No abstract available.

No abstract available.

PURPOSE: We analyzed the complications of femoral pertrochanteric fractures treated with proximal femoral nail (PFN®) to reduce the its complications. MATERIALS AND METHODS: We evaluated the complications among 198 patients who were treated with PFN® from June 2001 to August 2005 in our hospital. RESULTS: The complications were presented in 28 cases (14.1%). Cut-out of lag screw was in 1 case, cut-out of lag screw and antirotation screw were in 3 cases, cut-out of antirotation screw in 3 cases, of these femoral head fracture was in 1 case. Femoral neck fracture in 1 case, Osteonecrosis of femoral head in 1 case, cortical fracture during the insertion of distal interlocking screw in 1 case, breakage of drill bit intraoperatively in 1 case, fibrous union in 2 case, thigh skin irritation due to screw back-out in 3 cases, periprosthetic fractures in 2 cases, varus collapse more than 10 degrees in 4 cases, superficial and deep infections in 3 cases, breakage of nail in 1 case, varus collapse after PFN removal in 1 case, persistent thigh pain in 1 case. Of all these cases, 9 cases (4.5%) were required reoperation with general or spinal anesthesia. Complications related with screws or fracture reduction were 19 cases (9.6%) and, of these, 17 cases (89.5%) showed increased TAD (tip apex distance) or nonanatomical reduction. CONCLUSION: To reduce the complications of PFN®, we need to exact surgical technique and anatomical reduction and consider the modification of implant design to prevent of cut-out of screws.
Anesthesia, Spinal ; Femoral Neck Fractures ; Femur ; Head ; Humans ; Osteonecrosis ; Periprosthetic Fractures ; Reoperation ; Skin ; Thigh

Symptoms of deep cerebral vein thrombosis (DCVT) are variable and nonspecific. Radiologic findings are essential for the diagnoses. In the majority of cases of deep internal cerebral venous thrombosis, the thalamus is affected bilaterally, and venous hypertension by thrombosis causes parenchymal edema or venous infarction and may sometimes cause venous hemorrhage. Intravenous injections of mannitol can be administered or decompressive craniectomy can be performed for reduction of intracranial pressure. The objectives of antithrombotic treatment in DCVT include recanalization of the sinus or vein, and prevention of propagation of the thrombus. Herein, the authors report DCVT which was successfully treated by low molecular weight heparin.
Brain Edema ; Cerebral Infarction ; Cerebral Veins ; Decompressive Craniectomy ; Edema ; Hemorrhage ; Heparin, Low-Molecular-Weight ; Hypertension ; Infarction ; Injections, Intravenous ; Intracranial Pressure ; Intracranial Thrombosis ; Mannitol ; Thalamus ; Thrombosis ; Veins ; Venous Thrombosis

Chronic fatigue of the respiratory muscles has contributed to the decreased ventilatory capacity and reduced excercise tolerance of individuals with COPD, especially in kyphoscoliosis. Nasal mask BiPAP has been shown to be useful for the patient with nocturnal muscle fatigue and COPD. A 35-year-old man with severe kyphoscoliosis was admitted to ICU due to acute respiratory failure. He had been diagnosed of COPD and had been intubated with mechanical ventilatory support for 7 times. This time he was intubated with ventilatory support, too, in ICU and readmitted to the ICU for severe hypoxemia and hypercarbia from general ward. Thereafter he refused the intubation. Nasal mask BiPAP ventilatory support system was applied and IPAP, EPAP level being adjusted to the 12, 4 cmH2O under monitoring vital signs and arterial blood gas analysis. His condition was improved and discharged home with support of nasal mask BiPAP system after 33 day-stay in the ICU.
Adult ; Anoxia ; Blood Gas Analysis ; Fatigue ; Humans ; Intubation ; Masks* ; Muscle Fatigue ; Patients' Rooms ; Pulmonary Disease, Chronic Obstructive* ; Respiratory Insufficiency ; Respiratory Muscles ; Vital Signs

A case of cavernous angioma of the cerebellar vermis is described. Cevernous angioma is rare vascular malformation of the central nervous system and the cerebellar vermis is very unusual site. Exact preoperative diagnosis of this lesion is difficult because cavernous angioma is angiographically silent and generally accepted to be very rare. The relevant literature is reviewed.
Central Nervous System ; Diagnosis ; Hemangioma ; Hemangioma, Cavernous* ; Vascular Malformations

BACKGROUND/AIMS: ERCP using fluoroscopy should be practiced with an adequate radiation protection. However, the awareness of gastrointestinal endoscopists to radiation protection was considered insufficient. In Korea, a country with a rapid increase the number of ERCP procedures, there is no data about radiation protection practices for gastrointestinal endoscopists. The purpose of this study was to investigate current clinical practices and the awareness on radiation protection in ERCP performing physicians in Korea. METHODS: An anonymous questionnaire regarding radiation protection practices was mailed to 100 members of Korean Pancreatobiliary Association who was porforming ERCP. The questionnaire included ERCP volume of each endoscopist, use of protection devices such as apron, thyroid shield, lead glasses and any mobile shield for scattered radiation, and whether they monitored their own radiation exposure dosage. RESULTS: All respondents wore lead aprons during ERCP. While 52.5% of endoscopists answered that they always wear thyroid guards, 26.9% rarely or never wore it. Only 14% wore lead glasses during the procedure and 69% never wore it. The preparation rates of mobile shields or lead curtains were only 14% and 24%, respectively. Only 10% of endoscopists attached an X-ray badge and 66.7% never used it. Moreover, 75% of endoscopists responded that they did not monitor their own exposure dose to radiation during ERCP. CONCLUSIONS: The lack of radiation protection of ERCP endoscopists in Korea was seemed serious. Awareness of radiation hazard should be more concerned and educated in parallel with the preparation of radiation protection equipments.
*Cholangiopancreatography, Endoscopic Retrograde ; Eye Protective Devices ; Female ; Hospitals ; Humans ; Male ; Occupational Exposure/*prevention & control ; Questionnaires ; Radiation Monitoring ; Radiation Protection/*methods ; Thyroid Gland/radiation effects

