Malformations of the hand in newborn infants are comparatively uncommon, and the forms which these malformations assume are extremely varied, some being so bizzare as to almost defy description. The etiology of congenital anomalies of the hand has not been conclusively established, but at the present time the most acceptable theories are those of maldevelopment due to teratogens or of mutations which are subsequently inhereted. This paper is based upon our own series of 99 anomalies in 93 patients who were hospitalized and treated at Severance Hospital during the period between 1965 and 1979 and the following results were obtained. 1. There were 56 males and 37 females in 93 patients and the ratio between male and female was 1.5: 1. 2. Right hands were involved in 49 patients, left hands were in 33 patients, and both hands were in 11 patients. 3. The most common type of anomalies were polydactylism (60.6%), next were syndactylism (24.3%), and the following anomalies were found; congenital finger deficiency, congenital constriction band, camptodactyly, cleft hand, congenital clasped thumb, and symphalangism. 4. 33 associated congenital anomalies were found in 27 patients, in which, anomalies of the foot were most common. 5. Prenatal history such as drug ingestion, eclampsia or difficult labor, and prematurity were found, but no genetic or familial history could be obtainable. 6. Treatment was stressed upon the function of hand rather than cosmetic appearance.
Clinical Study ; Constriction ; Eating ; Eclampsia ; Female ; Fingers ; Foot ; Hand ; Humans ; Infant, Newborn ; Male ; Polydactyly ; Pregnancy ; Teratogens ; Thumb

With the development of spinal fusion and internal fixation, rehabilitation mediclne, urinary control and antibiotics, the outlook for patients with cervical spine injuries has brightened considerably, as compared with half a century ago. However, splnal cord injury still remains as one of the most devastating accidents that man can Incur and still survive. There is increasing tendency to stabllize unstable cervical spine injuries surglcally for the benefit of early mobilization,.early rehabilitation, easy nursing care, and rigid stability of the spine. A clinical study was performed on 72 patients with 76 fractures and fracture-dislocatlons of the cervical spine, who were hospitalized and treated at Severance Hospital during the period between January 1970 and December 1978 and the following results were obtained. 1. The prevalent age distribution was between 30 and 50 years of age (59.7%), and the ratio between males and females was 5:1. The most common cause of injury was falling from a height (51.4%). 2. In overall patients, neurologic damage was found at first examination in 69.4%, and among these, complete paralysis below the injured level In 41.7%, incomplete paralysis in 25%, and nerve root injury in 2.7%. 3. The mechanisms of injury included flexion-rotation (50%), extension-distraction (18%), flexion-compression (12.5%), pure flexion (5.5%), axial compression (5.5%), and unclassified (8.3%). 4. Among 72 patients, emergency decompressive laminectomy was performed on 10 patients, anterior interbody fusion on 15 patients, posterior fusion with wiring on 3 patients and the rest of patients were treated conservatively. 5. There was no significant difference in the recovery of neurologic loss between conservatively and surgically treated patients, but it was thought better to stabilize the unstable fracture-dislocations surgically for early mobilization and rehabllitatlon.
Accidental Falls ; Age Distribution ; Anti-Bacterial Agents ; Clinical Study ; Early Ambulation ; Emergencies ; Female ; Humans ; Laminectomy ; Male ; Nursing Care ; Paralysis ; Rehabilitation ; Spinal Fusion ; Spine

Epinephrine ; Pulmonary Edema

In 1992, Brugada described clinical features of patients with aborted sudden cardiac death who showed no demonstrable heart disease and a peculiar ECG pattern consisting of right bundle branch block and ST-segment elevation in right precordial leads. Recently, We experienced two cases with aborted sudden cardiac death and similar ECG pattern. Physical examination, routine laboratory tests including serum electrolytes, echocardiography, myocardial thallium SPECT, MRI and MIBG scans were within normal limit. Arrhythmias were not induced in treadmill exercise test, and signal averaged ECGs revealed positive late potentials. Coronary angiography showed normal coronary artery with no evidence of induced vasospasm. Polymorphic ventricular tachycardia and ventricular fibrillation were induced by ventricular stimulation. Intravenous administration of flecainide, procainamide augmented ST segment elevation in one patient, and isoproterenol reduced ST segment elevation in the other patient. For prevention of sudden death, ICDs were implanted in the two patients. Ventricular fibrillations occurred in one patient 12 and 13 months after the implantation and were successfully terminated by ICD.
3-Iodobenzylguanidine ; Administration, Intravenous ; Arrhythmias, Cardiac ; Bundle-Branch Block* ; Coronary Angiography ; Coronary Vessels ; Death, Sudden ; Death, Sudden, Cardiac* ; Echocardiography ; Electrocardiography ; Electrolytes ; Exercise Test ; Flecainide ; Heart Diseases ; Humans ; Isoproterenol ; Magnetic Resonance Imaging ; Physical Examination ; Procainamide ; Tachycardia, Ventricular ; Thallium ; Tomography, Emission-Computed, Single-Photon ; Ventricular Fibrillation

