BACKGROUND: Alterations in ventricular loading conditions lead to changes in action potential duration via mechanoelectrical feedback. A decrease in load immediately leads to prolongation of repolarization. QT interval and QT dispersion were measured to determine the long-term effect of changes in ventricular systolic load on the ventricular repolarization. METHOD: Corrected QT interval and QT dispersion were measured in 26 patients before and 3-6 months after valvuloplasty for pulmonary stenosis. To determine the effect of ventricular load on ventricular repolarization, patients were divided in 2 groups; Group 1 was those patients with a greater than 30 mmHg and Group 2 was those patients with a less than 30 mmHg decrease in right ventricular systolic pressure. RESULTS: Corrected QT interval (412.6+/-14.5 msec vs 426.4+/-16.8 msec, p < 0.05) and QT dispersion (35.0+/-7.3 msec vs 45.7+/-14..1 msec, p < 0.05)were increased significantly only in Group 1 after vlavuloplasty. CONCLUSION: It suggested that mechanoelectrical interactions are operative for long duration in humans that changes in ventricular load after successful pulmonary valvuloplasty showed long-term effect on the ventricular repolarization.
Action Potentials ; Balloon Valvuloplasty* ; Blood Pressure ; Humans ; Pulmonary Valve Stenosis*

Emphasis on healthcare during the 1990s has been to provide both optimal wellness and function with quality in a cost-effective manner. Critical Pathway was developed to meet the need to guide clients along the continuum of care and to achieve continuity of care. The purpose of this study was to develop on evaluating model of Critical Pathway practices. The topics which developed into Critical Pathway were normal delivery, repairment of cataract, cesarean section delivery, pediatric tonsillectomy and hemorrhoidectomy. The main goals set by teams were educations, improvement of process and quality of care, customer satisfaction and financial achievements. To evaluate the performace of Critical Pathway in clinical process, 13 kinds of perspective key performance indicators were selected by using Balanced Scorecard(BSC) method. The analysis method was Data Mining. Cesarean section discharge abstract data were reviewed for guidelines of model development and classification of control groups. Five kinds of Critical Pathway were developed by multidisciplinary participation by personnels of related departments, and pilot-test was performed. All the Critical Pathway was applied as standard protocols in patient s care since November, 1999. Length of stay was significantly shortened and increased patient s satisfaction in 4 case groups except pediatric tonsillectomy group. Hospital and medication cost of each patient remarkably decreased in all 5 case groups. And the improvement of process and quality of care was appeared during the Critical Pathway implementation period. These results show that new evaluation model of Critical Pathway in medical practice was an effective.
Cataract ; Cesarean Section ; Classification ; Continuity of Patient Care ; Critical Pathways* ; Data Mining ; Delivery of Health Care ; Female ; Hemorrhoidectomy ; Humans ; Length of Stay ; Pregnancy ; Tonsillectomy

OBJECTIVE: To evaluate the influence of the length of the median nerve in the diagnosis of carpal tunnel syndrome (CTS). METHOD: Inching test of median sensory nerve using Ten Electrodes was performed in 114 hands of 68 CTS patients and 68 hands of 34 controls. The abnormal cut-off values of 1-cm, 2-cm, 3-cm, 4-cm, 5-cm, 6-cm, and 7-cm segment studies were calculated as the maximal conduction delay per centimeter (maximal CD/cm)+SD x 2 for each segment in controls. Based on such values, the sensitivity of each segment study in the CTS group and the specificity in controls were obtained. RESULTS: In controls, mean CD/cm was 0.20+/-0.08 ms, and maximal CD/cm was 0.26+/-0.08 ms in the segment between 2 and 3 cm distal to distal wrist crease. With the abnormal cut-off value set at 0.26 ms, the sensitivity of the 1-cm segment study was 98.5% in CTS. The sensitivities of the 2-cm through 7-cm segment studies were 93.9%, 93.9%, 92.4%, 92.4%, 92.4%, and 90.9%, respectively. CONCLUSION: These suggest that studies of longer nerve segments tend to lower the sensitivity of the test because the inclusion of the unaffected segments in calculation attenuates the effect of conduction delay at the site of the lesion.
Carpal Tunnel Syndrome* ; Diagnosis* ; Electrodes ; Hand ; Humans ; Median Nerve* ; Sensitivity and Specificity ; Wrist

