No abstract available.
Gonadotropin-Releasing Hormone* ; Humans ; Hypogonadism* ; Male*

Bone defect of the long bone continues to challenge orthopedic surgeons. It is usually very difficult to obtain union. Ilizarov ext. fixation has recently gained popularity as a multifactorial approach to the management of tibial bone defect because nonunion, bone defects, limb shortening, and deformity can all be addressed simultaneously with the Ilizarov apparatus. From February 1992 to May 1993 at the department of orthopedic surgery, Inje University Pusan Paik Hospital, 9 patients aged from 8 to 37 years were treated for tibial bone defect. The causes were open comminuted fractures with initial bone loss and bone defect after removal of infected necrotic bone. Bony defect size was ranged from 2cm to 14cm, averaging 7.2cm. Bony defects were gradually closed by the Ilizarov's internal bone transport technique, and final equalization of leg length discrepancy was achieved by means of external lengthening technique. Soft tissue defects were treated with secondary closure, split thickness skin graft, and muscle flap. The average healing index was 42.8 days/cm. According to Paley's classification the complications were developed as follows; The problem included pin tract infection(9), knee flexion contracture(4), and intractable pain(1), the obstacles included delayed union(3) and premature consolidation(1), the complication included nonunion(9) and equinus ankle(1). At an average 1 years follow up, according to Paley and Catagnl's classification, body and functional results were either excellent or good in 7 cases. So, we recommend that Ilizarov technique is very useful treatment for open fracture with bone loss, bone defect after removal of infected necrotic bone and limb shortening.
Busan ; Classification ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Fractures, Comminuted ; Fractures, Open ; Humans ; Ilizarov Technique ; Knee ; Leg ; Orthopedics ; Skin ; Surgeons ; Tibia ; Transplants

BACKGROUND/AIMS: The ingestion of foreign bodies in the upper gastrointestinal tract usually happens as a result of accidental swallowing, and rarely produces symptoms. Although most foreign bodies are eliminated spontaneously, 10~20% of cases need treatment with endoscopy. We evaluated the role of endoscopy for removing foreign bodies from the upper gastrointestinal tract. METHODS: We analyzed one hundred and thirty-nine cases of foreign bodies in the upper gastrointestinal tract which were endoscopically treated at Chungnam National University Hospital from January 2001 to July 2004. RESULTS: Patients' age ranged from 6 months to 96 years old (mean 36.0 years old). The ratio of males to females was 1.2 : 1. The common foreign bodies included coins (29 cases) and fish bones (23 cases), animal bones (19 cases), and stones (15 cases) follows in order. The most common location was the esophagus (79.9%). In most cases (73.4%), the foreign body was removed using an alligator tooth and a grasping forceps. Twenty-eight among one hundred and thirty-nine patients had a co-morbid condition, such as esophageal disease, diabetes mellitus, hypertension, stomach cancer, or a psychiatric disorder. CONCLUSIONS: Endoscopic removal is a very powerful and useful method for removing foreign bodies from the upper gastrointestinal tract. Nevertheless, a simpler and more efficient endoscopic equipment is required
Alligators and Crocodiles ; Animals ; Chungcheongnam-do ; Deglutition ; Diabetes Mellitus ; Eating ; Endoscopy ; Esophageal Diseases ; Esophagus ; Female ; Foreign Bodies* ; Hand Strength ; Humans ; Hypertension ; Male ; Numismatics ; Stomach Neoplasms ; Surgical Instruments ; Tooth ; Upper Gastrointestinal Tract*

An 8-year-old boy presented with abdominal pain and poor oral intake for two months. Serum amylase and lipase levels were elevated. CT of the abdomen and chest X-ray showed two pseudocysts at the pancreatic uncinate process, pancreatitis with a parenchymal defect, a large amount of ascites, and a right pleural effusion. MR cholangiography and endoscopic retrograde cholangiopanreaticography revealed a pancreatic duct disruption. The patient was successfully treated with a chest tube placement and percutaneous drainage. After surgery, his general condition improved; the serum level of amylase normalized and the pleural effusion resolved. Pancreatic injuries are rare in pediatric blunt trauma; however, diagnostic difficulty is common with isolated blunt trauma. Therefore, a high index of suspicion should follow such an injury. We report the case of an 8-year-old boy with pancreas transection, ductal disruption, ascites, and pleural effusion who was successfully treated.
Abdomen ; Abdominal Pain ; Amylases ; Ascites ; Chest Tubes ; Child* ; Cholangiography ; Drainage ; Humans ; Lipase ; Male ; Pancreas ; Pancreatic Ducts ; Pancreatitis ; Pleural Effusion* ; Thorax