OBJECTIVE: To evaluate the efficacy of a mammography boot camp (MBC) to improve radiologists' performance in interpreting mammograms in the National Cancer Screening Program (NCSP) in Korea. MATERIALS AND METHODS: Between January and July of 2013, 141 radiologists were invited to a 3-day educational program composed of lectures and group practice readings using 250 digital mammography cases. The radiologists' performance in interpreting mammograms were evaluated using a pre- and post-camp test set of 25 cases validated prior to the camp by experienced breast radiologists. Factors affecting the radiologists' performance, including age, type of attending institution, and type of test set cases, were analyzed. RESULTS: The average scores of the pre- and post-camp tests were 56.0 +/- 12.2 and 78.3 +/- 9.2, respectively (p < 0.001). The post-camp test scores were higher than the pre-camp test scores for all age groups and all types of attending institutions (p < 0.001). The rate of incorrect answers in the post-camp test decreased compared to the pre-camp test for all suspicious cases, but not for negative cases (p > 0.05). CONCLUSION: The MBC improves radiologists' performance in interpreting mammograms irrespective of age and type of attending institution. Improved interpretation is observed for suspicious cases, but not for negative cases.
Adult ; Aged ; Breast Neoplasms/*radiography ; Education, Medical, Continuing/*standards ; Education, Professional, Retraining ; Female ; Humans ; Male ; *Mammography ; Middle Aged

BACKGROUND: Atrial mechanical dysfunction and its recovery time course after successful radiofrequency ablation of chronic atrial flutter (AFL) has been largely unknown. We serially evaluated left atrial function by echocardiography after successful ablation of chronic atrial flutter. METHODS: In 13 patients with chronic AFL, mitral E wave A wave, and the ratio of A/E velocity were measured at 1 day, 1 month, 3 months and 6-12 months after successful radiofrequency (RF) ablation. Doppler tissue imaging (DTI) technique was also used to avoid load-dependent variation in the flow velocity pattern. RESULTS: Left atrial mechanical function, assessed by A wave velocity and the annular motion, was depressed at 1 day, but improved significantly at 1 month and maintained through 6-12 months after the ablation. Left atrial size did not change significantly. CONCLUSION: Left atrial mechanical function was depressed immediately after successful RF ablation of chronic AFL, but it improved significantly after 1 month and was maintained over one year.
Adult ; Aged ; Atrial Flutter/*surgery/*ultrasonography ; Atrial Function ; Catheter Ablation/*methods ; Echocardiography, Doppler ; Female ; Follow-Up Studies ; Human ; Male ; Middle Age ; Sensitivity and Specificity ; Treatment Outcome

The inferior alveolar nerve block is the most common method of local anesthesia for intraoral surgery at the posterior mandibular region. However, unexpected complications may occur when administering the local anesthesia. One of these uncommon complications is the fracture of the needle. If the injection needle is broken during the surgery, it should be removed immediately. However, this is one of the most difficult procedures. In this report, we present two cases of needle fracture during the procedure, and its successful removal under general/local anesthesia administration.
Anesthesia ; Anesthesia, Local ; Mandibular Nerve* ; Methods ; Needles* ; Nerve Block

BACKGROUND AND OBJECTIVES: Despite the sporadic case reports on the cardiac involvement of Behcet's disease, any systemic investigation has not been reported on. We sought to investigate the frequency and clinical characteristics of the patients with the cardiac manifestations of Behcet's disease. SUBJECTS AND METHODS: We retrospectively analyzed the clinical data of 217 patients (mean age: 39+/-11 years) with Behcet's disease who were diagnosed in Asan Medical Center from January 1990 to September 2000. The patients were subgrouped into the mucocutaneous, cardiac, vascular, central nervous system, gastrointestinal and ocular group according to the involved organ. RESULTS: Among 217 patients, nineteen (8.8%) were found to have cardiac involvement: aortic regurgitation was found in ten patients (53%), right ventricular thrombi in six (32%), acute myocardial infarction in two (11%), and myocarditis in one (5%). The incidence of initial oro-genital ulcers at the first clinical presentation was significantly lower in the cardiac Behcet's group than in the other subgroups (52% vs 90%, p=0.001). The event-free survival rate during a mean follow-up duration of 67+/-46 months was also significantly lower in the cardiac Behcet's group (63% vs 14%, p=0.0001). CONCLUSION: Aortic regurgitation and right ventricular thrombus are two common types of cardiac Behcet's disease. Although its incidence is low, cardiac Bechcet's disease has a characteristic pattern for the clinical presentation, and it has a worse prognosis compared with the other subgroups of Behcet's disease that have other solid organ involvement.
Aortic Valve Insufficiency ; Central Nervous System ; Chungcheongnam-do ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Myocardial Infarction ; Myocarditis ; Prognosis ; Retrospective Studies ; Thrombosis ; Ulcer

