For the assessment the effect of succinylcholine (SCh) on atracurium, 59 adult patients undergoing elective surgery under general anesthesia were subjected to this study in which the nEMG response (twitch height) of the hand to TOF stimulation (0.2 Hz) of ulnar nerve was monitored and recorded with Datex Relaxograph. According to the amount and mode of the drugs administered, the patients were divided into four experimental groups;1) Group I, a bolus injection of atracurium in dose of 0.5 mg/kg 2) Group II, atracurium 1.0 mg/kg, a double dose of group I 3) Group III, atracurium 0.5 mg/kg after 25 to 50% recovery of initial twitch height from twitch height depression induced by SCh (1 mg/kg) 4) Group IV, mixed injection of SCh (1 mg/kg) and atracurium (0.5 mg/kg) Followings were the results. 1. Mean onset time of the atracurium, which was 4.5+/-0.6 minutes in group I and 4.00.7 minutes in group II, changed to 2.7+/-0.6 and 4.0+0.8 minutes in group III and IV respectively, showing no significance. 2. Mean action duration of atracurium was 49.1+/-3.4 minutes in group I and 72.0+/-3.7 minutes in group II, the latter being significant (p<0.001). It was, however, 49.0+/-3.6 minutes in group III, indicating that SCh shnwed a little effect, while it was 38.1+/-1.8 minutes in group IV, being significantly shorter than those of group I and IlI (p<0.01). 3. Mean potency of atracurium expressed by the percentage change of initial twich height was 0.7+/-0.5% in group I and it was decreased to 0% in group II but it was not sinificant. In group III, it was increased to 0.9+/-0.6% but it was also no significance. In group IV, it was decreased to 0.4+/-0.2% which was not significant. 4. Presence of atracurium (0.5 mg/kg) in group IV did not have any effect on the intensity of fasciculation induced by SCh. These results indicate that succinylcholine did not attect the onset time and action potency of atracurium. However, in group of the mixed injection, SCh shortened only the duration of action of atracurium.
Adult ; Anesthesia, General ; Atracurium* ; Depression ; Fasciculation ; Hand ; Humans ; Succinylcholine* ; Ulnar Nerve

For the assessment the effect of succinylcholine (SCh) on atracurium, 59 adult patients undergoing elective surgery under general anesthesia were subjected to this study in which the nEMG response (twitch height) of the hand to TOF stimulation (0.2 Hz) of ulnar nerve was monitored and recorded with Datex Relaxograph. According to the amount and mode of the drugs administered, the patients were divided into four experimental groups;1) Group I, a bolus injection of atracurium in dose of 0.5 mg/kg 2) Group II, atracurium 1.0 mg/kg, a double dose of group I 3) Group III, atracurium 0.5 mg/kg after 25 to 50% recovery of initial twitch height from twitch height depression induced by SCh (1 mg/kg) 4) Group IV, mixed injection of SCh (1 mg/kg) and atracurium (0.5 mg/kg) Followings were the results. 1. Mean onset time of the atracurium, which was 4.5+/-0.6 minutes in group I and 4.00.7 minutes in group II, changed to 2.7+/-0.6 and 4.0+0.8 minutes in group III and IV respectively, showing no significance. 2. Mean action duration of atracurium was 49.1+/-3.4 minutes in group I and 72.0+/-3.7 minutes in group II, the latter being significant (p<0.001). It was, however, 49.0+/-3.6 minutes in group III, indicating that SCh shnwed a little effect, while it was 38.1+/-1.8 minutes in group IV, being significantly shorter than those of group I and IlI (p<0.01). 3. Mean potency of atracurium expressed by the percentage change of initial twich height was 0.7+/-0.5% in group I and it was decreased to 0% in group II but it was not sinificant. In group III, it was increased to 0.9+/-0.6% but it was also no significance. In group IV, it was decreased to 0.4+/-0.2% which was not significant. 4. Presence of atracurium (0.5 mg/kg) in group IV did not have any effect on the intensity of fasciculation induced by SCh. These results indicate that succinylcholine did not attect the onset time and action potency of atracurium. However, in group of the mixed injection, SCh shortened only the duration of action of atracurium.
Adult ; Anesthesia, General ; Atracurium* ; Depression ; Fasciculation ; Hand ; Humans ; Succinylcholine* ; Ulnar Nerve

