Electrical burns constitude a unique type of thermal injury. Not only may there be a cutaneous burn but frequently hidden local and regional tissue damage exists. Tissue injury and tenden vascular necrosis are complete within eight to ten days follwoing the insult and additional tissue damage can occur because of infection and toxicity of necrotic tissue. Early excision and early graft can prevent this progressiv muscle necrosis because marginally viable tissue at the periphery are saved by the increased vascularity provided by immediate use of flaps or grafting. We have treated 67 cases of electrical burn from 1975 to 1979. The brief summary of the observations were as follows: 1. Good results were obtained in 15 cases after treatment of early excision and early graft. 2. Simultaneous involvements of hand, wrist, elbow, and shoulder were found because of tetanic contraction in alternating current in 21 cases. 3. In one case of spinal atrophic paralysis due to direct injury to spinal cord, paraplegia was permanent.
Burns ; Clinical Study ; Elbow ; Hand ; Necrosis ; Paralysis ; Paraplegia ; Shoulder ; Spinal Cord ; Transplants ; Wrist

From March 1973 to May 1979 at Hanil Hospital, seven patients with acute complete disiocation and three patients with chronic complete dislocation of the acromloelavlcular Joint had been treated surgically by Weaver and Dunn method which combines resection arthroplasty of the acromioclavicular jolnt with flxation of the clavlcle In an anatomical position by suture of the acromial end of the shortened coracoacromial ligament into the medullary canal of the clavicle. The results were considerably good In both acute and chronic cases. Full range of motion was observed on average In eight weeks in most cases.
Acromioclavicular Joint ; Arthroplasty ; Clavicle ; Dislocations ; Humans ; Joints ; Ligaments ; Methods ; Range of Motion, Articular ; Sutures

Actinomycosis is an indolent, suppurative infection caused by an anaerobic gram-positive organism (usually actinomyces israelii) which usually causes infection in the face, mediastitum, lung, and abdomen. Primary esophageal actinomycosis which is not related with pulmonary or mediastinal actinomycosis, is very rare, especially in immunocompetent host. A 58-year-old woman has been suffered from dysphagia, odynophagia, and chest pain after insertion of esophageal stent in esophageal acid stricture. She underwent a esophagectomy with esophagogastrostomy for above mentioned symptoms. Pathologic diagnosis was a esophageal actinomycosis.
Abdomen ; Actinomyces ; Actinomycosis* ; Chest Pain ; Constriction, Pathologic ; Deglutition Disorders ; Diagnosis ; Esophagectomy ; Female ; Humans ; Lung ; Middle Aged ; Stents*

Recently the male circumcision becomes a hot issue not only in abroad but especially in Korea. Under this circumstance, it will be right that doctors and scholars restart to study about the merits and demerits of the male circumcision. There are little clear answers about its advantages in urinary infection, penile cancer, sexual function, etc. The only issue is that WHO and UNAIDS admit the male circumcision as a significant precautionary measure against HIV (human immunodeficiency virus) after finishing a large scale study. As a doctor, it will be desirable to explain to the patients or parents about the advantages and disadvantages of the male circumcision and help them make a choice considering its cultural, religious, legal, social, and emotional situation when the patient comes to the hospital for a male circumcision. However, it will be difficult to follow the Western statistics impetuously since the course of diffusion of HIV in Korea is different from that in USA, and there is no study in Korea about the merits and demerits of the male circumcision. Therefore, we conclude that it will be an impetuous assertion to argue that the male circumcision should be done before the adolescence, before starting an active sexual life, without any countermeasure.
Adolescent ; Circumcision, Male ; Diffusion ; Female ; HIV ; Humans ; Korea ; Male ; Parents ; Penile Neoplasms