BACKGROUND AND OBJECTIVES: Right-sided infective endocarditis (RtIE) occurs in about 5-10% of total infective endocarditis cases. In western countries, many cases of RtIE are related to drug addiction. However, there been only scant reports of right-sided infective endocarditis in Korea. The aim of the study was to identify the clinical characteristics of RtIE, such as frequency, predisposing risk factors, causative organisms and in-hospital mortality in Korea. SUBJECTS AND METHODS: All episodes diagnosed as infective endocarditis, between 1989 and 2003, at the Asan Medical Center were retrospectively reviewed using Duke's criteria. A total of 308 patients were diagnosed as infective endocarditis. RESULTS: RtIE was found in 34 patients (11.0%), with a mean age of 44.1+/-15.0 years. Fifteen patients had congenital heart diseases. However, several in-hospital invasive procedures and skin injuries were the most common predisposing risk factors in patients with uncorrected congenital heart disease (group A), whereas unknown causes were most common in patients without uncorrected congenital heart disease (group B). The most common causative organisms in groups A and B were Streptococcus viridans (6/15, 40%) and Staphylococcus aureus (13/19, 68.4%), respectively. In group A, the location of vegetations was variable according to the turbulent flow, but was exclusively at the tricuspid valve in group B. There were 6.7% (1/15) and 26.3% (5/19) inhospital mortalities in groups A and B, respectively (p=0.196). CONCLUSION: No drug addict with RtIE was seen. The most important predisposing risk factor in patients with RtIE was the presence of uncorrected congenital heart disease. The predisposing risk factors, causative organisms and the locations of vegetation in patients with RtIE differed according to the patient's uncorrected congenital heart disease.
Chungcheongnam-do ; Endocarditis* ; Endocarditis, Bacterial ; Heart Defects, Congenital ; Heart Diseases ; Hospital Mortality ; Humans ; Korea* ; Retrospective Studies ; Risk Factors ; Skin ; Staphylococcus aureus ; Substance-Related Disorders ; Tricuspid Valve ; Viridans Streptococci

BACKGROUND: Unipolar electrogram was reported to be useful for localization of manifest accessory pathway conduction during surgical or transcatheter ablation. However, it is not clear whether the unipolar electrogram would also be useful for localizing the origin of idiopathic left ventricular tachycardia (ILVT) in which pace mapping, activation time and recording of Purkinje (P)-potential have been used for guiding the successful ablation. METHODS: In patients who underwent catheter ablation for ILVT, bipolar and unipolar electrograms were recorded at the sites of current delivery. We analysed the time from P-potential to QRS onset (P-QRS time), time from local ventricular electrogram to QRS onset (V-QRS time) and the morphology and slope of rapid downstroke of unipolar electrograms (Uni-slope) during induced ILVT both at successful and unsuccessful sites. RESULTS: In 14 consecutive patients (11M/3F, mean age 29.3) with ILVT and successful ablation, QRS morphology of ventricular tachycardia was of right bundle branch block (RBBB) with left axis deviation and right axis deviation in 11 and 3 patients, respectively. The average number of current delivery was 4.5 (range 2-12). P-potential was observed in 10/14 (71%) successful sites and 37/47 (79%) unsuccessful ablation sites. The morphology of unipolar electrogram was QS pattern in 12 and QrS pattern in 2 successful sites but rS pattern was not observed at successful sites. P-QRS time was 26.5+/-12.4 and 26.6+/-14.9 msec (p=ns), V-QRS time 3.9+/-7.7 and 0.2+/-8.9 msec (p=ns), Uni-slope 7.1+/-3.1 and 7.3+/-4.5 mV/10 msec (p=ns) at successful and unsuccessful sites, respectively, showing no significant differences between successful and unsuccessful sites. CONCLUSIONS: The slope of rapid downstroke in unipolar electrogram was not useful as a guide for localization of successful ablation in patients with ILVT. However, absence of initial 'r'wave in unipolar electrogram may be helpful in conjunction with other conventional criteria for successful ablation.
Axis, Cervical Vertebra ; Bundle-Branch Block ; Catheter Ablation ; Humans ; Tachycardia, Ventricular*