No abstract available.

Recently, continuous epidural catheter insertion is common practice not only in anesthesia but also in pain clinic. Meningitis is rare but serious complication of epidural analgesia. Acute bacterial meningitis occurred in a 82-year-old female patient with thoracic herpes zoster after continuous thoracic epidural analgeia. An MRI of thoracic region did not show an epidural abscess or granulation tissue. Gram stain and culture of the epidural catheter tip and the CSF yielded Staphylococcus aureus. Immediate treatment with antibiotics and supportive therapy was instituted and then the patient discharged without neurologic sequalae.
Aged, 80 and over ; Analgesia, Epidural* ; Anesthesia ; Anti-Bacterial Agents ; Catheters ; Epidural Abscess ; Female ; Granulation Tissue ; Herpes Zoster ; Humans ; Magnetic Resonance Imaging ; Meningitis ; Meningitis, Bacterial* ; Pain Clinics ; Staphylococcus aureus

No abstract available.
Compartment Syndromes*

Animals ; Bone Remodeling ; Bone Transplantation ; Cell Differentiation ; Embryonic Development ; Extracellular Matrix ; Female ; Fractures, Bone ; Hyaluronic Acid ; Intention ; Osteoblasts ; Osteoclasts ; Osteogenesis ; Pregnancy ; Rats ; Skull ; Sutures ; Tolonium Chloride ; Transplants ; Wound Healing ; Wounds and Injuries

OBJECTIVE: To obtain normal data of quantitative sensory test (QST) in Korean adult. METHOD: The subjects were 85 normal adults aging from 30 to 69 years old, who had no abnormal sensory and neurologic problem. We performed following three QSTs on dominant side and one verbal questionnaire. 1) Semmes-Weinstein monofilament wire system (0.05 G, 0.2 G, 2 G, 4 G, 10 G, 300 G) for touch sensation, 2) Rydel-Seiffer Tuning Fork for vibration sensation, 3) TSA-2001 Thermal sensory analyser for thermal sensation, 4)University of Texas Subjective Peripheral Neuropathy verbal questionnaire. RESULTS: 1) Touch perception score measured with Semmes-Weinstein monofilament wire system, declined with age (p<0.01). 2) Vibration perception score measured with the tuning fork, declined with age in foot (p<0.01). 3) Warm sense and heat pain threshold measured with TSA-2001 thermal sensory analyser increased with age, and cold sense and cold pain threshold declined with age. 4) Weight showed negative correlation with vibration perception score in man's foot. CONCLUSION: Normal data of three sensory test obtained from this study could be used for the early detection of peripheral neuropathy or loss of "protective sensation".
Adult* ; Aged ; Aging ; Foot ; Hot Temperature ; Humans ; Pain Threshold ; Peripheral Nervous System Diseases ; Surveys and Questionnaires ; Sensation ; Texas ; Touch Perception ; Vibration

PURPOSE: Sclerotherapy for renal cysts was performed, using 50% acetic acid as new sclerosing agent. Wereport the methods and results of this procedure. MATERIALS AND METHODS: Fifteen patients underwent sclerotherapyfor renal cyst, using 50% acetic acid. Because four patients were lost to follow-up, only 11 of the 15 wereincluded in this study. The renal cysts, including one infected case, were diagnosed by ultrasonograpy (n=10) ormagnetic resonance imaging (n=1). The patient group consisted of four men and seven women (mean age, 59 years;range, 23-77). At first, the cyst was completely aspirated, and 25 volume% of aspirated volume was replaced with50% sterile acetic acid through the drainage catheter. During the following 20 minutes, the patient changedposition, and the acetic acid was then removed from the cyst. Finally, the drainage catheter was removed, aftercleaning the cyst with saline. After treatment of infection by antibiotics and catheter drainage for 7 days,sclerotherapy in the infected case followed the same procedure. In order to observe changes in the size of renalcysts and recurrence, all patients were followed up by ultrasound between 2 and 8 months. We defined response totherapy as follows: complete regression as under 5 volume%, partial regression as 5-50 volume% and no response asmore than 50 volume% of initial cyst volume. RESULTS: No clinically significant complication occured during theprocedures or follow-up periods. All cysts regressed completely during follow-up of 8 months. Complete regressionoccurred as follows : two cysts at 2 months, seven cysts at 4 months, two cysts at 6 months. Two cysts showedresidues at the last follow-up, at 4 and 6 months, respectiivery. The volume of residual cysts decreased to under5 volume% of initial volume, however. Completely regressed cysts did not recurr during follow-up. CONCLUSION: Acetic acid sclerotherapy for renal cysts showed good results, regardless of the dilntion of sclersoing agent withresidual cyst fluid, and no significant complications. the procedure, therefore, appears to provide effectivetherapy for renal cysts.
Acetic Acid* ; Anti-Bacterial Agents ; Catheters ; Cyst Fluid ; Drainage ; Female ; Follow-Up Studies ; Humans ; Lost to Follow-Up ; Male ; Recurrence ; Sclerotherapy ; Ultrasonography

