The finger flexor injuries are very difficult to treat satisfactorily. It is usually said that the earlier the treatment performed, the better result obtained. But the delicasy of the hand anatomy and its function as well as the absence of the hand surgeon in the first aid care make the problem more complex. Even if we made the primary treatment to the flexor tendon injuries, some disabilities are often remained. We have treated fifty eight cases of old flexor tendon injuries in forty eight patients, the results can be summarized as follows. 1. The cause of the tendon damage is due to the laceration injury in the majorities of the cases. T,he tendon injuries are especially common between the late second and the early third decade. 2. In the injury of the Zone II with pulley distortion, the pulley reconstruction using palmaris longus or fascia from other sites will prevent bowstring and help the tendon function. 3. The Zone II can be subdivided into two subspecific areas. The proximal area is from the distal palmar crease to the midoprtion of porximal phalanx and the distal one is from the midportion of the proximal phalanx to the insertion of the sublimis tendon. In the proximal area one can repair the injured tendon directly after removal of the A1 and about proximal half of the A2 pulley without any subsequent bowstring if the tendon and its tunnel is relatively well preserved. Thus one can convert this proximal portion of Zone II to Zone III. So the proximal area of the Zone II should be differentiated from the remaining distal part of the Zone II. 4. At six months after the operation the result of the operation was analyzed by the percentage of the recovery, which was calculated by the postoperative active range of the interphalangeal joints divided by one hundred seventy five degrees that means the available total range of motion of normal interphalangeal joints. Excluding the cases with the tenodesis or arthrodesis, the total result revealed good or excellent in about ninty percentages with this method. 5. There were two fingers that showed a postoperative lumbrical plus state in Zone II, which were recovered spontaneously within three to four months postoperatively. So it is considered that the relative shortening of the lumbrical muscles can be treated and overcome conservatively by the active use of the fingers, and there is no need to perform an lumbrical tenotomy to correct this kind of muscle imbalance.
Arthrodesis ; Fascia ; Fingers ; First Aid ; Hand ; Humans ; Joints ; Lacerations ; Methods ; Muscles ; Patella ; Patellar Ligament ; Range of Motion, Articular ; Tendon Injuries ; Tendons ; Tenodesis ; Tenotomy ; Tibia

Forty-four strains of Helicobacter pylori were isolated from Kosin Medical Center were tested of resistance to antimicrobial agents, and the mechanism of resistance to clarithromycin was investigated. We determined the MICs of amoxicillin, amoxicillin/clavulanic acid, clarithromycin, and metronidazole by agar and broth dilution method. To detect the mutations of 23S rRNA which is associated with clarithromycin resistance, a 3'-mismatched polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis with restriction enzymes BbsI and BsaI were performed. The nucleotide sequence of 23S rRNA was determined. All H. pylori strains appeared to be susceptible to amoxicillin/clavulinic acid, but 2.3% of strains (1 strain) are resistant to amoxicillin, 13.6% (6 strains) to clarithromycin, and 15.9% (7 strains) to metronidazole. No PCR products was observed by the 3'-mismatched PCR. A 291 bp of PCR product was not digested by BbsI, but was digested by BsaI, which was a characteristic of the A2143G point mutation in the 23S rRNA gene. The nucleotide sequencing analysis revealed that all resistant strains had A2143G, T2182C, and T2244C mutations in 23S rRNA gene.
Agar ; Amoxicillin ; Anti-Infective Agents ; Base Sequence ; Clarithromycin* ; Genes, rRNA ; Helicobacter pylori* ; Helicobacter* ; Korea* ; Metronidazole ; Point Mutation ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length

