Twenty nine cases of wrist tuberculosis were reviewed(19 joint involvement cases and 4 tendon involvement cases) and twenty three cases were followed up more than one and half years. The mean follow up period was 26.7 months. Synovectomies were not satisfactory in cases of joint involvement and they were useful only in cases of tendon involvement. Arthrodesises were used for 16 cases of joint involvement and were satisfactory in 87,5 percent by Robin's criteria. Finger stiffness was most serious complication(initially, 8.7 percent and finally, 34.8 percent) and it is suggested that early motion of fingers after arthrodesis can prevent this complication.
Arthrodesis ; Fingers ; Follow-Up Studies ; Joints ; Tendons ; Tuberculosis ; Wrist

From 1981 to 1993, one hundred and thirty eight patients had been treated by free flap or island flap, for the tissue defects of the extremities. Among these 138 patients, vascularized bone graft was 29 cases, soft tissue free flap 40, replantation 22, local island flap 45, and lymphovenous shunt 2. Average age at the time of operation was 27 years(1-66 years), and men were 110, women 28. Average duration of follow-up was 2 years and 8 months(4 months-11 years and 8 months). Twenty nine cases of vascularized bone graft was consisted of fibular graft in 15 patients, ilium 8, joint transplantation 4, thumb reconstruction using big toe 1, and rib 1. Four of them were failed. Among 40 patients of soft tissue free flap, latissimus dorsi flap was 12 cases, dorsalis pedis flap 11, scapular flap 8, wraparound procedure 7 and gracilis flap 2. Seven of them were failed. The levels of replantations were both lower extremities in one patient, leg 1, arm 2, distal forearm 2, and finger(s) 16. In six patients, replantation was nor successful. Among 45 patients of local island flap, lateral supramalleolar island flap was performed in 8 patients, dorsalis pedis flap 2, Chinese flap 10, reverse ulnar artery flap 4, reverse posterior interosseous artery flap 3, neurovascular island flaps for fingers 14, and others 4. Two of them were failed. Two cases of lymphovenous shunt for the treatment of lymphedema were successful. As a whole, 119 cases were successful(86%) among 138 cases including local island flap 45 cases.
Arm ; Arteries ; Asian Continental Ancestry Group ; Extremities ; Female ; Fingers ; Follow-Up Studies ; Forearm ; Free Tissue Flaps ; Hallux ; Humans ; Ilium ; Joints ; Leg ; Lower Extremity ; Lymphedema ; Male ; Replantation ; Ribs ; Superficial Back Muscles ; Surgical Flaps ; Thumb ; Transplants ; Ulnar Artery

No abstract available.
Erythroblastosis, Fetal* ; Infant, Newborn

BACKGROUND: Pressure rise time (PRT) is the time in which the ventilator aclieves the set airway pressure in pressure-targeted modes, such as pressure control ventilation (PCV). With varying PRT, in principle, the peak inspiratory flow rate of the ventilator also varies. And if PRT is set to a shorter duration, the effective duration of target pressure level would be prolonged. which in turn would increase inspiratory tidal volume(Vti) and mean airway pressure(Pmean). We also postulated that the increase in Vti with shortening of PRT may relate inversely to the patients' basal airway resistance. METHODS: In 13paralyzed patients on PCV(pressure control 18±9.5cm H2, FIO2 0.6±0.3, PEEP 5±3cm H2O, f20/min, I : E, 1 : 2) with Servo 300(Siemens-Elema, Solna, Sweden)from various causes of respiratory failure, PRT of 10%, 5% and 0% were randomly applied. At 30min of each PRT trial, peak inspiratory flow (PIF, L/sec), Vti(ml), Pmean(cm H2O) and ABGA were determined. RESULTS: At PRT 10, 5% and 0%, PIF were 01.69±0.13, 0.77±0.19, 0.83±0.22, respectively(p<0.001). Vti were 425±94, 439±101, 456±106, respectively(p<0.001), and Pmean were 11.2±3.7, 12.0±3.7, 12.5±3.8, respectively(p<0.001). pH were 7.40±0.08, 7.40 ±0.92, 7.41±0.96, respectively (p=0.004) ; PaCO2 (mm Hg) were 47.4±15.8, 47.2±15.7, 44.6±16.2, respectively (p=0.004) ; PAO2 - PaO2 (mm Hg) were 220±98, 224±95, 227±94, respectively(p=0.004) ; and Vd/Vt as determined by (PaCO2 - P CO2/PaCO2 were 0.67±0.07, 0.67±0.08, 0.66 ±0.08, respectively(p=0.007). The correlation between airway resistance and change of Vti from PRT 10% to 0% were r=-0.243(0.498). CONCLUSION: Shortening of pressure rise time during PCV was associated with associated with increased tidal volume, increased mean airway pressure and lower PaCO2.
Airway Resistance ; Humans ; Hydrogen-Ion Concentration ; Respiratory Insufficiency ; Tidal Volume* ; Ventilation* ; Ventilators, Mechanical

