Statistical observation was made on 968 out-patients and 74 in-patients in the Department of Urology Han Ill Hospital, during the period from April 1, 1968 to Mar. 31, 1969.
Humans ; Outpatients ; Urology*

To analyze the changes of range of motion and manifestation frequency of impingement sign according to ages in shoulder impingement syndrome after excluding complete rotator tears by MRI, the authors reviewed 74 patients whose impingement injection tests to the subacromial space were positive in the Dankook university hospital. We used paired student t-test for comparison with the contralateral shoulder. l. Average forward elevation, abduction, external rotation and internal rotation of the shoulders were not significantly different in stage I and II, but significantly different statistically in stage II over 40 years old. 2. Average external rotation at 90degrees abductions of the shoulders was not significantly different statistically in stage I, II and stage II over 40 years old. 3. Frequencies of the painful arc were 83% in stage I, 71% in stage II and 58 % in stage II over 40 years old. Physical examinations of painful arc in 1 case of stage II, 7 cases of stage II over 40 years old were impossible because of limitation of motion. 4. Frequencies of lateral impingement sign were 100% in stage I, 86% in stage II, 100% in stage II over 40 years old. Frequencies of Neer's impingement sign were 75% in stage I, 67% in stage II, 88% in stage II over 40 years old. Frequencies of Hawkins impingement sign were 67% in stage I, 62% in stage II and 82% in stage over 40 years old. Except external rotation at 90degrees abduction, range of motion of the shoulder may be decreased in impingement syndrome over 40 years old. Because of difference of frequencies, more than two impingement signs should be tested for the diagnosis of shoulder impingement syndrome.
Adult ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Physical Examination ; Range of Motion, Articular ; Shoulder Impingement Syndrome* ; Shoulder Joint ; Shoulder*

The present study was performed to investigate the role catecholamine in the genesis of reperfusion injury of ischemic heart. The possible involvement of catecholamine in the xanthine oxidase-linked production of oxygen free radicals was studied. langendorff preparations of rat hearts were made ischemic for 60 min followed by reperfusion. Upon reperfusion norepinephrine(NE) was significantly released into the coronary effluent regardless of oxygenation of the perfusion solution. Both the increased releases of creatine phosphokinase(CPK) and malondialdehyde(MDA) and the production of superoxide anion in the ischemic-reperfused hearts were significantly reduced by the treatment with either reserpine, a catecholamine depletor, or propranolol, a beta-adrenergic receptor blocker. In the reserpinized hearts, infusion of exogenous NE reversed the releases of CPK and MDA and the superoxide anion production to the original higher levels. The releases of CPK and MDA as well as the production of superoxide anion induced by NE in the reserpinized hearts were significantly depressed either by allopurinol, a specific competitive inhibior of xanthine oxidase(XOD), or by the calcium removal from the perfusion solution. Compared with the XOD activity of control ischemic hearts, that of the hearts treated with reserpine or propranolol showed lower activity in the oxygen radical producing 0-form and higher activity in D/0-form. In the reserpinized ischemic hearts, infusion of exogenous NE increased 0-form, but decreased D/0-form of XOD. The changes in XOD activities induced by exogenous NE was prevented by phenylmethylsulfonyl fluoride(a serine protease inhibitor) and pimoxide(a calmodulin inhibitor) as well as by calcium removal from the perfusion solution. It is suggested from the results that in the inchemic-reperfused heart of rat catecholamine participates in D/0 to 0-form conversion of XOD by promoting the calcium-calmodulin-dependent proteolysis and plays a contributing role in the production of oxygen free radical.
Allopurinol ; Animals ; Calcium ; Calmodulin ; Creatine ; Free Radicals ; Heart* ; Oxygen ; Perfusion ; Propranolol ; Proteolysis ; Rats* ; Reperfusion Injury* ; Reperfusion* ; Reserpine ; Serine Proteases ; Superoxides ; Xanthine Oxidase* ; Xanthine*

