BACKGROUND: Intermediate myasthenia syndrome(IMS) is thought to have clinical importance because it may cause sudden respiratory failure during the recovery phase of a cholinergic crisis of organophosphate poisoning. We designed this study to identify the prevalence, the inducing agent, clinical predictor, and the proposed treatment of IMS. METHODS: Patients who had admitted with the diagnosis of acute organophosphate poisoning from 1992 to 1998 at two teaching hospitals were enrolled in this study. We selected the cases of IMS based on a review of medical records using modified He's criteria. RESULTS: Twelve(12) out of 110 patients with acute organophosphate poisoning were diagnosed for a prevalence at 10.9%. The drug inducing IMS were identified as dichlorvos, fenthion, EPN, methidathion, and phosphamidon. The occurrence of IMS was not related to either the initial treatment with atropine and pralidoxime, or the level of serum cholinesterase. Complications were pneumonia, sepsis, pancreatitis, and pseudomembranous colitis, etc. Eleven(11) patients were discharged without sequelae, and one patient was discharged as a hopeless care. CONCLUSION: This study suggests that IMS is not rare, so close observation is required to detect IMS in organophosphate-poisoning patients. Also, more studies are required to find predictors and treatments.
Atropine ; Cholinesterases ; Diagnosis ; Dichlorvos ; Enterocolitis, Pseudomembranous ; Fenthion ; Hospitals, Teaching ; Humans ; Medical Records ; Organophosphate Poisoning ; Pancreatitis ; Phosphamidon ; Pneumonia ; Prevalence ; Respiratory Insufficiency ; Sepsis

A clinical study was made on 12 cases of neonatal Group B beta-hemolytic streptococcal (=GBS) meningitis, who were admitted to the department of pediatrics, Dong-San Hospital, Keimyung University during the period of 3 years from Aug 1989 to Jul 1992. The following results were obtained: 1) GBS was cultured in 12 cases (57.1%) among 21 neonatal meningitis admitted during the same period. 2) Male and female ratio was 1.4:1, and 4 cases had early-onset and 8 cases had late-onset. 3) In 6 (50%) out of 12 cases, obstetric factors were noted, including premature rupture of membrane (2 caes), premature delivery(1 case), asphyxia (1 case), cesarean section (1 case) and maternal toxemia (1case). 4) The clinical manifestations were fever (91.7%), lethargy and poor feeding (83.3%),vomiting and irritability (50%), convulsion and bulging fontanel in order. 5) Associated diseases were GBS sepsis (8 cases), pneumonia (2 cases), hyperbilirubinemia (2 cases), etc. 6) Cerebrospinal fluid findings were increased cells(250-12600/mm3), decreased sugar (1-11), increased protim (220-678mg%) and the CBC differential ratio was less than 1.0 in all cases. 7) Overall survival rate was 83.3% with 75% in early-onset disease, and 87.5% in late-onsetdisease. 8) The acute neurologic complications were noted in 5 cases (45.5%) including subdural hemorrhage, brain swelling and cerebral infarction.
Asphyxia ; Brain Edema ; Cerebral Infarction ; Cerebrospinal Fluid ; Cesarean Section ; Female ; Fever ; Hematoma, Subdural ; Humans ; Hyperbilirubinemia ; Infant, Newborn ; Lethargy ; Male ; Membranes ; Meningitis* ; Pediatrics ; Pneumonia ; Pregnancy ; Rupture ; Seizures ; Sepsis ; Survival Rate ; Toxemia

To characterize the sympathetic nervous system response to congestive heart failure in infants and children, plasma norepinephrine levels were measured in 29 patients aged 4 months to 15 years undergoing routine cardiac catheterization at Dong San Hospital, Keimyung University during the period of 4 months from November 1990 to February 1991. Plasma norepinephrine levels were significantly higher in patients with heart disease and congestive heart failure than in those without congestive heart failure(P<0.001). A significant association was found between the level of plasma norepinephrine and severity of the symptoms of congestive heart failure. Plasma norepinephrine levels correlated well with size of the shunt (Qp/Qs)(gamma=0.75), degree of pulmonary arterial pressure (gamma=0.79) and degree of right ventricular pressure (gamma=0.82).
Arterial Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Child* ; Estrogens, Conjugated (USP)* ; Heart ; Heart Diseases ; Heart Failure* ; Humans ; Infant* ; Norepinephrine* ; Plasma* ; Sympathetic Nervous System ; Ventricular Pressure

BACKGROUND: The incidence and prevalence of gait disturbance increases as age increases. The importance of cognitive aspects of gait disturbances has been studied in various types of dementia and MCI. This study was performed to identify relationship between cognitive impairment and change in gait, and investigate specific domains of cognitive function that may have affects in gait disturbance. METHODS: Three hundred eighty three participants over 60 years old volunteered for the study. Three stages evaluation were performed, dementia screening and timed up and go test (TUG), work up for cognitive impairment and dementia, and classifying cognitive impairment and dementia into subcategories by evaluating cause of the disease. To evaluate cognitive impairment, MMSE-KC (MMSE in the Korean version of the CERAD assessment packet) and Korean version of Consortium to Establish a Registry of Alzheimer's Disease (CERAD-K) assessment were used. One hundred forty one people were excluded from study and 242 people were analyzed. Timed Up and Go test (TUG) was performed for evaluation of gait disturbance. Relationship in every subcategory of CERAD-K and TUG was studied by correlation and multiple logistic analysis. RESULTS: Of the 242 participants, 122 were without cognitive impairment, 51 had mild cognitive impairment, 56 had Alzheimer's disease and 13 had vascular dementia. These four groups showed different results in TUG. Normal group had the lowest values in TUG compare to other groups significantly. MMSE score also correlated with the value of TUG (r=-0.528, p<0.001). Every subcategory of CERAD-K score had significant correlation with the value of TUG. But there were no specific subcategory that had predominant effect in TUG. Only age was an independently significant factor influencing TUG (p<0.05). CONCLUSIONS: This study shows that increase in age and impairment in cognitive function has an association with gait disturbance. Therefore clinician should be concerned about cognitive factors for evaluation of a patient who has gait disturbance.
Alzheimer Disease ; Dementia ; Dementia, Vascular ; Gait* ; Humans ; Incidence ; Mass Screening ; Methods ; Mild Cognitive Impairment ; Prevalence

