After total knee replacement, the breakage of implant is unusual. We have been experienced the two cases, one is the porous tibial plate breakage that Miller/Galante total knee system(MG TKS) and the other is the metal-backed polyethylene patellar component breakage with low contact stress(LCS) pros-thesis. Revisions have been performed by using Nexgen and modular posterior stabilized P.F.C. total knee system. Considerations of these causes are habitual abrupt hyperflexion of the knee and weight bear-ing. So we need to careful observation of long term clinical, radiological and survival results of total knee prosthesis in regard of the breakage of implant.
Arthroplasty, Replacement, Knee* ; Knee ; Knee Prosthesis ; Polyethylene

BACKGROUND: The presence of cardiac metastasis from cervical cancer is very rare. Due to the rarity of this condition, clinical characteristics of the patients with cardiac metastasis from cervical carcinoma is not well known. This study is to investigate the clinical profiles and outcomes of patients with cardiac metastasis from the carcinoma of the uterine cervix. MATERIALS AND METHODS: From Jan. 1990 to May 1999, 4 patients with cardiac metastasis from cervical cancer during the course of the disease were registered in Korea Cancer Center Hospital. The clinical characteristics of these patients were reviewed retrospectively. RESULTS: Mean age of patients was 49 years, and median interval from initial diagnosis to recurrence was 27 months. Histologically, all 4 cases were squamous cell type carcinoma. The stage distribution is two patients with FIGO stage II, one with stage I and one with stage III. Clinical symptoms of patients were dyspnea and facial edema in 2 patients, facial edema in one patients, and dyspneas only in one patient. All patients were confirmed histologically by pericardiocentesis. Synchronous metastatic lesions were supraclavicular lymph node, lung parenchyme and paraaortic, mediastinal lymph node. Following pericardiocentesis or pericardiodesis, all patients were improved clinically and survived for mean interval of 5.3 months. CONCLUSIONS: The patients with pericardial metastasis from cervical carcinoma showed a short survival time, but could be managed by pericardiocentesis or pericardiodesis with improvement of clinical symptoms.
Cervix Uteri ; Diagnosis ; Dyspnea ; Edema ; Female ; Humans ; Korea ; Lung ; Lymph Nodes ; Neoplasm Metastasis* ; Pericardiocentesis ; Recurrence ; Retrospective Studies ; Uterine Cervical Neoplasms*

OBJECTIVE: There are various posterior fusion techniques in managing C1-2 instability. The aim of this study is to evaluate surgical techniques and clinical results including complications of the C1 lateral mass and C2 pedicle screw fixation (C1-2 LMPSF) in atlantoaxial disorders. METHODS: From February 1997 to July 2008, 24 patients were performed C1-2 LMPSF due to C1-2 instability. Pathway of vertebral artery was classified into three groups by 3D-angiogram. Diameter of C1 lateral mass and C2 isthmus on the plain X-ray and CT was measured before operation. Surgical method was divided into four groups according to fixation site (bilateral or unilateral) and bone graft (with or without graft). Stability of C1-2 fixation was postoperatively evaluated by flexion and extension cervical lateral films. We reviewed clinical data, imaging studies and old chart retrospectively as sources for analysis. RESULTS: Among 24 patients, os odontoideum was the most common cause (16 out of 24). Four patients had anomalous vertebral artery. Mean diameters of C1 lateral mass was 9.9(range 4.2~16.4) mm at right side, 10.3 (range 3.4~14.2) mm at left side. Mean diameter of C2 isthmus was 5.8 (range 1.0~10.1) mm at right side and 5.8(range 2.1~8.2) mm at left side. Two patients showed very narrow C2 isthmus. As a result, unilateral C1-2 LMPSF was performed on 6 patients (4 for anomalous vertebral arteries and 2 for narrow C2 isthmus). 12 of 18 patients were with C1-2 interlaminar bone graft and 6 patients without bone graft. All patients showed stable C1-2 fixation by flexion and extension cervical lateral X-ray films taken at least 6 months after surgery. Five out of 8 patients who had preoperative radiculopathy only showed improved symptoms. However, Seven out of 8 patients who had myelopathy showed little neurological improvement . CONCLUSION: For C1-2 LMPSF, preoperative 3D CT-angiogram study is mandatory to identify abnormal vertebral artery and narrow C2 isthmus. Bilateral C1-2 LMPSF without bone graft is enough to obtain stable C1-2 fixation. If there is an abnormal vertebral artery or narrow C2 isthmus, unilateral C1-2 LMPSF with bone graft and wiring is alternative successful method.
Humans ; Radiculopathy ; Retrospective Studies ; Spinal Cord Diseases ; Transplants ; Vertebral Artery ; X-Ray Film

