STUDY DESIGN: This biomechanical study was designed to perform flexibility tests in multiple loading directions to compare the stabilizing effects of supplemental hook or pedicle screw fixation on short segment pedicle instrumentation system. OBJECTIVE: To compare biomechanical flexibilities of short segment pedicle instrumentation constructs added by hook or pedicle screw fixation in an unstable calf spine model. SUMMARY OF BACKGROUND DATA: Short segment pedicle instrumentation is using recently for the surgical treatment of the unstable burst fractures of the thoracolumbar spine, but a high incidence of early screw tai lure in short segment pedicle instrumentation has reported. MATERIALS AND METHODS: Ten fresh frozen calf spines (T10-L3) were loaded with pure uncosstrained moments in flexion, extension, axial rotation, and lateral bending directions. A maximum moment of 6.4 Nm was achieved in 5 steps using dead weights. After removal of L1 vertebral body, testing was performed on intact specimens first and then each specimen after laminar hook or pedicle screw insertion on the short segment pedicle instrumentation of ISOLA implant. Any kinds of graft material or transfixation device were not used to make the worst possible case of instability of an injured spine. Three different fixation methods were instrumented. These included: (1) one level aboye and one level below with pedicle screw, (2) 2 levels above with pedicle screw and hook and one level below with pedicle screw, and (3) 2 levels abode and one level below with pedicle screws. RESULTS: At the level of corpectomy, all fixation methods significantly reduced motions in flexion, extension, and lateral bending as compared to the intact motion (P<0.001). The differences between all constructs were not statistically significant. The addition of a hook or screw on the short segment pedicle screw construct was not significantly reduced the flexibi lite as compared to the short segment pedicle screw construct. Axial rotational motions in groups I, II, and III were similar with each other and with intact motion as well and there were no significant statistical difference. The addition of the hook or screw on the short segment pedicle construct showed more stability as compared to the pedicle screw construct, but statistical difference was not. The addition of hook or screw on the short segment pedicle screw construct showed similar stability in all motions with each other. At the level above corpectomyl all tested fixation methods did not improve the axial rotational stability beyond the intact case, but reduced flexion, extension, and lateral bending motions significantly (p<0.001). The addition of hook or screw on the short segment pedicle screw construct showed significant stability in all motions (p<0.001) as compared to the short segment pedicle screw construct and their stabilities were similar with each other. CONCLUSIONS: All fixation methods showed more stabilities in all motions than normal specimen. The addition of pedicle screw on the short segment pedicle screw constructs are more stable than the addition of hook, but there was no statistical difference. Adding one level of fixation cranial to the fracture using pedicle screws or hooks may be necessary to decrease the rate of clinical failure and to enhance the stability of the construct with short segment pedicle instrumentation
Incidence ; Pliability ; Spine ; Transplants ; Weights and Measures

The use of intravacular catheterization for both diagnostic and therapeutic purposes increased the incidence of iatrogenic foreign bodies, which might cause many complications such as cardiac arrythmias, perforation of cardiac chamber or blood vessels, sepsis and thromboembolism. The authors experienced 5 cases of successful retrieval of intravascular iatrogenic foreign bodies: three cases of subclavian catheter wire and two cases of subclavian catheter. Subclavian catheter was introduced into right subclavian venous route for hyperalimentation or central venous pressure monitoring. The foreign bodies were located in superior vena cava and inferior vena in four cases and in left main pulmonary artery in the other case. We have successufully removed the foreign bodies by interventional procedures. The loop-snare technique is a safe and effective method for retrieval of iatrogenic foreign bodies in great vessels.
Arrhythmias, Cardiac ; Blood Vessels ; Catheterization ; Catheters ; Central Venous Pressure ; Foreign Bodies* ; Incidence ; Methods ; Pulmonary Artery ; Sepsis ; Thromboembolism ; Vena Cava, Superior

No abstract available.
Antipsychotic Agents* ; Drug Synergism* ; Humans ; Schizophrenia*

