No abstract available.
Arthroplasty* ; Joints*

The authors studied 54 patients (55 cases) of femoral shaft fractures treated by compression plate fixation and IM nailing from August 1986 to December 1991. The purpose of this study is to analyse comparatively the radiological and clinical results between the compression plate fixation and IM nailing in femoral shaft fracture of adult. The obtained results were as follows: 1. Among the 54 patients, the ratio of male and female was 44: 10, and the highest in cidence of age was between 3rd and 4th decades. 2. The main cause of injury was traffic accident in 38 cases. 3. The most common fracture type was B1-② in ten cases by AO-ASIF classification. 4. The mean duration of union was 13 weeks in compression plate fixation by the Koostra's criteria and the average 23 weeks in IM nailing by the Bjorens criteria. 5. The clinical result according to Margerl et al, was good in 25 cases (80.6%) with compression plate fixation and good in 20 cases (83.3%) with intramedullary fixation. 6. Complications of compression plate fixation were metal failure in 2 cases and deep wound infection in 1 case, and 1 case of femur neck fracture during operation and 1 case of metal failure in intramedullary fixation.
Accidents, Traffic ; Adult ; Classification ; Female ; Femoral Neck Fractures ; Fracture Fixation, Intramedullary ; Humans ; Male ; Wound Infection

Objective: The purpose of the present study was to screen the prevalence of aneurysms in migraineurs; to differentiate presenting features in migraineurs with and without aneurysm; and also to correlate the locations of aneurysm to the clinical features of migraine. Methods: A total of 4,416 subjects were interviewed and completed self-reported questionnaires on headache. Of these, 1,773 subjects diagnosed to have migraines based on the International Classification of Headache Disorders II (ICHD-II) criteria were screened for aneurysm by magnetic resonance angiography (MRA). When aneurysm was suspected, further investigation with trans femoral cerebral angiography (TFCA) or three dimensional computerized tomography (CT) angiography was performed. Based upon MRA findings, subjects were grouped into unruptured aneurysm migraine patients (UAMP) and no aneurysm migraine patients (NAMP). Results: The prevalence of aneurysm was 3.6% (63 of 1,773) with the mean age of 56.0 years, which were not different from those of general population. There was no difference in migraine subtypes between UAMP and NAMP. Aggravation of headache by estrogen replacement therapy during menopause (p=.039), history of migraine in young age (p= .021), diplopia (p=.026), and retroauricular pain (p=.025) were significantly associated with presence of aneurysm. Although aneurysms were detected more in anterior circulation, there was no correlation between aneurysm site and headache location. The average size of aneurysm was 3.5 ± 2.1 mm and none were ruptured. Interventional therapy of aneurysm did not alter the feature of migraine. Conclusions: The incidence of aneurysm was not different in migraine patients as compared to the general population. Some features which significantly differentiate whether migrainuers have aneurysm or not warrant further study to have a predictive and localizing value.

BACKGROUND AND OBJECTIVES: Although pain resulting from thalamic stroke was described by D jerine & Roussy in 1906, its pathomechanism & anatomical substrate have not been defined yet. Several clinical & experimental studies suggest that laterality of lesion for generation of central pain is as important as location of lesion. We performed this study to evaluate clinical features of thalamic pain syndrome, including incidence, onset interval from stroke, nature, distribution, accompaniments, and to assess the relationships between laterality & location of lesion and occurrence of pain. METHODS: We reviewed the medical records and brain imaging of all patients with thalamic stroke from 1990 to 1997. Patients with thalamic pain syndrome due to a single well-demarcated thalamic stroke were included, and excluded tumoral, non-vascular etilogy, and patients with sensory deficit without pain and excluded patients who had multiple cerebral lesions even they have thalamic pain syndrome. RESULTS: One-hundred one cases were selected under the inclusion criteria, and twenty-four patients(24%) with thalamic pain syndrome were identified from 101 thalamic stroke. Pain onset within the first week poststroke was 17(71%). The patients with allodynia were 8(33%), increased by movement, stress, and thermal contact. The painful area distributed mainly limbs(50%), especially arm(35%), face plus hemibody(34%), and hemibody below face(8%). Thalamic pain syndrome accompanied with the pain and temperature loss was 17(71%). Thirteen patients had a right-sided lesion, 11 left-sided lesion. The lesion causing thalamic pain syndrome mainly located in the posterolateral areas(75%). CONCLUSIONS: We conclude that the thalamic pain syndrome resulting from mainly posterolateral thalamic lesion cause the spontaneous pain on the contralateral body, especially upper extrimity, and accompanied with pain & tempterature loss. The laterality of lesion is not represent for generation of thalamic pain syndrome. Key word : thalamic stroke, central pain.
Humans ; Hyperalgesia ; Incidence ; Medical Records ; Neuroimaging ; Stroke*

