PURPOSE: To assess changes in MR signal intensity in the pars interarticularis and adjacent structures in pa-tients with lumbar spondylolysis. MATERIALS AND METHODS: The MR images of 36 patients with lumbar spondylolysis, confirmed by plain radiographs, were retrospectively analyzed. Using a 1.0T unit, we evaluated the signal intensity of a total of 216 parts interarticulares and adjacent structures from L3 to L5, as seen on sagittal images, and differences between areas with and without spondylolysis. The signal intensity of T1-and T2-weighted images was graded 0 (more hypointense than spinal body), 1(as isointense as spinal body), 2(more hyperintense than spinal body and more hypointense than epidural fat), or 3(as isointense as epidural fat). Signal intensity change in end-plates and degree of spondylolisthesis were analyzed, and the relationship between these factors was deter-mined. RESULTS: Spondylolysis was noted at L5 in 61 cases, at L4 in 22, and of L3 in no case. In three cases spondylolysis was unilateral, and in the remainder it was bilateral. The degree of signal intensity was the same on T1- and T2-weighted images, and no case was grade 0. Eighty-six of 133 areas without spondylolysis were grade 1, 43 were grade 2, and four were grade 3. In 42 of 47 cases, signal intensity change was localized at pedicles. Among 83 areas with spondylolysis, on the other hand, nine were grade 1, 48 were grade 2, and 26 were grade 3. Signal intensity change was most commonly observed at the pars interarticularis, pedicle, and lamina (50/74) (p<0.001). Signal intensity change at the pars interarticularis and adjacent structures was accompanied in most cases by degenerative endplate change(10/11) and spondylolisthesis(11/13) (p<0.001). CONCLUSION: In patients with spondylolysis, signal intensity was frequently higher at the pars interarticularis and adjacent structures, and is thought to have a close relationship with degenerative endplate change and spondylolisthesis. Increases in signal intensity at the pars interarticularis and adjacent structures can help diagnose spondylolysis in patients without spondylolisthesis.
Hand ; Humans ; Magnetic Resonance Imaging* ; Retrospective Studies ; Spondylolisthesis ; Spondylolysis*

To suggest a reasonable isometric point based on the anatomical consistency of interosseous membrane (IOM) attachment in association with topographic characteristics of the interosseous crests, the footprints of the central band (CB) of the IOM on the radial and ulnar interosseous crests (RIC and UIC) were measured. Methods: We measured the distance from the CB footprints from each apex of both interosseous crests in 14 cadavers and the angles between the forearm axis of rotation (AOR) and the distal slopes of the RIC and UIC in 33 volunteers. Results: The CB footprints lay on the downslope of both interosseous crests with its upper margin on average 3-mm proximal from the RIC’s apex consistently in the radial length, showing normality (p>0.05), and on average 16-mm distal from the UIC’s apex on the ulna without satisfying normality (p<0.05). The average angle between the UIC’s distal slope and the AOR was 1.3°, and the RIC’s distal slope to the AOR was 14.0°, satisfying the normality tests (p>0.05), and there was no side-to-side difference in both forearms (p<0.05). Conclusions: The CB attached to the downslope just distal to the RIC’s apex constrains the radius to the UIC that coincides with the AOR of the forearm circumduction, maintaining itself both isometrically and isotonically.

The effect of Pheniramine(Avil), a histaminergic-1 receptor blocking agent presently employed in treating various allergic diseases on pressor actions of norepinephring(NE) and tyramine (TR) was studied in the rabbit. Pheniramine, when given into a femoral vein with a dose(3mg/kg) enough to block H1-receptor, potentiated markedly the pressor responses of NE and TR. The pressor action of NE augmented by pheniramine was not affected by additional adminstration of debrisoquin (Drenergic neuron blocker) or phenelzine(monoamine oxidase inhibitor) or desipramine(U1-uptake blocker), or while potentiated by additional treatment with chlorisondamine(ganglionic blocker)or reserpine(catecholamine depleter). The hypertensive response of NE to phenelzine or desipramine was reinforced significantly by addition of pheniramine, but the response of NE in rabbits treated with reserpine or chlorisondamine or debrisoquin was not influenced by pheniramine-addition. Elevation of blood pressure to TR potentiated by pheniramine was attenuated significantly by reserpine treatment with chlorisondamine made the significant augmentation of pressor action to TR after pheniramine. Tyramine-induced response of blood pressure after pheniramine, but the response of blood pressure to TR caused by phenelzine or desipramine was enhanced markedly by pheniramine-treatment. From the above experimental results, it is thought that the pressor effect of NE and TR potentiated by pheniramine is similar to that of debrisoquin, i.e. the sensitization of effector cell, and that central action of pheniramine can not ruled out.
Blood Pressure ; Chlorisondamine ; Debrisoquin ; Desipramine ; Femoral Vein ; Neurons ; Norepinephrine* ; Oxidoreductases ; Phenelzine ; Pheniramine ; Rabbits ; Reserpine ; Tyramine*