No abstract available.
Urology*

The authors reviewed the medical records of 78 patients diagnosed as amyotrophic lateral sclerosis (ALS) at the Department of Neurology of Seoul National University Hospital from January 1980 to June 1986. The clinical features, serum CPK value, electromyographic findings and muscle biopsy findings were analysed. Results obtained were as follows: 1. The mean age of onset was 44.4 (17-68) which was about 10 years earlier than that in the reports from other countires. The sex ratio (male to female) was two to one (52:26). 2. The most common from was conventional type (48.7%), followed by pseudopolyneuritic type (30.8%) and bulbar type (20.5%). 3. Muscle weakness (100%), muscle atrophy (97%), hyperreflexia (94%), fasciculations (82%), bulbar signs (67%), frontal release signs (31%), Babinski signs (27%) and sensory deficits (5%) were observed. Four cases with sensory deficits proved that they were accompanied with carpal tunnel syndromes. 4. The mean interval from onset to generalization of symptoms was shorter in bulbar type (10.6 months) than in non-bulbar type (16.6 months), suggesting a more progressive course in the former. 5. Serum CPK value was checked in 62 cases. An increase up to four times the normal value was observed in 17 cases (27%). 6. EMG (N=73) revealed such abnormal findings in 70 cases (95.9%) as increased insertional activities, fibrillations, positive sharp waves, reduced interfernece patterns, fasciculations and giant motor unit potentials. No abnormal findings were found in three cases, however. 7. Muscle biopsy (N=61) showed neurogenic atrophy with various changes in 56 cases (92%), massive fatty infiltration in 4 cases and muscle fascia only in one case.
Age of Onset ; Amyotrophic Lateral Sclerosis* ; Atrophy ; Biopsy ; Carpal Tunnel Syndrome ; Fascia ; Fasciculation ; Generalization (Psychology) ; Humans ; Medical Records ; Muscle Weakness ; Muscular Atrophy ; Neurology ; Reference Values ; Reflex, Abnormal ; Reflex, Babinski ; Seoul ; Sex Ratio

BACKGROUND: The effects of a muscle relaxant may differ in elderly compared with young adult patients for a variety of the pharmacokinetic and pharmacodynamic reasons. Atracurium is eliminated by nonorgan dependent pathway, Hofmann elimination and ester hydrolysis. So there are some arguments for age-related differences. The purpose of this study was to compare the differences of the onset and duration of atracurium in young and elderly. METHODS: Eighteen young adults (21-54 yr) and 18 elderly (>65 yr) patients anesthetized with nitrous oxide and enflurane. Atracurium (0.5 mg/kg) was given and then intubation was performed after T1 response was blocked more than 80%. Neuromuscular relaxation was measured by the first twitch of train-of-four (T1) response at the adductor pollicis after supramaximal stimulation of ulnar nerve at 2Hz every 12 sec. The onset (disappearance of T1) and duration of 5, 25, 50, 75% recovery time of T1 and recovery index (time for 25-75% recovery of T1) were recorded. RESULTS: Onset of block was not significantly different between the young and elderly. Recovery time of 5, 25, 50, 75% and recovery index were not prolonged in elderly compared with young adults. CONCLUSIONS: There were no significant differences between young and elderly adults in onest time, recovery time of 5, 25, 50, 75% and recovery index when atracurium is used in a single bolus dose. The results suggest that atracurium in elderly patients has similar onset and action duration compared with younger patients.
Adult ; Aged* ; Atracurium* ; Enflurane ; Humans ; Hydrolysis ; Intubation ; Nitrous Oxide ; Relaxation ; Ulnar Nerve ; Young Adult

Myotonic dystrophy is a familial multisystem disorder transmitted by autosomal dominant pattern, which is the commonest of adult-onset muscular dystrophies. We analyzed clinically 16 patients of myotonic dystrophy who had admitted at Seoul National University Hospital during past 8.5 years (from Jan. 1977 to July 1985). Sex ratio is 7:1 (male; 14, female;2) and the average age is 29.6 (17-49). Chief complaints, at admission, are relaxation difficulty (88%), extremity weakness (69%), speech disturbance (63%), frontal baldness (38%), and impotence(31%), etc. in that order of frequency. Physical examination showed myotonia and typical myopathic appearnace in all cases. EMG and muscle biopsy revealed typical features of myotonic dystrophy. Associated other abnormalities are EKG abnormality (81%), eye involvement (68.7%), abnormal skull X-ray (46.7%), DM (18.8%), increased serum gonadotropin level (90%), abnormal semen composition (80%), decreased pulmonary function (100%) and mild brain atrophy, etc. Diphenylhydantoin was given and physiotherapy with genetic counselling was performed. Seven of sixteen patients showed slight decrement of myotonia.
Alopecia ; Atrophy ; Biopsy ; Brain ; Electrocardiography ; Extremities ; Gonadotropins ; Humans ; Muscular Dystrophies ; Myotonia ; Myotonic Dystrophy* ; Phenytoin ; Physical Examination ; Relaxation ; Semen ; Seoul ; Sex Ratio ; Skull

