It would seem logical that a left to right shunt may be localized to that chamber in which an increase in oxygen content beyond the normal variation is first seen, while this is generally true, there are certain limitations to such direct diagnostic interpretation. The interpretation of an observed difference in oxygen content is influenced by the result of extremely poor mixing or of a change in respiratory, circulatory or metabolic steady states. This is one of the major challenges to proper interpretation. The purpose of this study was to analyze the blood oxygen content in various chambers of the right side of the heart in patients without shunt and to study the difference in oxygen content between the various chambers. The right heart catheterization was performed in 19 cardiac patients without shunt in Cardiac Laboratory in Hospital. 1. The blood oxygen content was 12.36+/-2.23 volume per cent (mean+/-standard error) in superior vena vava, 12.59+/-2.23 volume per cent in inferior vena cava, 12.59+/-2.23 volume per cent in mid-right atrium, 12.92+/-1.90 volume per cent in mid-right ventricle and 12.26+/-2.13 volume per cent in main pulmonary artery. 2. The mean difference of oxygen content was 0.16 volume per cent between superior vena cava and right atrium, 0.08 volume per cent between right atrium and right ventricle, and 0.06 volume per cent between right ventricle and main pulmonary artery.

In order to understand the epidemiologic characteristics and trends of Leptespirosis in Korea, year book of acute infectious disease and literatures published were thoroughly reviewed. The results obtained are as follows: 1. The outbreak of Leptospirosis in Korea has decreased during recent years. Most of the patients occured in Semptember, October, and November. Seventy nine percent of reported patients occured in north Choongchung, south Choongchung, and Kyunggi province in 1987-1991. 2. Leptospires isolation rates were ranged from 0.2% to 16.0% among normal healthy person, higher in rural residents than military personnels. 3. Total of 92 strains were isolated from human in six years from 1984 to 1990. Its main serogroups were Icterhaemorrhagiae and Canicola, predominantly consisted of serovar lai, copenhageni and canicola. Eighteen strains of Biflexa were also isolated from healthy persons and patients. 4. The proportion of Leptospirosis among patients with acute febrile episode has decreased since 1985. Sero-positive rate of male among patients with acute febrile episode is higher than that of female. Sixty percent of sero-positive patients with acute febrile episode was older than 40-year of age. The seropositive rates were consistently the highest in harvest season than other seasons. Residents of north Choongchung, north Chunlla, south Chunlla, Kyunggi, and north Choongchung provinces showed higher seropositive rates than those of other ones. Main serogroups positive to most sera of Koreans were Icterohaemorrhagiae and Canicola. 5. The sero-positive rate of normal healthy persons ranged from 2.0 to 25. 6% ; the sero-positive rate of rural area was 4 to 8 times higher than that of healthy urban people. Little difference was observed in sero-positive rate by age group among above 40 years old people, although it was higher in male by sex, in farmers by occupation and in some provinces by area.
Adult ; Communicable Diseases ; Female ; Gyeonggi-do ; Humans ; Korea* ; Leptospirosis* ; Male ; Military Personnel ; Occupations ; Seasons

In Korea, the nosocomial infection control program is not well estabilished. This study was carried out to investigate the incidence rate of nosocomial infection occurred among patients of 18 hospitals for 7 days ; cases of hospital infection per 10,000 patients discharged during the same period in Korea. The study was done in 18 volunteer hospitals and nosocomial infection cases for 7 days were collected retrospectively. The result was as follows; 1. The incidence rate of nosocomial infection for 7 days was 578 cases per 10, 000 patients discharged. 2. Pneumonia was the most prevalent nosocomial infection ; the incidence rate 112.7 cases per 10,000 discharges. The incidence rate of urinary tract infection was 85. 7 cases and that of septicemia was 36. 7 cases per 10, 000 discharges. 3. The incidence rate of nosocomial infection among patients of neurosurgery department was the highest(2,742 cases per 10,000 discharges). And the incidence rate of nosocomial infection was 6 times higher among the patients of intensive care unit than that of general ward. The reasons of higher nosocomial infection rate of intensive care unit and neurosurgery appeared to be due to many invasive procedures. Thus the priority in nosocomial infection control program must be given to those groups.
Cross Infection* ; Humans ; Incidence ; Intensive Care Units ; Korea* ; Neurosurgery ; Patients' Rooms ; Pneumonia ; Retrospective Studies ; Sepsis ; Urinary Tract Infections ; Volunteers

The treatment of frozen shoulder should initially be conservative, with the emphasis on passive stretching of the capsular structures. If the patient's clinical progress stalls or the condition worsens, and his or her life style is disturbed enough, manipulation under gerneral anesthesia is indicated. The Authors practiced the passive manipulation under the general anesthesia on 7 patients of frozen shoulder, who had been treated at the Department of Orthopaedic Surgery, Yonsei University, Wonju College of Medicine, from March 1988 to April 1989. The results obtained were as follows:l. All seven patients achieved nearly full range of motion with minimal or no pain. 2. After 3 months of follow-up, all seven patients showed neither signs of readhesions nor recurrence of pain. 3. There were no complications, such as humerus shaft fracture and dislocation of shoulder.
Anesthesia ; Anesthesia, General ; Bursitis ; Dislocations ; Follow-Up Studies ; Gangwon-do ; Humans ; Humerus ; Life Style ; Muscle Stretching Exercises ; Range of Motion, Articular ; Recurrence ; Shoulder

