Background : Recurrent wheezing in infants is manifested in a number of disease spectrums and gastroesophageal reflux ( GER ) has been known to be associated with apnea, recurrent pneumonia, asthma, chronic cough, and wheezing. The prevalence of GER in infants with recurrent wheezing and the relationship between atopy and GER in infantile asthmatics have not yet been established, but it was hypothesized that microaspiration of food allergen could induce food-induced wheezing. Objective : To evaluate the prevalence of GER in infants with recurrent wheezing episodes, and to determine whether the presence of atopy affects the prevalence of GER in infantile asthmatics. Method : Seventy infants with recurrent wheezing episodes were evaluated for GER using 24 hour continuous esophageal pH monitoring. Patients were classified into five groups, : 12 atopic asthmatics : 20 nonatopic asthmatics : 15 infants with recurrent bronchiolitis : 8 infants with recurrent pneumonia : and 15 infants with chronic lung disease ( CLD ) of prematurity. GER was considered to be prevalent when reflux index was higher than 95 percentile of normal values by Vandenplas, 1991. Result : The prevalence of GER in infants with recurrent wheezing was 21.4%. The prevalence of GER in each group was 25% in atopic asthmatics, 20% in nonatopic asthmatics, 6.7% in infants with recurrent bronchiolitis, 12.5% in infants with recurrent pneumonia, and 40% in infants with CLD of prematurity. There were no significant differences in prevalence of GER between atopic asthmatics and nonatopic asthmatics, between asthmatics with atopic dermatitis and those without, and between asthmatics with family history of allergy and those without. CONCLUSION: The prevalence of GER in infants with recurrent wheezing was high, especially in infantile asthmatics and infants with chronic lung disease of prematurity. The presence of atopy may not affect the prevalence of GER in infantile asthmatics.
Apnea ; Asthma ; Bronchiolitis ; Cough ; Dermatitis, Atopic ; Esophageal pH Monitoring ; Gastroesophageal Reflux* ; Humans ; Hypersensitivity ; Infant* ; Lung Diseases ; Pneumonia ; Prevalence* ; Reference Values ; Respiratory Sounds*

BACKGROUND: Hemoptysis is a common clinical symptom, responsible for 11% of admission to the hospital chest service. Correct diagnosis, accurate localization of the bleeding source and proper management are imperative to reduce the risk of massive hemoptysis. We performed the study to define the optimal time of fiberoptic bronchoscopy in 63 patients with hemoptysis admitted to Kyung Hee University Hospital between Aug 1989 and Aug1992. METHODS: Retrospective analysis of medical records concerning the cause, amount, duration of hemoptysis and the timing of fiberoptic bronchoscopy in 63(M:F=36:27) patients. RESULTS: 1) The main causes of hemoptysis were pulmonary tuberculosis(52.4%) bronchiectasis(27.0%) and lung cancer(11.1%). 2) The bleeding sites were localized in 26 Patients(41.3%). 3) The rates of localization of bleeding site were not related to the amount and duration of hemoptysis. 4) The rates of localization of bleeding site were 61.8%(21/34) during hemoptysis,18.2%(122) within 24hr after resolution of hemoptysis, 14.3%(1/7) thereafter. CONCLUSION: Early bronchoscopy, especially during hemoptysis may show higher rates of successful localization than delayed bronchoscopy.
Bronchoscopy* ; Diagnosis ; Hemoptysis* ; Hemorrhage* ; Humans ; Lung ; Medical Records ; Retrospective Studies ; Thorax

The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2-20 mm, reflux time > or =0.5 seconds and distance from the skin > or =5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis > or =class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles' ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.
Baths ; Catheter Ablation* ; Catheters ; Consensus* ; Heparin ; Knee Joint ; Lidocaine ; Saphenous Vein ; Sclerotherapy ; Skin ; Stockings, Compression ; Swimming ; Thrombosis ; Varicose Veins* ; Walking