DPH is a firstlined antiepileptic drug and its toxic symptoms are mainly due to cerebellar and brainstem dysfunction. We tested 22 BAERs in 11 patients with DPH intoxication at the Department of Neurology of Seoul National University Hospital from Nov. 1986 to Oct. 1987. BAER IPLs were measured and analysed, including follow-up tests in 4 patients, and the results obtained were as follows. 1. Nine (81.8%) of 11 patients showed abnormal findings in BAER (biliateral in six, unilateral in three) but 2 showed no abnormal, findings. 2. Prolongation of I-III IPL was noted in 14 of total tests (N=22), III-V in only one. Prolongation of I-V IPL was noted 12 tests but seemed to be due to prolongation of I-III IPL. 3. Follow-up tests in 4 patients showed that abnormal IPLs tended to be normalized by decreasing serum DPH levels in three but persisted in one. In colclusion, 9 of 11 patients with DPH intoxication showed BAER abnormalities and main abnormalities were prolongation of I-III IPL. Considered with the results of follow-up tests, for confirmation of its reversibility, large-scaled and prospective study with strict follow-up seemed to be required.
Brain Stem* ; Evoked Potentials, Auditory, Brain Stem* ; Follow-Up Studies ; Humans ; Neurology ; Seoul ; Sodium*

This study was performed to account for the hyponatremic phenomenon in patients with subarachnoid hemorrhage (SAH) and to discuss the concept of SIADH which has been disputed as a responsible mechanism. The diagnosis of SAH was made by brain CT scans and the patients were managed under the protocol now being used in Seoul National University Hospital. Blood voulmes were measured in six hyponatremic (Na+<135mEq/L) patients with SAH, by using radioiodinated-human serum albumin (125-RIHSA) and claculating with Dilution Method. The same measurements were made in two control groups also. Group-I was composed of six subjects without SAH, who were given no diuretics and were neither fluid-restricted nor bed-ridden. Group-II comprised six eunatremic patients with SAH or ICH, who were managed under the same protocol as in the hyponatremic group. Mean blood volumes (ml/kg) of the hyponatremic group (RCV, 19.5+2.1; PV, 34.2+4.1; TBV, 53.7+4.2) were significantly contracted in comparison with both control groups. As for mean plasma and total blood volume, two control groups showed no significant difference statistically. Therefore the effect of mannitol on natriuresis and water excretion seemed negligible, if normal saline had been replaced as in the protocol. Considering the above findings, the remarkable contraction of blood volumes in the presence of hyponatremia in the patients with SAH could not be explained in the view of SIADH which is usually associated with increased blood volume. In conclusion the suggested mechanism of hyponatremia in SAH in this study seems the primary natriuresis with a resultant contraction of blood volume, which is probably caused by the damaged central nervous system. So, in the aspect of management of hyponatremia in the patients with SAH, both supplement of sodium and expansion of blood volume should be considered.
Blood Volume ; Brain ; Central Nervous System ; Diagnosis ; Diuretics ; Humans ; Hyponatremia* ; Inappropriate ADH Syndrome ; Mannitol ; Natriuresis ; Plasma ; Seoul ; Serum Albumin ; Sodium ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed ; Water

Acute appendicitis is the most common operative disease in general surgery, but it is not also rate disease to see in other clinical department such as Internal Medicine and Obstetric and Gynecology, because it reqnires to differenciate from many other diseases which have similar symptoms. Expecially, because the clipical aymptoms of acute appendicitis are not typieal in children, elderly, and women, it is hard to be diagnosed as acute appendicitis and it is often misdiagnosed as other disease. We performed colonoscopy due to be interpretated aa one of the colon diseases rather than acute appendicitis. But in colonoscopic findings, there were hyperemie and edematous change on the appendiceal orifice of cecum(cherry or acorn shape). So we report 5 cases of acute appendicitis diagnosed br colonoscopy.
Aged ; Appendicitis* ; Child ; Colon ; Colonoscopy* ; Female ; Gynecology ; Humans ; Internal Medicine