BACKGROUND: Wheezing which is defined as a continuous sound with a musical quality is commonly auscultated in patients with chronic obstructive airway diseases. The correlation between wheezing and airway obstruction is unclear. OBJECTIVE: This study was designed to evaluate the relationships among wheezing, severity of airway obstruction, and pulmonary function tests. METHOD: Forty-one subjects were examined by the same observer. Wheezing during normal breathing and maximal forced exhalation, was auscultated respectively. Posterior lung bases were auscultated bilaterally with the seated patient taking repeated inspiratory capacity breaths through an open mouth. To quantify wheezing intensity, a regional score was assigned for each area after a minimum of 3 breaths, according to the following scale: zero, no wheezing heard: one, faint or intermittent wheezes: two, moderate wheezing during every expiration: three, loud wheezing during every expiration. The lung function tests by standard pneumotachograph were performed by skilled technicians. RESULTS: Wheezing was auscultated more in forced exhalation than in normal breathing in patients with asthma and COPD [8/9(88%) vs 1/9(11%), p<0.01 ll/15(73%) vs 1/15(6%), p<0.05)]. Forced expiratory wheezes group (n=25) compared to no wheezes group (n=16) had significantly lower FEVl (75+-5.8% vs 95.6+-6.6%, p<0.05). Compared to no wheezes group, the group with forced expiratory wheezes had lower FEV1 and FEV1/FVC (50.4+- 21.3% vs 81.15+-27.7%, 70.4+-22.4% vs 92.5+-19.3%, respectively, p<0.05). Bronchial asthma compared with COPD tended to have higher wheezing scores (Wheeze scores Bronchial asthma 3.5 vs COPD 2.4, p=0.08). Wheezing scores were correlated to FEV1 (normal breathing: r=-0.35, p<0.05: forced exhalation: r=-0.45, p<0.05), but no differences were found in wheezing incidence according to severity of airway obstruction. CONCLUSION: These findings suggest that wheezing on maximal forced exhalation may be a useful physical indicator for evaluating the severity of airway obstruction.
Airway Obstruction ; Asthma ; Exhalation ; Humans ; Incidence ; Inspiratory Capacity ; Lung ; Mouth ; Music ; Pulmonary Disease, Chronic Obstructive* ; Respiration ; Respiratory Function Tests ; Respiratory Sounds*

No abstract available.
Aneurysm* ; Kidney* ; Renal Artery*

A 12-year-old boy developed cholestatic hepatitis with Steven-Johnson syndrome following the use of amoxicillin. The skin lesion and general condition were improved over 2 weeks, but jaundice was gradually aggrevated. We performed liver biopsy, on 30th hospital day, which showed cholestatic hepatitis. The patient improved gradually and liver function was normalized 5 months later.
Amoxicillin ; Biopsy ; Child ; Hepatitis* ; Humans ; Jaundice ; Liver ; Male ; Skin

Peptic ulcer can occur anywhere in the gastrointestinal tract that contact with acid and pepsin. But usually peptic ulcer occurs at the stomach and duodenum and the location of peptic ulcer are localized to specific area within the stomach and duodenum. So I think that predilection of peptic ulcer to localized area may have clue for releaving the pathogenesis of peptic ulcer. So I studied the location of peptic ulcer for the basic reserch of ulcer pathogenesis by means of dividing stomach into antrum, angle, lower body, middle body, upper body and lesser curvature, anterior wall, greater curvature, posterior wall and duodenum into anterior wall, lesser curvature, posterior wall, and greater curvature. The results obtained were as follows: 1) The chronic gastric ulcer was most common in the angle of lesser curvature (22.9%) and second common in the antrum of lesser curvature (22.3%). 2) The location of chronic and acute gastric ulcer was similar. 3) The proximal migration of ulcer site according to increasing age was not observed. 4) Chronic duodenal ulcer was occurred commonly in the lesser curvature (41.8%) and anterior wall (38.3%). 5) As the age increase, the incidence of chronic duodenal ulcer in the lesser curvature was increased and that of chronic duodemal ulcer in the anterior wall was decreased. 6) Acute ulcer of stomach and duodenum has no predilection site.
Duodenal Ulcer ; Duodenum ; Gastrointestinal Tract ; Incidence ; Pepsin A ; Peptic Ulcer* ; Stomach ; Stomach Ulcer ; Ulcer