The hindfoot in the human body is known to play an important function for weight bearng, shock absorption and locomotion. The defect of hindfoot presents serious problems of the leg length discrepancy and weight bearing. Therefore, it is essential to reconstruct the defect of hindfoot. Up to date, many surgical modalities from a skin graft to the innervated osteocutaneous flap have been developed, but a completely satisfactory method of reconstruction has not been found. The ideal reconstructive method should provide sufficient padding tissue and sensibility. In the Department of Orthopaedic Surgery, capital Armed Forces General Hospital, two cases of hindfoot defect due to explosion were reconstructed by the midplantar fasciocutaneous flap with free iliac bone graft. The results of our procedure were very acceptable one year after the operations.
Absorption ; Arm ; Explosions ; Hospitals, General ; Human Body ; Leg ; Locomotion ; Methods ; Shock ; Skin ; Transplants ; Weight-Bearing ; Wounds and Injuries

Posterior lumbar apophyseal fracture characterized by osteochondral fragments from posterior rim of a lumbar vertebral body, has often been misdiagnosed as herniated disc or spinal stenosis due to its similarity of symptoms. But recent use of CT scan facilitated the diagnosis of the lesion as a separate entity. This study was performed to verify the clinical characteristics, to find out the mechanism of injury and to determine the most effective method of diagnosis and treatment. Authors reviewed 17 patients(14 male, 3 female) who were subjected to surgical treatment at Department of Orthopaedic Surgery, Seoul National University Hospital for posterior lumbar spophyseal fracture during the period of 1990-1992, and followed up for average of 1 year and 6 months(range 1 to 3 years). Thirteen patients (76%) were related to a history of trauma or strenuous physical activity prior to the onset of symptoms. The mechanism of injury was the rapid flexion with axial compression in 7, hyperextension in 4, and pure axial compression in 2 patients. The mean age at the time of injury was 20 years(range 10 to 31 years). All patients presented low-back pain radiating to lower extremities and 11 patients showed neurogenic intermittent claudication. The mean age at the time of surgical intervention was 23 years and 10 months(range 15 to 31 years), and the mean duration of symptoms was 3 years(range 2 months to 13 years). Simple X-ray revealed the lesion in only 3 cases but CT scan demonstrated the characteristic osteochondral fragment displaced posteriorly into the spinal canal and the corresponding defect with degenerative changes in all patients. The fracture occured through the superior apophyseal rim of L5 in 9 superior rim of L4 in 3, inferior rim of L4 in 2, inferior rim of L5 in, superior rim of L2 in 1, and superior rim of L1 in 2 patients. Two patients had concomitant fractures at two levels. All patients except one were treated with posterior decompression including the removal of the displaced fragment and posterolateral fusion with pedicular screws was carried out to prevent further degenerative change and instablilty. One patient with the lesion at the superior rim of L1 was treated by anterior decompression and fusion. All patients showed relief of pain and claudication with satisfactory results. One patient had partial tear of L4 root with slight weakness of greater toe dorsiflexion, but it recovered in 4 months. In conclusion, posterior lumbar spophyseal fracture predominantly affected young males and the most common causative mechanism was rapid flexion with axial compression. The CT scan facilitated identification of the lesion. The most frequently affected site was the superior rim of L5. Satisfactory results could be achieved bvy adequate posteriior decompression with the removal of the fragment and posterolateral fusion with pedicular screws.
Decompression ; Diagnosis ; Humans ; Intermittent Claudication ; Intervertebral Disc Displacement ; Lower Extremity ; Male ; Methods ; Motor Activity ; Seoul ; Spinal Canal ; Spinal Stenosis ; Tears ; Toes ; Tomography, X-Ray Computed