BACKGROUND: With the rapid increase in the elderly population and the ensuing increase in osteoporosis and subsequent fractures, there has been a rise in socioeconomic costs. This study evaluated the relationship between osteoporosis and physical function in 66-year-old Korean women. METHODS: All of the 193 Korean women aged 66 years were recruited from life-transition health examinations from May to December, 2007. Background information was collected through a self-administered questionnaire; and height, weight, and waist circumference were measured. Bone mineral density of the lumbar spine was measured with the Dual Energy X-ray Absorptiometry and the 'timed up and go (TUG)' and 'one-leg balance (OLB)' tests were administered. Risk factors for osteoporosis were analyzed by correlation coefficients and binary logistic regression analysis. RESULTS: The prevalence of osteoporosis for 66-year-old women was 25.9%. A short stature and lower body mass index (BMI) were associated with osteoporosis of the lumbar spine. A longer time to complete the TUG test (>10 second) was associated with a 4-time higher prevalence of lumbar osteoporosis, which was not observed with the OLB test. CONCLUSIONS: One out of four 66-year-old Korean women had osteoporosis. A longer TUG time, short stature, and lower BMI were associated with osteoporosis.
Absorptiometry, Photon ; Aged ; Body Mass Index ; Bone Density ; Female ; Humans ; Korea ; Logistic Models ; Osteoporosis ; Prevalence ; Risk Factors ; Spine ; Waist Circumference

BACKGROUND: Ureteral stone(UTS) and acute pyelonephritis are the most common causes of nontraumatic acute flank pain in adults. Urography(IVU) is known as the most ideal diagnostic modality of obstructive uropathy to date. However, it has many practical limitations in overcrowding Korean emergency department to perform IVU as the diagnostic test of UTS. So we have performed prospective analytic study to compare IVU with its alternative diagnostic modalities. METHOD AND RESULTS: Our study was performed at Asan Medical Center from March, 1998 to July, 1999. We performed urinalysis, KUB, grayscale ultrasonography, and IVU in 243 patients, suspected to have UTS, based on histories, physical examination. After excluding patients with undetermined results(n=7) or spontaneous passage of stone before IVU(n=24), 212 patients were enrolled in our study. All of the other diagnostic tests were performed within one hour after emergency room presentation except IVU (53+/-24 hours). Diagnostic agreement among tests are as follows: Urinalysis shows good agreements with KUB(0.53) and IVU(0.62). KUB shows good agreement with IVU(0.48). Ultrasonography shows good agreement with IVU(0.58). Sensitivity(%), specificity(%), positive predicitive value(%), negative predicitive value(%), accuracy(%), and odds ratio of each diagnostic methods are as follows: Urinalysis is 91, 19, 78, 42, 74, 3.88; KUB is 55, 33, 72, 19, 50, 2.49; ultrasonography is 58, 92, 96, 41, 66, 45.61, and IVU is 81, 96, 98, 62, 84, 107.72. CONCLUSION: Although IVU seems to be the most ideal diagnostic modality for the UTS to date, it takes too long time for emergency physicians to confirm the diagnostic using IVU. We can performed other diagnostic modalities within one hour. However, emergency physicians suffer from poor diagnostic accuracy. Therefore, it is concluded that we are in need of more accurate alternative diagnostic modalities for UTS.
Adult ; Chungcheongnam-do ; Diagnosis* ; Diagnostic Tests, Routine ; Emergencies* ; Emergency Service, Hospital* ; Flank Pain ; Humans ; Odds Ratio ; Physical Examination ; Prospective Studies ; Pyelonephritis ; Ultrasonography* ; Ureter* ; Urinalysis