PURPOSE: We investigated the localizing and lateralizing values of auras in patients with lesional partial epilepsy on an outpatient basis. MATERIALS AND METHODS: A total of 276 subjects were retrospectively selected for this study if they had a unilateral single lobar lesion based on magnetic resonance image (MRI) results, and their scalp electroencephalography (EEG) findings were not discordant with the MRI-defined lobar localization and lateralization. According to the lesion locations, subjects were considered as having mesial temporal (MTLE), lateral temporal (LTLE), frontal (FLE), parietal (PLE), or occipital (OLE) lobe epilepsies. Auras were classified into 13 categories. RESULTS: A hundred and seventy-six subjects (63.8%) had experienced at least one aura. FLE subjects had the fewest number of auras. Epigastric and psychic auras were frequent among MTLE subjects, while visual auras were common in those with PLE and OLE. Somatosensory auras and whole body sensations were more frequent in the subjects with PLE than those without. Autonomic auras were more common in MTLE subjects than in LTLE subjects. Dysphasic auras were more frequently found in left-sided epilepsies. Five pairs of aura categories showed concurrent tendencies, which were the epigastric and autonomic auras, autonomic and emotional auras, visual and vestibular auras, auditory and vestibular auras, and whole-body sensation and auditory auras. Autonomic and emotional auras had a concurrent tendency in left-sided epilepsies, but not in right-sided epilepsies. CONCLUSION: Our results support the previously known localizing value of auras, and suggest that dysphasic auras and the association of emotional and autonomic auras may have a lateralizing value.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Epilepsies, Partial/*pathology ; Epilepsy/*pathology ; Female ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

BACKGROUND: Inspired concentrations of desflurane > or = 1 minimum alveolar anesthetic concentration (MAC) have been related to sympathetic stimulation such as hypertension and tachycardia. The current study examined whether labetalol, an alpha1 and beta-adrenergic antagonist would blunt these hemodynamic responses. METHODS: Fifty-four ASA physical status I patients, aged 20-60 years, were enrolled in this study. The patients were randomly divided into 2 groups. The breathing circuit was primed with an end-tidal desflurane concentration of 1.2 MAC in 6 L/min O2. Normal saline 5 ml or labetalol 0.3 mg/kg was injected into groups S and L respectively. After 5 minutes, anesthesia was induced with intravenous etomidate 0.2 mg/kg and vecuronium 0.1 mg/kg. Each patient inhaled desflurane through a tight fitting facemask. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and end-tidal concentration of desflurane (et-des) were measured at 5 minutes after saline or labetalol injection (baseline) and every 1 minute for 5 minutes after desflurane inhalation and for 2 minutes after intubation. RESULTS: In the saline injection group (group S), desflurane inhalation increased heart rate and blood pressure, while labetalol 0.3 mg/kg attenuated the heart rate and blood pressure increase in group L. After tracheal intubation, heart rate and blood pressure were significantly lower in group L than in group S. CONCLUSIONS: These results demonstrate that administration of intravenous labetalol is effective in attenuating tracheal intubation and desflurane-induced hemodynamic responses.
Aged ; Anesthesia ; Arterial Pressure ; Blood Pressure ; Etomidate ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Inhalation ; Intubation ; Isoflurane ; Labetalol ; Respiration ; Tachycardia ; Vecuronium Bromide

BACKGROUND: Paradoxical embolism through the patent foramen ovale (PFO) is a well-recognized mechanism for otherwise unexplained ischemic stroke. Although transthoracic contrast echocardiography (TCE) has been used frequently for noninvasive diagnosis of right to left shunt through PFO, its diagnostic accuracy appears limited, especially in patients with poor acoustic window. Since harmonic imaging (HI) can enhance the definition of contrast microbubbles, theoretical advantages of HI in the detection of right to left shunt through PFO using microbubbles can be considered. However, there are few data regarding the diagnostic efficacy of HI in the detection of right to left shunt through PFO. The purpose of this study was to compare the diagnostic value of transthoracic HI in the detection of right to left shunt through PFO in patients with stroke with that of fundamental imaging (FI). Methods: One hundred thirty-six consecutive patients with stroke (82 male, mean age:9) underwent TCE in both HI and FI and transesophageal echocardiography (TEE) during rest and Valsalva maneuver with intravenous administration of agitated saline. PFO was judged to be present if microbubbles appeared in the left atrium within 3 cardiac cycles of their appearance in the right atrium. TEE was regarded as the gold standard for assessing the diagnostic accuracy of TCE. Results: Right to left shunt through PFO was detected in 40 of 136 patients by TEE (29.4%). FI of TCE detected shunt through PFO in only 9 of 136 patients (6.6%). In contrast, HI detected shunt through PFO in 25 of 136 patients (18.4%). The overall sensitivity and specificity of FI and HI for detection of right to left shunt through PFO were 22.5%, 62.5% (p<0.05) and 100%, 100%, respectively. Valsalva maneuver during HI significantly increased the detection rate of shunt through PFO (during rest in 9 and during Valsalva maneuver in 25, p<0.05). CONCLUSION: HI with contrast microbubble injection significantly enhanced the detection of right to left shunt through PFO in patients with ischemic stroke compared with FI by transthoracic approach.
Acoustics ; Administration, Intravenous ; Diagnosis ; Dihydroergotamine ; Echocardiography* ; Echocardiography, Transesophageal ; Embolism, Paradoxical ; Foramen Ovale, Patent* ; Heart Atria ; Humans ; Male ; Microbubbles ; Sensitivity and Specificity ; Stroke ; Valsalva Maneuver