This study evaluated the methodological quality of CPGs using the Korean AGREE II scoring guide and a web-based appraisal system and was conducted by qualified appraisers. A total of 27 Korean CPGs were assessed under 6 domains and 23 items on the AGREE II instrument using the Korean scoring guide. The domain scores of the 27 guidelines were as following: the mean domain score was 82.7% (median 84.7%, ranging from 55.6% to 97.2%) for domain 1 (scope and purpose); 53.4% (median 56.9%, ranging from 11.1% to 95.8%) for domain 2 (stakeholder involvement); 63.0% (median 71.4%, ranging from 13.5% to 90.6%) for domain 3 (rigor of development); 88.9% (median 91.7%, ranging from 58.3% to 100.0%) for domain 4 (clarity of presentation); 30.1% (median 27.1%, ranging from 3.1% to 67.7%) for domain 5 (applicability); and 50.2% (median 58.3%, ranging from 0.0% to 93.8%) for domain 6 (editorial independence). Three domains including scope and purpose, rigor of development, and clarity of presentation were rated at more than 60% of the scaled domain score. Three domains including stakeholder involvement, applicability, and editorial independence were rated at less than 60% of the scaled domain score. Finally, of the 27 guidelines, 18 (66.7%) were rated at more than 60% of the scaled domain score for rigor of development and were categorized as high-quality guidelines.
Humans ; Internet ; *Practice Guidelines as Topic ; *Program Evaluation ; Quality Assurance, Health Care ; Republic of Korea

BACKGROUND: The purpose of this study is to report a modified transtibial technique to approach the center of anatomical femoral footprint in anterior cruciate ligament (ACL) reconstruction and to investigate the accurate femoral tunnel position with 3-dimensional computed tomography (3D-CT) and radiography after reconstruction. METHODS: From December 2010 to October 2011, we evaluated 98 patients who underwent primary ACL reconstruction using a modified transtibial technique to approach the center of anatomical femoral footprint in single bundle ACL reconstruction with hamstring autograft. Their femoral tunnel positions were investigated with 3D-CT and radiography postoperatively. Femoral tunnel angle was measured on the postoperative anteroposterior (AP) radiograph and the center of the femoral tunnel aperture on the lateral femoral condyle was assessed with 3D-CT according to the quadrant method by two orthopedic surgeons. RESULTS: According to the quadrant method with 3D-CT, the femoral tunnel was measured at a mean of 32.94% +/- 5.16% from the proximal condylar surface (parallel to the Blumensaat line) and 41.89% +/- 5.58% from the notch roof (perpendicular to the Blumensaat line) with good interobserver (intraclass correlation coefficients [ICC], 0.766 and 0.793, respectively) and intraobserver reliability (ICC, 0.875 and 0.893, respectively). According to the radiographic measurement on the AP view, the femoral tunnel angles averaged 50.43degrees +/- 7.04degrees (ICC, 0.783 and 0.911, respectively). CONCLUSIONS: Our modified transtibial technique is anticipated to provide more anatomical placement of the femoral tunnel during ACL reconstruction than the former traditional transtibial techniques.
Adolescent ; Adult ; Anterior Cruciate Ligament Reconstruction/*methods ; Female ; Femur/*radiography/surgery ; Humans ; Imaging, Three-Dimensional/*methods ; Male ; Middle Aged ; Surgery, Computer-Assisted/*methods ; Tibia/radiography/surgery ; Tomography, X-Ray Computed/*methods

