OBJECTIVE: Study was designed preliminarily to observe the accordance of caregivers strain and depression with other factors such as sex of the patient, caregiver, lesion side, Mini Mental Status Examination (MMSE) score and Beck's Depression Index (BDI). METHOD: We composed a questionnaire with BDI, and the Sense of Competence Questionnaire (SCQ) in order to evaluate the amount of stress and depression of caregivers. Evaluation of the patient was done by interviewing them along with reviewing their medical records and obtaining scores such as the MMSE, Functional Inependence Index (FIM) and the Geriatric Depression Scale (GDS). RESULTS: BDI of the caregivers showed a negative correlation with the patients' age. Lesion side nor age, nor the prevalence of hemiplegia of patients did not show statistical relevance with the strain that the caregiver felt. The first subscale of SCQ showed a positive correlation with the caregiving time that the caregiver gave. In accordance to the sex of the caregiver, females showed to spend more time with the patient, showed to be more unsatisfied with the patient but showed a tendency of lesser SCQ score. CONCLUSION: Depression, strain and burden that the caregivers went through showed to have slight correlation with the patient and caregiver factors.
Caregivers* ; Depression* ; Female ; Hemiplegia ; Humans ; Medical Records ; Mental Competency ; Prevalence ; Surveys and Questionnaires

OBJECTIVE: To compare the efficacy of epidural injection in accordance the distribution of dye in the epidural space for low back pain patient. METHOD: Twenty nine patients with herniated nucleus pulposus or spinal stenosis confirmed by the radiologic studies were treated with epidural injection of steroid. The patients were divided into two groups: 1) patients whose distribution of dye was in the posterior part of epidural space and 2) patients whose distribution of dye was in the anterior and posterior parts of epidural space. RESULTS: The efficacy of epidural injection was assessed using the visual analog scale (VAS) and straight leg raising test (SLR) on pre-treatment and post-treatment. The VAS and SLR change of pre-treatment and post-treatment in the first group was from 7.81 +/- 1.54 and 50.00 +/- 18.97 degrees to 4.45 +/- 2.16 and 75.00 +/- 17.61 degrees (p<0.05), respectively. The VAS and SLR change of pre- and post-treatment in the second group was from 7.72 +/- 1.56 and 43.33 +/- 15.28 degrees to 3.72 +/- 1.64 and 60.00 +/- 10.00 degrees (p<0.05), respectively. The VAS and SLR change between groups has no statistically significant difference (p>0.05). CONCLUSION: The different distribution of dye in epidural space had no significant difference in treating patients with low back pain.
Epidural Space* ; Humans ; Injections, Epidural* ; Leg ; Low Back Pain ; Spinal Stenosis ; Visual Analog Scale

In order to determine the electrophysiologic properties of aberrant ventricular conduction we analyzed the electrophysiologic studies done for various reasons in SNUH(1983.3 -1987.8). All patients did not have underlying heart disease and were in sinus rhythm with normal PR intervals & no intraventricular conduction delay at the time of study. The patients of preexcitation syndrome were excluded. Only aberrant ventricular conduction induced by premature atrial stimulation at the high right atrium or(HRA) during sinus rhythm or HRA pacing was analyzed. 1) Aberrant ventricular conuction was induced by premature atrial extrastimulation in 34 subjects of 156 cases reviewed(21.8%). The patients were 16 to 70 years old(sixteen males and eighteen females). 2) The longest atrial coupling(A1S2) interval resulting in aberrant ventricular conduction approximated 45%(600-280) of the basic cycle length(450-1550 msec). 3) As a prerequisite for aberrant ventricular conduction, the functional refractory period(FRP) of the AV node should be less than the relative refractory period(RRP) of the His Purkinje System and the most important determinant of aberrant ventricular conduction by atrial extreastimulation was resultant H1H2 interval, which should be between RRP and effective refractory period(ERP) of HPS. 4) There was good linear correlation between the basic cycle length(BCL) and RRP of the HPS(RRP=0.247xBCL+247.048, r=0.885, p-value<0.001). 5) 155 different configurations of aberrant ventricular conduction were recorded during atrial extrastimulation till atrial ERP. The pattern frequencies were as follows : left anterior hemiblock, 6(3.9%) ; right bundle brach block, 92(59.4%) ; left bundle branch block, 28(18.0%) ; left anterior hemiblock combined with right bundle branch block, 14(9.0%) ; left posterior hemiblock combined with right bundle branch block, 9(5.8%) ; unclassified intraventricular conduction disturbances, 6(3.9%). 6) As the atrial coupling intervals were further shortened, aberrant conduction persisted up to the point of atrial ERP at 19/41 BCL's(46.3%). Other patterns of atrioventricular conduction were as follows : atrio-His block, 7(17.1%) ; His-ventricular block, 6(14.6%) ; normal conduction due to prolonged A2H2, 9(22.0%). But there was no statistical significance between the pattern of A-V conduction and the longest S2H2 & H2V2 intervals during VAB (p-value=0.235>0.050). In conclusion, atrial extrastimulation which is routinely done during clinical EPS is an effective method to induce aberrant ventricular conduction and to study the electrophysiologic characteristics of atrioventricular conduction. Further study with recording of bundle branch electrogram, after infusion of cardioactive drugs and pacing of HRA at fixed rate should be done to determine the electrophysiologic properties of VAB more completely.
Atrioventricular Node ; Bundle-Branch Block ; Heart Atria ; Heart Diseases ; Humans ; Male ; Pre-Excitation Syndromes