BACKGROUND: Cortical suspensory femoral fixation is commonly performed for graft fixation to the femur in anterior cruciate ligament (ACL) reconstruction using hamstring tendons. The purpose of this study was to compare graft healing in the femoral tunnel, implant-related failure, and clinical results between fixed- and adjustable-length loop devices in outside-in ACL reconstruction. METHODS: A total of 109 patients who underwent ACL reconstruction using the outside-in technique from December 2010 to July 2014 were included. For femoral graft fixation, a fixed-length loop device was used in 48 patients (fixed-loop group) and an adjustable-length loop device was used in 61 patients (adjustable-loop group). For evaluation of graft healing in the femoral tunnel, magnetic resonance imaging was performed at postoperative 6 months and the signal-to-noise ratios (SNRs) of the tendon graft and tendon-bone interface in the femoral bone tunnel were evaluated. The presence of synovial fluid was evaluated to determine loop lengthening at the femoral tunnel exit. Clinical results assessed using International Knee Documentation Committee score, Tegner-Lysholm Knee Scoring scale, and knee instability tests were compared between groups. RESULTS: The SNRs of the tendon graft and tendon-bone interface were not statistically different between groups. The presence of synovial fluid at the femoral exit showed no statistical difference between groups. Clinical results were not significantly different between groups. CONCLUSIONS: The adjustable-length loop device provided comparable graft healing, implant-related failure, and clinical results with the fixed-length loop device, allowing adaptation of the graft to the different tunnel lengths. Therefore, it could be effectively used with an adjustment according to the femoral tunnel length.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Femur ; Humans ; Knee ; Magnetic Resonance Imaging* ; Signal-To-Noise Ratio ; Synovial Fluid ; Tendons ; Transplants

PURPOSE: We compared visible blood loss and calculated blood loss after intramedullary fixation in intertrochanteric fracture, and evaluated correlation between blood loss and its risk factors. MATERIALS AND METHODS: A total of 256 patients who underwent closed reduction and intramedullary fixation in femoral intertrochanteric fracture between 2004 and 2013 were enrolled in this study. The total blood loss was calculated using the formula reported by Mercuiali and Brecher. We analyzed several factors, including fracture pattern (according to Evans classification), gender, age, body mass index (BMI), anesthesia method, cardiovascular and cerebrovascular disease, preoperative anemia, American Society of Anesthesiologists (ASA) score and use of antithrombotic agents. RESULTS: Total calculated blood loss (2,100+/-1,632 ml) differed significantly from visible blood loss (564+/-319 ml). In addition, the blood loss of unstable fracture patient was 2,496+/-1,395 ml and multivariate analysis showed a significant relationship between blood loss and fracture pattern (p<0.01). However, other factors showed no statistically significant difference. CONCLUSION: Total calculated blood loss was much greater than visible blood loss. Patients with unstable intertrochanteric fracture should be treated with care in order to reduce blood loss.
Anemia ; Anesthesia ; Blood Loss, Surgical ; Body Mass Index ; Femur ; Fibrinolytic Agents ; Fracture Fixation, Intramedullary ; Hip Fractures ; Hip* ; Humans ; Multivariate Analysis ; Risk Factors*

OBJECTIVES: Some studies have suggested that lumbar spine and hip bone mineral density (BMD) are not associated with distal radius fractures (DRF), and a few studies have investigated regional BMDs at the fracture site, not just the lumbar or hip. We correlated distal radius BMD with DRF in postmenopausal women <60 years old. METHODS: A total of 121 women > or =50 years old with DRF were enrolled in the fracture group, and 72 women without fractures were included as a control group. We measured distal radius BMD in the distal radius contralateral to the fractured bone in the fracture group and that of the lumbar body 5 days after the trauma. BMDs at the distal radius of each group were compared in three age groups (50~59, 60~69, and > or =70 years). Age- and site-specific BMDs were analyzed in each group. RESULTS: No significant differences in the rate of osteoporosis at the distal radius or lumbar spine were observed in patients > or =60 years old. However, BMD and T-score values of the distal radius in female patients were lower than those in controls <60 years old. BMD and T-score values of the distal radius were lower than those of the lumbar spine in the fracture group <60 years old. BMD of the distal radius also carried a higher relative risk. CONCLUSIONS: Low BMD of the distal radius was an indicator of regional BMD and could be a sensitive risk factor for DRF in women <60 years.
Bone Density ; Female ; Hip ; Humans ; Osteoporosis ; Radius ; Radius Fractures ; Risk Factors ; Spine