PURPOSE: Speech and language development is an useful indicator of the overall development of children. Since speech and language delay can lead to emotional, social, and learning problems, the early intervention is very important. We examined 137 children with speech or language problems including 22 children of functional articulation disorders of their clinical features. METHODS: 137 children with speech or language problems in the Department of Pediatrics, Uijeongbu St. Mary's Hospital from January 2004 to December 2007 were reviewed for sex, age, developmental and language test findings retrospectively. Especially, in 22 children diagnosed with functional articulation disorders, articulation test findings were analyzed. RESULTS: 1) The mean age of 137 children was 46.8 months, the ratio of male to female was 2.5:1, and the most frequent age group was 24-35 months. The chief complaints included language delay(67.2%), mispronouncing speech sound(27%), stuttering(3.6%), learning disability(2.2%). The diagnoses of them were developmental language disorder(70.8%), functional articulation disorders(16.1%), mental retardation(5.8%), stuttering(2.9%), tongue tie(0.7%), normal language pattern(3.6%). 2) The mean age of 22 patients with functional articulation disorders was 63 months, the ratio of male to female was 1.4:1, and the most frequent age group was 60-71 months. The mean percentage of consonant correct of Picture Consonant Articulation Test was higher in older age group. In the types of phonetic errors substitutions were most common. Distortions, omissions, and additions were followed in the order of frequency. Substitutions and distortions were common in word initial and medial but omissions in word final. It is appeared that the patients had the difficulties in pronouncing alveolar fricative, palatal affricate, liquid, and velar plosive which mature lately in older children. Mainly palatal affricate, alveolar fricative, and velar plosive were substituted for alveolar plosive and the liquid and alveolar fricative were distorted as gliding. CONCLUSION: Categorizing the cause of language and speech delay is essential to make an adequate treatment plans and decrease the late complications. The future studies for the early screening, more suitable tests in Korean, treatment guidelines or prognosis are needed.
Articulation Disorders ; Child ; Early Intervention (Education) ; Female ; Humans ; Language Development ; Language Development Disorders ; Language Tests ; Learning ; Male ; Mass Screening ; Pediatrics ; Prognosis ; Retrospective Studies ; Tongue

5-fluorouracil(5-FU) and its derivatives have been prescribed preoperatively in Korea for oral administration to patients with gastric cancer as an adjuvant therapy. Since the conditions of the patients after gastrectomy may be different and thereby influence the absorption of 5-fluorouracil, we were interested in the pharmacokinetic changes of 5-fluorouracil absorption after gastric resection. Fourteen of 40 gastric cancer patients, who underwent radical subtotal gastrectomy with D2 lymphnode dissection for gastric cancer, were selected at Ewha Womans University Mok-Dong Hospital from May 1996 to December 1996. The plasma concentrations of 5-fluorouracil were determined before oral administration of 5-FU(500 mg/M2) at 15-min intervals for two hours, and then at 30-min intervals for two hours after oral administration during the pre- and the post-operative periods. High pressure liquid chromatography was used to determine the plasma concentrations of 5-FU. The pharmacokinetic indices included the area under the curve (AUC), the peak concentration (Cmax), and the time to peak concentration (Tmax). The mean postoperative AUC for 5-FU was 25.8+/-14.8% of the mean preoperative AUC, which was a significant decrease in the amount of 5-FU absorption postoperatively. The mean postoperative Cmax was 33.4+/-30.2% of the mean preoperative Cmax, which also meant a significant decrease of the peak concentration postoperatively. The Tmax of most patients were delayed postoperatively, but there was no significant change statistically. In conclusion, we found that the amount of absorbed 5-FU, as calculated by the AUC and the Cmax, significantly decreased after a subtotal gastrectomy by as much as 75 percent compared to the preoperation. Hence, it may be necessary to increase the dose of 5-FU after a subtotal gastrectomy by more than 75% of the preoperative dose. The subtotal gastrectomy did not have a significant effect on the absorptive velocity of 5-FU.
Absorption* ; Administration, Oral ; Area Under Curve ; Chromatography, Liquid ; Female ; Fluorouracil* ; Gastrectomy* ; Humans ; Korea ; Pharmacokinetics ; Plasma ; Stomach Neoplasms