Proper positioning of pulmonary artery catheter and predicting distal migration of it during cardiopulmonary bypass is important for the prevention of perioperative complication of pulmonary artery rupture. The authors therefore examined the insertion length of pulmonary artery catheter via right internal jugular vein at which catheter tip was advanced to the most proximal position where pulmonary capillary wedge pressure could be obtained. And also the distal migration is measured by comparing the difference between prebypass and postbypass corrected length. Just before bypass, pulmonary artery catheter was arbitrarily receded 5cm for the prevention of spontaneous distal migration and wedging. The subjects were 47 patients who underwent open heart surgery (valve replacement, coronary artery bypass graft) during the period of November, 1992 through April, 1993. The results were as follows. 1) The insertion length of pulmonary artery catheter from skin to the right ventricle inlet, pulmonary artery inlet and pulmonary capillary wedge position were 26.5+/-3.0 cm, 36.8+/-4.9 cm and 46.1+/-5.7 cm respectively. 2) There were no significant statistical correlations between insertion lengths and patient constitutions such as body weight and height(r=0.144, r=0.032). 3) Locations of catheter tips were distributed to the 0.9+/-3.1 cm left to the spinous process, 1.9+/-1.6 cm inferior to the carina ; mostly LLQ of the lung field(51%). 4) During cardiopulmonary bypass, pulmonary artery catheter tips were migrated distally in 93.6% of the cases and the migration lengths were 2.7+/-2.0 cm. 5) There were no major perioperative complications caused by pulmonary artery catheterization. These results suggest that 5 cm withdrawal of pulmonary axtery catheter just before cardiopulmonary bypass can prevent the fatal complication of pulmonary artery rupture owing to its spontaneous distal migration.
Bays ; Body Weight ; Capillaries ; Cardiopulmonary Bypass ; Catheterization, Swan-Ganz ; Catheters* ; Constitution and Bylaws ; Coronary Artery Bypass ; Extracorporeal Circulation* ; Heart Ventricles ; Humans ; Jugular Veins ; Lung ; Pulmonary Artery* ; Pulmonary Wedge Pressure ; Rupture ; Skin ; Thoracic Surgery

BACKGROUND: The purpose of this study was to investigate the characteristics of and to analyze the factors re-lated to the cost of the resolution of a medical dispute. METHODS: We have reviewed 2,346 cases reported to the Korean Medical Association(KMA)mutual-aid association from Nov. 1. 1981 to Oct. 31. 1994. RESULTS: The percentage rate of reported cases of were related field as follows .' obstetric gynecology(OBGYN) 31.9%, general practitice 28.1%, general surgery 13.3%, orthopedics 6.9% and internal medicine 6.4% 1,829 cases (80.0%) were settled out of court and without public intervention. 310 cases(13.2%) were settled by the police, the public procurators office or the court. The mean settlement amount per case was 9,340,000 won with annual growth rate 10.8%, and median settlement amount was 5,890,000 won. The mean settlement amount for OBGYN was 930,000 won, surgical group 8,900,000 won, medical group 7,710,000 won, and general practitice 7,490,000 won. The cases of medical dispute according to the types of medical care were : operation 21.1%, injection 18.0%, treat-ment and care 18.0%, delivery 13.0%, artificial abortion 10.3%, Cesarian section 7.2% and anesthesia 2.5%. The mean settlement amount according to the types of medical care were: delivery and Cesarian section 15,190,000 won, operation and anesthesia 9,500,000 won, others 6,610,000 won, and injection and medication 6,230,000 won. The mean settlement amount that was settled out of court without public intervention was 7,940,000 won. The mean settlement with public intervention in the court was 17,290,000 won. The cases of medical dispute according to the patients status were .' death 37.5%, complications 20.8%, disability 12.2% and others 28.9%. The mean settlement amout for death was 16,150,000 won, disability 9,430,000 won, others 4,850,000 won and complications 3,550,000 won. The mean settlement amount where doctors have asserted that the outcome was inevitable or have not agreed that it was their fault was higher than the cost of cases where they had admitted responsibility. The settlement amout where there was a misdiagnosis present had not shown to be higher than when the misdiagnosis was absent. The mean settlement amount for cases where multiple doctors were involved was higher than for cases of a single doctor. The mean settlement amount for disturbing the medical practice and suspension of are high. The mean settlement amount for complications was lower than others, and the mean settlement amount for disability and death presented were high. Concerning the types of care, the mean settlement amount for operation/anesthesia, delivery/ Cesarian sections were higher than for injection/medication. Concerning the type of settlement, the mean settlement amount in the police and public procurators office was higher than in out of court without public intervention. CONCLUSIONS: The mean settlement amount depended on the patient's status, the type of settlement, and the disturbance of medical practice regardless of the doctors misdiagnosis, fault, and standard care. Therefore, a reason-able method of resolution for medical dispute is needed.
Anesthesia ; Diagnostic Errors ; Dissent and Disputes ; Humans ; Internal Medicine ; Malpractice* ; Orthopedics ; Police

