The main problem in peripheral nerve repair is adhesion, axonal escape, and the ingrowth of extraneurial tissue into the wound. Meticulous microsurgical neurorrhaphy is one of possible answer for these problem. Shielding of nerve suture is another attractive practice. But the results are still unpredictable. We compared the results of nerve repair between microsurgical epineurial neurorrhaphy plus silastic cuff shielding group and epineurial neurorrhaphy group in the sciatic nerve of white rat. The reasults we obtained are as follows; 1. Silastic cuff shielding method was effective for reducing abnormal neurial growth and neuroma formation into the surrounding soft tissue. 2. Some adhesion was formed over the silastic cuff, but there was no adhesion at the inner space of the cuff. 3. Silastic cuff could prevent fibrous tissue ingrowth into the nerve. 4. The slit of the silastic cuff provided vascular ingrowth between surrounding connective tissue and nerve tissue. 5. No evidence of foreign body reaction was observed in and out of the silastic cuff. 6. Nerve conduction test showed a little supperior results in the silastic cuff shielding group. Silastic cuff shielding method in nerve suture might be recommanded to prevent axonal escape, fibrous scar tissue ingrowth to the nerve, and fibrous adhesion in clinical practice. But, it seemed that the final evaluation of the functional recovery of the nerve needed long term follow-up and nerve conduction study.
Animals ; Axons ; Cicatrix ; Connective Tissue ; Follow-Up Studies ; Foreign-Body Reaction ; Methods ; Nerve Tissue ; Neural Conduction ; Neuroma ; Peripheral Nerves ; Rats ; Sciatic Nerve ; Sutures ; United Nations ; Wounds and Injuries

graft as a successful procedure that provides functional stabiIity. Complications reported include arthro5brosis, patellofemoral joint pain, patellar tendinitis, patellar tendon rupture, recurrent laxity, posterolateral instabi5ty, medial subluxation of the patella, chronic knee pain and painful neuroma. Among them, anterior knee pain was the rnost frequent eomplication. Authors performed arthroscopy assisted one tunnel technique for reconsction of the ACL using autogenous Bone Patellar tendon-Rone (BPTB) in 87 patients. Patients were divid@d into two groups based on the harvested side (knee) of the BPTB. Group 1 consisted of 45 cases of ipsilateral side and group 2 consisted of 42 cases of contralsteral side in harvesting the BPTB. The patients were foll4wed up for at least 12 months to determine whether using the BPTB harvested from the contralateral knee wguld reduce the anterior knee pain at the ACL reconstructed knee. Althaugh there were no statistically signifiqant differences between group 1 and 2 with regard to anterior knee pain, the prevalence of the anterior knee pain was less frequent in group 2 than group 1. This study showed that using the contralateral side harvested autogenous patellar tendon would be a possible protector for anterior knee pain and assists for early rehabilitation.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Arthroscopy ; Humans ; Knee ; Neuroma ; Patella ; Patellar Ligament* ; Patellofemoral Joint ; Prevalence ; Rehabilitation ; Rupture ; Tendinopathy ; Transplants

PURPOSE: We investigated the autonomic and complex modulation in heart rate and blood pressure in preterm infants. METHODS: In 20 healthy preterm infants and 20 full-term infants (gestational age of 32.5+/-2.3 and 39.2+/-1.0 weeks each, P<0.0001), we recorded electrocardio gram and non-invasive blood pressure simultaneously and continuously during their sleep in the supine position. To evaluate the autonomic and complex modulation in heart rate and blood pressure, we performed power spectral analysis and analysis of the determinism. RESULTS: When compared to full-term infants and in the analysis of R-R interval, the preterm infants had significantly lower high-frequency power (30.7+/-15.1% vs 20.3+/-7.7%, P<0.05), higher low- to high-frequency power ratio (1.9+/-1.6 vs 3.0+/-2.1, P<0.05), and significantly lower prediction error (4.1+/-2.8% vs 2.9+/-1.3%, P<0.05). In the analysis of blood pressure, they showed no significant difference. CONCLUSION: Compared to heart rates of full-term infants, the heart rates of preterm infants are less modulated by cardiac parasympathetic activity and more deterministic.
Blood Pressure ; Cardiovascular System* ; Heart Rate ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Supine Position

