One fetal demise of twin pregnancy in the second or third trimester is an unusual and difficult problem in the managemcnt of pregnancy. It can be associated with an increased risk for mortality and morbidity in the remaining fetus and with maternal DIC. 255 twin gestations were delivered at our hospital between December 1984 and August 1998. 8 cases of twin pregnancies with one fetal demise were observed. We reviewed 8 cases of twin pregnancies with one fetal demise that had been managed conservatively. The incidence of twin pregnancies with one fetal demise was 3.14% in the study population. The incidence of preterm delivery was 87.5%. The perinatal mortality rate of surviving twins was 25%. There were no cases of maternal disseminated intravascular coagulation or infection. There were no cases of neurologic damages in the surviving twins. The main cause of neonatal death was prematurity. An expectant approach to the twin pregnancies with one fetal demise seems reasonable.
Dacarbazine ; Disseminated Intravascular Coagulation ; Female ; Fetus ; Humans ; Incidence ; Mortality ; Perinatal Mortality ; Pregnancy ; Pregnancy Trimester, Third ; Pregnancy, Twin*

The authors have reviewed 46 cases (38 males and 8 females) with ligamentous injuries of the knee in the Department. of Orthopaedic Surgery, St. Mary's Hostpital, Catholic Medical College and Center, during the period from Feb. 1983 to May 1985. The patients were divided into two groups according to the two different postoperative rehabilitation programs. In one group, rehabilitation was begun with limited motion brace from 2nd week postoperatively (Group I). In another group, a long leg circular cast was applied for 6 weeks postoperatively, followed by rehabilitation (Group II). All patients were allowed to bear full weight in 12 weeks postoperatively and were recommended to keep appling braces for at least 6 months postoperatively. Sports or other vigorous activities were allowed in one year postoperatively. Primary repair was performed in 14 cases in Group I (66.7%) and in 17 cases in Group II (68.0%). Reconstruction of ligament was performed in 7 cases in Group I (33.3%) and in 8 cases in Group II (32.0%). The results were analyzed in terms of range of motion, pain, instability and muscle power in each group according to O'Donoghue. The results were as follows: 1. Three months after operation, over 120 degrees in flexion was achieved in 18 cases in Group I (85.7%) and in 7 cases in Group II (28.0%). The recovery of range of motion was achieved earlier in Group I than in Group II. 2. Three months after operation, extension lag was seen in only 2 cases in Group I, all of which were below 10 degrees, and 13 cases in Group II of which 10 cases had extension lag of over 10 degrees. The recovery of muscle power was achieved earlier in Group I than in Group II. 3. Overall results showed “excellent” in 17 out of 21 cases in Group I (80.9%) and in 12 out of 25 cases in Group II (48.0%). In conclusion, the limited motion brace was effective in early recovery of range of motion and muscle power, without any significant loss of stability, after repair or even reconstruction of theligamenta of the knee, regardless of the type of injury, although the number of posterior cruciate ligament tears were too small to come to a concrete conclusion.
Braces ; Humans ; Knee ; Leg ; Ligaments ; Male ; Posterior Cruciate Ligament ; Range of Motion, Articular ; Rehabilitation ; Sports ; Tears

BACKGROUND: To compare the diagnostic usefulness of dobutamine stress echocardiography(DSE) and 99mTc-methoxyisobutyl isonitrile SPECT (MIBI SPECT), two studies were performed simultaneously. METHOD: Fifty-six consecutive patients undergoing coronary angiogram and MIBI SPECT for clinical indications without clincal evidence of myocardial infarction were studied prospectively. During the DSE, MIBI was injected at peak stress, and post-stress images of MIBI SPECT were required on hour later. Both echocardiographic and MIBI SPECT images were visually analysed in a blind fashion. RESULTS: On the basis of coronary angiographic findings, the sensitivites of the DSE and MIBI SPECT (n=36) were 89% and 86%, respectively. The specificities of those (n=20) were 90% and 85%, respectively. Among 33 patients without resting perfusion defect on MIBI SPECT, resting regional wall motion abnormalities on DSE were found in only one patient, whereas, resting perfusion defect on MIBI SPECT were found in 9 patients among 41 patients without resting regional wall motion abnormalities on DSE. Among 17 patients who had resting perfusion defects with partial reversibility on MIBI SPECT, resting wall motion abnormalities were present in 11 patients and five of them showed improvement in the regional wall motion during low dose dobutamine infusion. CONCLUSION: Both dobutamine stress echocardiography and MIBI SPECT are useful methods in the detection of the coronary artery disease, however, MIBI SPECT seems to overestimate the regional ischemic myocardium with contractile reserve that can hardly be evaluated with MIBI SPECT.
Coronary Artery Disease* ; Coronary Vessels* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Humans ; Myocardial Infarction ; Myocardium* ; Perfusion ; Prospective Studies ; Tomography, Emission-Computed, Single-Photon*

