The stress or fatigue fracture is well known in military medicine, but it is an unusual occurrence in civilian practice. The stress fracture of metatarsal bone is familiar to most, but in the tibia it is unusual. The clinical symptoms of pain, swelling and limping following strenuous activity were seen in the affected lower leg and proceeded radiological evidence of fracture. 17 cases of stress fracture of tibia were investigated in a military hospital between March 1973 and May, 1974. The results of this study are as follows, 1. The fractures mainly occurred in the upper one third of the tibia (13 cases among 17). 2. The cases with only callus formation were more frequent than the cases with fracture line on the tibia (11 cases among 17). 3. If pain occurs in the lower leg after strenuous activity, there should be attention with serial radiological checking.
Bony Callus ; Clinical Study ; Fractures, Stress ; Hospitals, Military ; Leg ; Metatarsal Bones ; Military Medicine ; Tibia

Total hip replacement, with a prosthesis replacing both the acetabular socket and the femoral head, has been developed during the last decade and is now being used extensively. Its major advantage is rapid rehabilitation of the patient, particularly when both the femorsl head and the acetabulum are diseased. Nine Cases of total hip replacements were performed at the Department of Orthopedic Surgery, Hanyang University Hospital from January 1972 to March 1976. Although the follow-up (range 4 months to 3 years) in the majority is too short to permit a complete assessment of the results, in our series, most patients presented for surgical treatment for the relief a pain and mobility has been complete.
Acetabulum ; Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Head ; Humans ; Orthopedics ; Prostheses and Implants ; Rehabilitation

Pyogenic osteomyelitis is at times tragic disease from which severe deformity and disability may result. The incidence and mortality rate of pyogenic osteomyelitis have decreased strikingly since penicillin became available for general use in the treatment of pyogenic osteomyelitis in 1944 and had a dramatic effect. Recently, since the use of new antlblotics, the effect of treatment has been expected in Pyogenic osteomyelitis. But causative organisms of pyogenic osteomyelitis was gradually increasing in resistance to antibiotics. There is also a trend of gradual increase of pyogenic osteomyelltis due to Gram negative bacilli. The author has been analysed 134 patients on whom followup was observed for a minimum of six months at the Department of Orthopedic Surgery of Hanyang University from May, 1972 to December, 1978. The results were as follows: 1. The incidence of pyogenic osteomyelitis is a trend of gradual increase with 14.2% in 1973, 15.7% in 1975 and 26.9% in 1978. 2. Sex ratio was 2.6: 1 (Male: Female): Age distribution showed the group between 5 and 15 years old was 20 patients(62.5%) in acute osteomyeIitis, and the group between 15 and 30 years oId was 52 Patients (51%) In chronic osteomyelitis. 3. The order of involved bones is femur(41%), tibia(27.8%) and humerus(10.4%). 4. Erythrocyte sedimentation rate was remarkably increased in 92.8% of male and 86.5% of female. 5. The causative organism was mostly staphylococcus aureus(84%) in acute osteomyelitis, and Staphylococcus aureus(44.8%), mixed organisms(20.9%) and Gram negative, bacilli(8.3%) in chronic osteomyelitis. Especially, mixed cases with Staphylococcus aureus and Gram negative bacilli contain 55% of mixed organisms. 6. Penicillin was most resistant (79.7%) to Staphylococcus aureus. Cloxacillin was most susceptable (91.3%) to Staphylococcus aureus. 7. The treatment of acute osteomyelitis showed arrest(72.7%) in case of massive antibiotics by early finding of clinical symptom, but if clinical symptoms were not improved within 48 hours with the use of antibiotics, early decompression was done and was arrested(84.6%) in acute osteomyelitis. Closed continuous irrigatlon with saucerization was done and was arrested(85.7%) in chronic osteomyelitis.
Age Distribution ; Anti-Bacterial Agents ; Blood Sedimentation ; Clinical Study ; Cloxacillin ; Congenital Abnormalities ; Decompression ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mortality ; Orthopedics ; Osteomyelitis ; Penicillins ; Sex Ratio ; Staphylococcus ; Staphylococcus aureus

Synovial sarcoma is an uncommon, malignant tumor which originates from the synovial lining of the joints, bursae and tendon sheaths. But it rarely occurs from bones. We have experienced a synovial sarcoma of the left ulna. Microscopically cleft spaces lined by epithelioid cells and bundle formation by spindle spaped cells were seen. Above elbow amputation of the left arm was done.
Amputation ; Arm ; Elbow ; Epithelioid Cells ; Joints ; Sarcoma, Synovial ; Tendons ; Ulna