BACKGROUND: Thromboembolism is the major complication in patients with the insertion of cardiac prosthetic valves. The purpose of this study is evaluate the risk factors about the formation of left atrial thrombi after cardiac valve replacement. METHOD: Transesophageal(TEE) and transthoracic echocardiography(TTE) were done to evaluate postoperative cardiac condition in 98 patients with cardiac prosthetic valves from Jan. 1991 to Oct 1991. Several clinical and echocardiographic parameters were analyzied to evaluate the relationship with the formation of left atrial thrombi. RESULT: In univariate analysis, important factors related to the formation of left atrial thrombi are type of operation (p=0.027), postoperative left ventricular function(p=0.003), preoperative(p=0.037) and postoperative systolic ventricular size(p=0.024). However, in multivariate analysis postoperative left ventricular size(p=0.017), presence of previous thrombi(p=0.014), preoperative left atrial size(p=0.014) and postoperative left atrial size(p=0.014) are significant factors. CONCLUSION: Patients with high risk and low risk for the formation of left atrial thrombi after valve replacement can be identified by readily available clinical and echocardiographic variables.
Echocardiography ; Heart Valves ; Humans ; Multivariate Analysis ; Risk Factors* ; Thromboembolism

Neuromuscular coordination is the process in the activation of muscle contraction patterns with appropriate forces and sequences coupled with simultaneous inhibition of other muscles to carry out desired activity. Through coordination training, engram can be developed as automatic preprogrammed multi-muscular patterns in extrapyramidal system by repetitive training millions of time, whereas control is the ability to voluntarily activate a single muscle in pyramidal system with conscious awareness. The development of coordination depends on voluntary repetition of precise performance with simple components until engram is formed. Balance training begins with therapeutic standing using a tilt table and a prone stander. Thereafter, patients with stable static posture proceed to dynamic balance training and progressive gait training using parallel bars and gait aids such as walker or cane. Balance training as a comprehensive early rehabilitation program can effectively improve balance performance. As a therapeutic modality for balance and coordination, neurologic music therapy for sensorimotor training consists of rhythmic auditory stimulation (RAS), patterned sensory enhancement, and therapeutic instrumental music performance (TIMP). RAS has been shown to increase the effect of gait training by stimulating reticulospinal tract in extrapyramidal system as the underlying mechanism. TIMP using keyboard playing has been introduced as therapeutic modality to enhance sequential and programmed coordination with precise execution and independent movement of individual fingers. Therefore, clinical application of neurologic music therapy might be considered to improve balance and coordination in patients with neurological diseases.
Acoustic Stimulation ; Brain ; Brain Diseases ; Canes ; Fingers ; Gait ; Humans ; Muscle Contraction ; Muscles ; Music ; Music Therapy ; Posture ; Walkers

The congenital long-QT syndrome (LQTS) is characterized by recurrent syncope, prolonged QT intervals, QT interval lability, polymorphic ventricular tachycardia, and sudden death. We report a case of congenital long QT syndrome in a 28-day-old male infant who presented with syncope, bradycardia with 2: 1 pseudo-atrioventricular block and a markedly prolonged QT inteval. One episode occured after crying and degenerated into ventricular fibrillation and terminated after cardioversion. A VVI type cardiac pacemaker was implanted. Subsequently, the infant's heart rate was over 110/min and 2: 1 AV block and any other arrhythmia were absent. The infant recovered from the accompanied pneumonia and sepsis and was discharged 47 days after adrnission. However, 13 days after discharge, the infant returned to our hospital ER with syncope. Ventricular fibrillation ceased after cardioversion. Despite medication with propranolol, ventricular tachycardia persisted. The infant expired the day after he was discharged against medical advice.
Arrhythmias, Cardiac ; Atrioventricular Block* ; Bradycardia ; Crying ; Death, Sudden ; Electric Countershock ; Heart Rate ; Hospitals ; Humans ; Infant ; Long QT Syndrome ; Male ; Pneumonia ; Propranolol ; Sepsis ; Syncope ; Tachycardia, Ventricular ; Ventricular Fibrillation

Judet's rib struts which are designed for osteosynthesis are made of stainless steel. This report describes clinical analysis of our experiences of 30 cases with the operative stabilization of multiple rib fractures with Judet's rib struts from December, 1995, to December, 1996 in Chungmoo Hospital, Chounan. Our indications for operative stabilization were as follows: 14 cases in flail chest, 8 cases in severe displacement of rib including segmental fractures, 7 cases in additional procedures during intrathoracic operation, and 1 case in other cause. Postoperative artificial ventilation is needed in only 1 case for 5 days and posto- perative complications were few: 2 cases of hemopneumothorax, 2 cases of alcohol with- drawal delirium, and 1 case of postoperative hepatitis. Average duration of hospital admission who have limited thoracic injuries was 10.5 days. Though more comparative studies is necessary, we find this technique to be better than previously published methods, since it provides better stabilization and immobilization of the ribs and shortening the duration of hospital admission.
Delirium ; Flail Chest ; Hemopneumothorax ; Hepatitis ; Immobilization ; Rib Fractures* ; Ribs* ; Stainless Steel ; Thoracic Injuries ; Ventilation