OBJECTIVE: To assess the feasibility, safety, and effectiveness of the balloon-assisted technique with HyperForm balloon in the endovascular treatment of wide-necked intracranial aneurysms. METHODS: A total of 34 patients with 34 wide-necked intracranial aneurysms were treated with endovascular coil embolization using balloon-assisted technique with Hyperform balloon. Twenty-nine aneurysms (85.3%) were located in the anterior circulation. The group of patients was comprised of 16 men and 18 women, aged 33 to 72 years (mean : 60.6 years). The size of aneurysms was in the range of 2.0 to 22.0 mm (mean 5.5 mm) and one of neck was 2.0 to 11.9 mm (mean 3.8 mm). The dome to neck ratio was ranged from 0.83 to 1.43 (1.15). Sixteen patients were treated for unruptured aneurysms and the remaining 18 presented with a subarachnoid hemorrhage. RESULTS: In the 34 aneurysms treated by the remodeling technique with HyperForm balloon, immediate angiographic results consisted of total occlusion in 31 cases (91.2%) and partial occlusion in three cases (8.8%). There were five procedure-related complications (14.7%), including two coil protrusions and three thromboembolisms; Except one patient, all were successfully resolved without permanent neurologic deficit. No new bleeding occurred during the follow-up. Twenty patients (59%) underwent angiographic follow-up from 2 to 33 months (mean 9.2 months) after treatment. Focal recanalization with coil compaction of the neck portion was observed in 5 cases (25%). Only one case showed major recanalization and underwent stent-assisted coil embolization. CONCLUSION: The balloon-assisted technique with Hyperform balloon is a feasible, safe, and effective endovascular treatment of wide-necked cerebral aneurysms.
Aged ; Aneurysm ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Male ; Neck ; Neurologic Manifestations ; Subarachnoid Hemorrhage

A case study and review of nephrotic syndrome associated with a total Hydatidiform mole in 54- year-old female is presented. She has generalized edema, nephrotic range proteinuria(8.05gm/day), hypoalbuminemia(2.5g/dl) and high serum level of beta- hCG(200,000IU/L). Radiological investigations showed a 16-cm sized heterogenous enhanced mass in the uterus. A renal biopsy performed before evacuation of H-mole showed a focal segmental glomerulosclerosis. The complete remission of symptoms and signs of the nephrotic syndrom after evacuation of a molar tissue was achieved. A review of the literature revealed that this patient appears to be the first case of the FSGS with nephrotic syndrome associated with a total mole that remitted completely after the mole evacuation.
Biopsy ; Edema ; Female ; Glomerulosclerosis, Focal Segmental ; Humans ; Hydatidiform Mole* ; Molar ; Nephrotic Syndrome* ; Pregnancy ; Uterus

Primary duodenal adenocarcinoma is rare disease with a poorly defined natural history. It represents less than 0.35% of all gastrointestinal tract malignant neoplasms and accounts for up to 33 to 45% of small bowel cancers. Diagnosis is always late because of the non-specific symptoms, consequently leading to poor prognosis. Surgical resection is the only potentially curative treatment, but not all patients whose tumor is removed necessarily survive long term. Recent widespread use of endoscopy has increased early detection of duodenal adenocarcinoma. Thanks to early detection, duodenal adenocarcinoma can now be treated endoscopically, which allows the patient's quality of life to be maintained. We have experienced one case of the primary early duodenal adenocarcinoma of the first portion, which was diagnosed by biopsy with endoscopic examination as part of a routine medical evaluation and was resected by endoscopic mucosal resection technique. We report the first primary early duodenal adenocarcinoma successfully treated by EMR method in Korea.
Adenocarcinoma ; Biopsy ; Diagnosis ; Endoscopy ; Gastrointestinal Tract ; Humans ; Korea ; Natural History ; Prognosis ; Quality of Life ; Rare Diseases

OBJECTIVE: While the optic nerve sheath diameter (ONSD) is measured by computed tomography and ultrasonography as an indicator of an elevation in the intracranial pressure (ICP), it is unclear which ONSD measurement is useful for predicting an increased ICP. This study examined the comparability between the ONSD measured by computed tomography and ultrasonography. METHODS: A prospective study of 150 patients in the emergency center was performed. The ONSD was measured 3 mm behind the globe of all patients by computed tomography and ultrasonography. The receiver operator characteristic (ROC) curve was analyzed to determine the diagnostic utility of detecting ICP through ONSD. RESULTS: A total of 150 patients were enrolled. Thirty-three patients (22.0%) were found to have an increased ICP. The ONSD in patients with increased ICP was significantly higher than that of normal ICP patients measured by computed tomography and ultrasonography. Moreover, computed tomography and ultrasonography revealed an area under the ROC curve value of 0.886 and 0.933, respectively. The ONSD measurement by computed tomography and ultrasonography produced similar results (P=0.256). CONCLUSION: The ONSD measured by computed tomography and ultrasonography is a valuable indicator of an ICP elevation. Therefore, either of the two diagnostic methods for monitoring the ICP can be used in patients with a critical care and resource-limited setup.
Critical Care ; Emergencies ; Humans ; Intracranial Pressure ; Optic Nerve ; Prospective Studies ; ROC Curve ; Ultrasonography