In the early stages of glaucoma the disc changes prior to the visual field loss, so assessment of the optic disc is very important for the evalutation of the glaucoma patient. The most senstitive techniques for detecting changes of the optic disc require highly sophisticated instruments, such as computerized image analyzer, which are expensive and not generally available in clinical practice. Less expensive, but reliable, is color stereoscopic photography. The aim of this topic is to assess glaucomatous discs and look for the features of the optic disc that are commonly associated with early visual field defect. Forty-three eyes of 28 patients were included in this investigation. The criteria for inclusion were a cup/disc(C/D) ratio more than 0.4 by direct ophthalmoscopy, no visual field defect with Goldmann perimetry, and open anterior chamber angle. Each optic disc was photographed with a Canon fundus camera with Polaroid 600 Plus. Each photographic set was then examined stereoscopically for morphologic parameters: 1) comparison of vertical versus horizontal C/D ratio; 2) presence of nasal cupping; 3) presence of overpassing vessels; 4) presence of baring of circumlinear vessles; 5) presence of peripapillary atrophy; 6) ratio of the thinnest neuroretinal rim(NRR) width in the vertical sectors to the NRR width of the temporal sector. All subjects were examined for central visual field with the automated static perimeter, Humphrey program C 30-2 with STATPAC. The C/D ratio estimated by direct ophthalmoscopy consistently showed smaller C/D ratio than that by the stereophotographic method. Parameter with highest probability value to differentiate between the optic disc of early visual filed loss and the optic disc of normal subjects was "Ratio of the thinnest NRR width in the vertical sectors to the NRR width of the temporal sector Anterior Chamber ; Atrophy ; Glaucoma ; Humans ; Ophthalmoscopy ; Photography ; Visual Field Tests ; Visual Fields*

To investigate the effects of ketamine on the hemodynamics decreased by fentanyl-diazepam, twenty-five patients were randomly assigned to three groups. In all patients fentanyl (10 ug/kg) diazepam (0.2 mg/kg) was intravenously administered, and then patients in group 1 recevied saline only, group 2 and group 3 recevied 1 and 2 mg/kg of ketamine, respectively. Hemodynamic parameters were obtained before and 5 minutes after durg in each group. In group 1, fentanyl-diazepam produced a decrease in heart rate (HR:17%), mean arterial pressure (MAP:27%), cardiac index (CI:40%) and sroke volume index (SVI:14%), and a increase in mean pulmonary arterial pressure (MPAP:27%) and pulmonary capillary wedge preasure (PCWP;25%), but no significant change in central venous pressure (CVP) and systemic vascular resistance index (SVRI). Patients in group 2 had decreases in HR(16%), MAP(10%), CI(10%) and SVI(16%), and decrease in MPAP(21%), PAWP(21%), PCWP(26%), CVP(58%) and SVRI(24%), but theae hemodynamic changes were no significant difference compared to those of group 1 except a bit increase in CVP and SVRI. In group 3, HR(11%), MAP(11%), CI(23%), and SVI(13%) were decreased, but MPAP(14%), PCWP(14%), CVP(69%) and SVRI(26%) were increased and these values were no difference compared to those of group 2. These results demonstrated that ketamine did not significantly affect the hemodynamics decreased by fentanyl-diazepam except CVP and SVRI were increased by ketamine. Base on this study, the author suggeeted that the mechanism of cardiovascular depression caused by diazepam-fentanyl might to be the result of myocardial depression, ketamine produced its sympathomimetic actions primarily by direct stimulation of central nervous system, and ketamine might to be unuseful to improve the hemodynamics to patients with cardiovaseulsr depreseion caused by fentanyl-diazepam.
Arterial Pressure ; Capillaries ; Central Nervous System ; Central Venous Pressure ; Depression ; Diazepam ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Ketamine* ; Vascular Resistance

BACKGROUND: Hormone replacement therapy(HRT) has an established role in reducing cardiovascular risk and In preventing osteoporosis. But compliance with HRT is not good as expected. There fore, So we assessed perimenopausal womens knowledge and attitude fowards menopause and HRT to. METHOD: Questionnaires were provided to the students mothers of a high school located in Seoul from June 10th, to 15th, 1996. General characteristics and routine breast examination routine Pap smear, the knowledge and practice of high calcuim diet for preventing osteoporosis, their menstural pattern, the in formation source of HRT, in attitude for HRT, and the reasons for refusing. RESULT: Among 560 women, 362 women(64.6%) responded, and the mean age was 45.5 years. For osteoporosis prevention they knew milk(74.7%) were, anchovy(27.4%), calcium(23.6%), HRT(7.4%) were beneficial. And almost(91.8%) all sublets answered that menopause was a natural course and 40.5% of women answered that physical change after menopause could not prevent. Among 34 postmenopause, 5(14.2%) received HRT and 48(20.3%) answered that they would receive HRT, and 57 (24.1%) answered that they would not receive HRT. The reasons for refusing HRT were that menopause was a natural course, there fore deciding the need for artificial hormone therapy(22.4%), increased incidence of brew cancer(21.8%), and that lack of information for HRT(13.9%).The association was not proven between the attitude for HRT and regular Pap smear, regular breast examination, exercise, oral intake for osteoprosis prevention. CONCLUSION: Almost all of the respondents recognized that menopause was a natural course. And the effectiveness of diet and exercise in preventing osteoporosis was more well known compared to HRT.
Breast ; Compliance ; Surveys and Questionnaires ; Diet ; Female ; Hormone Replacement Therapy* ; Humans ; Incidence ; Menopause* ; Middle Aged* ; Mothers ; Osteoporosis ; Postmenopause ; Seoul