Fracture dislocation or dislocation of the knee can produce a popliteal artery injury that may be difficult to evaluate clinically. Diagnosis of disruption or thrombosis of the popliteal artery is frequently delayed until the opportunity to salvage the extremity is lost. 22 cases of popliteal artery injury were reviewed from July 1978 to December 1983, associated with severe knee trauma at the Orthopaedic department of Kyung Hee University Hospital, of whom average follow-up for about 52 months. The results obtained were as follows; 1. In all 22 cases, 14 cases (63. 6%) were amputated. The amputation rate was correlated with ischemic time after injury. 2. Resection of all injuried vessels with reconstitution of continuity by the use of an interposed saphenous vein graft is often warrented to avoid tension. 3. All 8 patients, which was managed conservatively, were amputated in all cases(100%). In cases of suspicious popliteal artery injury, early aggressive exploration and obvious microvascular reconstruction should be mandatory. 4. Subperiosteal fibulectomy-fasciotomy should be done routinely immediately after vascular injury. 5. Diagnosis of popliteal artery injury was based on the clinical findings but the capillary filling was not contributary. 6. The use of Doppler flowmeter and emergency arteriography was recognizedtobeanexcellent methods in determination of arterial injury.
Amputation ; Angiography ; Capillaries ; Diagnosis ; Dislocations ; Emergencies ; Extremities ; Flowmeters ; Follow-Up Studies ; Humans ; Knee ; Popliteal Artery ; Saphenous Vein ; Thrombosis ; Transplants ; Vascular System Injuries

Most loci associated with type 2 diabetes mellitus (T2DM) discovered to date are within noncoding regions of unknown functional significance. By contrast, exonic regions have advantages for biological interpretation.

Most loci associated with type 2 diabetes mellitus (T2DM) discovered to date are within noncoding regions of unknown functional significance. By contrast, exonic regions have advantages for biological interpretation.

The bone mineral densities of 60 middle school boys were measured with dual photon absorptiometry to define the influence of Taekwon-Do. They were divided into Taekwon-Do and control group, each comprising 30 boys. The bone mineral densities of the head, trunk, pelvis, both upper and lower extremities, and body total were measured. The results were as follows. 1. The BMD of head was 1.668 ± 0.153 in Taekwon-Do and 1.554 ± 0.153 0.167 in control. It was significantly increased in aekwon-Do(p <0.05). 2. The BMD of trunk was 0.378 ± 0.153 0.044 in Taekwon-Do and 0.353 ± 0.153 0.053 in control. There was no significant difference(p >0.05). 3. The BMD of pelvis was 1.648 ± 0.153 0.112 in Taekwon-Do and 1.444 ± 0.153 0.215 in control. It was significantly increased in Taekwon-Do(p <0.005). 4. The BMD of right and left legs were 1.597 ± 0.153 0.118 and 1.579 ± 0.153 0.125 in Taekwon-Do and 1.425 ± 0.153 0.115 and 1.421 ± 0.153 0.113 in control group respectively. They were significantly increased in Taekwon-Do(p <0.005). 5. The BMD of right and left arms were 1.184 ± 0.153 0.090 and 1.178 ± 0.153 0.115 in Taekwon-Do and 1.056 ± 0.153 0.095 and 1.066 ± 0.153 0.097 in control group respectively. They were significantly increased in Taekwon-Do(p.<0.005). 6. The total body BMD was 0.932 ± 0.153 0.068 in Taekwon-Do and 0.846 ± 0.065 in control. It is significantly increased in Taekwon-Do(p<0.005). In conclusion, Taekwon-Do increases the total bone mineral density and the mineral densities of the head, pelvis and extremities but not that of trunk. It is thought that continued practice of Taekwon-Do throughout adult life might prevent the senile osteoporosis
Absorptiometry, Photon ; Adult ; Arm ; Bone Density ; Extremities ; Head ; Humans ; Leg ; Lower Extremity ; Miners ; Osteoporosis ; Pelvis