PURPOSE: There are ample experimental and clinical data showing that if the bladder does not receive a significant urine input for a prolonged period it suffers a reduction in capacity and develops hypertonicity. We investigated the urodynamic changes before and after renal transplantation in the patients of chronic renal failure(CRF) under dialysis. MATERIALS AND METHODS: Urodynamic evaluations were performed in 47 CRF patients(25 males and 22 females, average age : 39 years) prior to renal transplantation and 4 weeks after renal transplantation. The clinical notes of each of the patients were reviewed to ascertain the cause of renal failure, duration and type of dialysis. RESULTS: The maximal flow rate , voiding volume, voiding time, volume of first sensation of fullness and the volume of urge sense were abnormally low in the patients of CRF, and the degree of deterioration was more remarkable in the patients of longer duration of dialysis, but the voiding detrusor pressure was within normal range in the patients of CRF irrespective of duration and type of dialysis. The maximal flow rate, voiding volume, voiding time, volume of first sensation of fullness and the volume of urge sense were increased significantly after successful renal transplantation, but the change of voiding detrusor pressure was not significant. CONCLUSIONS: The bladder capacity of CRF patients under dialysis is decreased to physiologic disuse state because of decreased urine input into the bladder for a prolonged period, but the contractility is well preserved irrespective of duration of dialysis, and the bladder capacity is recovered in the course of time after successful renal transplantation.
Dialysis ; Female ; Humans ; Kidney Failure, Chronic* ; Kidney Transplantation* ; Male ; Reference Values ; Renal Insufficiency ; Sensation ; Urinary Bladder ; Urodynamics*

Posterior segment injuries due to non-penetrating ocular trauma have protean ocular manifestations. Vision may be unaffected or completely lost according to the injured area. Although most cases require no specific treatment, early accurate diagnosis and appropriate prophylactic treatment will prevent some patients from late visual loss. We analyzed retrospectively 36 eyes of 36 patients with non-penetrating posterior segment trauma who had visited our clinic from August, 1994 to February, 1997. Thirty two of the patients(88.8%) were male and the peak age group was in the third decade. Thirteen of the patients(21%) had Berlin`s edema, which was one of the most common findings seen in the posterior segment. The most common anterior segment finding associated with non-penetrating ocular trauma was hyphema(20%). The most common cause of non-penetrating trauma was violence(first, foot)(38.8%). Final visual acuity was better in eyes without the lesion involving the macula.
Diagnosis ; Edema ; Humans ; Male ; Retrospective Studies ; Visual Acuity

BACKGROUND: Many factors determine the distribution of local anesthetics in the subarachnoid space. These major factors are dosage of local anesthetics, baricity of local anesthetics, position of patient, contour of vertebral column. The temperature of local anesthetics alters the baricity of local anesthetics. At 20oC, the density of 0.5% plain bupivacaine is 1.0003 and generally act as isobaric solution in the CSF. As its temperature lowers, its baricity increases. METHODS: Forty patients (A.S.A I and II) scheduled for lower extremity operation under spinal anesthesia were randomized into four groups; group I (37oC 0.5% bupivacaine, sitting position), group II (37oC 0.5% bupivacaine, 15o head-down position), group III (4oC 0.5% bupivacaine, sitting position), group IV (4oC 0.5% bupivacaine, 15o head-down position). The patients were placed in the sitting position (Group I, III) or lateral decubitus (Group II, IV) and dural puncture was performed at the L3-4 interspace using a midline approach (25-gauge Quincke spinal needle). A free flow of clear cerebrospinal fluid was obtained before administration of drug (37oC 0.5% bupivacaine in Group I, II and 4oC 0.5% bupivacaine in Group III, IV). Patients remained in the sitting position or 15o head-down position for 3 minutes after injection. Patients in each group received a solution that had been previously equilibrated in a stove to 37oC and in a refrigerator to 4oC for more than 1 day. Syringes used to administer the bupivacaine solution were also equilibrated to 37oC and 4oC, respectively. We checked sensory block level using pin-prick test at every 5 minutes. RESULTS: There was statistic significance in sensory block level between Group I, IV and Group II, III. The maximum sensory block level and the time to maximum cephalad spread of analgesia was the T4 level and 9.6 minutes in Group I, the T5 level and 13.5 minutes in Group IV compared to the T9 level and 21 minutes in Group II, the T10 level and 18 minutes in Group III. CONCLUSIONS: The temperature of 0.5% plain bupivacaine affects sensory block level and time to block. It is concluded that the temperature of the injected solution plays an important role in the sensory spread of 0.5% plain bupivacaine.
Analgesia ; Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine* ; Cerebrospinal Fluid ; Humans ; Lower Extremity ; Posture* ; Punctures ; Spine ; Subarachnoid Space ; Syringes

