No abstract available.

OBJECTIVE: To investigate the clinical, laboratory and radiologic characteristics of arthritis presented as initial manifestation in patients with Behcet's disease. METHODS: We retrospectively reviewed medical protocols, laboratory and radiologic findings in 33 patients with Behcet's disease. Evaluation was made out at diagnosis and included age, sex, duration and onset pattern of arthritis, involved joint, and laboratory findings included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-nuclear antibody (ANA), rheumatoid factor (RF), and HLA type. RESULTS: In 33 patients (7 males and 26 females), mean age was 34.4+/-9.4 years, and duration of arthritis was 34.1+/-37.9 months. The frequency of involved joint was as follows ; 58% in knee, 33% in proximal interphalangeal joints, 27% in wrist, and 24% in ankle. The pattern of involvement was oligoarticular in 18 patients (55%), polyarticular in 9 patients (27%), and monoarticular in 6 patients (18%). Monoarticular pattern was more frequent in younger patients (< or =35 year-old) than older patients. ESR and CRP were elevated in 17 (53%) and 8 patients (24%), respectively. Radiologic examination of the involved joint was normal in 93% of patients. CONCLUSION: In patients with Behcet's disease diagnosed by arthritis as initial manifestation, the most commonly involved joint was knee and the most common pattern of involvement was oligoarticular.
Ankle ; Arthritis* ; Blood Sedimentation ; C-Reactive Protein ; Diagnosis ; Humans ; Joints ; Knee ; Male ; Retrospective Studies ; Rheumatoid Factor ; Wrist

PURPOSE: To report the voiding pattern and continence stati in male patients having undergone a radical cystectomy and orthotopic bladder substitution. MATERIALS AND MATHODS: Between March 2000 and June 2005, 20 men with advanced bladder cancer had a radical cystoprostatectomy and urinary diversion via an ileal orthotopic bladder substitution. The voiding pattern and continence stati were assessed using patient interviews, frequency- volume charts and pad tests at 1, 3, 6, 9 and 12 months after catheter removal. RESULTS: The mean age and follow-up were 60.5 years (41-72) and 34.1 months (12-69), respectively. Neobladder substitution was performed with an ileum in all patients. 17 patients had reconstruction with a Studer neobladder and 3 with a W-pouch Hautmann. All patients had transitional cell carcinoma (TCC) and their tumor stages ranged from T1G3 to T4aN1M0. The frequency of voiding ranged from 4 to 12 times during the day, and 0 to 5 times during the night, with a mean maximum neobladder capacity of 336ml (200-620) and maximum flow rate of 24.6ml/sec (12-46) 12 months after removal of the catheter. No patient required intermittent self-catheterization. All-time continence rates were 15, 30, 65 and 85%, and all-time incontinence rates were 55, 25, 10 and 5% at 1, 3, 6 and 9 months after catheter removal, respectively. CONCLUSIONS: Orthotopic bladder substitution has an excellent functional outcome over time, resulting in high daytime and nighttime continence rates within 9 months of catheter removal.
Carcinoma, Transitional Cell ; Catheters ; Colonic Pouches ; Cystectomy ; Follow-Up Studies ; Humans ; Ileum ; Male* ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion

PURPOSE: This study were to understand the caregiving situation of families with the demented elderly and to develop a self-help program for them. METHODS: A self-help program was designed to increase caregivers' confidence and skills in problem solving. In addition, it was designed to provide information about the demented elderly. The self-help program of this study was composed of nine sessions. RESULTS: Family caregivers of elderly patients with dementia obviously experience high level of stress. which often leads the caregivers to negative outcomes such as depression, interference with social activities and health difficulties. That is, caring is stressful for caregivers because the demands of the caregiving situation tend to overwhelm the caregivers' coping resources. Therefore, families with demented elderly persons need assistances in order to be relieved from their care burden. CONCLUSION: The self-help program includes the understanding of dementia, the family caregiving experiences of the demented elderly persons, the time for self-care, the search for helping, the improving of interpersonal relations and communications.
Aged* ; Caregivers ; Dementia ; Depression ; Humans ; Interpersonal Relations ; Problem Solving ; Self Care