The congenital dislocation. of the hip is a common congenital disease in the orthopedic field. It is well known that the early diagnosis and effective treatment is very important for the patient to provide a favorable function in the whole life. The Pavlik harness made an important contribution to the treatment of children before standing age. The authors report a clinical experience of 34 patients(35 hips) with congenital dislocation of hip who were treated with Pavlik harness at the Department of Orthopedic Surgery of Chonnam University Hospital. There were total 230 patients(237 hips) diagnosed as congenital dislocation of hip for 10 years from 1978 to 1987. Fifty-one patients(52 hips) of them were treated with Pavlik harness. Only 34 patients(35 hips) were included in this study excluding 17 patients(17 hips) because of inappropriate records or follow-up. The follow-up period ranged from 1 year to 6 years with an average of 2 years and 5 months. The results are as follows ; 1. The most patients were girls, comprising 33 girls and 1 boy. 2. The age of children was 124.6days in average ranging from 13 to 201 days. 3. Of the 35 hips treated with Pavlik harness, satisfactory reduction was obtsined in 30 hips(85.7%). For 5 failed cases, the authors performed closed reduction under the general anesthesia in 3 cases and open reduction in 2 cases. 4. The causes of reduction failure were impossible reduction in 3 cases, nonconcentric reduction in 1 case and repeated redislocation in 1 case. 5. The acetabular and metaphyseal-edge angle improved from the average 33 and 5.8 degrees at the first visit to the average 19.9 and 30.6 degree at the final follow-up (20.7 and 29.2 degrees in normal side). 6. When compared with the value of the 30 hips which were reduced successfully, the initial acetabular angle of 5 failed cases was similar but the metaphyseal-edge angle of them was very low. 7. There was no reduction failure in 27 hips which had metaphyseal-edge angle above 10 degrees. But 5 reduction failures were observed in 8 hips with below −11 degrees. 8. An avascular necrosis was observed in only one patient. In conclusion, the Pavlik harness proved to be a successful means in treating patients with congenital dislocation of hip under 7 months of age with particularly above −10 degrees in metaphyseal-edge angle.
Acetabulum ; Anesthesia, General ; Child ; Dislocations ; Early Diagnosis ; Female ; Follow-Up Studies ; Hip ; Humans ; Jeollanam-do ; Male ; Necrosis ; Orthopedics

Chronic osteomyelitis with protracted clinical course and pretibial skin loss imposes on every orthopaedic surgeon as one of the most difficult problems to deal with. All the conservative treatment hitherto reported have left much to be revised and they often accompany, to the despair of both surgeon and patient, recurrence of the lesion. The authors have had the opportunity of treating such four cases, in which the extensive removal of sclerotic bone as well as soft tissue adjacent to the focus was done, and lo cover the defect thus produced, the soleus muscle transferred anteriorly, followed by skin graft. It proves to have been successful and the rationale to meet the wider clinical applicability of this procedure is described.
Humans ; Muscle, Skeletal ; Osteomyelitis ; Recurrence ; Skin ; Transplants

We experience a 1 day old female patient with congenital esophageal atresia and tracheoeso-phageal fistula combined with a subglottic laryngeal stenosis which was 2 mm in diamete. At the time of surgery, an attempt was made to intubate, but it was impossible to pass a tube beyond the vocal cord which was mormal in size and shape. Thus a gastrostomy was performed only under mask with pure oxygen and local anesthesia. The child died one day later due to respiratory failure. Congenital subglottic laryngeal stenosis combined with esophageal atresia and tracheoeso-phageal fistula is very rare, but it is a very critical anomaly to anesthesia and resuscitation. Therefore, in the case of esophageal atresia and tracheoesophageal fistula with signs of respiratory obstruction, the possible presence of subglottic laryngeal stenosis should be considered and accurately assessed.
Anesthesia* ; Anesthesia, Local ; Child ; Esophageal Atresia* ; Female ; Fistula ; Gastrostomy ; Humans ; Laryngostenosis* ; Masks ; Oxygen ; Respiratory Insufficiency ; Resuscitation ; Tracheoesophageal Fistula* ; Vocal Cords

