The technique of plssma exchange has been applied to a number of immune disorders in which c4eulating antibodies are present. We observed a patient with bullous pemphigoid and serious side effects of longterm use of steroid therspy. We applied ten times of plasmapheresis to him over six months period. After the plasmapheresis, clinical symptoms have greatly improved and steroid maintenance doses have been decreased. We have not observed any side effect of plasmapheresis such as thrambotopenia or hypogarnrnaglobulinemia during the whole therapeutic period.
Antibodies ; Humans ; Immune System Diseases ; Pemphigoid, Bullous* ; Plasmapheresis*

PURPOSE: To compare the functional and radiographic results of the treatment in unstable intra-articular fractures of distal radius by closed reduction and external fixation versus open reduction and internal fixation. MATERIALS AND METHODS: Forty cases of unstable intra-articular fractures of distal radius were treated either by application of closed reduction and external fixation (CREF) or by open reduction and internal fixation (ORIF) between March 1989 and June 1997. They were followed up for more than one year. To assess the functional results, we used Green and O' Brien' s score system and for the radiographic results, measured volar tilt, radial inclination and radial length. RESULT: In functional results, excellent to good results were obtained in 19 cases (76%) in the CREF group and 10 cases (80%) in the ORIF group, and the average score was 81.4 and 82.8 by the Green and O' Brien' s score system. In radiographic results, mean loss of volar tilt, radial inclination and radial length were 1.4 degree (13.4%), 2.0 degree (9.0%), 1.3 mm (10.3%) in the CREF group and 1.2 degree (10.8%), 1.6 degree (6.1%) and 1.2 mm (11.5%) in the ORIF group on last follow-up radiographs. There was no evidence of statistical difference between two groups in functional and radiographic results (P>0.05). CONCLUSIONS: If an appropriate operative method is selected according to the presence of several properties, including the pattern of fracture, the general condition and activity of patient and the degree of soft tissue injury, the two operative managements are considered useful to restoring articular congruity and alignment and to allow early postoperative range of motion exercise
Follow-Up Studies ; Humans ; Intra-Articular Fractures* ; Radius* ; Range of Motion, Articular ; Soft Tissue Injuries

We studied thirteen, all male, patients who had trans-scaphoid perilunar dislocation(stage I, 5 cases) and dislocation of lunate(stage IV, 8 cases). Age of patient was ranged from 25 years to 49 years(avr. 36 years)and the most common cause of injury was fall down(6 cases, 46%). Seven acute cases, diagnosed and treated within 3 weeks from injury, were treated by open reduction and K-wire fixation(5 cases), and K-wire fixation and bone graft(1 case) and Herbert screw for fracture of scaphoid(1 case). Six chronic cases diagnosed and treated after 3 weeks from injury were treated by open reduction and K-wire fixation(1 case), K-wire fixation and bone graft(1 case), removal of lunate(2 cases), and arthroplasty using muscle after removal of lunate(2 cases). Thirteen cases were followed up for average 33 months(from 13 months to 81 months). Grip power was evaluated as excellent or good in 8 cases and fair in 5 cases. Range of motion of wrist joint was decreased 21 degrees in flexion, 22 degrees in extension, 4 degrees in ulnar deviation, and 5 degrees in radial deviation of wrist joint, compared with uninjured side. Carpal height and carpal height ratio were decreased to 33.1 and 0.51, compared with normal 35.8(p=0.001) and 0.55(P < 0.001), respectively. Between 2 groups of acute and chronic cases, no significant differences were noted in carpal height or carpal height ratio. The surgical treatment of perilunar fracture-dislocation has not simple option, therefore, we would recommend the early diagnosis and exact anatomical reduction.
Arthroplasty ; Dislocations ; Early Diagnosis ; Hand Strength ; Humans ; Male ; Range of Motion, Articular ; Wrist Joint

We assessed the accuracy of clinical evaluation, arthrography and arthroscopy in the diagnosis of meniscal lesions in ninty knees in which arthrotomy was performed for disabling symptoms after evaluation by these three methods. At surgery, ninty-two menisci were removed, of which seventy-two were abnormal and twenty were normal. In these ninty-two menisci, correct diagnostic rate was made clinically 78%, arthrographically 70% and arthroscopically 86%. Arthrographic diagnosis was least accurate for lesions of the lateral meniscus and arthroscopic diagnosis was least accurate for lesions of the posterior horn of the medial meniscus and peripheral lesions. Based on this study, it was concluded that both the arthrography and arthroscopy are valuable technique for diagnosis of meniscal lesions.
Animals ; Arthrography ; Arthroscopy ; Diagnosis ; Horns ; Knee ; Menisci, Tibial

