-specific reference values of the Korean Modified Mini-Mental State (K-3MS) Examination and the MMSE in the non-demented elderly population. We also evaluate the validity and reliability of the K-3MS for cognitive screening. METHODS: The K-3MS and the MMSE were administered to 112 dementia patients and 99 controls, aged 50~90 years old. K-WAIS, K-DRS, CDR were done with K-3MS in dementia patients. Test-retest reliability coefficients were obtained from 50 patients. NINCDS-ADRDA criteria for probable AD and NINDS-AIREN criteria for VaD were used. RESULTS: The K-3MS correlated with the MMSE (r=0.94, p<0.05). The area under the receiver operating characteristic (ROC) curve for the K-3MS was 0.872 and for the MMSE was 0.865. There was no statistically significant difference between both tests. The sensitivity and specificity of the K-3MS (cutoff score=72) for a dementia diagnosis were 0.83, 0.78 and those of the MMSE (cut-off score=23) were 0.78, 0.74. The K-3MS was found to have high test-retest reliability (r=0.93). CONCLUSIONS: The K-3MS is a reliable, valid, and stable cognitive screening instrument. The K-3MS is comparable to the MMSE as a dementia screening test.
Aged ; Dementia ; Diagnosis ; Humans ; Mass Screening ; Reference Values ; Repression, Psychology ; Reproducibility of Results* ; ROC Curve ; Semantics ; Sensitivity and Specificity

BACKGROUND: Alzheimer's disease (AD) and vascular dementia (VaD) are the most frequently occurring dementia. Although accurate differentiation of dementia subtype is important in treatment perspective, it is not easy even using expensive and time-consuming devices. To evaluate diagnostic value of the Modified Mini-Mental State (3MS) examination as a dementia screening and whether the first recall (FR) and delayed recall(DR) of 3MS are helpful in differentiating AD from VaD. METHODS: Patients comprised of 64 cases diagnosed for dementia at the Neurology department. Diagnosis of probable AD (n=34) and VaD (n=30) were made according to consensus criteria. Cognitive status was measured by the Mini-Mental State Examination (MMSE) and 3MS. Receiver operating characteristic (ROC) curves were used to identify the optimal FR and DR for differentiating AD from VaD. Ninety-three age- and education-matched controls were evaluated. The neuropsychologist was blind to clinical diagnosis. RESULTS: Sensitivity (SN), specificity (SP), diagnostic accuracy (DA), and positive likelihood ratio (+LR) of 3MS (cutoff score=76) were 0.75, 0.68, 0.70 and 2.34. The optimal score of FR and DR to differentiate AD from VaD were 2 (SN=0.81, SP=0.76, and +LR=3.38) and 1 (SN=0.81, SP=0.71, and +LR=2.79), respectively. CONCLUSIONS: The diagnostic value of 3MS is comparable to that of MMSE as well as covers broader cognitive functions and has wider difficulty levels. Among dementia patients, a low FR and DR scores on the 3MS produce small to moderate increases the post-test probability of AD.
Alzheimer Disease* ; Consensus ; Dementia ; Dementia, Vascular* ; Diagnosis ; Humans ; Mass Screening ; Neurology ; ROC Curve ; Sensitivity and Specificity

Juvenile spinal AVM consists of an abnormal tangle of vessels fills the spinal cord at involved levels. Contains neural parenchyma within the nidus of the AVM and is fed by mult ple medullary arteries. We report a case of juvenile spinal AVM treated with conventional radiation therapy instead of embolization or surgery because of its location(from C-2 to C-7) and multiple feeding arteries.
Arteries ; Radiotherapy* ; Spinal Cord