The various biomechanical responses such as stress distribution, facet contact force and nucleus pressure change in the lumbar spine under vertical static and dynamic loading conditions were. Investigated with a nonlinear three dimensional finite element model. Finite element model of one motion segment, consisted of two vertebral bodies(L3-4) with one disc, was developed from 1 mm thick transverse CT cross-sections. Geometrical nonlinearity was also considered for the large deformation on the disc. ABACUS package was used for calculation and its results were verified comparing with the existing in-vitro experimental data. Clinically useful results could be obtained with this analysis. Stress was concentrated on the endplate under static and dynamic loading condition, especially posterior and anterior aspect and central portion along midsagittal plane. The facet contact force showed some discontinuity when Δt/2=0.03 sec. This discontinuity was considered to de due to the vibration of upper vertebra. Relatively smooth contact force profile was detected when t/2=0.1342 sec. Intradiscal pressure and stress pattern changes on the vertebra were also analyzed.
Spine ; Vibration

No abstract available.
Thyroid Gland* ; Thyroid Nodule*

BACKGROUND: Postmenopausal osteoporosis is the main problem in women, but senile osteoporosis is believed to occur after 65 years and affects men and women equally. Measurement of biochemical markers in conjunction with bone mineral density (BMD) determination can detect individual patients at the greatest risk of developing osteoporosis. METHODS: We measured serum osteocalcin levels as a bone formation marker, and urinary deoxypyridinoline (DPD) levels as a bone resorption marker, in 2190 men (from 22 to 83 year-old), and 1209 women (from 25 to 80 year-old). The age and sex related variations of serum osteocalcin and urinary DPD levels were analysed. The serum osteocalcin and urinary DPD levels were compared with BMD. These biochemical bone turnover markers were compared with each other. RESULTS: In women, serum osteocalcin and urinary DPD levels were increased with age from forties to sixties, after then showed decrease from seventies. In men, serum osteocalcin levels were slightly decreased with age, but DPD levels were slightly increased with age in men. These biochemical bone markers and BMD showed negative correlations. Osteocalcin and DPD levels showed positive correlations, especially in women. Osteocalcin levels were higher in men than women, age before fifth decades but lower in men than women after fifties. DPD levels was higher in women than men through all the age. CONCLUSION: Osteocalcin and DPD levels showed age and sex related variations in healthy Koreans. In management of patients with a risk of osteoporosis, consideration of variations according to the age and sex should be given.
Biomarkers ; Bone Density ; Bone Resorption ; Female ; Humans ; Male ; Middle Aged* ; Osteocalcin* ; Osteogenesis ; Osteoporosis ; Osteoporosis, Postmenopausal

No abstract available.
Heart Diseases* ; Heart Septal Defects, Ventricular* ; Heart*

Hantaan virus is widely distributed among rodent populations in Korea. Two antigenically distinct hantaviruses were isolated from Apodemus agrarius in 1976 and Rattus norvegicus in 1980 in Korea. This study was designed to investigate the serological evidence of hantavirus infection among indegenous wild rodents, which were captured in 11 mountains located in Kyunggi, Kangwon, Chungnan, Chunbug and Kyungnam province of South Korea. A total 252 wild rodents of 3 species were trapped from Myungsung Mt., Chumbong Mt., Kali Mt., Hansuk Mt., Chachil peak, Kyebang Mt., Odae Mt., Kyerong Mt., Kaya Mt., Togju Mt. and Chiri Mt. in 1997. Serologic test for hantavirus infection was performed using hantavirus antigens by indirect immunofluorescent antibody technique. Among 122 Apodemus agrarius, 88 Apodemus peninsulae and 42 Eothenomys regulus; 18 A. agrarius (14.8%), 12 A. peninsulae (13.6%) and 4 E. regulus (9.5%) were immunofluorescent antibody (IFA) positive against hantaan virus. IFA titers 3 Eothenomys regulus sera were higher against puumalavirus than hantaan virus. These data imply that above three species of rodent might be natural reservoirs of hantaviruses in Korea.
Animals ; Gangwon-do ; Gyeonggi-do ; Gyeongsangnam-do ; Hantaan virus ; Hantavirus Infections* ; Hantavirus* ; Korea* ; Murinae ; Rats ; Rodentia ; Seroepidemiologic Studies* ; Serologic Tests