BACKGROUND AND OBJECTIVES: This study was designed to examine whether the multifractal Hurst exponents of heart rate can estimate activating and deactivating spontaneous baroreflex sensitivity (SBRS). SUBJECTS AND METHODS: Age and sex matched 24 healthy volunteers were placed in the supine position and head-up tilt position for 30 minutes, and the systolic blood pressure and heart rate were measured in an noninvasive manner. When the RR interval (RRI) sequence and systolic pressure sequence simultaneously increased or decreased for more than three successive beats, the slope of the linear regression line of systolic blood pressure and RR interval sequence was defined as the value of spontaneous baroreflex sensitivity (SBRS). From the RR intervals, very short-term (alpha range, < or =12 heartbeats), short-term (beta range, > or =12 heartbeats), and the multrifractal Hurst exponents were calculated to determine the linear correlation.coefficients for SBRS. RESULTS: In the supine position, the linear correlation coefficients (p) of SBRS and H-5alpha, H-4alpha, H-3alpha, H-2alpha, H-1alpha, H1alpha, H2alpha, H3alpha, H4alpha, H5alpha were -0.195 (NS), -0.207 (NS), -0.232 (NS), -0.282 (NS), -0.355 (NS), -0.621 (0.003), -0.650 (0.001), -0.677 (0.001), -0.699 (0.0006) and -0.708 (0.0005), respectively. In the tilting position, the linear correlation coefficients of SBRS and H-5beta, H-4beta, H-3beta, H-2beta, H-1beta, H1beta, H2beta, H3beta, H4beta, H5beta were 0.024 (NS), 0.020 (NS), 0.010 (NS), -0.028 (NS), -0.193 (NS), -0.627 (0.0034), -0.607 (0.0045), -0.598 (0.0053), -0.572 (0.0084) and -0.539 (0.0141), respectively. CONCLUSION: Some of the very short-term and short-term generalized Hurst exponents, such as H5alpha and H1beta, can be used for the estimation of spontaneous baroreflex sensitivity during patient placement in the supine and head-up tilt position, respectively.
Baroreflex* ; Blood Pressure ; Healthy Volunteers ; Heart Rate* ; Heart* ; Humans ; Linear Models ; Supine Position

OBJECTIVE: To evaluate the standards of handicapped driver's ability test in Korea and available driving aids in cervical cord injured persons. METHOD: Forty-two cervical cord injured persons (C5~C8) were evaluated with BTE (Baltimore Therapeutic Equipment) work simulator. The isotonic turning torque was measured during clockwise and counter-clockwise turning. And isometric turning torque was measured at 12 directions. RESULTS: By the isotonic measurement, the turning torque increased in the lower level of injury. In the C6 tetraplegics, the counter-clockwise turning torque was significantly higher than clockwise. Among 25 persons with C5 or C6 tetraplegia, only 2 with C6 tetraplegia could operate the power steering with the lowest wheel turning torque (3.0 Nm). Only three persons (1 person with C7 tetraplegia, 2 persons with C8 tetraplegia) could pass the handicapped driver's ability test of Korea (9.4 Nm). By the isometric measurement, turning torque was lowest at left upper quadrant (10 to 12 o'clock direction) in clockwise rotation. CONCLUSION: Among the 42 cervical cord injured persons, only 3 persons with C7 and C8 tetraplegia could pass the handicapped driver's ability test of Korea. And among 25 C5 and C6 tetraplegia, only 2 persons with C6 tetraplegia could operate the power steering. It seems to be essential to modify the standards of handicapped drivers ability test and to evolve the driving aids for the C5 and C6 tetraplegics in Korea.
Disabled Persons ; Humans ; Korea ; Quadriplegia ; Torque*