BACKGROUND: The etiologies of ischemic cerebrovascular diseases are various-thrombosis or artery to artery embolism, cardiogenic embolism and lipohyalinosis. In the past embolic cerebral infarct was thought to occur uncommonly. But these days substantial portion of patients have been found to have potential embolic sources by transesophageal echo cardiography and carotid duplex doppler. As transesophageal echocardiography has a high yield for identification of potential sources of cardiac embolism in patients with ischemic cerbrovascular diseases, its use has been increasing. In Korea an increasing number of patients with ischemic cerebrovascular diseases have been examined by transesophageal echocardiography since 1990. But in all the previous studies transesophageal echocardiographic evaluation has been confined to the patients with high probability of embolic cerebral infarct. All kinds of ischemic cerebrovascular diseases patients have never been examined by transesophageal echocardiography and carotid duplex doppler and the prevalence of potential embolic sources in Korean ischemic cerebrovascular disease patients is not known. The aim of this study was to evaluate the prevalence of potential cardiovascular embolic sources by transesophageal echocardiography and carotid duplex doppler in unselected patients with ischemic cerebrovascular diseases. METHODS: We evaluated all kinds of ischemic cerebrovascular diseases patients admitted from 1994. 9. 1. until 1995 9. 31. to the Departments of Neurology and Internal Medicine of Kangnam General Hospital. We evaluated them by transesophageal echocardiography, carotid doppler, brain CT(or brain MRI). A significant carotid stenosis was defined as a duplex scandetected lesion producing at least 50% vessel narrowing. The following echocardiographic findings were defined prospectively as potential cardiac sources of embolism : atrial appendage or left atrial cavity thrombus, spontaneous echocardiographic contrast, atrial septal aneurysm, interatrial shunt, ventricular aneurysm, ventricular thrombus, myxomatous mitral valve and protruding atherosclerotic plaque in the ascending aorta or transverse aortic arch. RESULTS: Of 64 patients admitted during the study period, 30 were excluded(Three patients were critically ill, and twenty seven patients refused diagnostic work-up.). Thorough diagnostic work-up was performed in 34 patients. Transesophageal echocardiographic positive findings were present in six patients(17.6%). Of them four(4/34, 11.7%) had spontaneous echo contrast, two(2/34, 5.8%) had left atrial thrombi, one(1/34, 2.9%) had ascending aorta atheroma. Eleven patients(11/34, 32.3%) had abnormalities in carotid doppler study. Five patients(5/34, 14.7%) had abnormalities both in transesophageal echocardiography and carotid doppler study. CONCLUSIONS: The results suggest that among ischemic cerebrovascular diseases patients substantial portion of patients have potential embolic sources. The prevalence of potential embolic sources in Korea may be higher than previously expected. Because the relative small number of the patients studied make it difficult to generalize the results, further studies with a large number of patients are needed.
Aneurysm ; Aorta ; Aorta, Thoracic ; Arteries ; Atrial Appendage ; Brain ; Carotid Stenosis ; Critical Illness ; Echocardiography ; Echocardiography, Transesophageal ; Embolism ; Hospitals, General ; Humans ; Internal Medicine ; Korea ; Mitral Valve ; Neurology ; Plaque, Atherosclerotic ; Prevalence ; Prospective Studies ; Thrombosis

No abstract available.
Breast ; Peptococcus

The rhinocerebral aspergillosis invading sinuses and CNS is known to be a fatal desease in immunocompromised patients. The management principle of rhinocerebral aspergillosis is often by extensive surgical removal through craniotomy combined with amphotericin B therapy, and endoscopic removal had not been reported until now. We report in this study a case of rhinocerebral aspergillosis invading the left frontal sinus and the left frontal lobe which were treated by the combination therapy of endoscopic removal and antifungal agents.
Amphotericin B ; Antifungal Agents ; Aspergillosis* ; Craniotomy ; Frontal Lobe* ; Frontal Sinus ; Immunocompromised Host