Interpostion arthroplasty with allograft has been known as a useful option for the shoulder arthropathy, but it has a limitation to immune response. We performed the pectoralis major muscle transfer for shoulder arthropathy. From January 2007 to December 2007, we performed the pectoralis major muscle transfer in 2 patients. They were 1 man and 1 woman, and the mean age of the patients was 70 years (range, 65 to 75). The average follow-up after surgery was 13 months (range, 12 to 14). We analyzed the clinical results by the American Shoulder and Elbow Surgeons (ASES) Score, and evaluated the pain by Visual Analogue Scale. The level of pain reduced from a preoperative average of 10 to a postoperative average of 1. The ASES scores increased from a preoperative mean of 9 to a postoperative mean of 58. These results indicated that interposition arthroplasty with the pectoralis major muscle transfer is a reliable treatment method for the shoulder arthropathy improving shoulder pain, and patient satisfaction.
Arthroplasty ; Elbow ; Female ; Follow-Up Studies ; Humans ; Muscles ; Patient Satisfaction ; Shoulder ; Shoulder Pain ; Transplantation, Homologous

Injuries to sural nerve through surgical incision or open wound in calcaneal fractures were reported as complications causing lateral hindfoot pain. But sural nerve entrapment by adhesive fibrous tissue after Essex-Lopresti axial fixation has not been reported. We report a case of sural nerve entrapment after Essex-Lopresti axial fixation which was successfully treated by nerve decompression.
Adhesives ; Decompression ; Nerve Compression Syndromes ; Sural Nerve* ; Wounds and Injuries

BACKGROUND: This study was undertaken to evaluate the diagnostic sensitivity of several muscles in repetitive nerve stimulation test (RNST) for myasthenia gravis (MG) patients. MATERIALS AND METHODS: The study population consisted of 39 MG patients classified by modified Ossermann's classification. Using Stalberg's method, RNST was systematically performed in facial (orbicularis oculi and nasalis) and upper extremity (flexor carpi ulnaris, abductor digiti quinti and anconeus) muscles. RESULTS: The significant electrodecremental response of RNST were noted in orbicularis oculi (58.9%), nasalis (51.3%), flexor carpi ulnaris (42%), anconeus (41%) and abductor digiti quinti muscles (27%). Among the 3 muscles of upper extremity (abductor digiti quinti, flexor carpi ulnaris and anconeus), the positive electrodecremental response of anconeus muscles was significantly higher than other two muscles (p<0.05) in type IIa, IIb and there were no statistical differences of the positive electrodecremental response between orbicularis oculi and nasalis muscles. The facial muscles showed more prominent decremental responses than upper extremity muscles in type I MG(p<0.05). In type IIa MG patients, there were no significant statistical differences between facial and upper extremity muscles but significant statistical differences among upper extremity muscles. In type IIb MG patients, there were no significant statistical differences in all tested muscles in spite of the increased positive electrodecremental response of RNST. CONCLUSION: On the basis of this study, RNST would be initially performed for the orbicularis or nasalis in type I MG and for the anconeus in type IIa or IIb MG.
Classification ; Facial Muscles ; Humans ; Muscles* ; Myasthenia Gravis* ; Upper Extremity

PURPOSE: Our aim was to evaluate the usefulness of fluid-attenuated inversion recovery (FLAIR) MR imaging for detection of acute subarachnoid hemorrhage (SAH) compared with unenhanced CT. MATERIALS AND METHODS: We compared FLAIR MR images with unenhanced CT scans in 28 patients with acute SAH. Findings of SAH on CT and MR images were graded as 0 (absence), 1 (suspicious), 2 (definite) in the cerebral sulci, sylvian fissure, basal cistern, and cisterns of the posterior fossa. We also compared FLAIR MR images of 28 patients with those of 35 normal subjects, and then the sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of acute SAH were calculated. RESULTS: FLAIR MR image was superior to CT in detecting SAH in the posterior fossa (1.41+/-.74 vs 0.78+/-.80; p<0.05) and cortical sulci(1.11+/-.80 vs 0.70+/-.83; p<0.05). There was no significant difference between FLAIR MR image and CT in detecting SAH in the basal cistern and sylvian fissure. The sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of SAH were 100% in all. CONCLUSION: FLAIR MR image is useful in detecting acute SAH, especially in patients with small amount of SAH or SAH in the posterior fossa.
Humans ; Magnetic Resonance Imaging* ; Sensitivity and Specificity ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed

