Congenital vertical talus associating tarsal coalition, which is a very anomalous condition and causes severe rigid flat foot, is presented with literary reviews. This case was treated with soft tissue release and triple arthrodesis.
Arthrodesis ; Flatfoot ; Talus

Interest in the prevalence of patent foramen ovale(PFO) and its relation to embolic stroke has increased with the sophistication of methods for noninvasive cardiac assessment. The effect of foramen ovale closure on the risk for subsequent strokes is promised. A 22-year old woman was presented with sudden onset of cerebral infarct. She had a patent formen ovale, and right to left shunt during the Valsalva maneuver, which was diagnosed by transesophageal contrast echocardiography. Transcatheter closure of PFO was performed with Rashkind PDA umbrella under the guidance of transesophageal echocardiography. Transcatheter closure of PFO can be accomplised with little morbidity and may reduce the risk of embolic episode.
Echocardiography ; Echocardiography, Transesophageal* ; Female ; Foramen Ovale ; Foramen Ovale, Patent* ; Humans ; Prevalence ; Stroke* ; Valsalva Maneuver ; Young Adult

BACKGROUND: Epidurally administered clonidine represents an approach to control the pain after cesarean section that produces analgesia by an alpha 2-adrenergic mechanism and may provide postoperative analgesia without nausea, pruritus, and respiratory depression associated with systemic or intraspinal opioid administration. This study was undertaken to evaluate the analgesic effect according to the dose of appropriate bolus and the combination of epidural morphine and clonidine after cesarean section. METHOD: Forty five women, ASA physical status 1 or 2, scheduled for elective cesarean section were randomly assigned to receive epidural administration for postoperative pain control. Group A (n=15) received 1 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 150 g clonidine. Group B received 2 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 300 g clonidine. Group C received 3 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 450 g clonidine. Each combination of drug was injected at Bromage scale 1 after surgery. RESULTS: All groups showed relatively stable hemodynamic status. Analgesic effect was significantly better in Group B and C than Group A (p<0.05). Sedative effect was not a problem in all groups. The incidence of side effects in Group C was more than Group B, which than Group A, but almost cases did not require treatment. CONCLUSION: 2 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 300 g clonidine with excellent analgesic effect and less side effects is considered as adequate dose in postoperative pain control after cesarean section with epidural anesthesia.
Analgesia ; Anesthesia, Epidural* ; Cesarean Section* ; Clonidine* ; Female ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative ; Pregnancy ; Pruritus ; Respiratory Insufficiency

BACKGROUND: In anemic patients, it has been usually traditional practice to correct the anemic state with preoperative blood transfusion. But now, there is an increasing tendency of refusing blood transfusion due to the transfusional complications, especially AIDS etc. The purpose of this study is to survey the effects of anesthesia in anemic patients with normal cardiopulmonary function compared to non-anemics. METHOD: 40 patients with uterine myoma were divided into two groups, an experimental group of 20 patients with hemoglobin concentration of 8~10 gm% and a control group of 20 patients with hemoglobin concentration higher than 10 gm%, and their blood pressure, pulse rate and arterial oxygen saturation were monitored and compared. RESULTS: There were no significant differences between two groups in blood pressure, pulse rate and arterial oxygen saturation. CONCLUSION: Preoperative blood transfusion, in patients with moderate anemia, does not seem to be a mandatory practice.
Anemia ; Anesthesia ; Blood Pressure ; Blood Transfusion* ; Heart Rate ; Humans ; Leiomyoma* ; Oxygen

BACKGROUND: This study was done to delineate the incidence and socioeconomic cost of fall-related injuries in the rural elderly population. METHODS: From February 1, 2010 to March 31, 2010, a questionnaire-based interview survey was conducted on 2,295 persons 65 years or older living in rural communities (1 Myoen and 1 Eup of Gyoengsangnam-do). The socioeconomic cost due to falls in the elderly in 2009 was estimated using direct and indirect costs. The direct costs included medical costs covered by health insurance and those not covered by insurance. The indirect costs included nursing care, diapers, transportation, health function foods, medical assistance device, and productivity loss. RESULTS: Of the 2,295 subjects, 735 (32.0%) had suffered from fall-related injuries during the previous year. The direct costs of these injuries calculated to be 596,466,000 Won (56.6%). The indirect costs was 458,081,000 Won (43.4%). Of the indirect cost, loss of productivity was 274,993,000 Won, health function foods was 65,531,100 Won, nursing care was 48,755,000 Won, and transportation was 43,122,000 Won. The total socioeconomic costs (direct costs+indirect costs) of the study subjects was 1,054,547,000 Won. The socioeconomic costs per person was 459,500 Won for the total number of study subjects and 1,435,000 Won for the 735 subjects. CONCLUSION: When the above calculated socioeconomic cost for the 2,295 subjects is applied to the 1,067,262 Korean rural elderly population in 2009, the socioeconomic costs owing to fall-related injuries can be estimated to as much as 343,614,988,000 Won. In the future, the socioeconomic costs due to injuries such as falls is expected to increase as the elderly population increases. Therefore, injury prevention programs and studies for reducing the socioeconomic costs in the elderly community are needed.
Aged ; Efficiency ; Humans ; Incidence ; Insurance ; Insurance, Health ; Medical Assistance ; Nursing Care ; Rural Population ; Transportation