PURPOSE: The prognosis of patients with advanced non-small-cell lung cancer (NSCLC) is extremely poor. Many prospective randomized trials on patients with advanced NSCLC suggested systemic chemotherapy improves both the survival and quality of life. A phase II trial was conducted to evaluate the efficacy and safety profile of the combination chemotherapy of gemcitabine and cisplatin in advanced NSCLC. MATERIALS AND METHODS: Forty-four patients with locally advanced or metastatic NSCLC were enrolled. The patients received a cisplatin, 75 mg/m(2), infusion over 30 minutes on days 1, followed by a gemcitabine, 1, 250 mg/m(2), infusion over 30 minutes on days 1 and 8 every 3 weeks. RESULTS: The median age of the patients was 64 years (range: 27~75). Forty-one patients were assessable for response and toxicity analyses. The overall response rate was 53.6%, but with no complete remissions. The median time to progression was 5.6 months (range: 1~15.4). The median survival was 14.2 months (95% confidence interval (CI), 13.8~22.5). A total of 179 cycles were administered, with a median of 4 cycles of chemotherapy, ranging from 2 to 9 cycles. The most common hematological toxicities were NCI grades 3/4 neutropenia (24%) and thrombocytopenia (7.8%). The most common non-hematological toxicity was fatigue (42.4%). There were no life-threatening toxicity or treatment related mortalities. The median duration of follow up was 9.4 months, ranging from 1.6 to 30.3 months. CONCLUSION: In this trial, the combination of gemcitabine and cisplatin showed significant activity, with acceptable and manageable toxicities as a first-line regimen for patients with advanced NSCLC.
Cisplatin* ; Drug Therapy ; Drug Therapy, Combination ; Fatigue ; Follow-Up Studies ; Humans ; Lung Neoplasms* ; Lung* ; Mortality ; Neutropenia ; Prognosis ; Prospective Studies ; Quality of Life ; Thrombocytopenia

Segmental defects of the tibia after open fractures, sepsis and a tumor surgery are among the most difficult and challenging clinical problems. Tibia defects in these situations are complicated with infection and are resistant to conventional bone grafting techniques. The aim of this study is to report the results and discuss the role of free flap followed by ipsilateral vascularized fibular transposition (IVFT) for reconstruction of tibia defects. Ten patients had free flap followed by IVFT in the period 1989~2007. Mean age was 25.3 years. The patients were followed for an average of 3.4 years. All flaps were survived including 1 case with venous thrombosis requiring additional surgery. The average time to union of proximal and distal end was 5.2 months, 8.2 months, each other. All transposed fibula were viable at last follow-up. IVFT offers the advantages of a vascularized graft. In patients with large bone and soft tissue defects combined with infection, free flap followed by IVFT is an useful and reliable method without microvascular anastomosis.
Bone Transplantation ; Fibula ; Follow-Up Studies ; Fractures, Open ; Free Tissue Flaps ; Humans ; Sepsis ; Tibia ; Transplants ; Venous Thrombosis

