Between 1984 and 1996, 8 patients who were suffered from stage g Kienbock's disease underwent interpositional arthroplasty using pronator quadratus pedicled bone. Patients comprised 2 males and 6 females, with an average age of 33 years(range 19-47). Range of motion of the wrist, residual pain, grip strength, and carpal height ratio of the patients were analyzed. The follow-up period was between 1.5 years and 12.5 years(average 5.5 years). The arc of flexion-extension of the wrist was increased from average 74 degrees preoperatively to 96 degrees postoperatively. Among eight patients, five were free of pain and three had intermittent pain during heavy work. None of eight patients had any discomfort in daily work and changed his or her occupation. The grip strength was average 83% of the normal side. Carpal height ratio was average 0.48 preoperatively and was not changed postoperatively. Clinical results, assessed by Lichtman-Evans criteria, showed 4 good and 4 fair. The interpositional arthroplasty using pronator quadratus pedicled bone was considered as a very effective method for the treatment of stage III Kienbock's disease.
Arthroplasty* ; Female ; Follow-Up Studies ; Hand Strength ; Humans ; Male ; Occupations ; Osteonecrosis* ; Range of Motion, Articular ; Wrist

Orbital blowout fractures are common consequence to blunt periorbital trauma. Pure orbital blowout fractures first occur at the weakest point of the orbital wall. Computed tomography(CT) is recognized to be the best imaging technique to evaluate orbital fractures. The extent and location of a blowout fractures in the CT scan were noted to have an effect on the clinical outcome. In the early posttraumatic period, the presence of significant enophthalmos is difficult to detect because of orbital edema. Early surgical intervention may improve the ultimate outcome because open reconstruction becomes more difficult if surgery is delayed. In this study, we evaluated isolated blowout fractures of the orbital floor by region-of-interest measurements from CT scans and their relationship to ophthalmologic findings. Six patients of the medial orbital wall fractures, eleven patients of the inferior orbital wall fractures, nineteen of the medial and the inferior orbital wall fractures confirmed by CT scan, were evaluated. The area of fracture and the volume of the displaced orbital tissue were determined from CT scan using linear measurements. Each of the calculated values for the area and the volume were compared with the degree of the enophthalmos, the diplopia, and the eyeball movement limitation to determine whether there was any significant relationship between them. The fracture area and the volume of the herniated orbital tissue were significantly positively correlated with the enophthalmos and the ocular motility limitation and not correlated with the diplopia. For the enophthalmos of 2mm or greater, the mean fracture area was 3.55+/-1.25cm2 and the volume of the herniated orbital tissue was 1.74+/-0.97cm3 for less than 2mm enophthalmos, 1.43+/-0.99cm3 and 0.52+/-0.49cm3, respectively. The enophthalmos of 2mm can be expected with 2.92cm2 of the fracture area and 1.40cm3 of the herniated orbital tissue. In conclusion, the enophthalmos of 2mm or more, which is a frequent indication for surgery. It can be expected when area of fracture is 2.92cm2 or more, or the volume of herniated orbital tissue is 1.40cm3 or more. And the CT scan using linear measurements has an application in the assessment of patients with blowout fractures and provides useful information in the posttraumatic evaluation of orbital fractures.
Diplopia* ; Edema ; Enophthalmos* ; Humans ; Orbit ; Orbital Fractures ; Tomography, X-Ray Computed

BACKGROUND: A question was whether it was preferable to give the reversal agent when profound block was present or wait for some spontaneous recovery before antagonizing the block. This study has been conducted to evaluate the reversal effects of neostigmine with divided doses in the rabbits after pancuronium when profound relaxation(PTC=O) or the first twitch of TOF stimulation was appeared (TOF,T1) was confirmed. METHODS: Rabbits(n=60) were randomly allocated to 5 groups. After pancuronium 0.2 mg/kg intravenously, spontaneous recovery was evaluated in group 1. When the profound relaxation(PTC=O) was confirmed at 5 min. after pancuronium, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 2. At that time, neostigmine 10 ug/kg with atropine 4 ug/kg were injected and after 3 min. neostigmine 40 ug/kg with atropine 16 ug/kg were injected in group 3. When TOF, Tl was confirmed, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 4. At that time, neostigmine and atropine were injected in group 5 as the same way of group 3. RESULTS: The mean time from injection of pancuronium to 95% recovery was 98.9 min. in group 1, 60.3 min. in group 2, 50.9 min. in group 3, 71.0 min. in group 4 and 67.1 min. in group 5. The recovery index was significantly reduced when neostigmine was injected at TOF,T1(p<0.05). The recovery time after neostigmine with divided doses was reduced, but there was no significant difference. CONCLUSIONS: The results of present study suggested that total recovery time was reduced when neostigmine was injected earlier with divided doses than single dose unrelated to profound relaxation.
Atropine ; Muscle Relaxation* ; Neostigmine* ; Pancuronium ; Rabbits* ; Relaxation

