BACKGROUND: Electroconvulsive therapy (ECT) that works by electrically inducing grand mal seizure is an effective therapy for patients with major psychosis and affective disorders. But ECT may produce intense stimulation of the central nervous system resulting in hypertension and tachycardia. Such an acute hyperdynamic state may be undesirable because of possible cardiovascular complications. We compared the ability of different bolus doses of esmolol to blunt the hemodynamic effects of ECT. METHODS: Twenty ASA physical status 1~2 patients were enrolled in a crossover design study to determine the effects of two standard esmolol bolus doses (0.5 mg/kg and 1.0 mg/kg) on the hemodynamic response and seizure duration during ECT. In each patients receiving esmolol or placebo, arterial pressure, heart rate, seizure duration and peripheral oxygen saturation (SpO2) were recorded. RESULTS: The seizure duration with placebo was 43 +/- 9 sec, esmolol 0.5 mg/kg bolus dose was 39 +/- 14 sec and esmolol 1.0 mg/kg bolus dose was 39 +/- 12 sec, but it was not significant. Compared with esmolol 0.5 mg/kg bolus dose, esmolol 1.0 mg/kg bolus dose decreased blood pressure and heart rate during ECT more effectively. CONCLUSIONS: Esmolol 1.0 mg/kg bolus dose was considered to be the better dose in blunting the hyperdynamic response during ECT without shortening of seizure duration.
Arterial Pressure ; Blood Pressure* ; Central Nervous System ; Cross-Over Studies ; Electroconvulsive Therapy* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hypertension ; Mood Disorders ; Oxygen ; Psychotic Disorders ; Seizures ; Tachycardia

Because clinical course of the Legg-Calve'-Perthes disease (LCPD) is varied and unpredictable, it is important that pediatric orthopedists have to know prognostic factors of LCPD in order to choose proper method of treatment. The most universally accepted prognostic factor is the patient's age at the onset of the disease, and most patient's who are less than 5 years old have been treated non-operatively. However, we believe that the extent of involvement of the femoral head is more important in this age group and that operative treatment can get good results in cases of servere head involvement. The purpose of this study is to evaluate the efficacy of femoral varus osteotomy in patients before the age of 5 years with severe involvement. We reviewed 18 patients (23 hips) who were less than 5 years old with Catterall group III (5 patients, 7 hips) or IV (13 patients, 16 hips) involvement from June 1984 to June 1994. Femoral varus osteotomies were performed in all cases. We followed up more than 2 years (range, from 24 to 130 months) and analysed clinical and radiological results. The results were as follows: 1. The mean duration from onset of the disease to the stage of repair was 16 months (range, from 8 to 27 months). 2. 2 hips (28.6%) in group III and 12 hips (75%) in group IV showed radiographic head at-risk signs. 3. Clinically all hips in group III showed good result. However, among the 16 hips in group IV, 13 hips were rated good and 3 hips were fair. Overall, 20 hips (86.9%) showed good result. 4. Radiologically all hips in group III showed good result, whereas in group IV, 10 hips were rated good and 6 hips were fair. Overall, 17 hips (78.9%) showed good result. We concluded that femoral varus osteotomy in patients less than 5 years old with severe involvement might shorten the course of disease and might be effective method.
Child* ; Child, Preschool* ; Fibrinogen ; Head ; Hip ; Humans ; Legg-Calve-Perthes Disease* ; Osteotomy*