PURPOSE: Complete release of the transverse carpal ligament(TCL) is accepted as the standard treatment for carpal tunnel syndrome(CTS). However, loss of grip and pinch power are reported in some patients after complete release of the TCL. This study was designed to evaluate the effectiveness of complete versus partial carpal tunnel release by using the inching technique. METHODS: Nineteen patients(a total of 27 hands) who each had a confirmed diagnosis of CTS were selected from September 2002 to February 2003. The cases were divided into three groups(mild, moderate and severe) based on preoperative electrodiagnostic studies. The patients with partial carpal tunnel syndrome were classified into the mild or moderate groups, while patients with complete carpal tunnel syndrome were classified into the moderate or severe groups. Patient oriented data (functional and symptomatic) were collected and electrophysiologic studies were undertaken preoperatively and postoperatively(on the 2nd week, 1st month, 3rd month and 6th month after surgery). RESULTS: In this study, the mild and moderate groups showed both good functional and symptomatic results and improvements in electrophysiologic studies. CONCLUSION: Carpal tunnel syndrome patients classified into mild or moderate groups based on nerve conduction studies, and whose precise compression sites were pinpointed using the inching technique, can be treated by partial carpal tunnel release.
Carpal Tunnel Syndrome* ; Diagnosis ; Follow-Up Studies* ; Hand Strength ; Humans ; Ligaments* ; Neural Conduction

The purpose of this study was to determine the effects of high heeled shoes on plantar pressure and muscle fatigue. The subjects were 36 women who were divided into three groups, i.e., high heel, middle heel and low heel. The mean height of each heel was over 7 cm, 5 cm and below 2 cm respectively. The plantar pressure was measured by F scan system. The fatigue of subjects was evaluated with endurance time and voluntary maximal contraction that was measured by Cybex 6000 system and the degrees of foot pain and fatigue by visual analogue scale. With high heeled shoes, the plantar pressure was shifted from hindfoot to forefoot, and from the lateral part to the medial part in forefoot. With all shoes, the plantar pressure was generally increased in the forefoot after 8 hours. Especially the pressure of medial and middle parts of forefoot was significantly increased on high heeled shoes. Voluntary maximal contraction and endurance time was significantly decreased in subjects with high heeled shoes for 8 hours. The degrees forefooot pain and fatigue by visual analogue scale were very significantly increased in subjects with high heeled shoes. With low heeled shoes, the fatigue was the least degree and the middle heeled shoes are recommendable for cosmetic needs and lesser fatigue and pain. In conclusion, when women were in high heeled shoes for a long time, the pressure of forefoot and foot pain and fatigue were increased. Therefore, these effects of high heeled shoes on the plantar pressure and fatigue should be considered in women with high heeled shoes.
Fatigue ; Female ; Foot ; Heel* ; Humans ; Muscle Fatigue* ; Shoes*

OBJECTIVE: To evaluate the association between neuralgic pain distribution and the severity of carpal tunnel syndrome (CTS). METHOD: Pain drawings using computerized pain chart system were collected from 131 patients (213 hands) with CTS. The presence and severity of CTS were determined by means of median motor and sensory nerve conduction studies. The severity was divided into 3 classes on the basis of electrophysiological findings: mild (93 hands), moderate (70 hands) and severe (50 hands). The similarities between pain drawing patterns and median nerve dermatome in the hands were evaluated. The pain distributions of the palmar and dorsal sides of each five fingers, palm and dorsum of hand were also evaluated. RESULTS: There were no significant differences in similarity values of pain distribution among the groups of CTS hands divided by severity: similarity values were 0.22+/-0.14 in mild CTS patients, 0.24+/-0.16 in moderate CTS patients and 0.27+/-0.14 in severe CTS patients. In the CTS patients, the pain drawings showed relatively frequent distributions in the palmar side of 2nd to 4th fingers. CONCLUSION: There was no significant correlation between pain drawing patterns and severity of CTS. The pain drawings of patients with CTS indicate distribution to be most frequent in the palmar side of 2nd to 4th fingers.
Carpal Tunnel Syndrome* ; Fingers ; Hand ; Humans ; Median Nerve ; Neural Conduction

OBJECTIVE: To evaluate the pain patterns of patients with osteoarthritis (OA) of the knee. METHOD: Forty-four patients (mean age 56.1 years) with pain around the knee who met the Simons' criteria for myofascial pain syndrome (MPS). Patients drew in their pain areas on a pain drawing diagram. The pain areas were input into the Pain Chart System (PCS) software program for analysis. Physical examination, trigger point injection, and exercises for knee muscles were performed. Oral analgesics were not prescribed. RESULTS: MPS was clinically diagnosed in all 44 patients. Radiologic examination revealed degenerative changes in 49 knees. Pain patterns detected by the PCS revealed pain patterns compatible with myofascial trigger point in the vastus medialis in 37 cases, rectus femoris in 32 cases, adductor longus in 5 cases, sartorius in 2 cases, vastus lateralis in 1 case, and the popliteus in 1 case. Following treatment, 36 of the 44 patients experienced pain relief. CONCLUSION: Degenerative changes of the joint seem not to be cause of the knee joint pain. Instead, pain relief following MPS treatment indicates the cause of knee pain as MPS. We recommend that the first step in the treatment for knee pain include recognition and treatment of MPS before applying invasive treatment.
Analgesics ; Exercise ; Humans ; Joints ; Knee Joint ; Knee* ; Muscles ; Myofascial Pain Syndromes* ; Osteoarthritis* ; Physical Examination ; Quadriceps Muscle ; Trigger Points