Many kinds of membrane have been used for the guided bone regeneration (GBR) technique. However, most membranes do not fulfill all requirements for the ideal membrane for the GBR technique. Among them, collagen membrane has been most widely used. However, its high price and weak tensile strength in wet condition are limitations for wide clinical application. Synthetic polymers have also been used for the GBR technique. Recently, silk based membrane has been considered as a membrane for the GBR technique. Despite many promising preclinical data for use of a silk membrane, clinical data regarding the silk membrane has been limited. However, silk based material has been used clinically as vessel-tie material and an electrospun silk membrane was applied successfully to patients. No adverse effect related to the silk suture has been reported. Considering that silk membrane can be provided to patients at a cheap price, its clinical application should be encouraged.
Bone Regeneration* ; Collagen ; Humans ; Membranes* ; Polymers ; Silk ; Sutures ; Tensile Strength

The clinical and radiological characteristics of progressing in situ thrombosis of the basilar artery have poorly been described. Patients with such condition present with minor neurologic deficits initially, progress in the hospital over several days, and present poor outcomes. We tried to find the common features of those patients that might have been associated with progression. We investigated the clinical pictures, risk factors, possible triggering factors, managements, and radiological data of seven patients whose basilar artery thrombosis progressed in the hospital after having presented with minor neurological deficits at first. The initial clinical presentations included dysarthria plus hemiparesis in four, vertigo plus ataxia in two, and hypersomnolence without sensorimotor deficits in one. In four patients the neurological progressions were preceded by clinical events that might have caused dehydration. On MR angiography (MRA) performed in five, the basilar artery was barely visible in all. Only one patient was under adequate anticoagulation. Intraarterial thrombolysis was done in two patients with partial improvement in one. In conclusion, poor visualization of the basilar artery on MRA may be a strong indicator of early progression of in situ thrombosis. Since dehydration may play as a trigger, sufficient hydration seems to be the best strategy in addition to adequate anticoagulation when basilar artery thrombosis is suspected clinically and radiologically. Once if clinical progression occurs, Intraarterial thrombolysis may be tried.
Angiography ; Ataxia ; Basilar Artery* ; Dehydration ; Disorders of Excessive Somnolence ; Dysarthria ; Humans ; Neurologic Manifestations ; Paresis ; Risk Factors ; Thrombosis* ; Vertigo

Although a major portion of terminal cancer patients have appealed pain, the management of their pains is not easy. We managed two terminal cancer patients. One subject was a 86-year-old female who, after pronounced lung cancer, suffered from shoulder pain. The other was a 28-year-old female who, after being subject to pronounced acute lymphocytic leukemia, suffered from hip joint and thigh pain. In our practice, their pain, which had not been controlled by various other sophisticated management strategies, was effectively alleviated by a continuous intravenous infusion of ketamine, a N-methyl-D-aspartic acid receptor antagonist. The initial dose was administered intramuscularly by injecting 10 mg. of ketamine into the patients and then an intravenous infusion was administered at the rate of 0.06 mg/kg/hr. After the continuous infusion of ketamine was initiated, the VAS decreased, respectively, from 9 and 10 to 4 and 3, without considerable side effects. In conclusion, intravenous infusion at the level of sub-anesthetic dose of ketamine is a good management to control totally bed-conditioned and intactable cancer pain.
Adult ; Aged, 80 and over ; Female ; Hip Joint ; Humans ; Infusions, Intravenous* ; Ketamine* ; Lung Neoplasms ; N-Methylaspartate ; Pain Management* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Shoulder Pain ; Thigh

Proliferating cell nuclear antigen (PCNA, PC10), an auxillary protein of DNA polymerase, plays a main role in the early stage of DNA Synthesis and is synthesized from Gl phase to s phase of the cell cycle. Nucleolar organizer region (NORs) are DNA loops encoding RNA proteins(AgNORs). To evaluate correlation with PCNA labelling index (LI)and AgNORs according to histological grades and clinical stages of transitional cell carcinoma of the urinary bladder, the authors analysed 54 transitional cell carcinoma using immunohistochemical stain for PCNA and silver stain for AgNORs in paraffin sections. The comparison of PCNA (PC10) LI and clinical stage showed a significant correlation (p<0.05), where as PCNA (PC10) LI according to histologic grade showed no significant correlation. High grade tumors showed increase PCNA LI. Superficial tumors (Ta-Tl) showed significantly lower PCNA LI than muscle invasive tumors (T2-T4)(p<0.05). There was no significant correlation between AgNORs and clinical stage, bur higher stage and higher grade tumors showed increased noubers of AgNORs. These results suggest that PCNA LI has a significant correlation with clinical stages of transitional cell carcinoma of the urinary bladder.

Congenital esophageal stenosis due to tracheobronchial remnants is one of main forms of congenital esophageal stenosis, and it was first described by Frey and Duschel in l936. An 18-month-old male presented with underdevelopment and dehydration state due to persistent vomiting several times per day since 3 months after his birth. Esophagogram revealed an elongated and diiated esophagus with marked stenosis at distal portion. Partial distal esophagectomy was performed. Histologically, the thickened esophageal wall is composed of tracheobronchial remnants including hyaline cartilages, mucous glands, and ductal structures lined by ciliated respiratory epithelium under stratified squamous mucosa.
Male ; Humans