Genital mycoplasmas are sexually transmitted. There are considerable public concern that causative agents of sexually transmitted diseases might be transmitted nonsexually through public restrooms. In the present study, Mycoplasma hominis, Ureaplasma urealyticum and M. penetrans among genital mycoplasmas were identified in 100 public restroom toilet bowls (50 men's and 50 women's public restrooms, each). Mycoplasmas were genotypically identified by two methods; (1) PCR of primary selective culture and (2) direct PCR of original specimens before primary selective culture. From 50 men's public restrooms, M. hominis, U. urealyticum and M. penetrans were identified from PCR of primary selective cultures in 6%, 4% and 0% of the specimens, respectively and M. hominis and U. urealyticum was codetected in 2% of those. And M. hominis, U. urealyticum and M. penetrans were identified by direct PCR in 20%, 16% and 0% of the original specimens, respectively and co-detection rate of M. hominis and U. urealyticum was 4% in those. From 50 women's public restrooms, 38% was positive for M. hominis, 14% for U. urealyticum, 0% for M. penetrans and 10% for both U. urealyticum and M. penetrans by PCR of primary selective culture. And 50% was positive for M. hominis, 46% for U. urealyticum and 0% for M. penetrans and 34% for both M. hominis and U. urealyticum by direct PCR of the original specimens. These results indicate that the genital mycoplasmas can survive for considerable duration in toilet bowels, and might be transmitted by through public restrooms.
Mycoplasma hominis ; Mycoplasma penetrans ; Mycoplasma* ; Polymerase Chain Reaction ; Sexually Transmitted Diseases ; Ureaplasma urealyticum

PURPOSE: For diagnosis of Mycoplasma pneumoniae infection, serological diagnosis, which is simple and rapid method, is uncertain to determine the reliable single serum titers. We compared serologic test, culture and polymerase chain reaction (PCR), and evaluated the reliable single titers of the specific serum antibody determination method for diagnosis of M. pneumoniae infection. METHODS: We included 73 pneumonic children between 3-11 years who were admitted to the pediatric department of St. Benedict hospital between November 2002 and July 2003. We used indirect particle agglutination test (Serodia-Myco II; Fujirebio, Tokyo, Japan) and serum specimens were obtained on admission and after 5-10 days. Fourfold rise of Mycoplasma antibody titers was considered as M. pneumoniae infection. We collected the throat swabs from all of the participants for culture and PCR. RESULTS: Of 73 patients, 41 patients met the diagnostic criteria by serologic test. PCR for M. pneumoniae was positive for 33 patients, sensitivity 80.5%, specificity 90.6%. M. pneumoniae was cultured from 24 patients, sensitivity 59%, specificity 100%. When cut-off was set at a titer of > or =1: 160, the sensitivity and specificity of PCR were significantly higher (61 % vs 68%) by receiver operation characteristic curve. (P=0.035) There was no correlation between culture method and Mycoplasma Ab titer. CONCLUSION: PCR is a highly sensitive and specific diagnostic method and enough to allow for early diagnosis in the acute phase. The single Mycoplasma Ab titer > or =1: 160 in child with respiratory symptoms is considered as M. pneumoniae infection and would be more sensitive, when combined with PCR.
Agglutination Tests ; Child ; Diagnosis* ; Early Diagnosis ; Humans ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pharynx ; Pneumonia ; Pneumonia, Mycoplasma* ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Serologic Tests*

BACKGOUND: The number of ICU beds related to the number of general acute care beds provides a broad measure of intensive care, but it has obvious limitations and underestimates extreme regional differences. As a first step, we evaluated the number of ICU beds or the ratio of ICU beds to hospital beds in university and non-university hospitals in Korea. METHODS: The number of ICU beds and hospital beds, the ratio of the number of ICU beds to hospital beds, and the types of ICU in each range of ICU beds and hospital beds in the university and non-university hospital were analyzed as well. RESULTS: Thirty university hospitals had 1,824 ICU beds out of 25,966 hospital beds, an average of 7.0%. The number of ICU beds ranged from 17 to 159 beds and hospital beds ranged from 400 to 2,000 beds in university hospitals. Fourteen non-university hospitals had 377 ICU beds out of 6,121 hospital beds, an average of 6.2%. In non-university hospitals, the number of ICU beds ranged from 6 to 67 beds with 50 to 700 hospital beds. If there was only one ICU, e.g. multidisciplinary, or more than one, the director of a multidisciplinary and surgical ICU was usually filled by an anesthesiologist, while the directors of other ICUs were usually specialists according to each specific ICU. CONCLUSIONS: There was a large disparity in the number of ICU beds and in the ratio of ICU beds to hospital beds between university and non-university hosptials, and even between university hospitals.
Hospitals, University ; Intensive Care Units* ; Critical Care* ; Korea* ; Specialization