Recently the internal rigid fixation with plates and screws became popular procedure. In the cases of the zygomatic fracture, it is sufficient to fix more than 2 point in many studies. Therefore, the internal rigid fixation requires the aggressive incision to expose the zygoma, such as coronal incision. Since many patients are afraid of this aggressive operation, we have provided a simple and effective method which is a 3-dimensional one point fixation on the zygomaticofrontal suture with X-shaped(6-hole) miniplate for the treatment of zygomatic fractures. From March 1995 to september 1995, we treated 13 cases of zygomatic fractures by open reduction and X-shaped miniplate fixation on the zygomaticofrontal suture. The results were as follows: 1) plane to plane contact on each side of the fracture with one point X-shaped miniplate. 2) 91.8% correction on Water's views, and 93.3% correction on zygomatic arch view with one point fixation. 3) patients were satisfied with these procedures because of minimal incision, mild edema and low operation price (short operation & anesthetic time, one plate & 6 screws cost).
Edema ; Humans ; Sutures ; Zygoma ; Zygomatic Fractures*

No abstract available.
Coronary Artery Disease* ; Coronary Vessels* ; Dobutamine* ; Echocardiography, Stress* ; Humans ; Myocardium* ; Tomography, Emission-Computed, Single-Photon*

This survey was conducted from January 1991 to May 1991. Two hundred and eight residents in 4 government supported homes for the aged and hundred and eleven living in the community in Taegu, Korea, were examined to evaluate the depression and the anxiety of the aged with combined anxiety and depression scale (CADS) and somatization symptom check list (SCL). There are no significant differences between residents in the home for the aged and those living in the community on the total scores of CADS and SCL. However, in the case of the total score of CADS of the female subjects in the home for the aged were significantly higher than those of the community residents. The elderly in the home for the aged tended to have pure depression, while community residents were likely to have anxiety and depression. Fifty-two subjects of home for the aged and sixty-nine of the community scored over 50 points of CADS, which indicates considerable depression or anxiety. In psychosocial factors, the subjects who in the following situations had statistically significant higher scores than others. The results were as follow. Poor health, unhappiness, unsatisfaction to the past occupation, pessimistic thought in future view for both group and unsatisfaction of the relationship with familiar people for the elderly in the community. The SCL scores of two groups subgrouped by under 49 and 50 on CADS showed significant differences between each subgroup on all of the SCL items. It could be suggested that somatic symptoms for the aged is a sign of depression.
Aged* ; Anxiety* ; Daegu ; Depression* ; Female ; Homes for the Aged ; Humans ; Korea ; Occupations ; Psychology

No abstract available.
Intussusception* ; Ultrasonography*

Obstructive jaundice of the bile duct resulting from tumor-producing copious, thick mucin, causing ductal obstruction and dilatation, has been reported very rarely. Also, the benign bile duct neoplasm is extremely rare. We report a case of a mucin-secreting villous adenoma of common hepatic duct causing obstructive jaundice and cholangitis. The patient was a 72-year-old male and had a 3 yeared history of common hepatic mass unchanged remarkably in size. The abdominal ultrasonogram and computed tomography revealed well circumscribed, more than 2cm sized mass on the CHD and ductal dilatation. We were able to get an interesting cholangioram showing irregular, nodular, ill defined filling defect in the extrahepatic bile duct, different from US and CT findings, And it was just caused by thick, copious mucin from the tumar. This case was confirmed as mucin-secreting villous adenoma after surgery.
Adenoma, Villous* ; Aged ; Bile Duct Neoplasms ; Bile Ducts ; Bile Ducts, Extrahepatic ; Cholangitis ; Dilatation ; Hepatic Duct, Common* ; Humans ; Jaundice, Obstructive ; Male ; Mucins* ; Ultrasonography

No abstract available.
Decompression* ; Spinal Stenosis*

Arthrography is an invaluable procedure in critically verifyging the concentricity of closed reduction and the optimum position of stability. And it is known to be the most accurate and certain way of demonstrating lesser degrees of incongruity. It can visualize the intrinsic obstructive fractors, such as capsular attachment, the labrum, the psoas tendon and its relationship to the joint, the pulvinar, ligamentum teres, the inferior transverse ligament, and the shape of the femoral head and acetabulum. We analyzed 20 cases of congenital dislocation of the hip in 17 patients, which had been evaluated by arthrography. The results are as follows: 1. We found the inferior approach very efficient among many kinds of arthrographic techniques. 2. Among 20 cases, 12 cases could be treated with closed reduction and 8 cases were treated by open reduction such as capsuloplasty, partial limbusectomy, and removal of space occupying lesion in acetabulum, including 2 cases of Salter's innominate osteotomy and 1 case of derotational osteotomy. 3. Among the intracapsular obstructive factors which played major role in hindering closed reduction, capsular constriction was shown in 8 case, inverted or hypertrophic limbus in 5 cases, and other space occupying lesions in 2 cases. 4. We performed combined operation including bone and soft tissue for severe extra- and intracapsular lesions and closed reduction for mild to moderate extra- and intracapsular lesions. 5. Arthrography of the hip joint was indispensable in evaluating the intracapsular osstructive lesions as well as detecting the subtle incongruent reduction.
Acetabulum ; Arthrography ; Constriction ; Dislocations ; Head ; Hip Joint ; Hip ; Humans ; Joints ; Ligaments ; Osteotomy ; Pulvinar ; Round Ligaments ; Tendons