PURPOSE: To estimate the incidence and risk of significant renal injury quantitatively in the admitted patients with abdominal trauma. MATERIALS AND METHODS: From January 1992 to July 1997, 511 patients who admitted to departments of urology and general surgery due to major abdominal trauma with and without renal injury were included in this study. The risk of renal injury was defined as the percentage of square of Abbreviated Injury Scale of kidney in the Injury Severity Score(ISS) per each patient. The patients were classified to 5 groups according to the causes of trauma as traffic accident, falls, assault, other blunt and stab Injury, then compared the incidence and risk of renal injury each other. RESULTS: The overall incidence of significant renal injury was 14.9%, and the incidence according to the causes was 27.0%,20.8%, 16.1%, 14.3% and 10.7% in falls, assault, stab injury, other blunt and traffic accident, respectively. The overall risk of significant renal injury estimated by ISS was 15.7% and the risk according to the causes was 26.7%,24.9%, 11.9%,9.9% and 4.9% in assault, falls, traffic accident, other blunt and stab injury, respectively Mean ISS in the patients with renal injury was markedly higher than that of the patients without renal injury(27.5 vs 13.6)(p < 0.01). CONCLUSIONS: Our study shows that both the incidence and risk of significant renal injury in the admitted patients with abdominal trauma can be expected in the probability of 15% or so, and according to the causes, those in the traumatized patients by the assault and falls mark high.
Abbreviated Injury Scale ; Accidents, Traffic ; Humans ; Incidence* ; Injury Severity Score ; Kidney ; Urology

In this study, the number of physicians presently living in Korea thoroughly estimated by several means and, on this bases, their productivity and level of supply were estimated. The results were as follows : First, the number of physicians who did not notify the Korea Medical Association in May 1987 were 10,110, including 4,093 emigrant physicians(40.5%), 861 military medical officers, 745 public health doctors, and 107 decreased physicians. A total of 1,330 physicians could not be identified by any effort. Second, among the 34,897 registered physicians as of May 1987, 29,933(85.8%) were residing in Korea, 4,115 physicians(11.8%) had emigrated to other countries, and 849 physicians(2.4%) were decreased. Practicing physicians defined as those in Korea who were not retired, serving in the military, or completing residencies or internships, comprised 78.6%(27,414 physicians) of the total number of registered physicians. Third, it is estimated that in the year 2000 the number of registered physicians, physicians residing in Korea, and practicing physician will be 75,040, 64,038 and 57,655, respectively and these are increases of 115.0%, 113,9%, and 110.3%, respectively, compared to 1987. Fourth, the population physician ratio will be 759 to one physician in the year 2000. Fifth, the productivity of physicians, as calculated by relative values defining the productivity of 35 to 44 year-old male physicians as 10, will increase 110.7% in the year 2000 compare to that of 1987, and this increment is almost the same level as that of physicians supply. From the results of the present analysis of physicians manpower and supply projection, it can be recognized that the development of a regular notification system is necessary in order to identify precisely the number of physicians. Also a policy a physician supply is essential in order to adjust in advance the number of physicians, otherwise there will be surplus to the medical demand.
Adult ; Efficiency ; Emigrants and Immigrants ; Humans ; Internship and Residency ; Korea* ; Male ; Military Personnel ; Public Health

OBJECTIVES: This study was designed to investigate the association between Ser311/Cys311 polymorphism in the dopamine D2 receptor gene and bipolar disorder in korean population. METHOD: Ser311/Cys311 polymorphism in the dopamine D2 receptor gene was typed with PCR in 86 bipolar disorders and 100 normal controls. RESULTS: Genotype of Ser/Ser, Ser/Cys, Cys/Cys were 82 (95.3%), 4 (4.7%), 0 (0.0%) respectively in the bipolar disorders, 96 (96.0%), 4 (4.0%), 0 (0.0%) respectively in the controls. Allele frequencies of Ser and Cys were 168 (97.7%), 4 (2.3%) in the bipolar disorders, 196 (98.0%), 4 (2.0%) in the controls. There were no differencies in genotype distribution and allele frequencies of dopamine D2 receptor gene polymorphism Ser311/Cys311 between in the bipolar disorders and in the controls. CONCLUSION: These result suggests dopamine D2 receptor gene polymorphism Ser311/Cys311 is not causally related to the development of bipolar disorder in korean population.
Bipolar Disorder* ; Gene Frequency ; Genotype ; Polymerase Chain Reaction ; Receptors, Dopamine D2