More than 17 different terms, including carcinosatcoma and pseudosarcoma, have been applied to the rare polypoid tumors of the esophagus that demonstrate both carcinomatous and sarcomatous components. The multiplicity in terminology seems related to the uncertain histogenesis of these tumors. A demonstration of the ultrastructure of the spindle cells (containing desmosomes and tonofilaments) is consistent with an epithelial origin. The patient was a 53 year-old man who had suffered from dysphagia and foreign body sensation in larynx. Endoscopic finding was a large polypiod mass with ulceroinfiltrative lesion at the level of 27cm from the incisor. Pathologic findings were that the covering epithelium showed well differentiated squamous carcinoma with invasive pattern and the stroma contained islands of sarcoma and squamousl cell carcinoma. Immunoreactivity to cytokeratin was not observed. Partial esophagectomy and esophagogastrostomy was done. We report a case of rare malignant esophageal carcinosarcoma.
Carcinoma, Squamous Cell ; Carcinosarcoma* ; Deglutition Disorders ; Desmosomes ; Epithelium ; Esophagectomy ; Esophagus* ; Foreign Bodies ; Humans ; Incisor ; Intestines* ; Islands ; Keratins ; Larynx ; Middle Aged ; Sarcoma ; Sensation ; Stomach*

Using KAIS 0.15 Tesla magnetic resonance imaging system, ECG gated magnetic resonance image (MRI) of cardiovascular system was obtained in 8 normal volunteers and 10 patients with various cardiovascular diseases diagnosed at Seoul National University Hospital. The findings of cardiovascular MRI were analysed and the results were as follows ; 1) ECG gated MRI revealed datailed normal anatomy of heart including both atrioventricles and great vessels in axial, sagittal and coronary sections with natural contrast of moving blood without contrast media. 2) Dynamic changes of both ventricular walls in systolic and diastolic phase were revealed in sequential axial MRI, and increased signals were detected in left ventricle and descending aorta due to slow flow in end diastole. 3) Left ventricular aneurysm and myocardial thinning were shown in 2 cases of myocardial infarction. Enlarged left atrium was noted in 1 cases of mitral stenosis. Segmental analysis was possible in 3 cases of corrected transposition of great vessels. 4) Enlarged lumen, intimal flap and irregular luminal narrowing were detected in each of ascending aortic aneurysm, dissecting aneurysm and Takayasu's arteritis respectively. Pericardial effusion due to lymphoma revealed low signal encircling heart in contrast with neighboring mediastinal structures and cardiac wall. 5) MRI is a new promising modality in the diagnosis of cardiovascular system, which has potentiality to give a hemodynamic information in addition to the anatomical detalis.
Aneurysm ; Aneurysm, Dissecting ; Aorta, Thoracic ; Aortic Aneurysm ; Cardiovascular Diseases ; Cardiovascular System* ; Contrast Media ; Diagnosis ; Diastole ; Electrocardiography ; Healthy Volunteers ; Heart ; Heart Atria ; Heart Ventricles ; Hemodynamics ; Humans ; Lymphoma ; Magnetic Resonance Imaging ; Mitral Valve Stenosis ; Myocardial Infarction ; Pericardial Effusion ; Phenobarbital ; Seoul ; Takayasu Arteritis ; Transposition of Great Vessels

BACKGROUND/AIM: Recent advances in both diagnosis and treatment have markedly improved the prognosis in patients with hepatocellular carcinoma (HCC). Bone metastasis has become a clinical problem in the treatment of HCC patients. The purpose of this study was to evaluate the palliative effect of radiotherapy for painful bone metastasis from HCC. METHODS: From January 1991 to June 2000, 51 patients (77 sites) with painful bone metastasis from HCC were retrospectively analyzed. Ages ranged from 21 to 80 years (median 55 years). The male:female ratio was 7.5:1. Synchronous or metachronous bone metastasis was seen in 20 (39%) and 31 patients (61%), respectively. The most common symptom of bone metastasis was pain (45 patients, 88%). Twenty-one patients (41%) had a solitary bone metastasis while 30 (59%) had multiple ones. The sites of bone metastasis, in order of frequency, were the vertebra (38), rib (20), and pelvis (19). The total radiation dose ranged from 12.5 to 50 Gy (median 30 Gy). The Wisconsin Brief Pain Questionnaire was used to evaluate pain response. RESULTS: The overall 1 and 2 year survival rates from the time of bone metastasis were 15% and 4%, respectively. The median survival time was 5 months. Intrahepatic stage(p=0.014), and metastasis to other organs(p=0.019) were significant prognostic factor for survival by univariate analysis. There was, however, no independent prognostic factor on multivariate analysis. Pain relief after radiotherapy was achieved for 56 sites (73%). CONCLUSION: The expected life span (median 5 months) in this group of patients suggests a strong necessity for effective treatment for symptomatic palliation. Radiation therapy was effective in pain palliation for bone metastasis from HCC, and this could improve patients' quality of life.
Adult ; Aged ; Aged, 80 and over ; Bone Neoplasms/*radiotherapy/*secondary ; Carcinoma, Hepatocellular/mortality/*radiotherapy/*secondary ; English Abstract ; Female ; Human ; Liver Neoplasms/mortality/*pathology ; Male ; Middle Aged ; Palliative Care ; Retrospective Studies ; Survival Rate