Liver has a dual blood supply from portal vein and hepatic artery. Hepatocellular carcinoma receive their blood supply almost exclusively from hepatic artery. Thus, the concept of treating hepatocellular carcinoma by chemoembolization through these arteries is very effective. However, there may be several collateral or parasitic vessels feeding them in case of huge tumor or previous chemoembolization. We experierced a case of huge tumor involving right upper posterior portion of liver fed by 9th, 10th, 11th right posterior intercostal arteries and an anomalous hepatic artery. We tried chemoembolization with Adriamycin-Lipiodol suspension and Gelfoam material through the right posterior intercostal arteries to treat the lesion. After the procedure, the patient(55 years old female) became paraplegic with voiding and defecation difficulty which could be due to spinal cord infarction .by anterior spinal arteri. al occlusion caused by embolic material through the artery of Adamkiewicz from a posterior intercostal artery. She recovered completely after 20 days of treatment.
Arteries* ; Carcinoma, Hepatocellular ; Defecation ; Gelatin Sponge, Absorbable ; Hepatic Artery ; Infarction ; Liver ; Portal Vein ; Spinal Cord Injuries* ; Spinal Cord*

PURPOSE: The rectoanal inhibitory reflex (RAIR) aids the anal continence function by a sampling process. On the other hand, it might impair the anal continence function because the internal anal sphincter is relaxed during the reflex. We assessed the parameters of RAIR in incontinent patients with or without a sphincter defect and compared them with healthy control subjects to clarify the exact role of that reflex in the anal continence function. METHODS: The recovery time, slope, amplitude, and area under the reflex curve of the RAIR were measured for 31 normal controls without any history of anorectal surgery (group A), 32 incontinent patients with a sphincter defect (group B), and 49 incontinent patients without a sphincter defect (group C). Incontinence was defined as bowel accidents of more than 3 by the Cleveland Clinic Florida score. A sphincteric defect was defined endoanal sonographically. The mean ages of group A, B, and C were 57.9+/-14.3, 54.5+/-13.6, and 61.8+/-15.4 years, respectively. RESULTS: When group A and group B+C were compared, the recovery times (seconds) were 17.5+/-3.5 and 14.8+/-5.5 (P=.003), the slopes (mmHg/second) were 0.67+/-3.04 and 3.27+/-2.44 (P<.001), the amplitudes (%) were 7.0+/-16.5 and 53.3+/-19.4 (P=.352), and the area under the reflex curve (mmHg*seconds) were 230.2+/-102.15 and 173.0+/-140.8 (P=.020). When group B and group C were compared, the recovery times were 15.0+/-5.8 and 14.7+/-5.3 (P=.828), the slopes were 3.6+/-2.8 and 3.1+/-2.2 (P= .388), the amplitudes were 54.2+/-22.4 and 52.7+/-17.4 (P=.737), and the area under the reflex curve were 188.0+/-151.1 and 163.2+/-134.3 (P=.443). All parameters of the RAIR, except the amplitude were significantly diminished in incontinent patients whether they had a sphincter defect or not. CONSLUSIONS: Although the RAIR functions against continence in normal conditions by inhibiting sphincteric tone, it behaves suitably for keeping continence in the presence of incontinence, whatever the cause is, by attenuating the degree of inhibition.
Anal Canal ; Fecal Incontinence ; Florida ; Hand ; Humans ; Reflex*

OBJECTIVES: The purpose of this study was to evaluate the psychometric properties of the Korean version of the Readiness to Change Questionnaire-Treatment version (RCQTV-K). METHODS: The participants were 92 patients who were seeking treatment of alcoholism in two hospitals for alcoholism. A confirmatory factor analysis was performed to test whether the factor structure of the RCQTV-K was consistent with the English version. Convergent validity was assessed by correlating the scores on the RCQTV-K with those on other scales (Alcohol Abstinence Self-Efficacy Scale, Beck Depression Inventory, Korean Version of Alcohol Use Disorders Identification Test). RESULTS: The factor structure of the RCQTV-K was consistent with the three-factor structure established for the original RCQTV. Cronbach's alpha was high, indicating that the reliability of the items for each subscale was satisfactory. Allocated stage of change showed significant differences among the scores on the other scales. CONCLUSION: The results of the present study indicate that the RCQTV-K is an effective and valid scale for evaluating the stage of readiness to change in patients seeking treatment for alcoholism. The findings suggest that the RCQTV-K is a promising assessment tool for use in the treatment and study of alcoholism.
Alcoholism ; Depression ; Humans ; Psychometrics ; Surveys and Questionnaires ; Reproducibility of Results ; Weights and Measures