Bilateral vocal cord paralysis (VCP) is a rare, life-threatening complication of stroke. We described the clinical course and treatment of bilateral VCP by acute ischemic stroke. We confirmed 4 cases of VCP. Two cases had brain-stem lesions, one case showed bilateral cerebral lesions and the last one had brainstem and cerebral lesions. One of the 4 cases showed spontaneous improvement of unilateral vocal cord function after 2 months. Among the rest, one under-went laser cordotomy, one remained tracheostomized, one was lost. (J Korean Neurol Assoc 19(4):400~403, 2001)
Brain Stem ; Cerebral Infarction ; Cordotomy ; Hoarseness ; Laryngeal Nerves ; Stroke* ; Vocal Cord Paralysis* ; Vocal Cords*

BACKGROUND AND PURPOSE: This study was undertaken to compare the sensitivity of the Repetitive Nerve Stimulation Test (RNST) between the upper and lower extremity muscles in myasthenia gravis(MG) patients. MATERIALS AND METHODS: The study population consisted of 20 normal persons(control group) and 10 MG patients(MG group). Using Stalberg's method. RNST was systemically performed in orbicularis oculi muscle. upper extremity muscles(flexor carpi ulnaris. abductor digiti quinti), and lower extremity muscles(tibialis anterior. extensor digitorum brevis. vastus medialis). RESULTS: There were statistical differences of decremental response(mean+/-SD) in orbicularis oculi and upper extremity muscles between the control and MG groups(p<0.05 or p<0.01). However, there was no statistical difference of decremental response(mean+/-SD) to RNST in lower extremity muscles between the control and MG groups. There were highersensitivity in orbicularis oculi and upper extremity muscles than lower extremity muscles. Although positive reponse were detected in the lower extremity muscles, the positive response rates of lower extremity muscles were lower than o.oculi and upper extremity muscles. CONCLUSIONS: When the response rates of RNST in facial and upper extremity muscles are normal, may not be required RNST in lower extremity muscles.
Humans ; Lower Extremity* ; Muscles* ; Myasthenia Gravis* ; Upper Extremity

BACKGROUND: The lockout interval is a safe guard to prevent patients from taking additional dose before the full effect of the preceding dose. Therefore, it should correlate with the time-to-peak effect of the opioid selected. The time-to-peak effect of meperidine is known to be different from that of morphine and fentanyl. But there have been few reports about the influence of varying lockout interval on IV-PCA using meperidine. So we studied the influence of varying lockout interval with constant hourly maximum dose on IV-PCA using meperidine. METHODS: This study included sixty patients undergoing low abdominal surgery under general anesthesia. After administration of initial dose of meperidine (0.5 mg/kg) they were randomly assigned to three groups according to the lockout interval; Group 1 (6-min lockout interval, 0.2 mg/kg bolus dose), Group 2 (9-min lockout interval, 0.3 mg/kg bolus dose), Group 3 (12-min lockout interval, 0.4 mg/kg bolus dose). We examined NRS pain score, sedation score, satisfaction score, PCA measurements and the incidence of side effects during 24 hours. RESULTS: There were no significant differences in NRS pain score, sedation score, satisfaction score, the amount of meperidine consumed, injections/attempts ratio and the incidence of side effects among three groups. The numbers of injections and attempts were significantly higher in Group 1 than in Group 2 and Group 3 (P<0.05). CONCLUSIONS: The lockout intervals chosen for this study (6-min, 9-min, 12-min) do not influence pain, side effects, satisfaction and meperidine consumption in IV-PCA using meperidine when hourly maximum dose is constantly 2 mg/kg.
Analgesia, Patient-Controlled* ; Anesthesia, General ; Fentanyl ; Humans ; Incidence ; Meperidine* ; Morphine ; Passive Cutaneous Anaphylaxis

