Ultrasound Guided Shoulder Joint Injection through Rotator Cuff Interval / 대한통증학회지

BACKGROUND: Shoulder joint injection is currently performed under fluoroscopic or computed tomography scan guidance. We performed this study to determine if an ultrasound guided shoulder joint injection through rotator cuff interval would have clinical usefulness. METHODS: A total of 17 volunteers [12 women, 5 men; mean age 28 yr (23-32 yr)] received shoulder joint injection under multilinear ultrasound (5-10 MHz). Volunteers were positioned supinely on a table with their arm in a neutral position. The anterior shoulder region of the patient was sterilized using povidone iodine. A 24 gauge needle was introduced and directly visualized in real time as it passed obliquely from the skin surface to the inferior space of the biceps tendon. If there was little or no resistance to the injection, a contrast media (omnipaque) was injected and checked fluoroscopically. RESULTS: Ultrasound guided shoulder joint injection through rotator cuff interval was successful in all cases. The average time taken for the procedure was 27.5 +/- 16.5 sec. The vertical distance from skin to the inferior space of the biceps tendon was 1.6 +/- 0.4 cm and the distance of needle from the skin to the inferior space of biceps tendon was 2.8 +/- 0.6 cm. The procedure was well tolerated by all volunteers. CONCLUSIONS: Ultrasound guided shoulder joint injection through rotator cuff interval is an effective, rapid, and easy-to-perform injection technique. Ultrasound guided injection enables exact needle placement and avoids the use of both ionizing radiation and iodinated contrast material.

An Anesthetic Experience of Intraoperative Hypercapnia in a Patient with Larsen Syndrome: A case report / 대한마취과학회지

Larsen syndrome is a rare congenital connective tissue disorder which is characterized by multiple dislocation of major joints, typical facial appearance, cervical spine narrowing and instability, and respiratory difficulties secondary to laryngotracheomalacia. We describe a case of general anesthesia for orthopedic operations in female infant consistent with Larsen syndrome. The patient showed hypercapnia intraoperatively, but recovered without any sequelae.

Percutaneous Treatment with Steroid Injections and Distension of Facet Synovial Cyst: A case report / 대한통증학회지

Facet joint synovial cysts are uncommon intraspinal abnormalities, which appear to be secondary to degenerative changes of the joints. They can cause chronic back pain and radiculopathy, as shown in spinal stenosis. When symptomatic cysts fail to respond to conservative measurements, surgical decompression is known as the standard treatment. Percutaneous steroid injections, and distension of the cysts under fluoroscopic guidance, may be a minimally invasive treatment option. Here, the case of a patient with a symptomatic L5-S1 facet joint synovial cyst and left S1 radiculopathy, who responded satisfactorily to percutaneous treatment, is presented.

Association between family APGAR and depression for one university freshmen

BACKGROUND: Though many adolescents are suffering from depression in Korea, there have been few studies about the prevalence of it and depressive adolescents are not managed appropriately yet because of ignorance of the society and family. This study was intended to find out college freshmen's prevalence of depression, and the relationship between family function and depression. METHODS: The subjects were college freshmen of one university both in Seoul and Suwon and the study period was from January to February on 1999. Family APGAR was used as a family function index and Beck's Depression Inventory (BDI) was used to measure the degree of depression. Chi square tests and logistic regression were done for analysis using SPSS 8.0/PC program. RESULTS: The prevalence of depression among college freshmen was 1.5%(37 out of 2465) as of BDI score 21 or more. Depression was more common in the families with low Family APGAR score and those in Suwon campus. No significant differences were found in gender, age, blood pressure, blood type, BMI, present illness, number of families, marital status of parents or siblings. Relative risks of depression were 4.5 times for family dysfunction group and 2.6 times for Suwon campus group. CONCLUSION: Depression is not a rare disease among college freshmen. Therefore, family physician as a primary care physician should consider the possibility of depression among adolescence and screen depression using BDI for adolescents in dyfunctional family particularly.

The comparision of the quality of life between the well controlled hypertension group and the uncontrolled hypertension group

BACKGROUND: Hypertension is an important as well as common disease in primary practice, so family physicians should concern about it. It is well known that if hypertension were well controlled, it could lower cardiovascular complications. However, there are few studies on the impact of hypertension affecting the quality of life. Therefore, we carried out this study to compare the quality of life in the hypertensive patients by whether it is well controlled or not. METHODS: The authors surveyed the quality of life using the questionnaire named as CMC Health Survey Version 1.0 for the hypertensive patients. The subjects had no complications and no other diseases, and aged 40 or more, and visited doctors at the Department of Family Medicine, Kyung Hee University Hospital or the Department of Internal Medicine, Sungmin Hospital from May 1 to Aug 31, 1998. We categorized the subjects into the two groups of the well controlled group(SBP or = 140 mmHg or DBP> or = 90 mmHg) and compared the quality of life and lifestyle. RESULTS: The total number of subjects was 119, that of well controlled group was 69, and that of the uncontrolled group was 50. Mean systolic and diastolic blood pressure was 133.1+/-7.5 mmHg and 85.3+/-5.2 mmHg in the well controlled group, 159.2+/-7.4 mmHg and 100.2+/-5.5 mmHg in the uncontrolled group. The comparison of the distribution of age, sex, education, occupation, and monthly income between the two groups showed no difference. The comparision of the lifestyle between two groups by Alameda 7 questionnaire showed no difference ,too. As for the comparison of quality of life between two groups, the well controlled group had significantly higher scores in the domain of physical function, social function, general health, vitality(above P<0.01), emotional function, role limitation, and health perception(above P<0.05) than uncontrolled group. However, the scores of the domain of change in health, satisfaction, bodily pain were not significantly different between two groups. After covariated by obesity, the comparion of quality of life between two groups showed similar results. CONCLUSION: We confirmed that the well controlled group had better quality of life than the uncontrolled group. So family physicians should consider the quality of life when they consult the patients with hypertension.