PURPOSE: Tertiary hyperparathyroidism (tHPT) means a persistent secondary hyperparathyroidism even after successful renal transplantation. Parathyroidectomy (PTX) is an efficient way to treat tHPT. In this study, we reviewed our single center Experience of PTX in regard to postoperative outcomes and analyzed any differences by the types of surgery. METHODS: Among 2,589 recipients who underwent renal allograft between April. 1979 and Dec. 2006, 11 patients (0.4%) were identified to have tHPT and underwent PTX. Levels of intact parathyroid hormone (iPTH) and serum calcium were measured before and after PTX to evaluate therapeutic effect, and serum-creatinine and GFR using the Modification of Diet in Renal Disease (MDRD) equation to investigate any effect to graft function. RESULTS: One patient showed persistent hyperparathyroidism and hypercalcemia after subtotal PTX. We experienced 10 successful PTXs in which 2 total PTX with autotransplantations, 4 subtotal PTXs and 4 limited PTXs. Level of iPTH and serum calcium were at normal range after PTX. Serum creatinine increased and estimated GFR decreased after PTX. Total PTX with autotransplantation showed a tendency of more decrease in the values of iPTH, and GFR after PTX than Subtotal PTX. CONCLUSION: PTX can cure tHPT-specific symptoms and sign by the recovery of hypercalcemia but may carry the risk of deterioration of kidney graft function. Subtotal PTX rather than total PTX might be recommended in the surgical treatment of tHPT to prevent any risk of kidney graft deterioration.
Allografts ; Autografts ; Calcium ; Creatinine ; Diet ; Humans ; Hypercalcemia ; Hyperparathyroidism* ; Hyperparathyroidism, Secondary ; Kidney ; Kidney Transplantation* ; Parathyroid Hormone ; Parathyroidectomy ; Reference Values ; Transplants

BACKGROUND/AIMS: The long-term virologic and biochemical changes in patients with HBeAg negative HBV infection, especially in Asia, remain unclear. To address this issue, we conducted a 3 year- retrospective, cohort study. METHODS: A total of 157 patients with HBeAg negative HBV infection who were monitored without treatment were reviewed between January 1999 and March 2004. Those patients were followed up every 3 months with liver function tests and serologic tests. All patients were stratified into 3 groups; inactive carrier (IC), viremic carrier (VC) and chronic hepatitis (CH). Serum HBV DNA was measured by a hybridization assay (sensitivity: 1.4 x 10(5) genomes/mL, Digene Diagnostics, Silver Spring, USA). RESULTS: The median age of enrolled patients was 42.7 years (M:F=2.3:1). By single time-point observations, the 3 year-cohort prevalence of HBeAg negative CH varied from 12.7 to 35.8% (median 20.7%) HBeAg negative CH was accumulated over time (P=0.002) and transition rates among three groups after 3 years of follow-up are as follows: IC to CH, 6.0%; IC to VC, 4.1%; VC to CH, 23.2%. VC seems to be a disease state in the middle of transition from IC to CH. CONCLUSIONS: We demonstrated the dynamic changing patterns of HBeAg negative CH with time, of which the change from IC or VC to CH was dominant.
Middle Aged ; Male ; Humans ; Hepatitis B, Chronic/*immunology/virology ; Hepatitis B e Antigens/*blood ; Female ; Carrier State/immunology ; Adult