Recent advances in surgical techniques and equipment have made bone lengthening by callotasis both easier and safer, and many successful clinical cases have been reported. The callus formation, however, has often been very poor, and prolonged applied of the external jixator increases the risk of serious complications, such as pin tract infection. We reviewed 68 cases of limb lengthenings performed with callus distraction in 48 patients at Kang Nam St. Mary' s Hospital between January 1989 and May 1994. There were 29 female and 19 male patients, with an average age of 19 (6-50) years. Causes of limb shortening were short stature (14), poliomyelitis (8), fracture and physeal damage (6), osteomyelitis (6), Legg-Calve-Perthe's disease (4), bone tumor (3), congenital dislocation of the hip (3), leg length discrepancy (3), achondroplasia (2) and hip dysplasia (1). Sixty eight calluses were classified radiographically into 6 types: external, straight, attenuated, opposite, pillar, and scattered. The healing indexes and complications following the procedure were evaluated. The mean femoral lengthening was 6.2 (2-10) cm, the tibial 6.5 (3.3-15.7) cm, the forearm 1.8 (1.6- 2.2) cm and the humerus 10 cm. Fifteen cases classified as external type, 5 femur, 7 tibiae, 2 forearm and 1 humerus, with healing index of 34 days/cm and no major complications. Thirty one cases classified as straight type, 7 femur, 22 tibiae, 1 forearm and 1 humerus with healing index of 38 days/cm and 2 obstacles. Fourteen cases classified as attenuated type, 4 femur and 10 tibiae with healing index of 47 days/cm and 2 obstacles. Six cases classified as opposite type, 4 femur and 2 tibiae with healing index of 65 days/cm and 3 obstacles and 1 residual complications. Two cases classified as scattered type, 2 tibiae with healing index of 116 days/cm and 5 obstacles. The scattered type of the callus in two cases was suspected to be a result of poor callus formation due to K-wire breakage conditions that autogenous bone marrow transplantations were performed. This classification enabled us to estimate the intrinsic conditions, predict the healing index, incidence of complications, and decide to apply early bone marrow injection to the callus.
Achondroplasia ; Bone Lengthening ; Bone Marrow ; Bony Callus* ; Classification* ; Dislocations ; Extremities* ; Female ; Femur ; Forearm ; Hip ; Hip Dislocation ; Humans ; Humerus ; Incidence ; Leg ; Male ; Osteogenesis, Distraction ; Osteomyelitis ; Poliomyelitis ; Tibia

The object of treatment of Legg-Calve-Perthes disease (L.C.P.D.) is to shorten the clinical course and minimize, or prevent residual deformity, This is accomplished by placing the femoral head deeply within the acetabulum, so that its articular surface is completely contained and maintaining a full range of motion, thereby preventing lateral extrusion of head, concentrated vertical loads and collapse. The purpose of this study was to determine the predicting value of prognosis and correlation of three different evaluating methods, when examining an identical series of radiographs to assess the effect of treatments, and to determine whether the result obtained by femoral osteotomy gave better result than those by non-surgical means. During the past ten years prior to writing, 89 patients with L.C.P.D. were treated by authors. Seventy eight (87.6%) patients were boys and 11 (12.4%) girls. Their ages at the time of initial visit ranged from 2 to 13 years. Twelve (13.5%) patients had bilateral and 77 had unilateral involvement for a total of 101 hips. They were analysed according to Catteralls classification, and also comparative study was done for 32 patients who were followed up over 15 months. The longest follow-up was 5 years and 2 months. They were divided into 2 groups: clildren in group A were treated by rest and abduction brace,. followed over 3 years and 3 months in average, and children in group B were treated, by intertro-chanteric osteotomy, followed over 2 years and 6 months in average. End results for 32 cases were evaluated at each follow-up time by Length/Width Index (L/W.I.) of femoral neck (Robichon, 1974), Migration Index (M.I.) and Spherical quotient (S.Q.) of capital femoral epiphysis (Edsberg et al, 1979). L/W.I.,M.I, S.Q. were used not only as the method of evaluation, but also were used as a predicting the prospective clinical course during the treatment by regular measurement whether it takes the good course or not. Results obtained were as follows: 1. 21(20.8%) were classified as group I, 30(29.7%) as group Il. 31(30.7%) as group III and 19 (18.8%) as group IV. 43 children (42.6%) on their initial visit were found to have this diasbling hip condition at stage II (necrosis and early fragmentation stage). 2. Regardless of the type of treatment, good results were obtained in younger children under age of 7 years, and in mild form as in group I, and lI. Also good, results were obtained in the cases who had treatment at early stage of the disease. No difference was found in the end results between girls and boys when they had same degree of head involvement. 3. In 14 surgically-treated patients, the good results were obtained in 9(64.3%) when assessed by L/W I. 10(75.4%) by M.I., and 7(50%) by S.Q., while in 18 conservatively treated patients good results were obtained in 8(44.4%) when assessed by L/W I. in 6(33.3%) by M.I., and 7(38.7%) by S.Q.. This fact means that S.Q. under-estimates the results of well-treated cases, while M.I. seemingly over-estimates them. 4. when X-rays of the hips were taken in different position's, different L/W Indices were unexpectedly obtained; these deviations in assessment may be listed as a drawback. Migration Index can prognosticate the healing process of the disease during treatment, if the index together with medial joint space is measured repeatedly with certain intervals. Also it is difficult to obtain accurately the S. Q. by measurements because of difficulty locating the center of fragmentary head, but it is considered the best method assessing the end-result at the healed stage. S.Q. expresses the head spherocity, while the M. I. expresses the degree of head coverage and the neck L/W.I. expresses the indirectly amount of neck deformity. 5. When the clinical course is assessed by three evaluating methods, occasionally these three results contradict to each other and do not show similar prognostic tendency or trend. The reason is that neck L/W Index and Spherical quotient indicate directly the progress of the disease while Migration Inex receases only the state of femoral head containment and there by indirectly indicates ensuing prospective course when containment is good, and do not indicate the state of severity of the involved head. 6. In this study, the result of surgically treated patients were superior to those of conservatively treated patients.
Acetabulum ; Braces ; Child ; Classification ; Congenital Abnormalities ; Containment of Biohazards ; Epiphyses ; Female ; Femur Neck ; Follow-Up Studies ; Head ; Hip ; Humans ; Joints ; Legg-Calve-Perthes Disease ; Methods ; Neck ; Osteotomy ; Prognosis ; Prospective Studies ; Range of Motion, Articular ; Writing