Unilateral vocal cord paralysis and dysphagia are not uncommonly seen in the ENT practice. Just less than 10% of unilateral vocal cord paralysis are caused by diseases of the central nervous system, and lateral medullary infarction (LMI) is a wellknown condition that causes dysphagia and unilateral laryngeal paralysis. However, cases of LMI with isolated dysphagia and dysphonia without other typical neurological signs have been rarely reported. We describe the case of a 67-year-old man with chronic hypertension who presented as dysphagia and unilateral vocal cord paralysis without other typical signs of LMI. He was finally diagnosed as LMI on MRI. Although cases of LMI presenting in the manner like this case are extremely rare, ENT physicians should consider LMI in differential diagnosis for this situation, especially when the patient has a previous episode or risk factors of stroke.
Aged ; Central Nervous System ; Deglutition Disorders* ; Diagnosis, Differential ; Dysphonia ; Humans ; Hypertension ; Infarction* ; Magnetic Resonance Imaging ; Paralysis* ; Risk Factors ; Stroke ; Vocal Cord Paralysis ; Vocal Cords*

BACKGROUND: Knowledge about the degree of risk and location of multiple primary cancers can facilitate the targeting of screening and surveillance practices on follow-up after treatment of cervical cancer. PURPOSE: The retrospective study was performed to evaluate the characteristics of multiple primary malignancies in patients treated for cervical carcinoma. METHOD: From data base file of gynecologic cancer patients between 1976 and 1995, total 20 patients were found to have cervical cancer and another primary malignancy. Their medical records and pathologic slides were reviewed. Follow-up information was obtained from medical records or by telephone. RESULT: There were 8 synchronous and 12 metachronous multiple primary cancers (MPC) among 20 patients. Their mean age was 51 years (range 23 ~ 68 years). The distribution of FIGO stage of the patients with cervical cancer was classified into stage I, 6 patients; stage II, 9 ; and stage III, 5. All patients showed squamous cell type histology of cervical cancer. Eight(40 %) of 20 patients developed second cancer in uterus : 6 malignant mixed Mllerian tumors(MMMT), one endometrial stromal sarcoma, and one endometrial adenocarcinoma. Seven of 8 synchronous type MPC patients are alive (median follow-up, 27 months). In contrast, only one out of 12 metachronous type MPC patients is alive(median follow-up, 114 months). The occurrence of eight malignancies including 6 MMMT, one bladder cancer, and one rectal cancer might be related with previous radiation therapy for cervical cancer. CONCLUSION: These results suggest that routine screening and surveillance work-up might not be necessary in most of patients with cervical cancer. However, the patients with cervical cancer undergoing radiation treatment have to be followed carefully with the consideration of possibility for developing second cancer in the field of irradiation.
Adenocarcinoma ; Follow-Up Studies ; Humans ; Mass Screening ; Medical Records ; Neoplasms, Second Primary ; Rectal Neoplasms ; Retrospective Studies ; Sarcoma, Endometrial Stromal ; Telephone ; Urinary Bladder Neoplasms ; Uterine Cervical Neoplasms ; Uterus

This study was performed to demonstrate the efficacy of combination of cold-knife conization and cold-coagulation for the treatment of cervical intraepithelial neoplasia(CIN). In addition, the accuracy of the colposcopic biopsy and Pap smear compare to conization was determined. Cold-coagulation was performed simultaneously in 151 patients after cold-knife conization for diagnosis and treatment of CIN from Jan. 1995 to Dec. 1996. Medical records and pathologic slides of those patients were reviewed. Histologic comparison between the Pap smear and conization specimens showed agreement with 70 % within one grade difference ; Histologic comparison between the colpodirected punch biopsy and conization specimens showed agreement with 80 %. The margin involvement of conization was seen in 35 patients(23 %). There was a tendency of increasing rate of positive cone margin with grade of the lesion : 14 %(1/7) in CIN 1, 20 %(2/10) in CIN 2, 35 %(31/88) in CIN 3, and 33 %(1/3) in microinvasive cervical cancer. Among these 35 patients, 11 patients underwent hysterectomy and showed residual disease in 4 patients(36 %). Recurrence of CIN was found in 4 patients(16 %) with positive cone margin and 1 patient(0.9 %) with negative cone margin. Bleeding was observed in 13 patients(9 %). Two patients underwent hysterectomy because of severe bleeding. These results suggest that cold-knife conization with cold-coagulation is an effective procedure to reduce recurrence rate of the patients with CIN regardless of status of cone margin and to reduce the severity of bleeding after conization.
Biopsy ; Cervical Intraepithelial Neoplasia* ; Conization* ; Diagnosis* ; Hemorrhage ; Humans ; Hysterectomy ; Medical Records ; Recurrence ; Uterine Cervical Neoplasms