BACKGROUND: Brief episode of coronary artery occlusion (i.e., ischemic preconditioning) makes the heart more resistant to injury from a subsequent ischemic insult. Although a great deal of effort has been made in studying ischemic preconditioning, the underlying mechanism of ischemic preconditioning and its effect on hypothermic insult has not been elucidated. This study was performed to see whether ischemic preconditioning protects against the depression of cardiac contractility induced by hypothermic cardioplegic arrest/reperfusion. And recently, adenosine was known to have some correlation with the mechanism of preconditioning. If so, does this effect remain after the blockade of adenosine receptor by 8-phenyl theophylline? METHOD: Twenty-four Sprague-Dawley rat weighed 250-350g were used and divided into three groups. Rat hearts were removed rapidly, and each isolated heart paced with a rate of 180/min was perused by modified Krebs-Hensleit buffer(KHB) solution on a Langendorff apparatus far an hour. After obtaining baseline data including left ventricular pressure(LVP), dp/dt, and coronary flow, cardiac arrest was induced by perfusion of 0degrees C crystalloid cardioplegic(St Thomas) solution. After that, all hearts were stored in the same St Thomas solution at salute temperature far 2 hours. In group I (control group), the hear was reperfused by KHB solution. In group II(preconditioning group), the heart was subjected to two 2-minute episode of global ischemia followed by 5 minute reperfusion with KHB solution(preconditioning) before cardiac arrest. In group III(phenyl theophylline group), the heart was subjected to preconditioning procedure and 8-phenyl theophylline at 10muM in concentration was added to KHB solution at time of reperfusion. Observing parameter was obtained in each group at 10, 20, 40 and 60 minutes after starting reperfusion and compared statistically by use of one way ANOVA test(STASTICA, release 4.5). P-value less than 0.05 was considered significant. RESULTS: Although depressed LVP, dp/dt, and Coronary flow were seen in all groups during the reperfusion period, the preconditioned group showed more effective recovery of LVP than that of the control group, especially at 10, 20 and 40 minutes(p<.05). We failed to demonstrate the difference between the phenyl theophylline group and the control group(p=NS). CONCLUSION: These results suggest that ischemic preconditioning has protective effect on recovery state of hypothermic cardioplegic arrest/reperfusion. Its protective effect was limited during early reperfusion stage and was blocked by adenosine blocker.
Adenosine ; Animals ; Coronary Vessels ; Depression ; Heart Arrest ; Heart* ; Ischemia ; Ischemic Preconditioning* ; Myocardium* ; Perfusion ; Rats ; Rats, Sprague-Dawley ; Receptors, Purinergic P1 ; Reperfusion ; Theophylline

Anesthesia for thoracic surgery is most commonly performed with the patient in the lateral decubitus position, with nondependent hemithorax comprising the operation field. When one-lung ventilation is employed, the nondependent lung is nonventilated and collapsed, while the dependent lung is ventilated. Consequently one-lung ventilation creates an obligatory right to left transpulmonary shunt through the nondependent nonventilated lung. Therefore one-lung ventilation results in a much larger alveolar-arterial oxygen tension-difference P(A-a)O2 and lower PaO2 than does two-lung ventilation. The present study was to evaluate oxygenation effect of selective CPAP to nondependent lung in the 17 thoracic surgical patients. Arterial blood gases were analysed, systolic blood pressures and heart rates were measured at following stages. Stage I; lateral decubitus position before chest opening Stage II; 15 min after chest opening and one lung ventilation stage III; 15 min after application of selective CPAP 5 cmHO to the nondependent lung stage IV; 40 min after application of selective CPAP 5 cmHO to the nondependent lung The results were as follows: 1) In stage II, the value of PaO2 was significantly lower as compared to that in stage I(224.9+/-78.0 vs 418.2+/-63.1 mmHg, P<0.01). 2) In stage III and IV, the values of PaC4 were significantly higher.as compared to that in stage II(333.8+/-97.1, 364.5+/-88.6 vs 224,9+/-78.0 mmHg, P<0.01). 3) In stage III, the value of PaCO2 was significantly lower as compared to that in stage II(37.1+/-2.9 vs 38.2+/-2.7 mmHg, P<0.05). 4) In stage IV, the value of pH was significantly lower as compared to that in stage III(7.37+/-0.05 vs 7.38+/-0.05 P<0.05). 5) Systolic blood pressures and heart rates remained unchanged at all times. We concluded that application of 5 cmHO CPAP to the nondependent lung during one-lung ventilation is one of most efficacious maneuvers to increase PaO2, accompanying less surgical interference.
Anesthesia ; Continuous Positive Airway Pressure* ; Gases ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Lung* ; One-Lung Ventilation ; Oxygen* ; Thoracic Surgery ; Thorax ; Ventilation*

No abstract available.
Suction* ; Tonsillectomy*