Of several possible configurations of pin fixation of a displaced supracondylar fracture of the humerus in children, the medial and lateral crossed pinning technique has been known to provide the greatest resistance to gross rotational displacement. A new technique with ipsilateral two lateral crossed pins was devised so as to avoid the ulnar nerve injury with good stability for fracture site. During the period from 1992 to 1994, 18 children with displaced supracondylar fracture of the humerus were treated by closed reduction and ipsilateral two lateral crossed pinning. Eighty nine percents of the final results were satisfactory. There were no ulnar nerve injuries and fixation loss in all cases from the treatment. This is a safe, simple and reliable technique for providing the good stability of fracture site as well as avoiding the ulnar nerve injury.
Child ; Humans ; Humerus ; Ulnar Nerve ; Ulnar Neuropathies ; United Nations

No abstract available.

Behcet's disease is an inflammatory condition of multiple organ systems in witch recurrent oral and genital ulcers are the most typical signs. Less common clinical features include cerebral vasculitis, arterial aneurysm, deep vein phlebitis, aseptic meningitis, and discrete bowel ulcers. The most serious complication of Behcet's disease is arterial involvement especially ruptured arterial aneurysm. The aneurysm of sinus of Valsalva in Behcet's disease is a rare condition. There is no report about it in Korea. We report a case of a aneurysm of the sinus of valsalva with Behcet's disease. The patient had complete AV block and a right coronary sinus of Valsalva aneurysm which ruptured into the left ventricle. The diagnosis was made with transesophageal echocardiography. The patient was implanted with permanent pacemaker for relief of congestive heart failure due to complete atrioventricular (AV) block. He discharged and he is still follow-up in outpatient clinic.
Ambulatory Care Facilities ; Aneurysm ; Aneurysm, Ruptured* ; Atrioventricular Block* ; Behcet Syndrome* ; Coronary Sinus ; Diagnosis ; Echocardiography, Transesophageal ; Follow-Up Studies ; Heart Failure ; Heart Ventricles* ; Humans ; Korea ; Meningitis, Aseptic ; Phlebitis ; Sinus of Valsalva* ; Ulcer ; Vasculitis, Central Nervous System ; Veins

With expanded and extended coverage of the national medical insurance and fast growing health care expenditures, appropriateness of health service utilization and quality of care are concerns of both health care providers and insurers as well as patients. An accurate patient classification system is a basic tool for effective health care policies and efficient health services management. A classification system applicable to Korean medical information-Korean Diagnosis Related Groups (K-DRGs)-was developed based on the U. S. Refined DRGs, and the performance of the developed system was assessed in this study. In the process of the development, first the Korean coding systems for diagnoses and procedures were converted to the systems used in the definition of the U. S. Refined DRGs using the mapping tables formulated by physician panels. Then physician panels reviewed the group definition, and identified medical practice patterns different in two countries. The definition was modified for the difference in K-DRGs. The process resulted in 1,199 groups in the system. Several groups in Refined DRGs could not be differentiated in K-DRGs due to insufficient medical information, and several groups could not be defined due to procedures which were not practiced in Korea. However, the classification structure of Refined DRGs was retained in K-DRGs. The developed system was evaluated for its performance in explaining variations in resource use as measured by charges and length of stay(LOS), for both all and non-extreme discharges. The data base used in this evaluation included 373,322 discharges which was a random sample of discharges reviewed ad payed by the medical insurance during the five-month period from September 1990. The proportion of variance in resource use which was reduced by classifying patients into K-DRGs-r-square-was comparable to the performance of the U. S. Refined DRGs: .39 for charges and .25 for LOS for all discharges, and .53 for charges and .31 for LOS for non-extreme discharges. Another measure analyzed to assess the performance was the coefficient of variation of charges within individual K-DRGs. A total of 966 K-DRGs (87.7%) showed a coefficient below 100%, and the highest coefficient among K-DRGs with more than 30 discharges was 159%.
Classification ; Clinical Coding ; Delivery of Health Care ; Diagnosis* ; Diagnosis-Related Groups* ; Health Expenditures ; Health Personnel ; Health Services ; Humans ; Inpatients* ; Insurance ; Insurance Carriers ; Korea

No abstract available.
Blood Donors* ; Female ; Humans ; Pregnancy ; Pregnancy Trimester, Third* ; Pregnancy*