The usher syndrome (US) is an autosomal recessive disorder characterized by congenital bilateral sensorineural hearing loss and progressive visual loss secondary to retinitis pigmentosa. It is the most common cause of the hereditary combined deafness-blindness in the western world. Three different types of US are recognized by clinical criteria. The US type I has severe to profound hearing loss, vestibular dysfunction, and prepubertally diagnosed retinitis pigmentosa, while the US type II has moderate to severe hearing loss, normal vestibular function, and later onset of retinitis pigmentosa. The US type III has a progressive hearing loss and retinitis pigmentosa with variable vestibular involvement. The diagnosis is confirmed by medical history and thorough otoscopical, audiologic, vestibular, and ophthalmological examinations. We have recently experienced a case of the US type I and report this with a brief review of the related literature.
Deaf-Blind Disorders ; Diagnosis ; Hearing Loss ; Hearing Loss, Sensorineural ; Retinitis Pigmentosa ; Usher Syndromes* ; Western World

We analyzed national data collected by the Health Insurance Review and Assessment Service in Korea from 2007 to 2011; 1) to document procedural numbers and procedural rate of bipolar hemiarthroplasty (BH), primary and revision total hip arthroplasties (THAs), 2) to stratify the prevalence of each procedure by age, gender, and hospital type, and quantified, 3) to estimate the revision burden and evaluate whether the burden is changed over time. Our final study population included 60,230 BHs, 40,760 primary THAs, and 10,341 revision THAs. From 2007 to 2011, both the number and the rate of BHs, primary THAs increased steadily, whereas there was no significant change in revision THAs. Over the 5 yr, the rate of BHs and primary THAs per 100,000 persons significantly increased by 33.2% and 21.4%, respectively. The number of revision THAs was consistent over time. The overall annual revision burden for THA decreased from 22.1% in 2007 to 18.9% in 2011. In contrast to western data, there were no changes in the number and rate of revision THAs, and the rates of primary and revision THAs were higher for men than those for women. Although 5 yr is a short time to determine a change in the revision burden, there have been significant decreases in some age groups.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/economics/*statistics & numerical data ; Databases, Factual ; Female ; Hemiarthroplasty/economics/statistics & numerical data ; Hip Fractures/epidemiology/*therapy ; Hospitals ; Humans ; Male ; Middle Aged ; Republic of Korea ; Sex Factors

Spontaneous splenic rupture is a rare disease but can cause a life threatening situation. It can occur under a pathological spleen such as infection, neoplastic, infiltrative and inflammatory disease. Although splenectomy is the treatment of choice for splenic rupture, it is uncertain that the effectiveness of non- surgical treatment in the hemodynamically stable patient. We report a case of a 66-year-old male undergoing hemodialysis for 4 years who presented to the emergency department with abdominal pain and distention. Blood pressure was 130/80 mmHg, heart rate was 108 bpm. White blood cell count was 7,130/mm3, hemoglobin was 6.7 g/dL, platelet was 156,000/mm3. PT INR was elevated up to 2.01 because he had taken warfarin due to splenic infarction. Abdominal CT scan revealed hemoperitoneum due to splenic rupture. We performed angiography but there was no active bleeding. We decided conservative management without embolization because of stable condition and increased bleeding risk in operation. He received 6 pints of packed red blood cell transfusion during continuous renal replacement therapy for 24 hours on ICU. He was discharged with complete recovery on the 21st hospital day. We suggest that non-surgical treatment in splenic rupture also could be considered in hemodynamically stable patients with a high risk of postoperative complication.
Abdominal Pain ; Aged ; Angiography ; Blood Platelets ; Blood Pressure ; Emergencies ; Erythrocyte Transfusion ; Heart Rate ; Hemoglobins ; Hemoperitoneum ; Hemorrhage ; Humans ; International Normalized Ratio ; Leukocyte Count ; Male ; Mustard Compounds ; Rare Diseases ; Renal Dialysis ; Renal Replacement Therapy ; Spleen ; Splenectomy ; Splenic Infarction ; Splenic Rupture ; Warfarin

PURPOSE: To evaluate the clinical result of the Wolter plate fixation for the acromioclavicular joint dislocation and the necessity of coracoclavicular ligament repair with the operation. MATERIALS AND METHODS: Twenty three patients operated between January 2003 to September 2005 with over 6 months of follow-up period were studied. The Constant-Murley scoring system was administered on 6 months postoperatively and stress films were taken for the surveillance of acromioclavicular joint and coracoclavicular distance after plate removal. All patients were classified into two groups in that coracoclavicular ligament was repaired (10 cases) or not (13 cases) and the clinical indices described above were compared. RESULTS: With the Wolter plate fixation for the acromioclavicular joint dislocations, 20 cases of Constant-Murley scores were more than 'good' except complicated 3 cases. The scores of the repaired group were 7 cases of excellent, 2 cases of good and 1 case of moderate to poor, and that of not-repaired group were 6 cases, 5 cases and 2 cases respectively. With mean coracoclavicular interspace on x-ray at postoperative 6 months, repaired group showed residual 9% of displacement from initial 194% but not-repaired group showed 28% from initial 188%. There's no statistically significant difference in clinical scores between two group (p=0.072) and neither was residual coracoclavicular interspace displacement (p=0.067). CONCLUSION: Short term follow-up of Wolter plate fixation for the acromioclavicular dislocation showed acceptable clinical results and there was no statistically significant difference between two groups of repaired coracoclavicular ligaments and not repaired.
Acromioclavicular Joint* ; Dislocations* ; Follow-Up Studies ; Humans ; Ligaments*