BACKGROUND: The distinction between non-invasive and invasive or thymic carcinoma has been severely compromised by lack of objective morphological criteria. A reliable biological marker of tumor aggressiveness is, therefore, mandatory for predicting tumor behavior. MATERIAL AND METHOD: Thirty thymic epithelial tumors, including 7 non-invasive thymoma, 10 invasive thymoma, and 13 thymic carcinoma of the Rosai's classification; and 5 stage I, 7 stage II, 2 stage III, and 3 stage IVa of the Masaoka stage of thymoma were investigated for expression of bcl-2 and p53 proteins by immunohistochemistry. RESULT: The thymic epithelial cells showed positive immunostain for bcl-2 in 0 (0%), 3 (30%), 8 (61.5%) of categories in the Rosai's classification respectively and in 0 (0%), 1 (14.3%), 2 (100%), 0 (0%) of stage I, II, III, IVa of the Masaoka stage respectively. Thymic carcinoma, and high stage thymoma had significantly higher proportion of bcl-2 expression than thymoma (p=0.021) and low stage thymoma (p=0.011). However, p53 showed no correlation with the histological subtypes nor with clinical aggressiveness. Bcl-2 expression appeared to be positively correlated with p53 immunoactivity (p=0.007, kappa=0.525). CONCLUSION: These date indicate that bcl-2 expression correlates with aggressiveness in thymic epithelial tumors, but further studies on mutation of p53 protein is necessary because bcl-2 expression appeared to be positively correlated with p53 immunoactivity.
Biomarkers ; Classification ; Epithelial Cells ; Immunohistochemistry ; Thymoma ; Thymus Neoplasms

The aim of this study was to evaluate a usefulness of serum SCC antigen in diagnosis or evaluation of therapeutic effect of lung cancer by investigation of the differences of SCC antigen concentration in lung mass according to TNM staging, and mass size of lung cancer. And the other aim was to know whether SCC antigen plays a role in infiltrative growth of lung cancer or not, comparing with concentration of epidermal growth factor receptor (EGFr) in tissue which is related with growth and differentiation of tumor cell. The results of this study were as follows. The concentration of SCC antigen in squamous cell carcinoma of lung (69+/-25ng/ml) was higher than in unaffected lung tissue (34+/-7ng /ml). (p<0.05). The concentration of SCC antigen was higher in squamous cell carcinoma (69+/-25ng/ml) than in adenocarcinoma (35+/-25ng/ml) (p<0.05), but the concentration of EGFr showed no any significant difference in both histological types. In small sized mass (<3cm in diameter) the concentration of SCC antigen in central portion of tumor was higher than that of peripheral portion, whereas in large sized mass (> or =5cm in diameter), the concentration of SCC antigen in peripheral portion of tumor was higher than that of central portion. (p<0.05). The concentration of EGFr according to tumor size was not significantly different in central and peripheral portion of tumor. The concentration of SCC antigen according to TNM staging of lung cancer was that from central portion was higher in stage I, II, but that from peripheral portion was higher in stage III, IV (p<0.05). The concentration of EGFr from central portion was higher in higher TNM stage (not significant) but that from peripheral portion shows no significant changes. In conclusion, the concentration of SCC antigen in tissue was higher in squamous cell carcinoma than in unaffected lung tissue or adenocarcinoma, and the concentration of SCC antigen increased according to tumor size or TNM staging like in serum level. so, serum SCC antigen is a useful tumor marker to diagnose or evaluate therapeutic effect of squamous cell carcinoma of lung. But further studies are necessary to confirm the relation of infiltrative growth in lung cancer and concentration of SCC antigen because there was a different pattern of regional tissue concentration of SCC antigen and EGFr.
Adenocarcinoma ; Carcinoma, Squamous Cell* ; Diagnosis ; Lung Neoplasms ; Lung* ; Neoplasm Staging ; Receptor, Epidermal Growth Factor