PURPOSE: Visceral obesity is a more reliable indicator of cardiovascular risk factor than BMI. Our study was designed to compare the prevalence of visceral obesity in peritoneal dialysis (PD) patients to hemodialysis (HD) patients with abdominal fat CT in a single center. METHODS: In this cross sectional study, the result of abdominal fat CT of dialysis patients was investigated from January, 2007 to March, 2007 in Uijeongbu St. Mary s Hospital. To evaluate the risk factors related to visceral obesity, we analyzed patients medical records such as duration of dialysis, lipid profiles, anthropometric data and the presence of DM. RESULTS: We enrolled 65 HD patients and 67 PD patients. PD group had higher mean body weight, mean body mass index (BMI), and triglyceride level, compared to HD group. The PD group had higher visceral fat area, measured by abdominal fat CT than HD group. The prevalence of visceral obesity was higher in PD group than HD group. Visceral fat area showed positive co-relation with BMI in HD group, but did not in PD group. The age related prevalence of visceral obesity was significantly increased in the patients with older age group (>65). CONCLUSION: Our cross sectional study points to the fact that visceral obesity is more common in PD patients than HD patients. It is necessary to control weight and nutritional status, especially in PD patients for preventing metabolic complications.
Abdominal Fat ; Body Mass Index ; Body Weight ; Dialysis ; Humans ; Intra-Abdominal Fat ; Medical Records ; Nutritional Status ; Obesity ; Obesity, Abdominal ; Peritoneal Dialysis ; Prevalence ; Renal Dialysis ; Risk Factors

A recent resurgence of pertussis has raised public health concerns even in developed countries with high vaccination coverage. The aim of this study was to describe the clinical characteristics of infant pertussis, and to determine the relative importance of household transmission in Korea. The multicenter study was prospectively conducted from January 2009 to September 2011. We identified the demographic and clinical data from these patients and performed the diagnostic tests for pertussis in their household contacts. Twenty-one patients with confirmed pertussis were included in the analysis. All infections occurred in infants younger than 6 months of age (mean age, 2.5 months) who had not completed the primary DTaP vaccination except for one patient. Infants without immunization history had a significant higher lymphocytosis and longer duration of hospital stay compared to those with immunization. All were diagnosed with PCR (100%), however, culture tests showed the lowest sensitivity (42.9%). Presumed source of infection in household contacts was documented in 85.7%, mainly parents (52.6%). Pertussis had a major morbidity in young infants who were not fully immunized. Household members were responsible for pertussis transmission of infants in whom a source could be identified. The control of pertussis through booster vaccination with Tdap in family who is taking care of young infants is necessary in Korea.
Bordetella pertussis/genetics ; Diphtheria-Tetanus-acellular Pertussis Vaccines/immunology ; Female ; Humans ; Immunization, Secondary ; Infant ; Length of Stay ; Lymphocytosis/etiology ; Male ; Parents ; Polymerase Chain Reaction ; Prospective Studies ; Republic of Korea ; Whooping Cough/diagnosis/immunology/*transmission