Balloon cell malignant melanoma (BCMM) is a rare histologic variant of malignant melanoma, which is composed either predominantly or entirely of large clear or foamy cells. The incidence of balloon cell malignant melanoma is about 0.15% of all cutaneous malignant melanomas. Recently, we experienced a case of cutaneous balloon cell malignant melanoma in the right lower abdomen with right inguinal and both axillary lymph node metastasis in a 56-year-old man. The cutaneous lesion was 4.5 3.5 cm in size, a well-demarcated black nodular mass, involving abdominal skin and subcutaneous tissue. The tumor was histologically composed of two types of tumor cells: predominant clear cell and focal, pigmented spindle cell. The nodal lesion was composed entirely of clear cells. Both clear and spindle cells showed positive reaction for S-100 protein and HMB-45 on immunohistochemistry.
Abdomen ; Humans ; Immunohistochemistry ; Incidence ; Lymph Nodes ; Melanoma* ; Middle Aged ; Neoplasm Metastasis ; S100 Proteins ; Skin ; Subcutaneous Tissue

During 1964 to 1967, a survey of 30,534 persons for filariasis was made on all over the country with the following results: Among 24,816 draftees from all over the country in the army recruitment camp 155(0.63 %) were found infected with Brugia malayi. Cheju Do showed the highest microfilaria rate(3.5 %), North Kyongsang Do(1.4 %) the next and South Cholla Do(1.2 %) the third. Blood films from 2,308 inhabitants were examined and 407(17.6 %) showed microfilaria in Cheju Do. 30(3.1 %) out of 974 inhabitants in North Kyongsang Do were found to be infected. The microfilaria rates were 2.0 per cent for 400 inhabitants of Chindo island in South Cholla Do. However, no positive case of microfilaria was found in the inhabitants of Kokumdo among 1,820 persons examined in South Cholla Do and of Namhae island(among 165 persons examined) in South Kyongsang Do. The mean microfilarial density per 20 cu. mm of blood was 52.6 in the inhabitants of Cheju Do, 12.2 in North Kyongsang Do and 27.3 in Chindo island(South Cholla Do). Any distinct relationship between the incidence of positive cases of microfilariae and age or sex of the cases was not observed in Cheju Do. However, in Norh Kyongsang Do and South Cholla Do the microfilaria rate of the male group is higher than the one of the female group of the inhabitants. From the above survey results it turned out that filariasis was found throughout Southern Korea except Kyonggi Do and South Kyongsang Do. A total 30,534 persons examined, 601(2.0 %) were found to be infected by Brugia malayi. Therefore, it seems that there are some endemic foci of malayian filariasis in three main areas such as North Kyongsang Do, South Cholla Do and Cheju Do.
parsitology-helminth-nematoda-Brugia malayi ; filariasis ; epidemiology ; Army