BACKGROUND/AIMS: The most common type of syncope in young adults is neurocardiogenic in origin, which is not related to organic problems and has a benign nature. Therefore, there have been few reports regarding syncope in young Korean adults. Here, we examined the causes of syncope and its clinical characteristics in young combat and auxiliary police in Korea. METHODS: We performed a retrospective study of the medical records of 193 combat and auxiliary police in Korea admitted to the National Police Hospital for syncope or presyncope between January 2004 and December 2007. RESULTS: The subjects' mean age was 21+/-1.2 years, and there were 2.8+/-2.9 episodes of syncope (mean+/-SEM). The first syncope occurred after enlistment in the police in 102 patients (52.8%). Basic diagnostic studies showed two cases of elevated creatine phosphokinase and one case of anemia to be related to syncope. Syncope-related traumatic injuries occurred in 38 patients (19.7%), and syncope was more prevalent in the summer. Head-up tilt test was performed in 175 of the 193 patients, and 123 showed a positive response. Other evaluations, including brain magnetic resonance imaging, electroencephalography, and echocardiography, were not helpful for diagnosis. Syncope was neurocardiogenic in origin in the majority of cases. Other causes of syncope were exhaustion (n=2), hyperventilation syndrome (n=2), Meniere's disease (n=1), anemia (n=1), and psychiatric problems (n=5). The causes of syncope could not be identified in 59 patients (30.5%). CONCLUSIONS: Neurocardiogenic syncope was the most common type in our study population. More than half of our patients experienced their first episode after enlisting with the police. Further studies in these groups are necessary.
Adult ; Anemia ; Brain ; Creatine Kinase ; Echocardiography ; Electroencephalography ; Humans ; Hyperventilation ; Korea ; Magnetic Resonance Imaging ; Medical Records ; Meniere Disease ; Police ; Retrospective Studies ; Syncope ; Syncope, Vasovagal ; Young Adult

BACKGROUND: Heat-treated cells are known to be protected from lysis by TNF, which is considered to play a central role in the pathogenesis of sepsis-induced acute lung injury. The objective of the study was to investigate the effect of heat shock response by heat-pretreatment on the acute lung injury of the rats induced by intratracheally administered TNF-alpha. METHODS: We intratracheally instilled either saline or TNF (R&D, 500ng) with and without heat pretreatment in Sprague-Dawley rats weighing 250-350 g. The heated rats were raised their rectal temperature to 41degrees C and was maintained thereafter for 13 minutes at 18 h before intratracheal administration of saline or TNF. After 5 h of intratracheal treatment, lung leak, lung myeloperoxidase activity (MPO) and heat shock proteins were measured in rats. Lung leak index was defined as counts per minute of I125 in the right lung divided by counts per minutes of I125 in 1.0 ml of blood. All data are expressed as means+/-SE. RESULTS: There is no difference in acute lung leak index (0.099+/-0.024 vs 0.123+/-0.005) among the rats given saline intratracheally with and without heat pretreatment, but MPO activity showed a decreased tendency in heat-pretreated rats (4.58+/-0.79 U/g) compared with heat-unpretreated rats (7.32+/-0.97 U/g) (P= 0.064). Rats administered TNF intratracheally with heat-pretreatment had decreased lung leak index (0.137+/-0.012) and lung MPO activity (5.51+/-1.04 U/g) compared with those of heat-unpretreated and TNF-administered rats (0.186+/-0.016, 14.34+/-1.22 U/g) (P<0.05 in each). There were no significant difference of lung leak index and MPO activity between TNF-treated rats with heat-pretreatment and saline-treated rats with and without heat-pretreatment CONCLUISON: The heat shock response attenuated neutrophil recruitment and acute lung leak induced by intratracheal instillation of TNF-in rats.
Acute Lung Injury* ; Animals ; Heat-Shock Proteins ; Heat-Shock Response* ; Hot Temperature* ; HSP70 Heat-Shock Proteins ; Lung ; Necrosis* ; Neutrophil Infiltration ; Neutrophils ; Peroxidase ; Rats* ; Rats, Sprague-Dawley ; Respiratory Distress Syndrome, Adult ; Tumor Necrosis Factor-alpha