BACKGROUND: Gravity traction is a widely used conservative procedure, and several studies using various techniques have reported changes in blood pressure (BP) or heart rate (HR) or stress variables in the head-down tilting position, with varying results. The purpose of this study was to investigate BP, HR and serum lactic acid (LA) responses to inverted gravity traction at six angles. METHODS: Thirty volunteers (males 15, females 15) were assigned randomly to either of two experimental groups. After the resting BP, HR and LA concentration were measured in the sitting position, they were measured repeatedly at standing, supine, and inverted at -30, -60 and -90 degrees every 2.5 minute. RESULTS: Compared to the systolic BP (SBP) at sitting, SBP decreased at standing and at inverted -30degrees and increased at -60degrees and -90degrees in the males group, whereas SBP decreased at supine to inverted -60degrees and increased at -90degrees in the females group. Compared to the diastolic BP (DBP) at sitting, DBP diastolic blood pressure (DBP) decreased at standing to -60degrees in both groups and increased at inverted -90degrees. Compared to HR at sitting, HR decreased at supine to -90degrees in both groups. The results of the post hoc test comparisons showed that the SBP, DBP, and HR differed significantly at all six positions. However, compared to serum LA at sitting, LA at all positions were not significantly different in both groups. CONCLUSIONS: As seen in previous research, our results showed increases in BP and HR at inverted -90degrees. However, BP and HR at the other inverted positions including supine showed decreases. LA did not change significantly at any of the positions. Finally, our study showed that angles above -30degrees or -60degrees can benefits the cardiovascular system in young people.
Blood Pressure ; Cardiovascular System ; Female ; Gravitation ; Head-Down Tilt ; Heart ; Heart Rate ; Humans ; Lactic Acid ; Male ; Posture ; Traction

BACKGROUND: Institutionalized subjects were assumedly suggested to be a high-risk for the infectious source of syphilis. OBJECTIVE: Our purpose was to study the syphilis prevalence institutionalized subjects who were admitted in Taegu Hope Village for the poor or crippled and to evaluate the presence of neurosyphilis among them. MEHTODS: We conducted the serologic tests for syphilis with the qalitative and quantative VDRL and TPHA tests in 1558 subjects(M:936, F:622). The trend of the rcactive rate was compared with those of the two studies dong, in the same institute in 1983-1985 and 1988. The cerebrospinal fluid (CSF) examination was perfarmed among the reactive subjects. RESULTS: There were 97(6.2%) reactive subjects. There were 80(82.5%) reactive subjects with titers of 1:4 or below and 17(17.5%) with titers of 1:8 or over The biologic false positive rate of VDRL test was 12.6%, showing 92.3% with the titer below 1:4. The reatest number of the subjects were in their 40s and 50s in both sexes. The rate in subjects in their 40s or over was 3 times higher than in the younger groups. The CSF examination showed 5(5.2%) with significant neurosyphili;ic findings. There were 1 male and 4 females, with an avechge age of 47.8 years. Four had asymplomatic and 1 meningovascular forms. The CSF findings revealed an increased number of white cells in 4 and an increased total protein level in 3. The CSF-VE)RL titers were trended lower than seum titers. From the comparison of the results since 1983, i.e., 11,6% in 1983-1985, 7.5% in 1988 and 6.2 % in 1992, the reactive rate of syphilis was gradually decreasing, but still remained high. CONCLUSION: The drastic control in the sociomedical aspect is needed n institutionalized subjects who are at high-risk for syphilis was well as the CSF examination for the presence of neurosyphilis among the reactive subjects.
Cerebrospinal Fluid* ; Daegu ; Epidemiologic Studies* ; Female ; Hope ; Humans ; Male ; Neurosyphilis ; Prevalence* ; Serologic Tests ; Syphilis*

Authors report herein a case of a 27-year-old male patient who had been suffering from chronic ulcerative dermatitis with scar-like changes and successive involvement of the ankles, limb folds, nape and abdomen, and no tendency to heal from age 4. At the age 14, an immunologic study showed a selective IgA deficiency with partial T-lymphocyte inactivation. Ten years later, at age 24, he showed a severe form of morphea over a generalized area and disabling joint contractures, and was diagnosed as disabling pansclerotic morphea with an IgA value that returned to a near normal level. At the age 27, an adult-fist, 7×6×4cm sized, squamous cell carcinoma with an easy bleeding tendency like an overgrowing granulation tissue vascular tumor had developed on the chronic ulcerative lesion on the posterior aspect of the right ankle for 2 months. Aggressive metastatic lesion occurred on the right popliteal area 3 months later. He died 1 month thereafter.
Abdomen ; Adult ; Ankle ; Carcinoma, Squamous Cell* ; Contracture ; Dermatitis ; Epithelial Cells* ; Extremities ; Granulation Tissue ; Hemorrhage ; Humans ; IgA Deficiency ; Immunoglobulin A ; Joints ; Male ; Scleroderma, Localized* ; T-Lymphocytes ; Ulcer*