PURPOSE: The aim of this study was to clarify the risk factors and clinicopathologic features of gastric cancer patients with a second primary cancer (SPC). METHODS: The data on 2455 patients with gastric cancer was analyzed retrospectively with respect to the clinicopathologic features of the pathologically proven SPC. RESULTS: Of the 2,455 patients, there were 90 (3.7%) gastric cancer patients with SPC. Among them, 31 patients had synchronous cancers and 59 had metachronous cancers. Of the 59 metachronous cancers, 21 were found before the gastric surgery and 38 were found after the gastric surgery. The most prevalent SPC was colorectal cancer (28 cases) and followed by cancer in the liver (13 cases) kidney and pancreas (6 cases each, respectively). Among the 61 patients with SPC found after gastric cancer surgery, 31 cases (50%) were diagnosed within 2 years. On comparison of the clinicopathologic features, the patients with SPC tended to be older, more prone to have early gastric carcinoma and to have multiple gastric lesions. The survival rate of the patients with SPC and gastric cancer alone was not different; however, there was a significantly difference for the patients with early gastric cancer (61.7% vs. 91.3%, respectively, P < 0.05). CONCLUSION: For the patients who were older, had multiple primary lesions or they had early gastric cancer, evaluation for SPC, and especially in the colon and liver, should be considered during routine follow up.
Colon ; Colorectal Neoplasms ; Humans ; Kidney ; Liver ; Neoplasms, Second Primary ; Pancreas ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; Survival Rate

Unilateral femoral neck factures are common and their incidence is increasing. However, simultaneous bilateral femoral neck fractures are rare. Although cases of simultaneous bilateral femoral neck fractures have been reported, most were caused by strong muscle contractions during electroconvulsive therapy. Simultaneous bilateral femoral neck fractures caused by a simple fall are an extremely rare injury; therefore, limited literature is available, and no case has been reported in Korea. We report herein a case of simultaneous bilateral femoral neck fractures caused by a simple fall. An 83-year-old woman visited the emergency department with bilateral hip joint pain and gait disturbance, which developed 1 day after a fall. Tenderness and severe limitation in left hip joint range of motion and mild limitation in right hip joint range of motion were observed on a physical examination. A Garden type IV femoral neck fracture in the left hip joint and a Garden type I femoral neck fracture in the right hip joint were observed on plain radiography. She underwent right screw fixation and left bipolar hemiarthroplasty 2 days after admission. The patient could walk using a walker 4 weeks postoperatively. Bone union in the right femoral neck was observed at the 3 month follow-up. No specific findings were observed at the left hip hemiarthroplasty site.
Aged, 80 and over ; Electroconvulsive Therapy ; Emergency Service, Hospital ; Female ; Femoral Neck Fractures ; Femur Neck* ; Follow-Up Studies ; Gait ; Hemiarthroplasty ; Hip ; Hip Joint ; Humans ; Incidence ; Korea ; Muscle Contraction ; Physical Examination ; Radiography ; Range of Motion, Articular ; Walkers

PURPOSE: Though it is very important obtaining exact data about patients’ voiding patterns for managing voiding dysfunction, actual practice is very difficult and cumbersome. In this study, data about urination time and interval measured by smart band device on patients’ wrist were collected and analyzed to resolve the clinical arguments about the efficacy of voiding diary. By developing a smart band based algorithm for recognition of complex and serial pattern of motion, this study aimed to explore the feasibility of measurement the urination time and intervals for voiding dysfunction management. METHODS: We designed a device capable of recognizing urination time and intervals based on specific postures of the patient and consistent changes in posture. These motion data were obtained by a smart band worn on the wrist. An algorithm that recognizes the repetitive and common 3-step behavior for urination (forward movement, urination, backward movement) was devised based on the movement and tilt angle data collected from a 3-axis accelerometer. The sequence of body movements during voiding has consistent temporal characteristics, so we used a recurrent neural network and long short-term memory based framework to analyze the sequential data and to recognize urination time. Real-time data were acquired from the smart band, and for data corresponding to a certain duration, the value of the signals was calculated and then compared with the set analysis model to calculate the time of urination. A comparative study was conducted between real voiding and device-detected voiding to assess the performance of the proposed recognition technology. RESULTS: The accuracy of the algorithm was calculated based on clinical guidelines established by urologists. The accuracy of this detecting device was high (up to 94.2%), proving the robustness of the proposed algorithm. CONCLUSIONS: This urination behavior recognition technology showed high accuracy and could be applied in clinical settings to characterize patients’ voiding patterns. As wearable devices are developed and generalized, algorithms detecting consistent sequential body movement patterns reflecting specific physiologic behavior might be a new methodology for studying human physiologic behavior.
Humans ; Memory, Short-Term ; Posture ; Urination* ; Wrist