Erdheim-Chester disease is a rare non-langerhans cell histiocytic disorder of an unknown cause that may associate with multisystem, rapidly fatal, infiltrative disease. We report here on a case of Erdheim-Chester disease in a 45-year-old man who presented with chronic renal failure. The patient visited a local clinic due to renal failure that was accidentally diagnosed on a routine health examination. At that time, abdominal computed tomography revealed retroperitoneal fibrosis and bilateral hydronephrosis. However, he did not visit hospital for further evaluation. After 1 year, he visited our clinic due to exertional dyspnea that had developed several months previously. The chest and abdominal CT showed interstitial pneumonitis and pleural effusion and there was progressed hydronephrosis and perirenal fibrosis. He was diagnosed with Erdheim-Chester disease based on the characteristic findings of pleural biopsy (interstitial fibrosis, infiltration of macrophge, CD68-positive but S-100 negative). The patient was treated with insertion of a double J catheter and immunesuppression with prednisolone and azathioprine. Erdheim-Chester disease is a rare disease, but it should be considered in those patients displaying chronic renal failure with retroperitoneal fibrosis.
Azathioprine ; Biopsy ; Catheters ; Dyspnea ; Erdheim-Chester Disease* ; Fibrosis ; Humans ; Hydronephrosis ; Kidney Failure, Chronic* ; Lung Diseases, Interstitial ; Middle Aged ; Pleural Effusion ; Prednisolone ; Rare Diseases ; Renal Insufficiency ; Retroperitoneal Fibrosis ; Thorax ; Tomography, X-Ray Computed

OBJECTIVE: Jumping from high place for the purpose of suicide results in various damages to body area. A burst fracture of vertebrae is representative of them and we reviewed eight patients who were diagnosed with spinal burst fracture following suicide falling-down. The demographics, characteristics, performed operation, combined injuries, psychological past histories of the patients were analyzed. METHODS: A retrospective study was made of patients who are diagnosed with vertebral burst fracture from falling-down with the purpose of suicide admitted to department of neurosurgery of the author's hospital, covering the period between 2003 and 2012. RESULTS: Total eight patients were suicidal jumper. There were eleven vertebral burst fractures in eight patients and mean age was 26.5 years old. Seven patients already had psychological past history and there were various combined injuries except vertebrae burst fracture. The ankle fracture such as calcaneus, talus, navicular and malleolus was the most common injury and there were also various combined injury. CONCLUSION: Suicidal jumper is different from incidental faller in some aspects because of different injury mechanism. For managing suicidal jumper, physician had to consider patients' age, affected site, psychiatric problem and combined injuries. Each department related to the injuries of patient have to cooperate each other with departments of psychiatry and rehabilitation from beginning to end.
Ankle Fractures ; Calcaneus ; Demography ; Humans ; Neurosurgery ; Rehabilitation ; Retrospective Studies ; Spinal Fractures ; Spine ; Suicide ; Suicide, Attempted* ; Talus

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.
Absorption ; Biological Availability ; Fasting ; Gastric Acid ; Hospitals, General ; Humans ; Itraconazole* ; Korea ; Outpatients ; Tablets ; Tinea Pedis* ; Tinea* ; Treatment Failure