No abstract available.
Myelitis* ; Neuralgia*

Many operative procedures for osteonecrosis of the femoral head(ONFH) have been proposed, but their clinical results remain controversial to many clinicians. Recently, a new surgical procedure that incorporates cementation with polymethylmethacrylate(PMMA) after core drilling has been tried clinically. In this study, a finite element method (FEM) was employed to analyze and compare various surgical procedures of ONFH to provide a biomechanical insight by varying physiological loading conditions. Our finite element models were constructed for this purpose they included normal, necrotic, core decompressed, fibular bone grafted, and cementation models. The extent of necrotic region was determined based upon the average CT-scan data from 10 patients. The physiological load directions and magnitudes during the gait cycle were selected at the stage of heel-strike, toe-off, and average stance. The von Mises stresses were calculated and volumetric percentages of the necrotic region under different levels of stresses were analyzed for each model. Our results indicated that there were substantial increase of the necrotic region subjected to the high stress level (beyond 11 MPa) and decrease in the low stress level (below 5 MPa) with the core decompression model, an indication of a malignant stress transfer pattern. On the other hand, the exact opposite pattern of stress transfer was noted with the fibular bone graft and cementation methods suggesting that they could provide structural integrity within the necrotic region.
Cementation ; Decompression ; Gait ; Hand ; Head* ; Humans ; Osteonecrosis* ; Surgical Procedures, Operative ; Transplants

Recent studies suggest that addition of transfixators to pedicle screw instrumentation enhances rotational stability of the constructs. However, the effectiveness of the transfixators along with their ideal numbers and positions still remains unclear. In this study, finite element analysis was performed to suggest the most effective positions of the transfixators based on their numbers. For this purpose, a finite element model of a spinal segment(L3-5) with total vertebrectomy at L4 and pedicle screw instrumentation was developed. The finite element model was made with 3-D 8 node solid elements so that they are more realistic and closer to the actual human vertebrae than the preciously published models. On this model, the transfixator(s) were placed along the pre-determined position(s) along the rod while its number was varied between 1 and 2. Appropriate boundary conditions were designated and rotational moment of 6.4 Nm was applied both in axial rotation and lateral bending. Improvement in rotational stability due to addition of the transfixator(s) was calculated as the percent decrease in motion relative to the case without. Results suggested that with one transfixator the rotational stability increased by the average of 19.0% and 6.1% against axial rotation and lateral bending, respectively. With two, the corresponding improvements were 32.3% and 10.7%. Against axial rotation, it was most effective when transfixator was placed at the middle of the rod(22.9%) for one transfixator and at the 1/3 and 2/3 sites along the rod(35.8%) for two. Against lateral bending, the ideal position(s) were at the proximal end(10.7%) for one transfixator and at the proximal and distal ends of the construct(17.7%) for two. It was also found that adding of a transfixator was more sensitive against lateral bending than against axial rotation(78% versus 64%). In conclusion, base on our biomechanical results, it can be suggested that the ideal positions for the ators are located at the equidistance from the both ends of the rod against axial rotation and at the both ends against lateral bending.
Finite Element Analysis* ; Humans ; Spine

No abstract available.
Abducens Nerve Diseases* ; Abducens Nerve* ; Gangliosides ; Guillain-Barre Syndrome* ; Humans

Radiofrequency catheter ablation (RFCA) is a useful treatment for drug-refractory atrial fibrillation. RFCA can cause cerebral infarction that remains the neurologic deficit if prompt managements are delayed. We report on 3 patients who developed cerebral infarctions immediately after RFCA. Periprocedural anticoagulation such as warfarin should be continued for patients, even if they are at low risk for cerebral infarction.
Atrial Fibrillation* ; Catheter Ablation* ; Cerebral Infarction* ; Humans ; Neurologic Manifestations ; Warfarin

The purpose of this study is to devlop the basic algorithm for the finite slsment method modeling of indivdual malocclusions. Usully, a great deal of time js spent in preprocessiong. To reduce the time required, we developed a stsndardized proccrdure for measuring the position of each tooth and a program to automatically preprocess. The following procedures were carride to complete this study. 1. Twenty-eigth teeth mofphologies were constructed three- dimensionally for the finite element analysis and saved as separate files. 2. Standard brackets were attached so that the FA points conincide with the center of the brackets. 3. The study model of a patient was made. 4. Using the study model, the crown inclination, and the vertical distance from the tip of a tooth was measured by using specially designed tools. 5. The arch form was determined from a picture of the model with an image processing technique. 6. The meadured data were input as a rotational matrix. 7. The program provides an output file containing the necessary information about the three-dimensional position of teeth, which is applicable to several finite element programs commonly used. The program for basic algorithm was made with Turbo-C and the subsequent outfile was applied to ANSYS. This standatdized model measuring procedure and the program reduce the time required, espccially for preprocessing and can be applied to other malocclusions easily.
Crowns ; Finite Element Analysis ; Humans ; Malocclusion* ; Tooth