No abstract available.
Brain* ; Meningitis* ; Tuberculosis, Meningeal

In the real-time two-dimensional Doppler flow mapping(2DD) system, Doppler signals are processed using auto-correlation technique, so that the direction, velocity and turbulence of the intracardiac blood flow are displayed by coloration on the B mode image of the heart in real time. Aortic regurgitant flow is imaged as a mosaic jet spurting out from the aortic valve orifice to cardiac chamber. Dynamic features in the direction and extent of regurgitant flow and the site of regurgitation on the aortic valve orifice are readily obtained. Feasibility of the 2DD system in the assesment of aortic regurgitation was examined in 30 cases documented by angiography. In 30 cases, there were 20 cases with aortic regurgitation(AR) aged 16 to 57 years(mean 34) and 10 cases without AR aged 17 to 39 years(mean 30). The underlying disorders of AR were rheumatic in 15 cases, bicuspid aortic valve in 1, ventricular septal defect in 1, aortitis in 1, Marfan's syndrome in 1 and unknown in 1. The results are as follows : 1) In 19 out of 20 cases with AR the 2DD showed regurgitant jet spurting out from valve orifice(sensitivity=95%). One case missed by the 2DD had 1+AR. None of the 10 cases who had no AR manifested the evidence of AR on the 2DD(specificity=100%). 2) There was an excellent positive correlation between the maximal jet length of regurgitant flow on the 2DD and angiographic severity of regurgitation(r=0.998, p<0.001). The maximal jet length was less than 3cm for cases with 1+, 3-4.9cm for 2+, 5-5.9cm for 3+, and 6cm or more for 4+AR. 3) In 19 out of 20 cases with AR, the 2DD identifed the anatomic valvular site of regurgitation(sensitivity=95%, specificity=100%). 4) The regurgitant aortic valvular area was measured as 0.6cm2 or less in all of 12 cases with 2+ or less AR, while 0.9cm2 or more in 6 out of 7 cases with 3+or more AR. Thus, a less or greater than 0.8cm2 regurgitant aortic valvular area provides to discriminate between mild(< or = 2+) and severe(> or = 3+) AR. 5) In all 8 cases with fluttering of anterior mitral leaflet and 8 out of 9 cases with fluttering of interventricular septum, a regurgitant jet impinged on them. The results of this investigation indicate that the 2DD system is a very useful and unique noninvasive technique in the detection, estimation of severity and spatial orientation of AR.
Angiography ; Aortic Valve ; Aortic Valve Insufficiency* ; Aortitis ; Bicuspid ; Equidae ; Heart ; Heart Septal Defects, Ventricular ; Marfan Syndrome

Late aseptic loosening of the acetabular component following total hip arthroplasty become increasing frequently after about 10 years and has become a more severe problem both in frequency and severity than femoral component loosening. The complexity of acetabular revision depends largely on the reconstruction required to restore normal anatomy due to acetabular bone loss. The clinical and radiologic results of acetabular revision using a porocoated acetabular component fixed to the pelvis with screws were studied in 36 patients (40 hips) who had moderate or severe acetabular loss. Acetabular revision in patients whose bone stock had already been destroyed provied more formidable problems at revision surgery. The mean Harris hip score was improved 46 to 84. Bone graft union was achieved by 7.4 months and incorporated by 16 months. The graft bone resorption was noted minor degree lateral to the cup. Of 40 cases, 2 cases required re-revision of acetabular cup for identifiable failure of fixation and one was showed probable loosening. The results of the present study suggest that revision of the acetabulum with use of a hemispherical cementless component stabilized with multiple screws and morselized bone grafts filling bone defects appears to be successful in restoring bone stock and providing a stable, pain-free reconstruction.
Acetabulum* ; Arthroplasty, Replacement, Hip ; Bone Resorption ; Hip ; Humans ; Pelvis ; Transplants

The fracture of the upper end of the femur is unique in orthopedics because it is endemic to an elderly population with special problem. In trochanteric fractures open reduction and internal fixation, with a hip nail used to maintain reduction, have become the standard treatment protocol for the elderly. Unlike fractures of the femoral neck, nonunion and avascular necrosis is rare but more frequently complicated by fatal sequele, such as pneumonia, thromboembolic disease, and decubitus ulceration. In order to achieve early ambulation of a patient with a trochanteric hip fracture, two conditions must be met: The implant used for fixation must be strong enough to withstand loadings exerted upon it during fracture healing, and the fracture itself must be rendered stable in a suitably reduced position. The treatment of the fracture of the femoral neck has a long and frustrating history. As recently as 20 years ago McCarroll remarked that this fracture must be considered “unsolved” until the incidence of aseptic necrosis and nonunion could be diminished or abolished. But now with adequate reduction, impaction, accurate internal fixation with newer devices, and carefully supervised postoperative care the fracture of the femoral neck can be expected to heal at least 90 per cent of the patients. A lower incidence of recognizable aseptic necrosis has been reported under these circumstances. X-ray films of 94 cases of hip nailing for hip fractures were collected in the Department of Orthopedic Surgery of Seoul National University Hospital. Twenty seven cases considered to be failed in hip nailing were analysed radiologically, and following results were obtained. 1. The incidence of failed hip nailing was most frequent in the fifties with average age of 54. 6 years, which seemed somewhat younger than that of the hip fracture. There was no sexual difference. 2. Hip nailings were failed in 23 cases of the femoral neck fractures and in 4 cases of the trochanteric fractures, which revealed respectively 52.3% and 8.2% of failure. Among these the technical failure was 22.7% in femoral neck fractures and 6.1% in trochanteric fractures. 3. Among the various fixation devices, Smith-Petersen nail or hip screws which has no side plate to fix the shaft rigidly showed high failure rates. 4. In all cases the etiology of the failed hip nailing was functional, such as failure of reduction, failure of fixation, penetration of the head, avaseular necrosis, infection, and inadequate postoperative management. 5. Most cases of femoral neck fractures which was not achieved near anatomical reduction was failed in fixation. 6. Too long or short nails showed high failure rates. In view point of this, hip nail should fix the lateral cortex, calcar femorale and center of subchondral bone, even in the trochanteric fracture. So devices such as heavy compression sliding nail or multiple pinning were more desirable to achieve complete fixation. 7. When, in the fresh fractures of the femur neck cannot be reduced to an anatomical or slightly overcorrected position, endoprosthesis should be considered seriously. When the joint is abnormal, the total hip arthroplasty can reduce morbidity and mortality, and also shorten the hospitalization.
Aged ; Arthroplasty, Replacement, Hip ; Clinical Protocols ; Early Ambulation ; Femoral Neck Fractures ; Femur ; Femur Neck ; Fracture Healing ; Head ; Hip Fractures ; Hip ; Hospitalization ; Humans ; Incidence ; Joints ; Mortality ; Necrosis ; Orthopedics ; Pneumonia ; Postoperative Care ; Pressure Ulcer ; Seoul ; X-Ray Film