BACKGROUND: We evaluated the feasibility and the efficacy of Video-Assisted Thoracic Surgery (VATS) lobectomy for treating patients with non-small cell lung cancer (NSCLC) and we compared the outcomes of VATS lobectomy with those of open lobectomy. MATERIAL AND METHOD: From 2003 to March 2008, 133 NSCLC patients underwent VATS lobectomy. The patients were selected on the basis of having clinical stage I disease on the chest CT and PET scan. The outcomes of 202 patients who underwent open lobectomy (OL group) for clinical stage I NSCLC were evaluated to compare their results with those of the patients who underwent VATS lobectomy (the VL group). RESULT: The number of females and the number of patients with adenocarcinoma and stage IA disease were greater in VL group (p<0.05). There was no operative mortality or major complications in the VL group. Conversion to thoracotomy was needed in 8 cases (6%), which was mostly due to bleeding. The chest tube indwelling time and the length of the postoperative hospital stay were significantly shorter in the VL group (p<0.001). The number of dissected lymph nodes and the size of tumor were significantly smaller in the VL group (p<0.001). For the pathologic stage I patients, there was no significant difference in the three-year survival rates between the two groups (p=0.15). CONCLUSION: VATS lobectomy is a safe procedure with low operative mortality and morbidity. VATS lobectomy is feasible for early stage NSCLC and it provides outcomes that are comparable to those for open lobectomy. Further long-term data are needed
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Chest Tubes ; Female ; Hemorrhage ; Humans ; Length of Stay ; Lung ; Lymph Nodes ; Positron-Emission Tomography and Computed Tomography ; Survival Rate ; Thoracic Surgery, Video-Assisted ; Thoracotomy ; Thorax

BACKGROUND AND OBJECTIVES: The overriding influence of physical activity and the diurnal variation during ambulatory blood pressure monitoring (ABPM) has been well demonstrated. We prospectively evaluated the usefulness of electronic activity monitoring for deriving the actual physical activity and the diurnal variation of ABPM. SUBJECTS AND METHODS: 24-hour ABPM with using an electronic activity monitor was performed on ten normotensive volunteers and fifteen hypertensive subjects. To interpret the ABPM results of the fifteen hypertensive subjects, we obtained the actual awake/sleep periods of every subject with using an electronic activity monitor. RESULTS: The activity values obtained from the ten normotensive volunteers correlated well with the values of the blood pressure (BP) and the heart rate. In the hypertensives, the nocturnal mean BP derived by the actual period was significantly lower than that derived by the arbitrary period (130+/-16/81+/-13 mmHg versus 124+/-13/77+/-12 mmHg, respectively, p<0.05). The nocturnal BP fall derived by the actual period was significantly larger than that derived by the arbitrary period (14.9+/-8.7/11.6+/-7.5 mmHg versus 21.1+/-8.6/16.2+/-7.4 mmHg, respectively, p<0.01). Four among the 7 non-dippers determined by the arbitrary period were re-classified as dippers when the actual period was used. One among the 13 hypertensives, as determined by the arbitrary period, was also re-classified as a non-hypertensive. CONCLUSION: The electronic activity monitor was able to determine the actual activity level. The interpretation of ABPM may be altered by the use of the electronic activity monitor. These results suggest that the accuracy and reproducibility of the 24-hour ABPM will be improved by using an electronic activity monitor.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory* ; Heart Rate ; Motor Activity ; Prospective Studies ; Volunteers

The basic laboratory test for diagnosis of hematological diseases most widely used is microscopic examination of blood smear slides. The purpose of development of integrated hematological management program of microscopic examination is to improve effectiveness of microscopic examination of blood smear slides and to offer references consistent and easy to use. The lists of various blood cells and hematological diseases were prepared, and 2,589 microscopic photo slides were made corresponding to these lists. The images made of microscopic photo slides were developed through multimedia PC and slide scanner. Thirty-seven references always used for hernatological diagnosis were arranged in the form of tables and figures. With integration of these images and references, an application software consists of functions such as reports of peripheral blood cell morphology and bone marrow examination, stepwise learning of diagnostic procedures, finding hematology atlas and references, and reports of other special hematology laboratory tests was developed. The development tool was Visual FoxPro (version 5 .Oa, Microsoft, USA). Internet hematology atlas contained in the homepage of Department of Clinical Pathology of Seoul National University Hospital were also prepared. The contents developed in this study may be a good guideline for diagnosis of hematological diseases. As a good supporting material, hematology atlas, references and internet homepage will be basic study materials that will help medical students and clinicians understand the workflow of hematological diagnosis.
Blood Cells ; Bone Marrow Examination ; Diagnosis ; Education ; Hematologic Diseases ; Hematology* ; Humans ; Internet ; Learning ; Multimedia* ; Pathology, Clinical ; Seoul ; Students, Medical