Spinal instrumentation using pedicle screws offers several advantages such as 1) achievement of rigid fixation through the pedicles which is the strongest structure of spine, 2) nearly anatomic reduction by direct force on the deformed sites of fracture and 3) preservation of mobile segments by short segment fixation. The authors analysed 14 cases of unstable thoracolumbar and lumbar fracture treated by pedicle screw fixation from May 1988 to June 1989. Mean follow up was 14 months(8M.-20M.) and following results were obtained. 1. Most of the cases were male(13 cases) and their age ranged from 26 to 55 with an average of 36. 2. According to Denis classification, there were 7 cases of burst fracture, 5 cases of fracture-dislocation, 1 case of seat belt injury and unclassified one case. 3. After operation, the height of anterior column was reduced from 61% to 86%, posterior column, from 134% to 105%, local kyphosis, from 17.4% degrees to 3.4 degrees and anterior translation, from 6mm to 1.2mm. 4. In comparision of preoperative and postoperative moter index between fracture-dislocation and burst fracture, the former changed from 3.2 to 21.8 and the latter, from 40.2 to 48.6. 5. Significant neurologic recoveries were observed in all cases except one complete paraplegia. 6. There was no significant complication and minimal loss of correction was noted.
Classification ; Follow-Up Studies ; Kyphosis ; Paraplegia ; Pedicle Screws ; Seat Belts ; Spine

Closed interlocking nailing has become a common method of treatment of femoral fractures in adults. Interlocking nailing had a tendency toward rotational deformity and shortening. Therefore, we determined anteversion of the femoral neck after closed IM nailing of the femoral fractures. Femoral rotational deformity in both leg was determined by the construction of a line through the femoral neck and another through the transcondylar plane of the distal portion of the femur, using the CT scanning. We performed a retrospective study of 15 patients treated with closed IM nailing for femoral shaft fractures from 1989 to 1994. 1. The average differences in anteversion angle was 12.9 degree. 2. 3 cases(50%) in 6 cases that have difference more than 15° are accompanied with ispilateral injury of the knee joint and the lower leg. 3. Angle difference of the rotational deformity of proximal or distal femoral fractures is 15.5° which is 3.5° larger than that of fractures of femoral midshaft, 12.0°.
Adult ; Congenital Abnormalities ; Femoral Fractures ; Femur ; Femur Neck ; Humans ; Knee Joint ; Leg ; Methods ; Retrospective Studies ; Tomography, X-Ray Computed

The management of distal femur fractures are difficult because of many complications including nonunion, delayed union, infection, loss of fixation, joint stiffness and angular deformity. Until 1960s, conservative management was considered superior to operative treatment in distal femur fracture. But, with advancement of new fixation devices and techniques, open reduction and internal fixation is recent trend. For the purpose of analyzing the factors effecting the results, we studied the 36 cases of distal femur fracture treated surgically from may, 1991 to May, 1994. By AO classification nineteen cases were type C fracture and seventeen cases were type A. According to Schatzker and Lambert criteria, excellent results were in 10 cases, good in 16, fair in 6 and fail in 4. We have analysed the results by fixation device, age, osteoporosis degree, fracture classification, open or closed fracture, operative approach in type C fracture and bone graft. Fair and fail results were more common in the cases of severe osteoporotic bone, type C with lateral approach and open fracture. Excellent and good results were more common in the cases of using the anatomical plate and dynamic condylar screw. We concluded that treatment device should be decided by fracture type, degree of communication, degree of osteoporosis and soft tissue state, and then satisfactory results will be obtained by accurate anatomical reduction, rigid internal fixation and early exercise.
Classification ; Congenital Abnormalities ; Femur ; Fractures, Closed ; Fractures, Open ; Joints ; Osteoporosis ; Transplants