Radical cystectomy is the most common and effective treatment modality for invasive bladder cancer. However, in case of the elderly patient its application accompanies anxieties over the possible mortality and complications. We purposed to analyze the postoperative mortality and early complication of the elderly patients compared to those of non-elderly patients. We reviewed retrospectively the medical records of 27 elderly patients, over 70 years of age and 61 non-elderly patients, under 69 years of age who were not at high risk anesthesiologically and underwent radical cystectomies with ileal conduits for invasive bladder cancers during last 11 years. We compared mortality, early complications, and postoperative hospital days between two groups. There was no death related to operation in elderly group, but one of the non-elderly group died of sepsis and DIC(disseminated intravascular coagulation) postoperatively Overall early complications were significantly higher in elderly group(P=0.013). But the major complications that were life threatening or required reoperation revealed no significant difference between two groups. There was no significant difference in postoperative hospital days(16.8 days in elderly group, 16.1 days in non-elderly group) between two groups. In conclusion, radical cystectomy can be performed as an effective and safe modality for the treatment of invasive bladder cancer even in elderly patients if only they are not at high risk anesthesiologically.
Aged* ; Anxiety ; Cystectomy* ; Humans ; Medical Records ; Mortality* ; Reoperation ; Retrospective Studies* ; Sepsis ; Urinary Bladder Neoplasms ; Urinary Diversion

The influence of vitamin A acetate on the induction of bladder carcinogenesis by N-butyl-N-(4- hydroxybutyl) nitrosamine(BBN) was studied in male Wistar rats. Animals were divided into 4 groups : Group I and II received BBN and/or vitamin A acetate for 12 and 20 weeks. respectively. Group I and II were further divided into 3 subgroups : Subgroup a received BBN only, subgroup b BBN and vitamin A acetate in 100 IU per gram diet and subgroup c BBN and vitamin A acetate in 200 IU per gram diet, respectively. Group E received only vitamin A acetate and Group IV only basal diet. Animals were killed at 20 weeks after first carcinogen exposure and bladder was examined by both light and electron microscopy. At the two dose levels. vitamin A acetate significantly reduced the incidence and extent of carcinoma in Group I, as well as in Group X Vitamin A acetate of lower and higher dosage were nearly same in the inhibitory effect of development of carcinoma. Vitamin A acetate did not reduce the incidence of papilloma, but reduced the extent of papilloma in group I significantly. Vitamin A acetate also reduced the incidence of high grade neoplasm and deeply invasive cancer. Hypervitaminosis A did not develop at both lower and higher dosage of vitamin A acetate. Cancer cells in animals which received both vitamin A acetate and BShl often showed cytolysis, pyknosis and disruption of cellular membrane. The present findings indicate that vitamin A acetate inhibits or delays the development of bladder carcinoma without significant toxicity.
Animals ; Carcinogenesis* ; Diet ; Humans ; Hypervitaminosis A ; Incidence ; Male ; Membranes ; Microscopy, Electron ; Papilloma ; Rats* ; Rats, Wistar ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Vitamin A* ; Vitamins*

No abstract available.
Bartter Syndrome*

No abstract available.
Fistula* ; Pyriform Sinus* ; Thyroiditis, Suppurative*

No abstract available.

OBJECTIVES: This study examined the effects of illiteracy on neuropsychological functions of older Korean adults. Illiteracy was evaluated with the Literacy Questionnaire which involved interview with the subjects. METHODS: The participants were 206 healthy people, ages between 55 and 84, who were sampled in the Seoul-Kyungki region and Chungnam province. RESULTS: The results revealed that verbal memory tests were not disadvantageous to illiterate people. Rather non-verbal tasks such as the copy condition of the Simple Rey Figure Test and the Clock Drawing Test proved disadvantageous. CONCLUSION: Literacy appears to be beneficial to the development of visuospatial abilities. Neuropsychological tests that involve visuospatial function may not be efficient in discriminating dementia patients who are illiterate.
Adult* ; Chungcheongnam-do ; Dementia ; Literacy ; Humans ; Memory ; Neuropsychological Tests ; Surveys and Questionnaires