Authors experienced an unusual case of malunited trans-epiphyseal fracture of the proximal femur in a 2 year-old girl. She was treated at a private clinic by closed reduction and cast immobilization, which subsequently resulted in malunion and capital subluxation. Because of subsequent failure of remodelling of the subluxated malunited fracture for two years, corrective femoral varisation and internal rotation osteotomy was done to reduce the subluxated femoral head. Postoperatively congrous reduction was obtained and gradual remodelling of the malunited fracture took place during 5 and a half years follow-up period.
Child ; Female ; Femur ; Follow-Up Studies ; Fractures, Malunited ; Head ; Hip ; Humans ; Immobilization ; Osteotomy

No abstract available.
Decompression* ; Follow-Up Studies* ; Spine* ; Titanium*

Objectives: There was no previous report about the electrical cardioversion for the patients with atrial fibrillation after successful percutaneous ballon mitral valvuloplasty (PBMV). We performed electrical cardioversion after PBMV to evaluate the effectiveness of this procedure in the view of conversion to and maintenance of the sinus rhythm. METHODS: 28 patients who had persistent atrial fibrillation after successful PBMV were included in this study. All patients were anticoagulated with warfarin. Amiodarone was loaded and maintained before cardioversion. The PBMV procedures were guided by transesophageal echocardiography in all patients. Transthoracic echocardiography was done before and after PBMV and cardioversion, and was followed. RESULTS: The number of patients were 28 (male 9 and female 19) within the mean age of 50.3+/-12.0 years (24-66). Initially 24 patients (86%) succeeded in electrical cardioversion. The energy required for successful conversion was 230+/-75J, on average. There were no complications except for the transient sinus bradycardia in 2 cases. The mean follow-up duration was 357+/-144 days and when followed-up, the sinus rhythm was maintained in 15 patients out of 24 with initial success (63%). No factor was significantly related to the success of cardioversion, but left atrial dimension after 1 month of PBMV was significantly related to the maintenance of the sinus rhythm. CONCLUSIONS: This study suggests that electrical cardioversion of atrial fibrillation after successful PBMV is favorable and recommendable treatment modality of chronic valvular atrial fibrillation with high conversion rate (88%) and good maintenance rate (63%).
Amiodarone ; Atrial Fibrillation* ; Bradycardia ; Echocardiography ; Echocardiography, Transesophageal ; Electric Countershock* ; Female ; Follow-Up Studies ; Humans ; Warfarin

Blastoschizomyces capitatus (formerly Trichosporon capitatus) causes piedra and sometimes invasive infections in immunocompromised hosts. Arthritis by B. capitatus in a previously healthy person has not been reported. Herein we experienced a case of pyogenic arthritis of the knee joint in a farmer and reported the clinical course and literature review. A 68-year old man was adimitted because of swelling and painful left knee joint. Under the impression of septic arthritis of the left knee, empiric antibiotic treatment was initially done. On fifth admission day, B. capitatus was reported in joint fluid culture for the first time. Arthroscopic finding revealed infected synovium and pus-like fluid collection on patello-femoral joint. Amphotericin B was tried but discontinued due to hypokalemia after 7 day use. Secondary arthroscope showed subchondral destruction on medial femoral condyle and medial tibial plateau. Eight week treatment with parenteral fluconazole (daily 100 mg) and oral ketoconazole (200 mg daily) resulted in complete resolution of the patient's symptom. But knee joint ankylosis was remained.
Aged ; Amphotericin B ; Ankylosis ; Arthritis* ; Arthritis, Infectious ; Arthroscopes ; Fluconazole ; Humans ; Hypokalemia ; Immunocompromised Host ; Joints ; Ketoconazole ; Knee ; Knee Joint ; Piedra ; Synovial Membrane ; Trichosporon