Management of subtrochanteric fractures of the femur is difficult because of the high mechanical stresses in this region; furthermore, the bone here is mainly cortical and comminution is frequent. These two factors, involvement of cortical bone tissue and concentration of stress, have been mentioned as reasons for the high incidence of complication in the treatment of these fractures, such as Relayed union, mechanical failure and rnalunion. Thirty cases of subtrochanteric fractures in twenty-nine patients were reviewed, which have been managed at the Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine from Jan. 1980 to Dec. 1984 and the following results were obtained: l. Of the 29 patients reviewed, 22 were male and 7 were female. Mean age was 45.7 years in male and 67.3 years in female. 2. Traffic accidents were the most common cause of injury(44.8%) 3. Pelvic bone fractures(7 cases) and rib fractures(7 cases) were the most common associated injuries. 4. Fielding's type II (13 cases) fracture and Seinsheimer's type IV (10 cases) fracture were most common. 5. Of the 30 cases, 26(86.7%) were treated by open reduction and internal fixation. Of fixation devices, a Jewett nail was most commonly used in 13 cases (50.0%). 6. The mean duration of bony union was 20.4 weeks. There was no significant difference in union rate between fractures which were treated by operative means and fractures by conservative means. And more longer period was needed in union as fracture goes distally. 7. Weight bearing was allowed earlier in patients treated by operative means (average 10.5 weeks) than in patients by conservative means (average 18.0 weeks.). 8. Of the 30 cases, 8 complications (26.7%) occured, that is: delayed union(4 cases), mechanical failure (3 cases) and angular deformity(1 case). All of them occured in Fielding's type II and III fractures except 1 case. Loss of medial buttress and unstable reduction were considered to be causing factors. 9. Satisfactory result was obtained by stable anatomical reduction and internally fixed by Jewett nail and compression hip screw. In case of intramedullary nail, good result was expected when used in non-comminuted fracture of distal portion. Also, additional supplementary screw fixation, circlage wire and bone graft were recommended, when necessary.
Accidents, Traffic ; Bone and Bones ; Clinical Study ; Female ; Femur ; Hip ; Hip Fractures ; Humans ; Incidence ; Male ; Orthopedics ; Pelvic Bones ; Ribs ; Stress, Mechanical ; Transplants ; Weight-Bearing

BACKGROUND/AIMS: The principle of the rapid urease test is the assessment of the color change of the pH indicator, phenol red, by ammonium and bicarbonate ions which were produced by the urease. We modified a conventional rapid urease test, and quantified H. pylori infection by measuring the change of spectrophotometric absorbance. METHODS: 202 patients with upper gastrointestinal symptoms were endoscopically examined and three biopsies were performed in each antrum and fundus. Two biopsy specimens were stained with Giemsa and scored from 0 to 4 according to the distribution of bacteria by the Wyatt method. Another specimen was used for the quantitative rapid urease test. The tissue was incubated in a cuvette containing 10% of urea solution and phenol red at 37C. We measured optical densities in 550 nm at 5 min, 10 min, 15 min, 30 min, 1 hrs, 2 hrs, 4 hrs and 24 hrs time points.
Ammonium Compounds ; Bacteria ; Bicarbonates ; Biopsy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Hydrogen-Ion Concentration ; Phenolsulfonphthalein ; Urea ; Urease*

BACKGROUND: Reestabilshment of blood flow is a standard therapeutic modality to salvage the myocardium at risk in an acute phase of myocardial infarction. However, there are significant evidences that reperfusion per se may injure the potentially viable myocardium, and a number of pharmacological agents were tried to reduce this reperfusion injury. Adenosine, an endogenous vasodilator, is suggested to reduce repergusion inury. To evaluate the myocardial protective effect of adenosine, magnetic resonance spectroscopy with superscript P was applied to feline model of acute myocardial ischemia-reperfusion, as well as pathological examination. METHODS: Effects of adenosine on the recovery of high energy phosphorous metabolites during 90 minutes of reperfusion period following 90 minutes of left anterior descending coronary artery ligation were assessed by31P spectroscopy in 27 cats(10: control group, 8: adenosine I group, 9: adenosine II group). In adenosine groups 0.2 mg/kg/min of adenosine was infused intravenously for 90 minutes from 30 miniutes before reperfusion in group I, and from just before reperfusion in group II. The experiments were performed on a 4.7 T/30 cm Biospec MRS/MRI system and the MR signals were obtained by using inner-diameter 1.5 cm-sized doubly tuned surface coil. The size of the spectral peaks was measured by area integration method. RESULTS: 1) Phosphocreatine(PCr) decreased rapidly with progression of ischemia, and recovered in reperfusion period in each group. PCr values in the reperfusion period were significantly higher in adenosine group than those in control group, although there was no difference between adenosine group I and II. 2) ATP decreased with progression of ischemia, and recovered in reperfusion period in each group. ATP values in the reperfusion period were significantly higher in adenosine groups than those in control group, byt there was no difference between adenosine group I and II. 3) pH decreased uniformly with progression of ischemia and recovered in reperfusion period, showing no difference between control and adenosine groups. 4) PCr/ATP ratio, representing the potential of oxidative phosphorylation, dereased with progression of ischemia and increased in reperfusion period. PCr/ATP ratio showed no difference between control, adenosine I and II groups. 5) Risk area/left ventricle ratio was not different in control and adenosine groups. Infarct size/risk area and infarct size/left ventricle ratios were smaller in adenosine II than those in control group. Howerver no significant diffence was noticed between adenosine I and control, and between adenosine I and II group. CONCLUSION: Intravenous infusion of adenosine showed the tendency of reducing the infarct size in the feline model of acute myocardial ischemia-reperfusion, and adenosine could improve significantly the recovery of high energy phosphate metabolites. This myocardial pretective effect of adenosine is considered to be present mainly in the reperfusion period.
Adenosine Triphosphate ; Adenosine* ; Coronary Vessels ; Hydrogen-Ion Concentration ; Infusions, Intravenous ; Ischemia ; Ligation ; Magnetic Resonance Spectroscopy ; Myocardial Infarction ; Myocardial Ischemia ; Myocardium ; Oxidative Phosphorylation ; Polymerase Chain Reaction ; Reperfusion ; Reperfusion Injury ; Spectrum Analysis