OBJECTIVES: Fatigue is a primary human factor for decreased job performance in the workplace. It is well documented that drowsiness is a typical symptom of fatigue and is closely associated with commercial drivers'safety and well-being. However, few studies have been conducted to develop or validate fatigue symptom instruments for a working population. The main purpose of this study was to develop a general fatigue checklist and a driving fatigue checklist for Korean commercial drivers. METHODS: A total of 287 bus drivers in a commercial transportation company participated in a self-administered survey that was designated Study 1. Based on the statistical results of Study 1, a focus meeting with 16 professional consultants was conducted to revise the fatigue symptom instrument for Study 2. In Study 2, 288 commercial drivers (156 bus drivers and 132 truck drivers) participated in the revised questionnaire survey. All collected responses were entered into a SPSS worksheet and the data analysis was conducted using SPSS software 11.1. The exploratory factor analysis used in this study followed the principle component factoring rule and the varimax rotation method for factor extraction. The criteria for item selection were an Eigen value of 1.0 or greater, a communality score of .50 or greater, and no 'fence rider'property over the extracted factors. RESULTS: Through Study 1, the consultant meeting, and Study 2, a general fatigue checklist was developed with a total of 3 factors and 11 items, and a driving fatigue checklist was developed with 2 factors and 10 items. The 3 factors of the general fatigue checklist were physical fatigue, psychological fatigue, and chronic tiredness. The two factors of the driving fatigue checklist were physical fatigue and perceptive and functional fatigue. CONCLUSIONS: The primary contents of general fatigue were different from those of driving fatigue according to the two fatigue instrument factors developed in this study. The primary fatigue symptoms of the commercial driving population were identified as physical fatigue and perceptive and functional fatigue.
Checklist* ; Consultants ; Fatigue* ; Humans ; Motor Vehicles ; Questionnaires ; Sleep Stages ; Statistics as Topic ; Transportation

Moyamoya is a chronic cerebrovascular disease characterized by progressive stenosis or occlusion of the terminal parts of both intermal carotid arteries with telangiectatic vascular network of collateral circulation at the base of the brain and leptomeningeal arteries. The etiology and pathophysiology of this disease are still unknown. Although the idiopathic presentattion is the commonest, moyamoya disease has also been reported in several hereditary or acquired clinical conditions including neurofibromatosis, sickle cell anemia, tuberculous meningitis, atherosclerosis, and following radiation therapy to the head. The term moyamoya disease should be reserved for those cases in which the characteristic angiogrphic pattern is idiopathic; moyamoya syndrome is used when the underlying condition is known. We have experienced a case of coexistence of moyamoya syndrome and hereditary spherocytosis in a 6-year-8-month-old girl who presented with right-sided hemiparesis and pallor. A cerebral angiogram revealed occlusion of proximal portion of left middle cerebral artery and abnormal collateral network. The peripheral blood smear and osmotic fragility test disclosed hereditary spherocytosis. To our knowledge, the coexistence of moyamoya syndrome and hereditary spherocytosis has not been documented. We report here the case and the brief review of related literatures. Further studies are needed to clarify the intimate relationship between the two diseases.
Anemia, Sickle Cell ; Arteries ; Atherosclerosis ; Brain ; Carotid Arteries ; Collateral Circulation ; Constriction, Pathologic ; Female ; Head ; Humans ; Middle Cerebral Artery ; Moyamoya Disease* ; Neurofibromatoses ; Osmotic Fragility ; Pallor ; Paresis ; Tuberculosis, Meningeal

OBJECTIVE: Treatment of intracranial dural arteriovenous fistulas (dAVFs) remains a challenge. However, after introduction of Onyx, transarterial approach is the preferred treatment option in many centers. We report our experience of dAVFs embolization with special emphasis on transarterial approach. METHODS: Seventeen embolization procedures were performed in 13 patients with dAVFs between Jan 2009 and Oct 2014. Clinical symptoms, location and type of fistulas, embolization methods, complications, radiological and clinical outcomes were evaluated using charts and PACS images. RESULTS: All 13 patients had symptomatic lesions. The locations of fistulas were transverse-sigmoid sinus in 6, middle fossa dura in 4, cavernous sinus in 2, and superior sagittal sinus in 1 patient. Cognard types were as follows : I in 4, IIa in 2, IIa+IIb in 5, and IV in 2. Embolization procedures were performed > or =2 times in 3 patients. Nine patients were treated with transarterial Onyx embolization alone. One of these required direct surgical puncture of middle meningeal artery. Complete obliteration of fistulas was achieved in 11/13 (85%) patients. There were no complications except for 1 case of Onyx migration in cavernous dAVF. Modified Rankin scale score at post-operative 3 months were 0 in 11, and 3 in 2 patients. CONCLUSION: Transarterial Onyx embolization can be a first line therapeutic option in patients with dAVFs. However, transvenous approach should be tried first in cavernous sinus dAVF because of the risk of intracranial migration of liquid embolic materials. Furthermore, combined surgical endovascular approach can be considered as a useful option in inaccessible route.
Cavernous Sinus ; Central Nervous System Vascular Malformations* ; Fistula ; Humans ; Meningeal Arteries ; Punctures ; Superior Sagittal Sinus

