Rheumatoid arthritis can result in progressive deformity of the forefoot, which leads to marked limitation in shoe wear, significant pain, and substantial diminution in standing and walking ability. Twenty feet of seventeen patients with severe forefoot deformities underwent surgical correction hy means of first metatarso-phalangeal arthrodesis and resection arthroplasties of the lesser M-P joints from May, I 994 to March, l996. The results were as follows; l. Suhjective improvement in pain, standing and walking ability, and shoe wear was excellent in fifteen (7~5%) feet, good in three (l5%), fair in one (5%), and poor in one (5%) foot. 2. The average hallux valgus angle (HVA), 1st intermetatarsal angle (IMA) were improved from 46.7 and 13.7 to 11. 1 and 8.2 degree individuaIly. 3. The average angle of dorsiflexion after the first metatarsophalangeal (MP) joint arthrodesis was 12.9 degree. 4. Complications of the procedures were minimal; three delayed wound healing, one non-displaced fracture of fusion site due to trauma, one malunion of the 1st MTP joint, one recurrence of the fibular deviation of the lesser toes.
Arthritis, Rheumatoid ; Arthrodesis ; Arthroplasty ; Congenital Abnormalities* ; Foot ; Hallux Valgus ; Humans ; Joints ; Recurrence ; Shoes ; Toes ; Walking ; Wound Healing

Seventy cases of moderate to severe hallux valgus deformities were operated by proximal metatarsal chevron osteotomy combined with modified McBride procedures from September 1994 to September 1996. The hallux valgus angle improved from an average of 35.1 degrees to 12.1 degrees postoperatively. The first intermetatarsal angle improved from an average of 15.4 degrees to 7.9 degrees. The position of sesamoids was normalized and the metatarsal bone shortened minimally. Union occurred in 6 weeks. Subjectively, pain was relieved in 95% of the patients, while walking and standing abilities improved in 90%. The shoewear improved in only 60% of the patients, showing less satisfactory results compared to other factors. In terms of complications, two recurrences occured but were treated without repeat surgery. Two malunions and four superficial wound infections occurred. In conclusion, proximal chevron metatarsal osteotomy combined with modified McBride procedures is a reliable operation as regards stability, technical ease, low complications and satisfactory results for moderate to severe Hallux valgus deformities.
Congenital Abnormalities ; Hallux Valgus* ; Hallux* ; Humans ; Metatarsal Bones* ; Osteotomy* ; Recurrence ; Reoperation ; Walking ; Wound Infection

No abstract available.

This study aims to determine the changes in health beliefs and practices of dental hygienists on infection control after having received special training on that subject. The study population consisted of dental hygienists working at the dental institutions located in Seoul and Gyeonggi areas. The intervention group and the control group each had randomly assigned 26 dental hygienists. The intervention group received training courses on infection control once a week for 3 hours, for a total of 4 training sessions. We used a survey tool to find the changes between the two groups regarding their health beliefs and practices on infection control measures. The survey was conducted prior to the training sessions, 3 months and 2 weeks after the training. The study results revealed statistically significant increases in perceived sensitivity, perceived seriousness, and perceived benefits after the training courses in the intervention group (p<0.05). A statistically significant decrease in perceived barriers was also noted in the intervention group (p<0.05). Additionally, there was a statistically significant increase in the practice of infection control in the intervention group as compared to the control group (p<0.05). Therefore, we conclude that infection control training is crucial in bringing about positive changes to the health beliefs of dental hygienists, and a structured system is necessary for continuous infection management along with training in order to improve infection control practices.
Dental Hygienists ; Education ; Gyeonggi-do ; Humans ; Infection Control* ; Seoul

