Recently there has been a noted increase in the incidence of traumatic bony gap in long bones due to accidents in industry, high speed traffic accidents and common gunshot accidents. There are several methods to treat traumatic bony gap such as bone graft (autogenous, homogenous and heterogenous), bone transplantation, periosteal osteogenesis and reinplantation of the extruded bone etc. The authors studied 26 patients of traumatic bony gap in the long bones which had been treated by autogenous bone grafting. The results of the clinical observation were as following; 1 The causes were shotgun accidents, vehicle accidennts and explosive accidents. 2 There was bony gap involved in 10 upper extremities and 16. lower extremities. The radius was the most common site in the upper extremity and the femur in the lower extremity. 3. The largest bony gaps were 10.5cm. in the tibia and next were 10.6cm. in ulna and 9.0cm. im humerus. 4. The period of the bony union in these cases was prolonged 1.5~3 times the usual healing period of simple fractures. 5. It was very important to prevent and control infection of the open fractures and to decide the correct time for bone grafting operation after healing of the infected wounds. We did the bone grafting sugery 2 or 3 months later after the infected wounds had been healed. 6 The authors could avoid some complications such as delayed union, shortening of the affected limbs and stiffness of the joints of the affected limbs etc.
Accidents, Traffic ; Bone Transplantation ; Extremities ; Femur ; Fractures, Open ; Humans ; Humerus ; Incidence ; Joints ; Lower Extremity ; Osteogenesis ; Radius ; Tibia ; Transplants ; Ulna ; Upper Extremity ; Wounds and Injuries

OBJECTIVES: Working at other times than the regular day shift has been reported to be a stressor associated with health consequences and mental disorders as well as disturbance of sleep. In current study, we aimed at investigating the relationship between work schedule, sleep quality and depression among police officers. METHODS: Eleven hundreds and forty five police officers (male:1040, female:105) completed questionnaires of basic socio-demographic data, Pittsburgh Sleep Quality Index (PSQI), Korean Scale of Occupational Stress (KOSS), Impact of Event Scale - Revised (IES-R) and Center for Epidemiologic Study-Depression (CES-D). RESULTS: After controlling for age, sex and educational level, score of CES-D was correlated positively with the score of KOSS, PSQI and IES-R on partial correlation analysis (r=-0.077;p=0.009, r=0.262;p<0.000 and r=0.421, p<0.000, respectively). Logistic regression analysis revealed that female sex, age, the score of KOSS and IES-R and schedule of rotating shift work predicted higher score than 16 score of CES-D significantly in total subjects (p=0.023, p=0.015, p=0.000, p=0.000 and p=0.022, respectively). CONCLUSION: Current result suggested that not only female sex, age, higher occupational stress and impact of event scale but also rotating shift work schedule might be related to depression among police officers.
Appointments and Schedules ; Depression ; Female ; Humans ; Logistic Models ; Mental Disorders ; Police ; Surveys and Questionnaires ; Risk Factors