Treacher Collins syndrome is inherited as an autosomal dominant trait with variable penetrance. It shows a marked variability even in the same family. This syndrome is developmental defect affecting the branchial arches. It is not usually associated with acute respiratory distress, but has symptoms of microtia, hypoplastic zygomatic bones, hypoplastic mandibular rami, and bilateral coloboma. It usually requires an emergency operation immediately after the birth. We experienced an infant with Treacher Collins syndrome who showed retrognathia, glossoptosis, microtia, and cleft palate. Intermittent cyanosis, depression of the chest, respiratory difficulty associated with airway obstruction, and swallowing difficulty were also observed. To relieve severe upper airway obstruction caused by retrognathia and glossoptosis, we simultaneously performed tongue-lip adhesion and subperiosteal release of the floor of the mouth. The respiratory and swallowing difficulties were relieved and the tongue repositioned anteriorly. We report the present case with a review of the literature.
Airway Obstruction* ; Branchial Region ; Cleft Palate ; Coloboma ; Cyanosis ; Deglutition ; Depression ; Emergencies ; Humans ; Infant* ; Mandibulofacial Dysostosis* ; Mouth ; Parturition ; Penetrance ; Retrognathia ; Thorax ; Tongue

The management of mandibular condylar fractures in children has long been a matter of controversy. The fracture, if not treated appropriately, may result in complications such as disturbance of mandibular growth and temporomandibular joint ankylosis. They are usually treated nonsurgically, which has been proved to be satisfactory in the long term results. Nineteen children with 25 condylar fractures experienced during their growth period (age at trauma from 10 months to 12 years, mean 7.0 years) were studied. All patients were treated by arch bars and intermaxillary fixation for 7-14 days. They have been evaluated with clinical and radiographic examination. The maximum mouth opening and lateral movement of the mandible were within normal limits. There was no malocclusion or ankylosis. Beginning of remodelling was evident at postoperative 1.3 months. Remodelling of the condyle was good in 21, while partial adjustment occured in the other 4 condyles. These results suggest that the conservative treatment of condylar fractures in growing children results in good functional results and good remodelling of the condyle.
Ankylosis ; Child* ; Humans ; Malocclusion ; Mandible ; Mouth ; Temporomandibular Joint

Adenomyomatosis of the gallbladder is Characterized by hyperplastic changes including overgrowth of the mucosa, thickening of the muscle wall, and intramural diverticula, crypts, or sinus tracts(Rokitaasky-Aschoff sinuses). The main diagnostic test for the detection of this disease is oral cholecystography but it's use is being decreased. Recently, Ultrasound, ERCP, and CT have been used for diagnosis. We present a report of case in whom ademomyomatosis of gallbladder was disgnosed on ultrasound and ERCP and confirmed by surgery. The essential feactures of ultrasound and ERCP diagnosis are discussed.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystography ; Diagnosis ; Diagnostic Tests, Routine ; Diverticulum ; Gallbladder* ; Mucous Membrane ; Ultrasonography

STUDY DESIGN: A retrospective study. OBJECTIVES: By analyzing the patients of neurofibromatosis with spinal deformities, to identify presence of dystrophic changes, progression of deformity and associated factors, and treatment results according for sagittal curve pattern and operative methods. SUMMARY OF LITERATURE REVIEW: A single thoracic curve involving four, five, or six vertebrae is recognized as the most common pattern. Risk factors for progression of curve were anterior vertebral scalloping, particularly in younger patients, three or more penciled ribs, abnormal kyphosis, etc. It has been stated that the most effective management for dystrophic curves is early and aggressive surgery. MATERIALS AND METHODS: Thirty nine patients with neurofibromatosis and spinal deformities were reviewed with chart and radi-ographic review from 1977 to 1999. RESULTS: Four of thirty nine patients were nondystrophic type, and all patients were treated nonoperatively. Thirty five of thirty nine patients were dystrophic type, and twenty seven patients were treated operatively. Eight of these patients had been in progress till operation with 7.9 degrees/year progression rate, and their commonest pattern of deformity is a single curve in lower thoracic area with dystrophic changes such as vertebral scalloping, wedging, pencilling of average four ribs, particularly. Forty three percent of dystrophic type has sagittal plane deformities. The pedicle screw system was most excellent among the instrumentations. The complications of surgery were 6 progression of curve, 2 metal failure. Reoperation was done in 5 of 27 operated patients. CONCLUSIONS: Nondystrophic type had good results with nonoperative treatment, but dystrophic type mostly required surgical intervention and had rapid progression. The treatment should be done by rigid fixation after considering sagittal plane deformi-ties and long term follow-up was needed for progressions of curve.
Congenital Abnormalities* ; Follow-Up Studies ; Humans ; Kyphosis ; Neurofibromatoses* ; Pectinidae ; Reoperation ; Retrospective Studies ; Ribs ; Risk Factors ; Scoliosis ; Spine