Intramuscular hemangioma, an infrequent but important cause of musculoskeletal pain, is often difficult to establish the diagnosis clinically. This report describes a case of a 32-yr-old woman who presented with severe left calf pain for 10 yr. Initial conservative treatments consisting of intramuscular electrical stimulation, herb medication, acupuncture, and intramuscular lidocaine injection under the diagnosis of myofascial pain syndrome in other facilities, failed to alleviate the symptoms. On physical examination, there was no motor weakness or sensory change. Conventional radiography of the leg revealed a soft tissue phlebolith. Conventional angiography study showed hemangioma. Intramuscular hemangioma within the soleus muscle was confirmed by magnetic resonance imaging. Following surgical excision of the hemangioma, the patient's symptom resolved completely. Intramuscular hemangioma is a rare cause of calf pain and should be considered in the differential diagnosis if a patient with muscle pain, particularly if associated with a soft tissue mass, fails to respond to conservative treatment.
Adult ; Diagnosis, Differential ; Female ; Hemangioma/*diagnosis ; Humans ; Magnetic Resonance Imaging/methods ; Muscle, Skeletal/anatomy & histology/pathology ; Muscular Diseases/*diagnosis ; Myofascial Pain Syndromes/*diagnosis ; Pain ; Radiography/methods ; Time Factors

The purpose of this study was to investigate the maturation characteristics of neonates. Ninety three neonates underwent a somatosensory evoked potentials(SEPs) testing. Twenty four point seven percent of them were neonates at risks including the neonatal asphyxia, low birth weight under 1500 g, or a suspicious CNS abnormality. Seventy five point three percent of neonates showed normal median SEPs, and 24.7% of them showed abnormal or a flat response. The mean latency of the first cortical component(N1) was 25.3+/-5.4 msec, duration 16.3+/-5.5 msec and amplitude 1.00+/-1.27 V. Thirty one point two percent of neonates showed normal posterior tibial SEPs, and 68.8% showed abnormal or a flat response. The mean latency of the first cortical component(P1) was 44.9+/-5.6 msec, duration 17.5+/-3.9 msec and amplitude 0.47+/-0.38 V. This result suggests that the maturation of rostal nervous system develops earlier than the caudal system. Linear decrease of the cortical latency with post-menstrual age reflects maturation of the central pathway and not merely maturation of the peripheral nerves. But our study showed much less frequency of recordings of the tibial nerve SEPs than the median nerve responses, which suggested that the maturation of spinal cord and lower-limb nerves would be slow, in addition to that the length of pathway was increasing. This result suggests that the maturation of the proximal shorter nervous pathway develops earlier than the distal longer pathway.
Asphyxia ; Evoked Potentials, Somatosensory* ; Humans ; Infant, Low Birth Weight ; Infant, Newborn* ; Median Nerve ; Nervous System ; Peripheral Nerves ; Spinal Cord ; Tibial Nerve

OBJECTIVE: The purpose of this study was to evaluate the reliability of patient pain drawings using a 3-dimensional (3D) virtual human body system. METHOD: Pain drawings were collected from thirty-four patients with various types of musculoskeletal pain. On the first clinic visit, patients were instructed to draw in their pain areas on a diagram depicting the body (P1). The examining physiatrist, blinded to the patients drawing, also drew in the pain areas on a separate diagram based on thorough history taking (D). After 2 to 9 days without treatment, patients repeated their pain drawings (P2). A second physiatrist input each of the pain drawings into thePain Chart System (PCS), for comparison of pain distribution sites and areas among the three drawings. The weighted-sum of comparison algorithms was calculated for similarity determinations between drawings. RESULTS: The similarity values between P1 and P2, and P1 and D were 0.63+/-0.18 (mean+/-S.D.) and 0.62+/-0.18 (mean+/-S.D.), respectively, reflecting a high reliability of pain drawings. CONCLUSION: High test-retest and inter-individual reliability of successive pain drawings suggest that pain drawings may be a useful tool to describe the painful sites.
Ambulatory Care ; Human Body* ; Humans ; Humans* ; Musculoskeletal Pain