Bronchopulmonary lavage using a double-lumen endotracheal tube is an accepted modality for treatment of pulmonary alveolar proteinosis which characterized by filling of alveolar space with periodic acid-schiff positive proteinaceous material. Massive bronchopulmonary lavage is not without hazard. Improper positioning and inadequate cuff inflation of the endotracheal tube may lead drowning. So correct placement of double-lumen endotracheal tube and confirming complete seperation of the two lungs is important to prevent drowning. And periods of tidal drainage are accompanied with reperfusion to the non-ventilated lung and cause potentially dangerous levels of hypoxemia. One must investigate maneuvers to minimize perfusion to non-ventilated lung and to maximize gas exchange during unilateral lung lavage. The distribution of pulmonary blood flow during unilateral lung lavage can be manipulated by nonocclusive inflation of an ipsilateral pulmonary artery balloon. We report a case of sequential bronchoalveolar lavage in a patient with pulmonary alveolar proteinosis performed safely with pulmonary arterial catherter insertion.
Anoxia ; Bronchoalveolar Lavage* ; Drainage ; Drowning ; Humans ; Inflation, Economic ; Lung ; Perfusion ; Pulmonary Alveolar Proteinosis* ; Pulmonary Artery ; Reperfusion

PURPOSE: Bleeding from esophago-gastric varices needs urgent treatment. Esophageal varix bleeding usually was controlled by intervention, but rebleeding rate was high. Gastric varix bleeding is unable to be controlled by intervention. Recently, newly developed methods for varix bleeding controll have been used, but surgical intervention is still advocated. We report our experience with esophago-gastric devascularization for bleeding control in portal hypertension and its effectiveness. METHODS: This retrospective study was performed on 32 cases who underwent esophago-gastric devascularization in portal hypertension at Kyuung Hee University Hospital from Nov. 1990 to Feb. 2004. Author analyzed characteristics & patients, causes of portal hypertension, liver function reserve, operation methods, perioperative finding, complications and factors determining postoperative mortality. RESULTS: Sex ratios of male to female was 5.4:1. The ages were ranged from 25 to 70 years old with mean age of 50.5. Postoperative complication rate was 40.6% (13/32) and those were recovered by conservative management. There was one case of recurrent bleeding at 9months postperatively (3%). Mortality rate was 4% in Child-Pugh group A and B, and 57% in group C. The overall mortality rate was 15%. Preoperative hepatic reserve (P<0.05) & preoperative blood pressure (P<0.05) was a significant factors. A mean follow up period is 18.7 months. CONCLUSION: In our study, esophago-gastric devascularization in portal hypertension showed good results with 3% rebleeding rate and 85% overall survival rate. Esophago-gastric devascularization was effective method for esophago-gastric varix bleeding.
Aged ; Blood Pressure ; Esophageal and Gastric Varices ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension, Portal* ; Liver ; Male ; Mortality ; Postoperative Complications ; Retrospective Studies ; Sex Ratio ; Survival Rate ; Varicose Veins

A reduced retroversion angle of humeral head may predispose to recurrent anterior shoulder dislocation and may also be a factor in persistent instability after soft tissue procedures. Rotation osteotomy of proximal humerus is one of many surgical modalities proposed for recurrent anterior shoulder dislocation. To support such an operation, fundamental knowledge of shoulder anatomy is essential. The semi-axial view by Soderlund have been regarded as simple and reliable method for measuring humeral head retroversion angle. The purpose of this study was to evaluate validity of the semi-axial view and to assess reference values for humeral head retroversion angle in Korean. Humeral head retroversion angle was determined from 80 healthy subjects, 48 men and 32 women. Radiographs which shown less than 10degrees between humeral shaft axis and epicondylar axis were defined as acceptable radiographs by Soderlund. Acceptable radiographs were selected and two orthopedic surgeons measured retroversion angle, separately. Acceptable radiographs were obtained in only 70 shoulders (43.8%). The mean angle was 35.2+/-8.24degrees for dominant hand and 32+/-6.27degrees for nondominant in Korean. The mean angle was 35.3+/- 7.78degrees for right side and 31.9+/-6.8degrees for left. The interobserver difference was 2.9degrees. The semi-axial view by Soderlund was not reproducible solely. But if correct arm position is considered, the method presented is easy to use daily.
Arm ; Axis, Cervical Vertebra ; Female ; Hand ; Humans ; Humeral Head* ; Humerus ; Male ; Orthopedics ; Osteotomy ; Reference Values ; Shoulder ; Shoulder Dislocation