To evaluate effect of coronary collateral circulation on left ventricular function in patients with acute myocardial infarction, global ejection fraction(EF), left ventricular end distolic pressure(LVEDP), peak creatine kinase(CK) level and regional wall motion were analysed and compared in 30 patients with acute myocardial infarction according to grade of coronary collateral circulation. Patients with total or near total(above 95% of diameter) occlsion of left anterior descending coronary artery without significant lesion in right coronary artery or left circumflex artery were selected and divided into 3 groups according to the degree of collateral circulation on coronary angiography, to be compared by the index of ejection fraction, peak creatine kinase level, left ventricular and diastolic pressure and regional wall motion. The result are as following : 1) There were no statistically significant differences in ejection fraction, peak creatine kinase level, left ventricualr and diastolic pressure among the groups. 2) Regional wall motion of infarct related area of G2+3 group(adequate collateral) were better than that of G0(no collateral) group(p<0.05). Therefore, adequate coronary collateral circulation in acute myocardial infarction is thought to have beneficial effect on left ventricular function especially in regional wall motion of infarct related area.
Arteries ; Blood Pressure ; Collateral Circulation* ; Coronary Angiography ; Coronary Vessels ; Creatine ; Creatine Kinase ; Humans ; Myocardial Infarction* ; Ventricular Function, Left*

Aortic dissection is clinically suspected from the typical symptoms and signs and may be confirmed by computed tomography or aortography. But atypical presentations can be seen in a minority of cases, such as SVC syndrome, right pulmonary artery stenosis etc. We present a case which was initially suspected to be a right atrial tumor because of a large filling defect in the right atrium on radionuclide angiocardiography but finally confirmed to be dissection of ascending aorta by computed tomography.
Angiocardiography ; Aorta ; Aortography ; Constriction, Pathologic ; Heart Atria ; Pulmonary Artery

Reentrant tachycardias can often be terminated by discrete pacing stimuli that penetrate the reentrant circuit. Antitachycardia pacemaker PASAR 4172 (Programmable Automatic Scanning Arrhythmia Reversion, Model 4172, Telectronics) is designed to detect tachycardia automatically and subsequently to deliver programmed one or two extrastimuli to revert to sinus rhythm. We experienced two patients, one paroxysmal supraventricular tachycardia and one paroxysmal ventricular tachycardia, who had had frequent and often prolonged episodes of tachycardia that responded poorly to pharmacologic antiarrhythmic therapy. Each patient underwent a detailed preimplantation clinical electrophysiological study in order to determine the number of stimuli required for termination of tachycardia, the most satisfactory site for electrode placement, and the tachycardia termination zone. During the follow-up period of 7 to 11 months after implantation of PASAR 4172, no patient complained of an episode of sustained tachycardia although they experienced symptoms of an impending attack. We conclude that antitachycardia pacemaker PASAR 4172 is a safe, effective, and well tolerated method for the therapy of drug resistant paroxysmal supraventricular tachycardia and paroxysmal ventricular tachycardia.
Arrhythmias, Cardiac ; Electrodes ; Follow-Up Studies ; Humans ; Tachycardia ; Tachycardia, Paroxysmal* ; Tachycardia, Supraventricular ; Tachycardia, Ventricular

OBJECTIVE: We measured current perception threshold (CPT) with transcutaneous electrical nerve stimulation (TENS) to prove the selective increment of the threshold of C sensory fiber and to determine onset time and duration of effect for application of TENS. METHOD: TENS were applied to fifteen control volunteers for 20 minutes on hand three times per week for 2 weeks duration. The CPT was tested at the distal interphalangeal joint of the second finger with 5 Hz, 250 Hz, and 2,000 Hz in frequency, respectively. The test was repeated immediately and 30 minutes after cessation of TENS. These tests were performed on the first, eighth, and fifteenth day on application of TENS. RESULTS: The baseline CPT of C fiber was 32.7 +/- 6.4 10 2 mA, A gamma fiber 23.2 +/- 9.4 10(-2) mA, and A beta fiber 83.9 +/- 18.1 10(-2) mA. At 30 minutes after cessation of TENS in the fifteenth day, the CPT of C fiber increased markedly and that of A gamma fiber increased a little. The CPT of A beta fiber didn't increase for 2 weeks. CONCLUSION: With application of TENS, the threshold of C and A gamma fibers selectively increased, especially 30 minutes after removal of TENS application. This effect was outstanding after 2 weeks' application.
Fingers ; Hand ; Joints ; Median Nerve* ; Nerve Fibers, Unmyelinated ; Transcutaneous Electric Nerve Stimulation* ; Volunteers