PURPOSE: Neonatal respiratory distress syndrome is caused by the deficiency of lung surfactant in premature babies. For the treatment of RDS at present surfactants such as Surfacten (Tokyo-Tanabe Co., Japan) and Exosurf (Wellcome Co., USA) are used. As awarded the grant from the Ministry of Science and Technology for a model research project of Medium-Technology program, we have modified (supplemented) the bovine lung extracts to get YY-38, for which we have performed physical and biological activities. METHODS: For physical properties, we performed stable microbubble test (SMR) and measured surface tension lowering activity using a pulsating bubble surfactometer. Minimum and maximum surface tensions measured at 1 and 5 minutes gave surface tension-surface area diagrams, from which compressibility at surface tension 10mN/m was also calculated. As to the biological activity, we used premature rabbit fetuses as a model for the study of pressure-lung volume relationship. The lung pathology was examined on the lung tissues subsequently obtained, and aerated area ratios were calculated based on the area measured by an image analyzer. RESULTS: The minimum surface tensions of YY-38 at 1 and 5 minutes for all different concentrations were low at 10mN/m, while the maximum surface tensions ranged from 33.01mN/m to 41.07mN/m. The surface tension-surface area curve showed a definite hysteresis at 1 and 5 minutes for all concentrations, and the surface tension fell below 10mN/m with 20% surface area compression. The compressibilities at surface tension 10mN/m at 5minutes for all concentrations were all below 0.02. In animal experiments, the mean lung volume of premature rabbit fetuses was inflated to 80.9ml/kg at maximum 30cmH2O, while the lung volume was maintained at 38.3mg/kg when the lung was deflated to 5cmH2O. The overall aerated area ratio was 45.4%. CONCLUSIONS: YY-38 formed sufficient amount of stable microbubbles and had a surface tension low enough to maintain alveolar stability and to exhibit a good hysteresis curve. In animal experiments it helped the expansion of premature lungs during inspiratory phase and was effective in the prevention of collapse during expiratory phase.
Animal Experimentation ; Awards and Prizes ; Fetus ; Financing, Organized ; Lung* ; Microbubbles ; Pathology ; Respiratory Distress Syndrome, Newborn ; Surface Tension ; Surface-Active Agents

Idiopathic hypoparathyroidism is frequeutly associated with intracranial calcification and neuropsychiatric abnormalities. The most commonly recognized central nervous system manifestations of chronic hypoparathyroidism are seizure, alteration of mental function and extrapyramidal signs. We present a care of hypoparathyroidism, demonstrating extensive intracranial calcification, not only basal ganglia, but also outside the extrapyramidal system. An 58-year-old woman presented with 30 year history of seizure and memory disturbance. The physical examination and several laboratory studies disclosed normal. However hypocalcemia, hyperphosphatemia with hypocalciuria and decreased parathormone level were demonstrated. Clinical symptoms and signs showed improvement after supplementary calcium and Vit D3 therapy.
Female ; Humans

We studied occupational status of 175 epileptics have been treated at Yeungnarn university hospital from 1991 to 1992. Their age were in the range of being capable of working. The main purposes were to study the effect of seizure type and degree of control to having job;the effect of additional disabilities to the means of living of epileptics. The results were like these: 1. The employment rate of our patients was 56%. 2. There were no statistical significancy at the effect of seizure type and degree of control to having job(P<0.05). 3. The degree of seizure control did not influence to the position at the job(P>0.05). But additional disabilities and education showed significant effect to the position of job (p<0.05). 4. Among the 138 responders 14 patients had experienced seizure attacks at work and 6 of these 14 patients had some kinds of problem on performing their work by the attacks. 11 of 138 patients disclosed their disease to the employer at the beginning of employment. Conclusion our epileptic patients also have many problems on having job. Which were predominantly related to education. Disabilities and self-denial rather than other related factors.
Education ; Employment* ; Humans ; Seizures