BACKGROUND: Family counseling is an essential part of family practice in which patients are cared in psychosocial dimension as will as in physical dimension and the family is dealt with as a whole unit. However, it is little applied in practice. The department of family medicine has made efforts to activate family counseling. This study was done to estimate the patients response on the effect of family counseling that we have performed, and to investigate what clinical problems counseling was held and in what situations the counseling was perceived to be useful by the patients. We hope this study will be useful to establish some useful data and ideas for the development of family counseling in family practice in Korea. METHODS: The subjects of this study are 53 households who received family counseling at the department of family medicine from Oct. 1, 1994 to May 31, 1995. 64 households received counseling during this peroid, but 11 persons who could not be reached by the phone were excluded. Patients demographic charateristics, patients chief complaints, physicians assessrnent on the complaints and major prolems presented in the counseling sessions were identified from the medical records. Patients own estimation of the effect of counseling and the reasons for termination of counseling were inquired through the telephone interview. Finally the association between the usefulness of counseling and some factors was statistically analyzed. RESULTS: Subjects were predominently women(84.9%), especially middle aged. The most common chief complaint was headache complained by 10 subjects (18.9%), and the second and the third were abdominal pain complained by 8 (15.1%) and chest discomfort complained by 7(13.2 %), respectively. The list of physicians assessment included depression(34.0%), physical symptom per se without any assessment(20.8%), family problem(15.1%), somatization(13.2%), and anxiety(9.45). More than half of the subjects(60.4%) had only one session, 26.4% two sessions and 7.5% more than 4 sessions. The most common problem presented in the counseling was marital conflict(28.3%), the second was trouble with in-laws(15.1%), and the third was chronic illness in the family(9.4%). 32.1% replied that the counseling was very helpful, 28.3% somewhat helpful, 17% little helpful, 20.8% never helpful, and 1.9% not sure. The session was experienced to be more useful in the group of duration of symptom less than 6 months, than in the group of longer duration(p<0.05), and in the group with motivation for counseling than in the group without motivation(p<0.05). CONCLUSIONS: About 60% of subjects replied the counseling was useful to them. Symptom duration and patients motivation to participate in counseling showed significant association with the effect of family counseling.
Abdominal Pain ; Chronic Disease ; Counseling* ; Family Characteristics ; Family Practice ; Headache ; Hope ; Humans ; Interviews as Topic ; Korea ; Medical Records ; Middle Aged ; Motivation ; Thorax

BACKGROUND: Family counseling is an essential part of family practice in which patients are cared in psychosocial dimension as will as in physical dimension and the family is dealt with as a whole unit. However, it is little applied in practice. The department of family medicine has made efforts to activate family counseling. This study was done to estimate the patients response on the effect of family counseling that we have performed, and to investigate what clinical problems counseling was held and in what situations the counseling was perceived to be useful by the patients. We hope this study will be useful to establish some useful data and ideas for the development of family counseling in family practice in Korea. METHODS: The subjects of this study are 53 households who received family counseling at the department of family medicine from Oct. 1, 1994 to May 31, 1995. 64 households received counseling during this peroid, but 11 persons who could not be reached by the phone were excluded. Patients demographic charateristics, patients chief complaints, physicians assessrnent on the complaints and major prolems presented in the counseling sessions were identified from the medical records. Patients own estimation of the effect of counseling and the reasons for termination of counseling were inquired through the telephone interview. Finally the association between the usefulness of counseling and some factors was statistically analyzed. RESULTS: Subjects were predominently women(84.9%), especially middle aged. The most common chief complaint was headache complained by 10 subjects (18.9%), and the second and the third were abdominal pain complained by 8 (15.1%) and chest discomfort complained by 7(13.2 %), respectively. The list of physicians assessment included depression(34.0%), physical symptom per se without any assessment(20.8%), family problem(15.1%), somatization(13.2%), and anxiety(9.45). More than half of the subjects(60.4%) had only one session, 26.4% two sessions and 7.5% more than 4 sessions. The most common problem presented in the counseling was marital conflict(28.3%), the second was trouble with in-laws(15.1%), and the third was chronic illness in the family(9.4%). 32.1% replied that the counseling was very helpful, 28.3% somewhat helpful, 17% little helpful, 20.8% never helpful, and 1.9% not sure. The session was experienced to be more useful in the group of duration of symptom less than 6 months, than in the group of longer duration(p<0.05), and in the group with motivation for counseling than in the group without motivation(p<0.05). CONCLUSIONS: About 60% of subjects replied the counseling was useful to them. Symptom duration and patients motivation to participate in counseling showed significant association with the effect of family counseling.
Abdominal Pain ; Chronic Disease ; Counseling* ; Family Characteristics ; Family Practice ; Headache ; Hope ; Humans ; Interviews as Topic ; Korea ; Medical Records ; Middle Aged ; Motivation ; Thorax

We present an autopsy case of signet ring cell carcinoma of urinary bladder which underwent widespread metastsis through nearly entire organ. The patient, 45-year old male, suffered from hematuria, dysuria and flank pain for 6 months. Under the diagnosis of the signet ring cell carcinoma by the cystoscopic biopsy, radical cystectomy and ileocutaneous ureteral division were performed. But he died after 11-months after the diagnosis. The autopsy confirmed the widespread metastasis at the lung, kidney, adrenal gland, parathyroid gland, heart, stomach, ileum, spine, rib and meninges. The preveously resected urinary bladder discolosed the well defined fungating mass at the dome and anterio-lateral portion without apparent evidence of the remnant of the urachus. Histologically, the signet ring cells were predominent and focally mucinous pool floating the signet ring cells was noted. We could find several foci of the well differentiated adenocarcinoma and poorly differentiated adenocarcinomas. The above findings may reflect that the origin of carcinoma may be from the multipotential transitional cell epithelium.
Adenocarcinoma ; Neoplasm Metastasis