No abstract available.
Obesity, Morbid* ; Polycystic Ovary Syndrome*

BACKGROUNDS: Obstructive sleep apnea syndrome(OSA) can divided into two groups, positional (PP) and non-positional(NPP) obstructive sleep apnea syndrome, according to the body position while sleeping. In this study, we evaluated the differences of anthropometirc data and polysomnographic recordings between the two types of sleep apnea syndrome. MATERIALS: Fifty patients with OSA were divided two groups by Cartwright's criteria. The supine respiratory disturbance index (RDI) was at least two times higher than the lateral RDI in the PP group, and the supine RDI was less than twice the lateral RDI in the NPP group. This patients underwent standardized polysomnographic recordings. The anthropometirc data and polysomnographic data were analyzed, statistically. RESULTS: Of all 50 patients, 30% were found to be positional OSA. BMI was significantly higher in the PP group(p<0.05). Total sleep time was significantly longer in the PP group (350.6±46.0min, p<0.05). Sleep efficiency was high in the PP group(89.6± 6.4%, 85.6±9.9%, p<0.05). Deep sleep was significantly higher and light sleep was lower in the PP group than in the NPP group but no difference was observed in REM sleep between the two groups. Apnea index(AI) and RDI were significantly lower(17.0±10.6, 28.5±13.3, p<0.05) and mean arterial oxygen saturation was higher in the PP group(92.7 ±1.8%, p<0.05) than in the NPP group. CONCLUSION: Body position during sleep has a profound effect on the frequency and severity of breathing abnormalities in OSA patients. A polysomnographic evaluation for suspected OSA patients must include monitoring of the body position. Breathing function in OSA patients can be improved by controlling their obesity and through postural therapy.
Apnea ; Humans ; Obesity ; Oxygen ; Polysomnography ; Respiration ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Sleep, REM

No abstract available.

No abstract available.
Psoriasis

Lidocaline if frequently administered as a component of an anesthetic : for local or regional nerve blocks, to mitigate the autonomic response to laryngoscopy and tracheal intubation, to suppress the cough reflex, and for antiarrythmic therapy. Diazepam dectease the potential central nervous system (CNS) toxicity of local anesthetic agents but -may modify the sitmulant action of lidocaine in addition to their own cardiovascular depressant. The potential cardiovascular toxicity of local anesthetics may be enhanced by the concomitant administration of diazepam. This study was designed to investigate the effects of lidocaine dose and pretreated diazepam to cardiovascular system and plasma concentration of lidocaine. Lidocaine in 100 mcg/kg/min, 200 mcg/kg/min, and 300 mcg/kg/min was given by sequential infusion to dogs anesthetized with halothane-nitrous oxide (Group I). And in group II, after diazepam pretreatment, lidocaine was infused by same way when lidocaine was administered in 100 mcg/kg/min, the low plasma levels (3.97+/-0.22-4.48+/-0.36 mcg/ml) caused a little reduction in cardiovascular hemodynamics. As administered in 200 mcg/kg/min, 300 mcg/kg/min, the higher plasma levels (7.50+/-0.66-11.83+/-0.59 mcg/ml) reduced mean arterial pressure (MAP), cardiac index (CI), stroke index (SI), left ventricular stroke work index (LVSWI), and right ventricular stroke work index (PVSWI) and incresed pulmonary artery wedge pressure (PAWP), central venous pressure (CVP), systemic vascular resistance index (SVRI), but was assciated with little changes of heart rate (HR), mean pulmonary artery pressure (MPAP), and pulmonary vascular resistance index (PVM). When lidocaine with pretreated diazepam was administered in 100 mcg/kg/min, the low plasma level, the lower level than when only lidocaine administered. reduced MAP, but was not changed other cardiovascular hemodynamics. While lidocaine was infused in 200 mcg/kg/min, 300 mcg/kg/min in dogs pretreated diazepam, the higher plasma level (7.64+/-0.79-13.79+/-0.82 mcg/ml) was maintained and was associated with reduced CI, SI, LVSWI and incresed PAWP, CVP, SVRI but was a little changes of HR, MPAP, PVRI. After CaCl2 administeration, CI, SI, SVRI, LVSWI was recovered but PAWP, UP was rather incresed than recovered. The foregoing results demonstrate that pretreated diazepam imposes no additional burden on cardiovascular system when a infusion of large dose of lidocaine is given to dogs anesthetized with halothanenitrous oxide. But caution may be advised if the addition of lidocaine is indicated in subjects who have impared autonomic nervous system and who are in hypercarbic, hypoxic, or acidotic states.
Anesthetics ; Anesthetics, Local ; Animals ; Arterial Pressure ; Autonomic Nervous System ; Cardiovascular System* ; Central Nervous System ; Central Venous Pressure ; Cough ; Diazepam* ; Dogs* ; Heart Rate ; Hemodynamics ; Intubation ; Laryngoscopy ; Lidocaine* ; Nerve Block ; Plasma* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Reflex ; Stroke ; Vascular Resistance

Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC) was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO) priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.
Blood Transfusion ; Death, Sudden, Cardiac ; Erythrocyte Transfusion ; Erythrocytes ; Extracorporeal Membrane Oxygenation* ; Heart Arrest* ; Humans ; Hyperkalemia* ; Infant* ; Infant, Newborn ; Potassium