BACKGROUND: Clonidine, an 2-adrenergic agonist, shows the analgesic effect and potentiates the analgesic effect of opioid. However, when it is injected with bolus technique, it reveals the short duration of inadequate analgesia and induces hypotension, bradycardia or sedation. We examined the analgesic and side effects of clonidine administered by continuous epidural infusion over 24 hrs, following epidural morphine injection. METHODS: Sixty parturients, scheduled for elective cesarean section under epidural anesthesia were randomly allocated into three groups. They received an infusion of saline alone (group 1, n= 20), clonidine 20 g/hr (group 2, n= 20), or 40 g/hr (group 3, n= 20) respectively, following epidural morphine 3 mg injection at the end of operation. The total doses and number of request for supplemental analgesic, blood pressure, heart rate, and degree of sedation were measured during 24 hrs. RESULTS: There were significant differences in pain relief between clonidine groups and group 1. The total doses and number of patient's request for supplemental analgesic in clonidine groups, compared to group 1 were significantly decreased (p<0.05), but no significant differences between the two clonidine groups. The diastolic pressure of group 3 was significantly lower than that of group 1 over 24 hrs, and that of group 2 at 18 hr, 24 hr (p<0.05). However, there was no severe hypotension, bradycardia or sedation in the three groups. CONCLUSION: Clonidine administered by continuous epidural infusion over 24 hrs enhances the analgesic effect of epidural morphine, and the infusion of clonidine with 20 g/hr rather than 40 g/hr shows minimal changes of blood pressure. Therefore, administration of epidural clonidine (20 g/hr) following epidural morphine may be considered as a regimen for pain management after cesarean section.
Analgesia* ; Anesthesia, Epidural ; Blood Pressure ; Bradycardia ; Cesarean Section* ; Clonidine* ; Female ; Heart Rate ; Hypotension ; Morphine ; Pain Management ; Pregnancy

Sleeve fractures of the superior pole of the patella are rare but usually occurs in adolescents with an immature skeletal system. This paper reports a 15-year-old male who complained of knee pain after a bicycle accident. The initial radiographs and magnetic resonance imaging showed a bony bruise of the patella with signal change on the medial meniscus. After conservative treatment with immobilization for four weeks, he slipped down, and eccentric forced flexion of the knee was applied. This second injury caused a sleeve fracture of the superior pole of the patella. After splint immobilization for five weeks, the patient showed adequate function of the quadriceps and range of motion.Among the cases collected, some patients showed a similar history of sleeve fracture of the superior pole of the patella after serial knee injuries.

Migration of an intrauterine contraceptive device (IUD) into the urinary bladder is very rare. We experienced a case of a foreign-body migrating into the bladder of a 35-year-old women who has been suffering from frequency and dysuria for the recent 5 months. The IUD had originally been inserted 10 years ago. Removal of the IUD had been performed for achieving pregnancy, but the IUD was not detected at the correct site 7 years ago. One year later, the patient had given birth without complication. It is thought that it took less than 6 years for the IUD to invade the bladder wall.
Adult ; Dysuria ; Female ; Foreign-Body Migration ; Humans ; Intrauterine Devices* ; Parturition ; Pregnancy ; Urinary Bladder*

Segmental testicular infarction is an uncommon and usually idiopathic phenomenon. Some case reports have linked segmental infarction to sickle cell anemia, hypersensitivity angiitis, polycythemia, and an idiopathic cause. Magnetic resonance imaginge (MRI) might be of great diagnostic value as the ischemic lesions have a characteristic pattern. Nonetheless, as its clinical and radiological presentation may resemble testicular tumors, a definite diagnosis can only be established following surgery. We report a case of testicular infarction which presented as a malignancy even in the frozen biopsy.
Anemia, Sickle Cell ; Biopsy ; Diagnosis ; Infarction* ; Magnetic Resonance Imaging ; Polycythemia ; Testicular Neoplasms* ; Testis ; Vasculitis, Leukocytoclastic, Cutaneous