INTRODUCTION: There has been an increasing interest in the relationship between sleep and suicidality. In addition, suicidal patients habitually report their sleep problems. Although sleep-related complaints and electroencephalographic changes are generally encountered in psychiatric disorders, sleep complaints such as insomnia, hypersomnia and nightmares are more common in suicidal patients. In current study, we aimed at investigating the relationship between self-reported sleep duration and suicidality in general population. METHODS: One thousand general population (male : female=500 : 500, mean age=39.6+/-11.6 years, ranged age=20-77 years) completed Center for Epidemiologic Study-Depression (CES-D), Beck Suicide Intent scale (BSI), Spielberger State-Trait Anger Expression Inventory (STAXI), Barratt Impulsiveness Scale (BIS), Morningness-Eveningness Scale (MES) and brief questionnaire of sleep habits. RESULTS: After controlling for age and sex, score of BSI was correlated positively with the score of CES-D, STAXI and BIS on partial correlation analysis (r(p)=0.251 ; p<0.001, r(p)=0.352 ; p<0.001, and r(p)=0.175 ; p<0.001, respectively). In addition, score of BSI was inversely correlated with the score of MES (r(p)=-0.066; p=0.037). However, score of BSI showed no significant correlation with sleep duration. However, regression analysis revealed that short (<6 hrs) or long (>10 hrs) sleep duration, the family history of psychiatric illness, the score of CES-D, and the score of STAXI predicted higher score of BSI significantly in total subjects (F=17.837, adjusted R2 =0.166 ; p=0.003, p=0.003, p<0.001, and p=0.003, respectively). This model was explained better in depressed subjects with 16 or higher score of CES-D (F=9.920, adjusted R2=0.298). CONCLUSION: Current result suggested that not only short sleep duration (<6 hrs) but also long sleep duration (>10 hrs) might be related to suicidality.
Anger ; Depression ; Disorders of Excessive Somnolence ; Dreams ; Humans ; Surveys and Questionnaires ; Republic of Korea ; Sleep Initiation and Maintenance Disorders ; Suicide

High output heart failure due to congenital arteriovenous fistula is a rare disease and is difficult to treat. A 27 year old man, suffering from dyspnea, palpitation, lower extremity edema, and abdominal distension admitted May, 1987. At admission there were continuous thrill and bruit at left supraclavicular and infraclavicular area. The heart sound was irregular and rapid, and grade IV/VI pansystolic murmur was audible at the apex. Chest PA showed marked cardiomegaly with pleural effusion and notching at superior aspect of left 2nd rib. Selective left subclavian artery angiogram showed extensive congenital arteriovenous fistula at the area of left subclavian artery and its branches. After setrial feeding artery embolization and palliative operation, the fistula size decreased much with clinical improvement.
Adult ; Arteries ; Arteriovenous Fistula* ; Cardiomegaly ; Dyspnea ; Edema ; Fistula ; Heart Failure ; Heart Sounds ; Humans ; Lower Extremity ; Pleural Effusion ; Rare Diseases ; Ribs* ; Subclavian Artery* ; Thorax

BACKGROUND: Despite the emerging danger of MDR-TB to human beings, there have only been a limited number of drugs developed to treat MDR-TB since 1970. This study investigated the cross-resistance rate between rifampicin (RFP) and rifabutin (RBU) in order to determine the efficacy of rifabutin in treating MDR-TB. In addition, the results of rifabutin were correlated with the rpoB mutations, which are believed to be markers for MDR-TB and RFP resistance. METHODS: The MICs of RBU were tested against 126 clinical isolates of MDR-TB submitted to the clinical laboratory of National Masan TB Hospital in 2004. Five different concentrations (10-160 microgram/ml) were used for the MICs. The detection of the rpoB mutations was performed using a RFP resistance detection kit with a line probe assay(LiPA), which contains the oligonucleotide probes for 5 wide type and 3 specific mutations (513CCA, 516GTC, and 531TTG). The rpoB mutation was determined by direct sequencing. RESULTS: The rate of cross-resistance between RFP and RBU was 70.5%(74/105) at 20 microgram/ml RBU(ed note: How much RFP?) Most mutations (86.3%) occurred in the 524~534 codons. The His526Gln, His526Leu, Leu533Pro, Gln513Glu, and Leu511Pro mutations(Ed note: Is this correct?) were associated with the susceptibilty to RBU. CONCLUSION: Based on the cross-resistance rate between RFP and RBU, RBU may be used effectively in some MDR-TB patients. Therefore, a conventional drug susceptibility test for RBU and a determination of the critical concentration are needed. However, rpoB gene mutation test may be have limited clinical applications in detecting RBU resistance.
Codon ; Humans ; Oligonucleotide Probes ; Rifabutin* ; Rifampin*

No abstract available.