PCR is a rapid and sensitive method for detection of viruses from clinical samples and good primers are essential for successful PCR. However, high mutation rate of viral genomes often results in failure in detecting viruses, and there have been attempts to develop primers from multiple viral sequences. Thus, we developed a program called Universal Primers Score Ranking (UPSR) which generates primers from multiple sequences and ranks the quality of primers automatically. The feasibility of the UPSR program was tested using hepatitis B viruses (HBV) isolated from Korean patients. UPSR generated primer candidates with quality score ranks according to two T(m) values. We found that T(m2) values calculated based on the thermodynamics of nearest neighboring bases were better correlated with actual detection rate of HBV from patients' sera. The primer with number 1 rank by T(m2) values detected more samples than any other primers designed by UPSR, commercial primer, or other reference primers suggested by previous literatures. Thus, UPSR proved to be easy and useful to design primers from multiples sequences in detecting viruses.
Collodion ; Genome, Viral ; Hepatitis B virus ; Humans ; Mutation Rate ; Polymerase Chain Reaction ; Thermodynamics

No abstract available.
Foreign Bodies* ; Pulmonary Artery*

BACKGROUND: Intubation of the trachea frequently results in a rise in respiratory system resistance (Rrs) that is reversed by inhaled bronchodilators. In asthmatics, this reflex may occasionally result in profound bronchoconstriction, and anesthesiologists often try to avoid tracheal intubation if possible in asthmatics. The hypothesis of this study was that insertion of a laryngeal mask airway (LMA) would be less likely to result in reversible bronchoconstriction than would insertion of an endotracheal tube (ETT). METHODS: A total of 52 (45 male, 7 female) patients were randomized to placement of a 7.5 mm (females) or 8.0 mm (males) endotracheal tube or a #4 (females) or #5 LMA (males). Anesthesia was induced with 2 microgram/kg fentanyl and 5 mg/kg thiopental and airway placement facilitated with 1 mg/kg succinylcholine. After ensuring that a seal to greater than 20 cmH2O existed, Rrs was measured immediately following airway placement using the isovolumic method during positive pressure ventilation with oxygen. Correction was made for the resistance of the ETT but not for the resistance of the LMA, which was insignificant at the flows used. Inhalation anesthesia was then begun with isoflurane (ISF) to achieve an end-tidal concentration of 1.0% for ten minutes. Rrs was then measured again under identical conditions. In the LMA patients, fiberoptic laryngoscopy was then performed to ensure that the scope could be passed to the level of the cords without epiglottic obstruction. RESULTS: Among LMA patients, the initial Rrs was significantly lower than among ETT patients (9.2 0.7 vs 13.4 1.9 cmH2O/L/s, P <0.05). After 10 minutes of ISF, the resistance declined to 8.6 0.7 in the ETT group but remained unchanged at 9.1 0.7 cmH2O/L/s in the LMA group. The decline in Rrs in the ETT group of 4.7 1.4 cmH2O/L/s was highly significant compared to the lack of change in the LMA group (P <0.01). CONCLUSIONS: Despite the inclusion of the resistance of the LMA and the laryngeal resistance, Rrs in LMA patients was still clearly lower than in ETT patients. Furthermore, resistance dropped rapidly only in ETT patients after ISF, a potent bronchodilator, suggesting that reversible bronchoconstriction was present in ETT patients but not LMA patients. We conclude that an LMA is a better choice of airway to minimize airway reaction.
Anesthesia ; Anesthesia, Inhalation ; Bronchoconstriction* ; Bronchodilator Agents ; Fentanyl ; Humans ; Intubation ; Intubation, Intratracheal* ; Isoflurane ; Laryngeal Masks* ; Laryngoscopy ; Male ; Oxygen ; Positive-Pressure Respiration ; Reflex ; Respiratory System ; Succinylcholine ; Thiopental ; Trachea