BACKGROUND: Episodes of bradycardia hypotension (BH) or vasovagal syncope have a reported incidence of 13-29% during arthroscopic shoulder surgery in the sitting position after an interscalene block (ISB). This study was designed to investigate whether intravenous fentanyl during shoulder arthroscopy in the sitting position after ISB would increase or worsen the incidence of BH episodes. METHODS: In this prospective study, 20 minutes after being in a sitting position, 160 patients who underwent ISB were randomized to receive saline (S, n = 40), 50 microg of fentanyl (F-50, n = 40), 100 microg of fentanyl (F-100, n = 40) or 30 mg of ketorolac (K-30, n = 40) randomly. We assessed the incidence of BH episodes during the operation and the degree of maximal reduction (Rmax) of blood pressure (BP) and heart rate (HR). RESULTS: The incidence of BH episodes was 10%, 15%, 27.5% and 5% in the S, F-50, F-100 and K-30 groups, respectively. Mean Rmax of systolic BP in the F-100 group was significantly decreased as compared to the S group (-20.0 +/- 4.5 versus -6.3 +/- 1.6%, P = 0.004). Similarly, mean Rmax of diastolic BP in the F-100 group was also significantly decreased (P = 0.008) as compared to the S group. CONCLUSIONS: These results suggest that fentanyl can increase the incidence of BH episodes during shoulder arthroscopic surgery in the sitting position after ISB.
Arthroscopy ; Blood Pressure ; Bradycardia ; Fentanyl ; Heart Rate ; Humans ; Hypotension ; Incidence ; Ketorolac ; Prospective Studies ; Shoulder ; Syncope, Vasovagal

The appearance of a tumor in the chest wall is rare compared to that in any other part of the body. It can be classified into benign and malignant types and can be located in the rib, clavicle, sternum, cartilage and soft tissues. Tumors that are metastatic are commonly located in the lung, breast, bone and pleura. But, the soft tissue mass of anterior chest wall is rarely metastasized from a distant organ that is not confined to the thoracic cavity. This and thus has rarely been described. A 68-year-old man was admitted to our hospital with a chief complaint of resting dyspnea. A huge non-tender mass of about 10*15 cm in size was visible on his left lower anterior chest wall. We pathologically confirmed that the mass was a metastatic renal cell carcinoma of clear cell type by incision biopsy. Through an incision biopsy, the mass was pathologically confirmed as a metastatic renal cell carcinoma of the clear cell type.
Aged ; Biopsy ; Breast ; Carcinoma, Renal Cell* ; Cartilage ; Clavicle ; Dyspnea ; Humans ; Lung ; Neoplasm Metastasis* ; Pleura ; Ribs ; Sternum ; Thoracic Cavity ; Thoracic Wall* ; Thorax*

OBJECTIVE: The pathophysiology of chronic subdural hematoma (CSH) is not yet clear. Trauma alone is not sufficient to result in CSH in young individuals, while a trivial injury can result in CSH in older adults. Although the causality and apportionment of trauma are important issues in CSH, especially in terms of insurance, it is too obscure to solve all struggles. METHODS: There are three key factors for producing CSH. First, CSH necessitates a potential subdural reservoir. Other important precipitating factors are trauma and coagulopathy. However, these factors are not sufficient to cause CSH development. The trauma apportionment score (TAS) can be used to compare the relative importance of these three factors. Here, we applied the TAS to 239 consecutive cases of CSH. We retrospectively obtained the patients' history and laboratory results from their medical records. RESULTS: The TAS ranged from −5 to 5. The most common score was 0. If we defined the cause of CSH as being combined when the TAS was 0, then the cause was combined in 30 cases (12.6%). If we extended the criteria for a combined cause from 0 to −1 to 1, the cause was combined in 107 cases (44.8%). Regardless of the criteria used, traumatic CSHs were more common than were spontaneous CSHs. Spontaneous CSHs were more common in older than in younger patients (p < 0.01, Fisher's exact test). CONCLUSION: The TAS is a useful tool for differentiating the causality of CSH.
Adult ; Aging ; Craniocerebral Trauma ; Hematoma, Subdural, Chronic* ; Humans ; Insurance ; Intracranial Pressure ; Medical Records ; Precipitating Factors ; Retrospective Studies

Brunners gland adenoma is a benign epithelial tumor of the duodenum originating from submucosal Brunners gland. This is an extremely rare entity that account for only 10.6% of benign duodenal tumor, which are themselves relatively rare, representing 0.008% of all surgical and autopsy specimens. The clinical manifestation are nonspecific gastrointestinal complaints, such as bloating or epigastric pain, and the tumor gives rise to melena or anemia, due to the ulceration or erosion of the tumor. The diagnosis is usually made by radiologic studies and gastroduodenal endoscopy which can also provide definitive treatment. The aim of treatment is complete removal of the lesion and exclude malignancy. We report on 4 cases of Brunners gland adenoma which was confirmed by operation or endoscopic polypectomy.
Adenoma* ; Anemia ; Autopsy ; Diagnosis ; Duodenum ; Endoscopy ; Melena ; Ulcer