BACKGROUND AND OBJECTIVES: We compared functional MRI acquisition methods of sparse temporal acquisition (STA) and continuous acquisition (CA) to estimate the effect of MRI scanner background noise (SBN) on blood oxygen level-dependent (BOLD) activation of cortical and subcortical auditory centers during auditory stimulation. SUBJECTS AND METHOD: Fourteen healthy subjects (eight males, age 30.6+/-4.7 years) were presented with classical music in a block paradigm (36 s on/off) in two STA [repitition time (TR)=12 s, 60 volumes] and two CA (TR=2 s, 360 volumes) functional MRI sessions. To account for the sample size difference, an additional volume-matched continuous dataset (CAm) was generated by matching CA to 60 volumes of STA. A group-level analysis based on BOLD activation maps was performed. Percent signal change (PSC), T-statistic values and signal variability in cortical and subcortical auditory regions of interest (ROIs) were calculated from individual activation maps and compared between the STA, CA, and CAm. RESULTS: The group analysis showed activation in the primary and secondary auditory cortices in all datasets. However, the activation of subcortical auditory centers above the accepted threshold was only observed in STA. STA (less SBN) showed higher PSCs and T-statistic values in all ROIs except planum temporale when compared to CAm. However, there was no difference in signal variability among the datasets. CONCLUSION: Our results suggest that SBN should be considered as a significant confounder in auditory-evoked functional MRI studies particularly in the activation of subcortical auditory centers, and that STA can be an effective imaging method for reducing the effect of SBN.
Acoustic Stimulation ; Dataset ; Humans ; Magnetic Resonance Imaging* ; Male ; Music ; Noise* ; Oxygen* ; Sample Size ; Temazepam

BACKGROUND: The currently available reverse shoulder arthroplasty (RSA) designs can be classified into medial glenoid/medial humerus (MGMH), lateral glenoid/medial humerus (LGMH), and medial glenoid/lateral humerus (MGLH) prosthesis designs. The purpose of this study was to radiologically analyze the effect of different RSA designs on humeral position following RSA. METHODS: A total of 50 patients who underwent primary RSA were retrospectively analyzed. Among 50 patients, 33 patients (group A: MGMH) underwent RSA with Aequalis system (Wright, Inc, Bloomington, MN, USA), 6 (group B: LGMH) with Aequalis system using bony increased offset, and 11 (group C: MGLH) with Aequalis Ascend Flex system. The acromiohumeral distance, acromioepiphyseal distance (AED), lateral humeral offset (LHO), LHO from the center of rotation (LHO(COR)), and deltoid length were radiologically measured to quantify the distalization and lateralization of the humerus. RESULTS: The increment in postoperative AED was 19.92 ± 3.93 mm in group A, 24.52 ± 5.25 mm in group B, and 25.97 ± 5.29 mm in group C, respectively (p=0.001). The increment in postoperative LHO was 0.13 ± 6.30 mm, 8.00 ± 12.14 mm, and 7.42 ± 6.88 mm, respectively (p=0.005). The increment in postoperative LHOCOR was 20.76 ± 6.06 mm, 22.04 ± 5.15 mm, and 28.11 ± 4.14 mm, respectively (p=0.002). CONCLUSIONS: The radiologic analysis of the effect of different RSA designs on humeral position following RSA showed significant differences in the increment in postoperative AED, LHO, and LHO(COR) between the 3 groups. Therefore, MGLH design seems to be more effective for humeral distalization and lateralization compared to original Grammont design.
Arthroplasty ; Humans ; Humerus ; Prosthesis Design ; Retrospective Studies ; Shoulder