BACKGROUND: Obese type 2 diabetic subjects are recently increasing in Korea, indicating the importance of insulin resistance rather than insulin secretory defects in the pathophysioloy of type 2 diabetes. The purpose of this study is to evaluate the safety and efficacy of fixed dose rosiglitazone/metformin combination therapy in poorly controlled subjects with type 2 diabetes mellitus. METHODS: 12 type 2 diabetic subjects who had a HbA1c > 11% or fasting plasma glucose > 15 mmol/L were included. After a 2 week screening period, the subjected took the fixed does rosiglitazone/metformin for 24 weeks. The treatment with rosiglitazone/metformin began at week 0 with an initial dose of 4 mg/1000 mg and, unless tolerability issues arose, subjects would be increased to 6 mg/1500 mg at week 4 and at week 8 to the maximum dose of 8 mg/2000 mg. The primary object of this study was to characterize the magnitude of HbA1c reduction from baseline after 24 weeks of rosiglitazone and metformin treatment in poorly controlled type 2 diabetics. RESULTS: The mean age of the subjects was 48.9 +/- 10.6 years old, body mass index was 25.0 +/- 3.5 kg/m2, HbA1c was 12.0 +/- 1.0%, and fasting plasma glucose was 16.3 +/- 3.1 mmol/L. HbA1c was reduced to 7.54 +/- 1.45% and fasting plasma glucose reduced to 7.96 +/- 2.38 mmol/L at week 24. The proportion of HbA1c responder who showed the reduction from baseline of > or = 0.7% or HbA1c < 7% was 11 among 12 subjects (91.7%). 41% of the subjects (5 among 12 subjects) achieved HbA1c level < 7.0% and 75% (9 among 12 subjects) achieved HbA1c level < 8.0%. CONCLUSIONS: In this study, rosiglitazone and metformin combination therapy was effective in glycemic control in poorly controlled subjects with type 2 diabetes mellitus.
Body Mass Index ; Diabetes Mellitus, Type 2 ; Fasting ; Glucose ; Insulin ; Insulin Resistance ; Korea ; Mass Screening ; Metformin ; Plasma ; Thiazolidinediones

BACKGROUND: Type 2 diabetes is usually preceded by a long and clinically silent period of increasing insulin resistance. The purpose of this study is to demonstrate that rosiglitazone and metformin fixed-dose combination therapy (RSG/MET) will safely and effectively control glycemia as a first line of oral therapy, better than rosiglitazone (RSG) or metformin (MET) monotherapy in Korean type 2 diabetes patients. METHODS: This study was a 32-week, multicenter, randomized, double-blind study. Twenty-seven type 2 diabetes patients (males 14; females 13) were included and randomly divided into the rosiglitazone, metformin group, or rosiglitazone /metformin combination groups. The primary objective of this study was to determine the change in HbA1c from baseline (week 0) to week 32. The secondary end-points were to determine changes in fasting plasma glucose (FPG) and homeostasis model assessment insulin resistance (HOMA-IR), from baseline to week 32. Other cardiovascular risk markers were also assessed. RESULTS: At week 32, there were significant reductions in HbA1c and FPG, in all three treatment groups. There was no statistical difference in HbA1c among the three groups, but the decrease in FPG in the RSG/MET group was statistically significant compared to the MET group (P < 0.05). RSG/MET significantly reduced HOMA-IR at week 32 compared to baseline, but there was no difference among the three groups. RSG/MET significantly decreased high-sensitive C-reactive protein (hs-CRP) value at week 32, compared to baseline. There were increases in adiponectin from baseline to week 32 in the RSG and RSG/MET groups, and the increase in the RSG/MET group was statistically significant compared to that of the MET group (P < 0.05). At week 32, there was a significant decrease in plasminogen activator inhibitor-1 (PAI-1) in all three treatment groups, but no statistically significant difference among them. The RSG/MET group significantly decreased in terms of urinary albumin-creatinine ratio at week 32, compared to baseline. CONCLUSIONS: In this study, rosiglitazone and metformin combination therapy was effective in glycemic control as an initial therapy, and it improved cardiovascular risk markers in Korean type 2 diabetes patients.
Adiponectin ; C-Reactive Protein ; Diabetes Mellitus, Type 2 ; Double-Blind Method ; Fasting ; Female ; Glucose ; Homeostasis ; Humans ; Insulin Resistance ; Metformin ; Plasma ; Plasminogen Activators ; Thiazolidinediones