Cortex mori (Morus alba L.: Sangbaikpi), the root bark of mulberry tree, has been used as an antiphlogistic, diuretic, and expectorant in herbal medicine. Previous studies have demonstrated that the phenolic extract of Cortex mori have hypotensive, hypoglycemic, antifungal, antiviral, antiinflammatory, and anticancer effects, and the hot water extract from Cortex mori has inhibitory effects on compound 48/80- induced mast cell degranulation and histamine release from rat peritoneal mast cells (RPMCs). This study was perforrned to investigate the effects of polysaccharide fraction from Cortex mori (PFCM) on compound 48/80-induced degranulation, histamine release, calcium influx, changes of intracellular cAMP and cGMP level, and morphological changes of RPMCs. The results were summarized as follows. 1) Compound 48/80-induced cytomorphological changes such as swelling, degranulation, intracellular vacuoles, and interrupted cell boundary were significantly inhibited by pretreatment with either hot water or polysaccaride fractions frorn Cortex mori (PFCM), 2) the compound 48/80-induced histamine release from RPMCs pretreated with PFCM was significantly inhibited, compared to that of control without PFCM pretreatment, 3) the PFCM inhibited remarkably the compound 48/80-induced calcium influx into the RPMCs, 4) the PFCM increased significantly the intracellular cAMP levels and decreased the intracellular cGMP levels of RPMCs, compared to those of normal control, and 5) the compound 48/80-induced cAMP levels of RPMCs pretreated with PFCM were significantly increased, compared to those of positive control without PFCM, and the compound 48/80-induced cGMP levels of RPMCs pretreated with PFCM were remarkably decreased, compared to those of positive control without PFCM. From the above results, it is suggested that PFCM have an activity to inhibit the compound 48/80-induced mast cell activation.
Animals ; Calcium ; Herbal Medicine ; Histamine Release ; Mast Cells* ; Morus ; Phenol ; Rats ; Trees ; Vacuoles ; Water

PURPOSE: The purpose of this study was to analyze teaching status and knowledge about children with Attention Deficit Hyperactivity Disorder (ADHD) in elementary school teachers. METHODS: The participants of this study were 204 elementary school teachers in Busan. From July to September 2010, the researchers collected data by using self-report questionnaires consisted of questions about their teachers' characteristics and teaching status and KADDS (36 items) developed by Sciutto, Terjesen and Frank. Frequency, percentage, arithmetic mean, standard deviation, t-test and ANOVA were used to analyze the data using SPSS WIN 16.0 program. RESULTS: Less than 50% of the participants had previous education on ADHD. According to this experience, there were significant differences in participants' knowledge about children with ADHD (t=4.703, p<.001). For the 36 items, participants had an average of 19.19+/-4.58 points out of a possible 36. Moreover, lack of knowledge about teaching children with ADHD and communication problems with the parents of these children were considered to be the most disturbing factors. CONCLUSION: These results suggest that networks among teachers, parents and medical care professionals should be established. The results also indicate that educational programs for elementary school teachers should be developed in order to identify and teach children with ADHD appropriately.
Attention Deficit Disorder with Hyperactivity ; Child ; Humans ; Parents ; Child Health ; Surveys and Questionnaires

No abstract available.
Paget Disease, Extramammary

Cranial fasciitis is a rare fibroblastic tumor which shows a predilection for the scalp of young children. We present a child with a rapidly growing mass and lytic skull lesion which on pathologic evaluation was diagnosed as cranial fasciitis. Histologically this lesion was identical to nodular fasciitis which was typically found in the trunk and extremities of adults. Cranial fasciitis is unique in that it may present as a lytic lesion in the skull, but this disease entity is not widely known to pathologists and radiologists, and should be included in the differential diagnosis of fibroblastic lesion occurring in the cranium of young children.
Adult ; Child ; Diagnosis, Differential ; Extremities ; Fasciitis* ; Fibroblasts ; Humans ; Scalp ; Skull