Arthroscopy assisted anterior cruciate ligament(ACL) reconstruction with the autogenous bone-patellar tendon-bone(BPB) graft showed more favorable results in the hand of experienced surgeon, but it requires long leaming curve for skillful techniques. On the contrary, open method is very easy to learn, but it needs more soft tissue dissection affecting rehabilitation and morbidity. Arthrotomy through the patellar tendon harvest site provide good surgical approach without supplementary incision, and hence short operation time and good clinical result can be expected. The purpose of this study is to introduce this technique and compares the results with arthroscopic one. We performed 67 cases of ACL reconstruction with autogenous BPB graft through the patellar tendon harvest site. We recorded and analysed the physical findings, Lysholm score and Cybex test at preoperative and postoperative 3, 6, 12 months. Average Lysholm score was 58.0 preoperatively and 90.5 at postoperative one year. Cybex test at one year follow-up showed decreased muscle strength of quadriceps, which was nearly the same result with arthroscopic technique. In conclusion, this technique provided similar excellent clinical results comparing with the arthroscopy assisted ones. Furthermore, this technique had merits of short learning curve and short operation time.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Arthroscopy ; Follow-Up Studies ; Hand ; Learning Curve ; Muscle Strength ; Patellar Ligament* ; Rehabilitation ; Transplants

Background: Norepinephrine, a potent α-adrenergic agonist with β-adrenergic effects, has recently emerged as a potential alternative to phenylephrine that does not lower cardiac output (CO) and heart rate (HR) during cesarean deliveries. We examined the systemic hemodynamic effects of both agents in this setting, using intermittent bolus doses to treat spinal anesthesia-induced hypotension. Methods: A total of 56 parturients consenting to spinal anesthesia for elective cesarean delivery were randomly assigned to phenylephrine (100 μg/ml) or norepinephrine (5 μg/ ml) intermittent bolus dosing. The primary study outcome was maternal normalized CO, examining and other hemodynamic variables, maternal side effects, and fetal outcomes secondarily. Results: In terms of systolic blood pressure and HR, there were significant within-group differences over time (P < 0.001 and P < 0.001, respectively). Normalized CO and stroke volume (SV) also showed significant differences between groups (P < 0.001 and P = 0.002, respectively). In the phenylephrine group, normalized CO and SV declined (relative to baseline values) by as much as 13% and 9%, respectively; whereas in the norepinephrine group, normalized CO did not differ significantly from baseline, and SV increased up to 5% (relative to baseline). Normalized total peripheral resistance likewise displayed significant within-group differences over time (P < 0.001). Conclusions During elective cesarean delivery, intermittent bolus doses of norepinephrine proved effective for treating spinal anesthesia-induced hypotension, while maintaining CO and SV. No maternal complications or fetal effects were evident.

Leiomyomas of vagina and vulva are rare solid tumors, but most common mesenchymal tumors in adult woman. Most of the reported cases have been benign. The tumors were firm, well-defined submucosal masses in a majority of patients. We experienced two cases of vulvar and vaginal leiomyoma, thus it is presented with a brief review of the cases and its literatures.
Adult ; Female ; Humans ; Leiomyoma* ; Vagina* ; Vulva*

Larval nematodes belonging to genera Ancylostoma, Strongyloides, Rhabditis, Gnathostoma or microfilariae (Onchocerca volvulus)/adult filaria (Loa loa) can invade human skin, each making different lesion. In a 71-year old immunocompetent Koreanman with 23% eosinophilia and elevated serum IgG (2530 mg/dl), a skin biopsy was undertaken for a nodular lesion at abdominal wall. A longitudinal section of a larval nematode was recognized in mid-dermal tunnel surrounded by pseudolymphomatous diffuse lymphoreticular cell infiltration. The larval nematode, 15 um in maximum diameter, had outermost cuticular layer and pale intestinal cells. The nematode section was identified as a filariform larva of Strongyloides stercoralis mainly based on its maximum diameter. In Korea, this is the first description of a cutaneous larval nematode infection. This case did not show quick migration of lesion which is a typical manifestation of classical cutaneous larva migrans.
Adult ; Male ; Female ; Humans ; Biopsy