PURPOSE: The isolated microscopic hematuria is the most common abnormality detected by school urinary screening, but there is no consensus about the range of investigations and long-term outcomes of isolated hematuria in children yet. This study aims to elucidate the prognosis of hematuria and the range of diagnostic studies by follow-up results. METHODS: Students with isolated hematuria who were referred to the Department of Pediatrics, Asan Medical Center from Aug. 1990 to Feb. 2004 were analysed retrospectively. Cases that presented Through significant proteinuria(>250 mg/day), other symptoms of nephritis or renal dysfunction (creatinine clearance <85 mL/min/1.73m2) were excluded. Follow-up was done every six months with checking urinalysis, serum creatinine, protein and albumin. When albuminuria was detected, 24 hour urine protein was checked. Renal biopsy was done when urine protein was over 500 mg/day. RESULTS: A total of 331 students were enrolled in this study. There were 157 males and 174 females. The mean age at presentation was 9.9+/-2.3 years(7-15 years) and mean follow-up period was 2.2+/-1.6 years(1-10 years). Seventy five(22.7 percent) patients showed the resolution of microscopic hematuria. The mean resolution period was 2.6+/-1.7 years(1-8 years). Eight(2.4 percent) patients developed significant proteinuria and renal biopsy was done in four of them. Two cases of mild IgA nephropathy and two of minimal change were detected. None of them developed hypertension. At the end of the follow-up, renal function had remained stable in all subsets of patients. CONCLUSION: The prognosis of isolated microscopic hematuria was good. This study suggests that invasive studies including renal biopsy are not necessary and a regular follow-up of urinalysis is enough for children with isolated microscopic hematuria.
Albuminuria ; Biopsy ; Child* ; Chungcheongnam-do ; Consensus ; Creatinine ; Female ; Follow-Up Studies* ; Glomerulonephritis, IGA ; Hematuria* ; Humans ; Hypertension ; Male ; Mass Screening* ; Nephritis ; Pediatrics ; Prognosis ; Proteinuria ; Retrospective Studies ; Urinalysis

BACKGROUND: In case of tuberculous pneumonia, differentiation from bacterial lobar pneumonia is sometimes very difficult because clinical symptoms, signs and radiological images are very similar. So we investigated the usefulness of CA125, which is known to increase in tuberculous diseases, in differential diagnosis between tuberculous pneumonia (TBPN) and community acquired bacterial lobar pneumonia (LP). METHODS: Serum CA125 level was measured in 20 patients with TBPN (female 12 male 8: mean age 36.1 years) and 14 patients with LP (female 5 male 9: mean age 45.1 years) by radioimmunoassay (Centocor(R) CA125 RIA kit). RESULTS: 1) The serum CA125 level in TBPN (333.7 283.5 u/ml) was higher than in LP (60.9 66.2 u/ml). (P < 0.05) 2) If we took cut-off value as 195 u/ml in differential diagnosis between TBPN and LP, the sensitivity and specificity of CA125 level in the diagnosis of TBPN were 70% and 93%, respectively. 3) There was no significant difference in serum CA125 level between noncavitary TBPN (242.1 +/- 16.6 u/ml,n=10) and cavitary TBPN (399.6 +/- 318.4 u/ml,n=10). (P > 0.05) 4) Following up of serum CA125 level after initiation of antituberculosis treatment showed rapid decline and approach to near normal range in 6 months. CONCLUSION: High serum CA125 level (> 195 u/ml) was useful in differential diagnosis of TBPN from LP.
Diagnosis ; Diagnosis, Differential ; Humans ; Male ; Pneumonia* ; Radioimmunoassay ; Reference Values ; Sensitivity and Specificity

Cholangiocarcinoma has been associated with various fibrocystic diseases of liver and biliary tract, but cholangiocarcinoma in polycystic liver disease (PLD) was extremely rare. It was reported that the prognosis of cholangiocarcinoma associated PLD was very poor and distant metastases were common. We report a rare case of intrahepatic cholangiocarcinoma associated with PLD in 58- year- old female who presented vague abdominal pain. She had also polycystic kidneys with normal renal function. MRI showed well demonstrated tumor with central scar and a adjacent large cyst in the left lobe of the liver. She underwent extended left lobectomy. On microscopic examination, the tumor was moderately differentiated cholangiocarcinoma having abundant fibrous stroma and necrosis and the adjacent cyst showed focal in situ carcinomatous changes in the lining epithelium.
Abdominal Pain ; Biliary Tract ; Cholangiocarcinoma* ; Cicatrix ; Epithelium ; Female ; Humans ; Liver Diseases* ; Liver* ; Magnetic Resonance Imaging ; Necrosis ; Neoplasm Metastasis ; Polycystic Kidney Diseases ; Prognosis ; Cholangiocarcinoma