Usability of HHIE S as a screening test of hearing imairment in the Korean elderly

BACKGROUND: Hearing impairment is one of the most common physical handicaps of the aged. This diseases has recently attracted such amount of social attention and understanding as never attracted several years ago, and high degree of achievement was made with regard to screening test method, diagnosis, treatment and rehabilitation. However, unfortunately, even now, not enough attention is being paid upon early discovery hearing handicap for patients frequently encountered in clinics. Therefore, as a screening test method of senile hypacusis, we were to apply "Hearing Handicap Inventory for the Elderly Screening Version" (HHIE S) inquiries in Korea and studied the usability, sensitivity, specificity, positive predictive value and negative predictive value and cutoff point of this method. METHODS: This study was performed for 120 persons over the age of 60, who visited general health screening centers of one university hospital located in Seoul, during the period of October 1997 through to March 1999. HHIE S questionnaires were used and pure tone audiometry was performed to generate gold standard. RESULTS: Only 110 out of 120 initial subjects were included in the study because of incomplete questionnaire answers by excluded 10 subjects. We defined gold standard of hearing handicap to be (1) lower than 40 dB of hearing capability of both ears to frequency between 1000 Hz and 2000 Hz or (2) lower than 40 dB of hearing capability of an ear to frequency between 1000 Hz and 2000 Hz, as determined by pure tone audiometry. Assuming cutoff point of HHIE S as 4 points, the sensitivity and specificity resulted to be 80% and 67% each. Assuming cutoff point of HHIE S as 6 points, the sensitivity and specificity were 76% and 78% each. At 8 points, the percentages were 64% and 80%. At 10 points, the percentages were 64% and 85%. As a result of this study, the appropriate cutoff point is 6 points. In order to specify the correlation between questionnaire result and pure tone audiometry, we performed 500 Hz, 1000 Hz and 2000 Hz audiometry which are within conversational range, calculated arithmetic mean from the results, and inspected correlation between the resultant mean of the better performing ear and questionnaire resultant points. The correlation coefficient was 0.612 and Chronbach's alpha, as a measurement of internal consistency of the questionnaire was 0.9044. CONCLUSION: HHIE S proved to be useful in screening hearing handicap in the Korean elderly.

Patellar Tendon Length Change after Donor Tendon Repair in ACL Reconstruction

PURPOSE: Shortening of the patellar tendon after ACL reconstruction has been one of the causes of postoperative complieations such as anterior knee pain, patellar baja syndrome because of that reason, donor tendon defect was not closed generally. It took at least two years far the tendon to fill the gap by regenerated tendon tissue. But, sometimes protrusion of infra-patellar fat pad may prohibit the regenera-tion of patellar tendon, This study was designed to assess the amount of actual tendon shortening after tendon closure and complications because of it. MATERIALS AND METHODS: Thirty-two cases of arthroscopically assisted midthird patella tendon autograft ACL reconstruction were studied. Patella tendon defect was closed in all cases and the follow-up duration was more than 12 months. The patellar tendon length was measured before and after the defect site closure in operating room, Also, radiolagic tendon length changes were assessed using Insall-Salvati technique. RESULT: The mean patellar tendon length that had been measured in operating room was 51.5mm, 49.8mm (before and after the tendon defect closure). So, the mean shortening was 1.71mm(3.3%). The mean LT/LP ratio was 0.922, 0.894, 0.898(pre-operative and post-operative 6months, 12months). so, the radiologic mean shortening was 3.0%(6months), 2.6%(12months). There were only 4 cases of anterior knee pain and other complications were not found. CONCLUSION: Patellar tendon length change after donor tendon defect closure was about 3% and there were no complications associated with it.

A Case of polymyalgia rheumatica

Polymyalgia rheumatica is characterized by pain and stiffness of the shoulder and pelvic girdles, morning stiffness, constitutional symptoms and an elevated erythrocyte sedimentation rate. We have experienced a 45-year-old female patient with polymyalgia rheumatica who presented with pain and stiffness of the shoulder and pelvic girdle, an elevated erythrocyte sedimentation rate and dramatic response to low-dose steroids. To our knowledge, thes is the second case of polymyalgia rheumatica with a brief review of literature.