Open discectomy is one of usual treatment for herniated intervertebral disc. We may expect the reduction of height of intervertebral disc due to decreased volume by partial resection of herniated disc. But the effect of decreased height of intervertebral disc space to posterior joint and spinal canal has not been identified, and the correlation between the amount of reduced height and the changes of range of motion has been undetermined. Thus, we analyzed radiologic changes of disc height and segmental motion by the flexion-extension view in 20 patients who had undergone discetomy for prolapsed intervertebral disc from June 1989 to January 1991 who could be followed up for 3 years or more. As a result, lumbar discetomy associates with 1) significant decrement of disc height (average 14%), 2) decreased disc motion of involved segment without hypermobility (average 34%), 3) hypermobility of adjacent segment, 4) and posterior facet overriding consistent with recurred low back pain.
Diskectomy ; Humans ; Intervertebral Disc ; Intervertebral Disc Displacement ; Joints ; Low Back Pain ; Range of Motion, Articular ; Spinal Canal

The diagnosis of ovarian tumor has been mainly dependent on manual pelvic examination and ultrasonography. Butin case of malignant ovarian tumor, CT has more advantages over ultrasonography in assessing anatomic details,relationships to bowel loops, precise extents of tumors and follow-up examinations after surgery. Authors analyzedCT features of 46 cases of patholgocially proven ovarian tumors for recent 4 years at keimyung University DongsanHospital. The results were as follows: 1. The msot common tumor was serous cystadenocarcinoma(9 cases:20%),followed by metastases(8 cases: 17%), mucinous cystadenocarcinoma(7 ases:15%), mucinous cystadenocarcinoma(5cases:11%), teratoma(5 cases:11%), lymphoma(3 cases: 7%) and dysgerminoma(2 cases:4%). 2. The ovarian tumors werevariable in size from 2.5cm to 33cm in diameter. Most of the solid tumors were smaller than 10cm in diameter andmost of the cystic tumors were larger than 10cm in diameter. Usually mucinous tumors were much larger than seroustumors. Mucinous cystadenomas were the largest tumors. 3. Unilateral tumors(left 19,right 13 cases) were morecommon than bilateral tumors(12 cases). Bilateral tumors were seen in serous and mucinous cystadenocarcinoma,metastases and lymphoma. 4. CT features of mucinous cystadenomas were smooth margins and thin wall of the tumormasses and multiloculated cysts with internal septa in all 7 cases. 5. In contrast, CT demonstration ofbilaterality, irregular margin, thick wall, enhancing solid lesions, septal irregularity, adhesion to adjacentstructures, peritoneal/omental implantation, ascites and hydronephrosis were signs suggesting malignancy. CTfeaturs of the serous cystadenocarcinoma were mostly solid to mixed nature(83%), irregular margin(75%), enhancingsolid lesion(67%), papillary growth (75%), internal septa(58%), multilocularity (58%) and calcification (25%) indescending order of frequency. 6. On CT, mucinous cystadenocarcinoma were irregular-marginated, thick-walled,cystic tumors with enhancing solid lesion, septal irregularity and signs of metastasis, although there were somecases having similar features of benign. 7. Among the extrapelvic CT findings of malignant epithelial ovariantumor, peritoneal/omental implants(11 cases:79%) and ascites(10 cases:71%) were the most common, and indistinctuterus(6 cases:43%), bowel adehsion(5 cases:36%) and pseudomyxoma peritonei (2 cases) were descending order offrequency. 8. CT features of teratoma were diagnostic having at least three more of different tissue densitiesamong fat, water, soft tissue and calcific densities. Also there were thick wall (4 cases) and fat-fluid level(1case). 9. In 8 cases of ovarian metastases, there were solid type tumor smaller than 10cm in 4 cases and hugecystic in 2 cases. The site of primary cancer were stomach in 4 cases, colon , cervix, endometrium and unknown ineach one case. 10. In 3 cases of malignant lymphoma, the CT featurs were solid in appearance, smaller than 10cmand accompanied by lymphadenopathy in all cases.
Ascites ; Cervix Uteri ; Colon ; Cystadenocarcinoma, Mucinous ; Cystadenocarcinoma, Serous ; Cystadenoma, Mucinous ; Diagnosis ; Endometrium ; Female ; Follow-Up Studies ; Gynecological Examination ; Hydronephrosis ; Lymphatic Diseases ; Lymphoma ; Mucins ; Neoplasm Metastasis ; Pseudomyxoma Peritonei ; Stomach ; Teratoma ; Ultrasonography ; Water