OBJECTIVE: The ultrasonographic (US) findings of the sternoocleidomastoid muscles (SCM) in patients with congenital torticollis were studied to evaluate the correlation between the US findings and outcome of physical theraphy. METHOD: We studied 52 patients diagnosed as congenital muscular torticollis. We evaluated the thickness, mass, echogenicity and echotexture of both SCM muscles. The US findings of the SCM muscles were divided into 5 grades according to the severity. The physical theraphy included heat theraphy and passive stretching of involved muscle. The outcomes of the treatment were evaluated by physical examination and follow-up US examination. RESULTS: Neck rotation of lesion site comparing to non-lesion site was improved significantly from 83.0+/-16.5% to 94.9+/-7.16% and lateral flexion from 77.9+/-18.1% to 90.5+/-12.4% after the treatment. In 20 US follow-up cases, thickness ratio of the involved SCM muscle decreased significantly from 177.8+/-46.2% to 158.3+/-83.1%. The therapeutic effect tends to be low with higher grades of the US findings. But, there were no significant statistical correlation between age and treatment outcome. CONCLUSION: The US findings of the SCM muscles had a significant correlation with the outcome and the duration of treatment.
Follow-Up Studies ; Hot Temperature ; Humans ; Muscle Stretching Exercises ; Muscles ; Neck ; Physical Examination ; Torticollis* ; Treatment Outcome ; Ultrasonography

OBJECTIVE: To evaluate the relationship between the electrophysiologic findings and the ultrasonographic findings of the ulnar neuropathy around the elbow. METHOD: We examed 20 elbows with the ulnar neuropathy around the elbow and 22 healthy elbows. We measured the cross-sectional area (CSA) and the diameters of the long, short axis of the ulnar nerve at the swollen portion and the compressed portion by ultrasonography. RESULTS: The CSA, diameters on the longitudinal and transverse view of the swollen portion of the ulnar nerve of the patients group was larger than that of the control group (p<0.05). The decrement of conduction velocity across the elbow was -0.54+/-5.74 m/s in the control group and 18.60+/-10.45 m/s in the patients group (p<0.05). There was no significant correlation between the decrement of the nerve conduction velocity across elbow and the decrement of CSA (r=0.346, p>0.05). There was significant correlation between the decrement of the nerve conduction velocity across elbow and the increment of the diameter on the swollen portion on the longitudinal and transverse view (r=0.541, 0.466, p<0.05, respectively). CONCLUSION: The difference of diameter between swollen and compressed portion of the ulnar nerve on the ultrasonography was correlated with the conduction velocity decrement on the electrophysiologic study.
Axis, Cervical Vertebra ; Elbow* ; Humans ; Neural Conduction ; Ulnar Nerve ; Ulnar Neuropathies* ; Ultrasonography

OBJECTIVE: This study was designed to observe the general characteristic of patients with shoulder pain, interrelation between the ultrasonographic findings, physical examination and radiological findings, and the effect of treatment of shoulder pain classified by ultrasonographic findings. METHOD: We examined 334 patients (165 male and 169 female) with shoulder pain who had been consulted to us. We examined degenerative changes such as subacromial spur, greater tuberosity sclerosis using radiological method. We classified patients into three categories -capsular, noncapsular and mixed - in accordance to physical examination and ultrasonographic findings. In order to estimate the effect of treatment, VAS change one week after injection, treatment duration, and frequency of injection were checked. RESULTS: The mean age of patients was 54.4 (range: 22~77) years. The average VAS change, duration of treatment, and frequency of injection were 4.68+/-2.93, 6.14 +/- 4.83 weeks, 3.59 +/- 2.70 times. There was meaningful correlation between diagnosis done with physical examination and ultrasonography in cases showing capsular and noncapsular patterns. Although there was meaningful difference of treatment effect classified by ultrasonographic findings, no meaningful difference in treatment effect was ween in patients classified by physical examination. CONCLUSION: Ultrasonography is an useful tool supporting diagnosis based on physical examination. The ultrasonography of shoulder could predict progress and prognosis of patients with shoulder pain.
Diagnosis ; Humans ; Male ; Physical Examination ; Prognosis ; Sclerosis ; Shoulder Pain* ; Shoulder* ; Ultrasonography*