We tried to evaluate frequencies and severities of malocclusion of various socioeconomic areas according to growth and development. To obtain objective validity, we used Handicapping Labiolingual Deviation (HLD) suggested by Draker, Treatment Priority Index (TPI) by Grainger, Handicapped Malocclusion Assessing Record (HMAR) by American Dental Association and American Association of Orthodontist. Seoul and Kwangju were selected as an urban group, Ahnyang as an middle socioeconomic group and Hwasun near the Kwangju area as an rural group. 140 (male 63, female 73) of 5th grade in 'E' elementary school students in Seoul, 202 (male 101, female 101) of 'S' elementary school students in Kwangju, 207(male 105, female 102) of 'H' elementary school students in Hwasun, and 100(male 49, female 51) of 'M' elementary school students of in Ahnyang of all the same grade were analyzed and we obtained the results as follows; 1. TPI, HLD, and HMAR showed high coincidence and reproducibility between different observer. (p<0.01) 2. In comparison of TPI, HLD, and HMAR according to clinical decision, there was statistically difference between each other. (p<0.01) 3. As the severity of malocclusion increases there was high correlation between TPI and HLD, and between HLD and HMAR (p<0.05) 4. With respect to differences between areas in TPI and HLD, there was statistically difference between Ahnyang and other areas. 5. In Seoul as an urban group there was a high incidence of periodic checkup and history of orthodontic treatment than other area. 6. Mode of feeding and posture during sleeping did not affect the severity of malocclusion. As a conclusion, TPI, HLD and HMAR are so reproducible and coincident that they can be used as a guide on evaluating the frequency and severity of malocclusion and determining the priority of orthodontic treatment to determine the need and supply of orthodontic treatment. Furthermore these indices can provide objectively valid data for establishing public health problem solution.
American Dental Association ; Disabled Persons ; Female ; Growth and Development ; Gwangju ; Humans ; Incidence ; Malocclusion* ; Posture ; Public Health ; Seoul

Degenerative lumbar spondylolisthesis requires fusion of the involved segments and decompression laminectomy because it is mechanically unstahle and usually associated with stenosis of the spinal canal. Transabdominal retroperitoneal approach through small longitudinal pararectal skin incision provides easy and safe access to L3-4 and L4-5 disc spaces with less bleeding. We thought that anterior interbody fusion enable us to restore the disc space and to reduce partially the listhesis with less hleeding and less harvest of graft hone compared to posterolateral fusion, and also without the risk of neural or dural damage which could he occurred in posterior lumbar interbody fusion 4.15.16.17). Thus, authors performed the same-day anterior and posterior spinal surgery (APSS) in 28 patients (30 disc spaces) from 1992 to 1996 and analyzed the clinical and radiological results. The most common site of involvement was L4-5 level (82.1%). The mean follow-up period was 2 years and 2 months (from l2 months to 4 years). Fusion was ohtained at 29 disc spaces (96.7%) within 24 weeks (average, I 6 weeks). The anterior displacement was corrected up to the average of 65.4% (5.8mm) postoperatively and the average of 60.7% (5.2mm) correction remained at last follow-up. The intervertebral disc space was restored up to the average of 96.9% (7.5mm) postoperatively and the average of 86.0% (6.2mm) restoration remained at last follow-up. Twenty-five out of 28 patients (89.2%) showed excellent or good clinical results hy the criteria of Kim, et al6). In conclusion, the same-day procedure of successive anterior interbody fusion, decompression laminectomy and posterior pedicular instrumentation for the degenerative lumbar spondylolisthesis associated with spinal stenosis was thought to be a good method of treatment.
Constriction, Pathologic ; Decompression ; Follow-Up Studies ; Hemorrhage ; Humans ; Intervertebral Disc ; Laminectomy ; Skin ; Spinal Canal ; Spinal Stenosis ; Spondylolisthesis* ; Transplants