OBJECTIVE: To study the changes of magnetic evoked potentials by thinking of simple motion without actual muscle action of that motion. METHOD: We use H-reflex to test the excitability of relevant pools of spinal motor neurons and Magnetic Evoked Potentials (MEPs) to study the core of brain motor activity. The H-reflex and MEPs were obtained in three different conditions. 1) non-facilitation (NF), that is, resting state without actual motion and without thinking of that motion. 2) volitional-faciliation (VF), with actual motion which is usual manner of facilitation of MEPs. 3) thinking-facilitation (TF), without actual motion but with imaginary thinking of that motion. We evaluate the thresholds, amplitudes and latencies of H-reflex and MEPs in each three condition. RESULTS: Comparing with the parameters in NF condition as a baseline, there were no significant changes in any parameters of H-reflex in TF condition, but there were significant changes in threshold and amplitude of H-reflex in VF. On the while there were significant changes both in VF and TF of MEPs. The amount of facilitation of MEPs were greater in VF than in TF; the amount threshold decrement, amplitude increment and latency decrement of MEPs were greater in VF than in TF. CONCLUSION: Thinking of simple motion without actual muscle action of that motion could facilitate the MEPs, and this facilitation is induced by increasing activity of brain motor cortex not by that of spinal cord level.
Brain ; Evoked Potentials* ; H-Reflex ; Motor Activity ; Motor Cortex ; Motor Neurons ; Spinal Cord ; Thinking*

OBJECTIVE: This study was designed to evaluate the usefulness of stretch reflex threshold speed (SRTS) in biomechanical assesment of spasticity of hemiplegic patients. METHOD: Thirty-eight hemiplegic patients and twenty-seven control subjects were studied. The spasticity of ankle plantar flexor muscles were assessed both clinically and biomechanically. Modified Ashworth scale (MAS) and Brunnstrom stage were used in clinical assessment. For biomechanical assessment, ankle plantar flexor muscles were stretched isokinetically while EMG signals were recorded simultaneously. SRTS was defined as a minimum angular velocity in which EMG signals evoked by stretch reflex were recorded. RESULTS: SRTSs of ankle plantar flexors were 128.1 47.1o/sec in control group, 163.7 79.7o/sec in intact legs, and 83.4 69.1o/sec in involved legs of hemiplegic group. STRS was significantly lower in involved legs of hemiplegic group than in intact legs of hemiplegic group and control group. Significant reverse correlation was observed between SRTS and MAS. There was significant difference in SRTS between MAS 0 group and other groups. The patients with Brunnstrom stage 3 and 4 groups showed decreased SRTS compared to the patients with other groups. CONCLUSION: SRTS is thought to reflect increased excitability of stretch reflex and seems to be one of useful parameters in quantitative assessment of spasticity.
Ankle ; Equidae ; Hemiplegia ; Humans ; Leg ; Muscle Spasticity* ; Muscles ; Reflex, Stretch*

OBJECTIVE: To evaluate the usability of near-nerve needle recording techniques in cases of unrecordable sensory nerve action potentials (SNAPs) with a surface electrode and to determine a proper alternative value of the missing latencies. METHOD: Twenty six hands of 23 patients with a carpal tunnel syndrome (CTS) and an unobtainable median SNAP by surface electrode were evaluated by the near-nerve needle recording of median SNAPs. Using the nerve conduction data of 113 patients with CTS, we have established 3 alternative values: maximal, 95 percentile and predictive latencies. The alternative values were compared with the mean onset latencies by the near-nerve needle recordings of median SNAPs. RESULTS: Median SNAPs were obtainable in the 22 out of 26 hands by the near-nerve recording technique. The mean onset latency was 5.51+/-0.36 ms. The alternative values from 113 patients with CTS were as follows: maximum latency, 6.9 ms; 95 percentile latency, 5.6 ms; and predictive latency, 5.52 ms (Y = 0.123x X 5.52491; Y, onset latency; X, amplitude; r2=0.564; p=0.00). The Predictive latency was nearest to the mean onset latency. CONCLUSION: To minimize the selection bias and statistical errors, the near nerve recording techniques proved to be a valuable method in cases of unrecordable SNAPs with surface electrode. For compensation of missing data, a proper alternative value can be obtained by the predictive latency calculated from a linear regression.
Action Potentials ; Carpal Tunnel Syndrome ; Compensation and Redress ; Electrodes ; Hand ; Humans ; Linear Models ; Needles ; Neural Conduction ; Selection Bias