Although antithrombotic drug therapy is not a substitute for precise surgical technique, it has become an important adjunct for the microsurgeon performing replantation and elective free-tissue transfers. Systemic anticoagulant use in 60 free flap procedures performed from January 2001 to February 2004 was reviewed to determine the flap loss rate, associated risk of hematoma formation and heparin-induced thrombocytopenia. Patients were divided into two groups: a single intraoperative bolus of 1250 units of heparin(20 flaps, Group 1), 2500 units(40 flaps, Group 2) respectively. Partial and complete flap loss rate was higher in Group 1(35 percent) than in Group 2(10 percent). Neither the difference in hematoma incidence nor the difference in thrombocytopenia incidence between two groups was significant and there was no case presenting heparin- induced thrombocytopenia. We have encountered unusually high flap loss rate in the group who received a single intraoperative bolus of 1250 units of heparin. Although a cause-and-effect relationship between the use of systemic heparin and flap loss or prevention of thrombosis could not be established, it seems to be beneficial that a single bolus of 2500 units of heparin is given intraoperatively without significantly increasing the risk of hematoma or heparin-induced thrombocytopenia.
Drug Therapy ; Free Tissue Flaps* ; Hematoma ; Heparin* ; Humans ; Incidence ; Replantation ; Thrombocytopenia ; Thrombosis

In order to maintain the donation of the human bodies required for medical education and research, we investigated social characteristics of those who have signed up to the donation program. The data registered in Chungbuk National University were analyzed and then compared to those registered in 9 of other universities in Korea. In addition, a telephone survey was performed for 128 registrants of Chungbuk National University. The number of registrants was rapidly increased after 1999 and the donation of body was sufficient for medical education and research after 2005. The number of registrants of Chungbuk after 2005 shows gradual increase whereas 10 other schools shows slight decrease. The age of registrants at signing up to the program showed the largest proportion in seventies (33.9%), followed by sixties (28.9%) and fifties (22%). Multiple registration which means two or more registrants from one family represented 40.9%. After the use of cadaver and cremation, most of the bereaved family preferred to keep and visit the cremains in the charnel house of medical school more than to carry out the school. By the telephone survey, 71% of the registrants answered they are in middle or upper middle class of living, and 77% responded that the motivation was voluntary for the society without any reward. Based on the present results we could expect the body donations will reasonably maintaine. Most of dornors have pure motivation without any reward from the school. Keeping their cremains at charnel house of the medical school were strongly favored so it is important to make enough facilities and management system as well.
Cadaver ; Cremation ; Education, Medical ; Human Body ; Humans ; Korea ; Motivation ; Reward ; Schools, Medical ; Sociology ; Telephone

Protein-tyrosine phosphatases (PTPs) constitute a family of receptor-like, and cytoplasmic enzymes, which catalyze the dephosphorylation of phosphotyrosine residues in a variety of receptors and signaling molecules. Together with protein tyrosine kinases (PTKs), PTPs are critically involved in regulating many cellular signaling processes. In this study, diverse compounds were screened for PTP inhibition and selectively screened for inhibitors with the end product inhibition properties. Among phosphate analogues and their derivatives for PTP inhibition, Keggin compounds phosphomolybdate (PM) and phosphotungstate (PT) strongly inhibited both PTP-1B and SHP-1, with K(i) values of 0.06-1.2 micromM in the presence of EDTA. Unlike the vanadium compounds, inhibition potencies of PM and PT were not significantly affected by EDTA. PM and PT were potent, competitive inhibitors for PTPs, but relatively poor inhibitors of Ser/Thr phosphatase. Interestingly, PM and PT did not inhibit alkaline phosphatase at all. The crystal structure of PTP-1B in complex with PM, at 2.0 A resolution, reveals that MoO(3), derived from PM by hydrolysis, binds at the active site. The molybdenium atom of the inhibitor is coordinated with six ligands: three oxo-ligands, two apical water molecules and a S atom of the catalytic cysteine residue. In support of the crystallographic finding, we observed that molybdenium oxides (MoO(3), MoO(2), and MoO(2)Cl(2)) inhibited PTP-1B with IC(50) in the range 5-15 micromM.
Binding, Competitive ; Catalytic Domain ; Crystallography, X-Ray ; Dose-Response Relationship, Drug ; Drug Evaluation, Preclinical ; Edetic Acid/pharmacology ; Enzyme Inhibitors/*pharmacology ; Human ; Inhibitory Concentration 50 ; Kinetics ; Models, Molecular ; Molybdenum/*pharmacology ; Phosphoric Acids/*pharmacology ; Protein Structure, Tertiary ; Protein-Tyrosine-Phosphatase/*antagonists & inhibitors/*chemistry/isolation & purification ; Substrate Specificity ; Tungsten Compounds/*pharmacology