We report a case of generalized plane xanthoma which showed no-rmolipoproteinemia and was not associated with unerlying disorders or other type of xanthomas. A 48-year-old female has noticed well defined, slightly elevated, yellowish plaques which occurred on the periorbital areas, sides of the neck, scapular areas, anterior chest, buttocks and lower extremities for 3 years. Biopsy specimen taken from the neck showed perivascular accumulations of foam cells in the upper and mid dermis. Paper electrophoresis didn't, show elevation of any lipoprotein.
Biopsy ; Buttocks ; Dermis ; Electrophoresis, Paper ; Female ; Foam Cells ; Humans ; Lipoproteins ; Lower Extremity ; Middle Aged ; Neck ; Thorax ; Xanthomatosis*

Death by drowning is a major cause of unnatural death worldwide. It is therefore important to conduct forensic examination of immersed bodies following drowning, in order to determine the diagnosis of drowning, because no specific methods have been established thus far. Therefore, we performed a series of rat experiments to compare autopsy findings between seawater and fresh water drowning cases, which included the presence of pleural effusion and histologic findings of the lung. The results showed that the volume of pleural effusion increased in the seawater drowning group compared to the fresh water drowning group, and the total weight of lung was affected by the type of drowning medium and postmortem interval. However, histologic findings of the lung showed no significant difference between the 2 types of drowning mediums.
Animals ; Autopsy ; Drowning ; Fresh Water ; Lung ; Pleural Effusion ; Rats ; Seawater

No abstract available.
Diatomaceous Earth* ; Pneumoconiosis*

BACKGROUND: In 1996, our emergency department(ED) had 148.4 patients per day and an average time for managing simple and uncomplicated patients was 248 minutes. To relieve congestion, delay and conflict in ED, we have developed Fast Track to treat patients with minor illness rapidly and effectively. The Fast Track area is located in a separate area in front to the main department. The efficiency and effectiveness of new system and patients satisfaction were investigated. METHODS: All ambulatory patients(> 15 years of age) were triaged and treated at Fast Track by emergency physicians. Patients, triaged as severe illness, were moved directly to main ED and the other patients with minor illness were managed in Fast Track. We analysed the patients who were managed at Fast Track from Jan. 1st 1997 through Nov. 30th 1997. The total time staying in Fast Track from beginning of trige to final decision such as discharge or admission was recorded retrospectively. A questionnaire was obtained from random patients in the same period to evaluate the patient's satisfaction. RESULTS: The number of patients who were managed in Fast Track was 13,378, and it was 55.8% of all adult patients who visited ED during the period. The average staying time was decreased significantly with time, (140.9+/-2.9 minutes in June, 125.4+/-2.8 minutes in July, and 97.7+/-1.0 minutes after July). The 75 percentile weighted average time was also decreased significantly; 196 minutes in June, 107 minutes in July, 135 minutes from August to November(p<0.01). The questionnaire were obtained from 107 patients. The results were revealed that 90 of 107 patients(84.1%) were satisfied with emergency care at Fast Track, and the remaining patients expressed unsatisfied comments such as long waiting time(4.7%), overcrowding(1.9%), unsatisfactory care(1.9%). CONCLUSION: The Fast Track system could decrease patient's staying time and improve patient's satisfaction. In addition, the efficiency and effectiveness of the acute care in ED would be enhanced by managing minor illness in Fast Track rapidly and effectively.
Adult ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Estrogens, Conjugated (USP) ; Humans ; Surveys and Questionnaires ; Retrospective Studies ; Tertiary Care Centers*

The proteins, especially the 19S globulin (IgM) and 7S globulin (IgA) in the CO2 snow-induced blister fluids of 10 male healty volunteers were analyzed immunoelectrophoretically. The fnllawing results were obtained. 1) Compared with autologous serum, all blister fluids tested lacked some protein fraction lines. 2) The 19S globulin (lgM) line was absent in all of the blister fluids except one which was contaminated with blood. 3) The 7S globulin (IgA) line was present in all of the blister fluids when undiluted. In 1 : 2 dilution, however, it was absent, or of trace amount in a few cases.
Blister* ; Humans ; Male ; Volunteers