Crossed aphasia refers to disturbances of language following a purely right-hemisphere lesion in right-handed individuals. In right-handed individuals, aphasia is almost invariably related to a left cerebral lesion and crossed aphasia occurs in only 1 percent who developed a sudden left hemiparesis with global aphasia. He has neither family history of left-handedness or ambidexterity. Brain MRI showed an acute large infarct of the middle cerebral artery territory on the right side and brain SPECT disclosed extensive areas of hypoperfusion in the right hemisphere and no abnormal finding in the left hemisphere. The sensory component of language function was almost improved, but the motor component has been changed. Further studies of crossed aphasia may supply more data on the functional organization of the brain for speech and language.
Aphasia* ; Brain ; Functional Laterality ; Humans ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Paresis ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: To evaluate the metabolic and pathological changes associated with myocardial ischemia-reperfusion, magnetic resonance spectroscopy with 31P was applied as well as pathological examination. METHODS: Effect of adenosine on the recovery of high energy phosphorous metabolites during the reperfusion period following 90 minutes of left anterior descending coronary artery(LAD) ligation was assessed by 31P spectroscopy in 13 cats(8 : control group, 5 : adenosine group). In adenosine group 0.2 mg/kg/min of adenosine was infused intravenously for 90 minutes from 30 minutes before reperfusion. The experiments were peformed on a 4.7 T/30cm Biospec MRS/MRI system(Bruker, Switzerland) and the MR signals were obtained by using innerdiameter 1.5 cm sized doubly tuned surface coil. The size of the spectral peaks was measured by area integration method. RESULTS: In control group, high energy phosphorous metabolites decreased continueously during the ischemic period revealing the lowest values at the end of the periods : 17.0% for PCr and 24.0% for ATP, PCr depleted below 50% of the baseline level immediately after the LAD ligation and ATP, after 15 minutes of ischemia. Therfore the depletion rate was faster in PCr change than in ATP. The recovery of the PCr and ATP occurred after reestablishment of blood flow showing, for example, 43.3% and 36.3% of the baseline levels after 10 minutes of reperfusion. After infusion of adenosine, there was a tendency of higher recovery rates of high energy phosphates than in control group. Recovery rates of PCr and ATP after 90 minutes of reperfusion, were 28.2%, 11.2% in control group and 38.3%, 18.6% in adnosine group, respectively. In adenosine grop, relative sizes of infarction were not statistically different from those of control group. CONCLUSIONS: 31P MRS can be used for in-vivo assessment of the changes of high energy phosphorous metablites concerning acute myocardial ischemia and reperfusion. Adenosine infusion improves the recovery of ATP and PCr during the reperfusion period following acute ischemia.
Adenosine Triphosphate ; Adenosine* ; Animals ; Cats* ; Infarction ; Ischemia ; Ligation ; Magnetic Resonance Spectroscopy ; Myocardial Ischemia ; Phosphates ; Polymerase Chain Reaction ; Reperfusion ; Spectrum Analysis

BACKGROUND: The 5-level triage tool, the Korean Triage and Acuity Scale (KTAS), was developed based on the Canadian Triage and Acuity Scale and has been used for triage in all emergency medical institutions in Korea since 2016. This study evaluated the association between the decrease in level number and the change in its relative importance for disposition in the emergency department (ED). METHODS: Using the registry of the National Emergency Department Information System (NEDIS) ver. 3.1, data regarding consecutive emergency patients from March 2017 to October 2017 were reviewed retrospectively. Reconfiguring KTAS levels, a total of 15 multinomial logistic regression models (KTAS_0 to KTAS_14), including the KTAS, its variants, and covariates were constructed to determine significant factors affecting ED disposition. The relative importance of each model was obtained using a dominance analysis. RESULTS: A total of 79,771 patients were included in the analysis. In the model KTAS_0, the KTAS and 8 covariates were found to be significantly related to ED disposition. The KTAS and the decision maker of each ED visit, whether it was the physician or others, had the largest relative importance, 34.8% and 31.4%, respectively (P < 0.001). In other models of KTAS variants, including 4-level, 3-level and 2-level, the rates of the KTAS decreased to 31.8% (interquartile range [IQR], 28.9–34.2), 26.4% (IQR, 23.2–31.0), and 18.7% (IQR, 7.5–24.9), respectively (P = 0.016). On the other hand, the rates for covariates tended to be larger for smaller triage levels and so there was a significant interaction effect between the KTAS and the covariates according to the triage level (P < 0.001). CONCLUSION: The 5-level triage tool, the KTAS, had the largest relative importance among the predictors affecting ED disposition only at its original level. Therefore, it is recommended that no attempt should be made to reduce the number of levels in the triage tool.
Cohort Studies ; Emergencies ; Emergency Service, Hospital ; Hand ; Humans ; Information Systems ; Korea ; Logistic Models ; Registries ; Retrospective Studies ; Triage