There is still discussion concerning the methods for treating Tossy type 3 dislocations of the acromioclavicular joint. Since 1995, the authors have treated 10 patients of type 3 dislocations by arthroscope-assisted modified Weaver and Dunn operation with favorable results. The operation consisted of diagnostic shoulder arthroscopy, arthroscopic resection of acromial end of coracoacromial ligament with bone block, excision of distal end of clavicle, bone block transfer of coracoacromial ligament into the medullary canal of clavicle, and augmentation between coracoid process and resected distal end of clavicle with the Mersilene tape. The advantages of this arthroscope-assisted modified Weaver and Dunn operation are as follows: (1) Using the shoulder arthroscope, associated patholgy in the shoulder joint can be found and treated appropriately. (2) Arthroscopic resection of the acromial end of coracoacromial ligament can give the small incision and least damage to the deltoid muscle so that immediate post-operative range of motion exercise can be possible. (3) Bone block transfer of coracoacromial ligament and augmentation between coracoid process and resected clavicular end can prevent displacement of the resected clavicular end.
Acromioclavicular Joint ; Arthroscopes* ; Arthroscopy ; Clavicle ; Deltoid Muscle ; Dislocations* ; Humans ; Ligaments ; Range of Motion, Articular ; Shoulder ; Shoulder Joint

In the literature, the scapular neck fracture with ipsilateral acromioclavicluar dislocation(type I), mid-clavicular fracture(type II) or sternoclavicular dislocation(type III) is defined as floating shoulder. Authors managed 4 cases of type II floating shoulder, 3 cases by open reduction and internal fixation for the clavicular fracture only and 1 case by conservative therapy. The final results were excellent in 3 cases of the operative group and good in 1 case of the conservative group, by UCLA shoulder rating scale. There were no complications, including drooping or limited motion in the operative treatment group. However, there was shoulder pain in the case of the conservative treatment. It is thought that internal fixation for the clavicular fracture only may be the simple and sufficient treatment method for type lI floating shoulder.
Neck ; Shoulder Pain ; Shoulder*

No Abstract Available.
Chondrocytes* ; Phenotype*

Pulmonary edema is a rare adverse reaction to the iodinated contrast medium. Complaining of huge abdominal mass, a 52 years-old female was admitted to the Hangang Sungsim Hospital. On physical examination, the patient appeared to be healthy. She had stable vital Signs, i.e. BP: 120/80 mmHg, pulse rate: 80/min. etc. An adult head sized mass was palpated in the left mid and lower abdomen. Otherwise nonspecific. On laboratory studies, the positive findings were 8-10 WBC/HPF in urine, 25.6 mg/dl for BUN and PVC in EKG. It was negative for urine protein, serum creatinine and liver function test. We injected 100ml and 30 ml for Urografin 60 through the abdominal aortadividing 3 times and major branches of the abdominal aorta, respectively. Immediately after completing angiography, interstitial pulmonary edema was found, showing blurring of the vascular margins, perivascular haziness and thickening of the interiobular septal lines in the both lower lung fields. The blood pressure was dropped to 80/60 mmHg, but pulse rate was normal. She did not complian of dyspnea, and cyanosis was not developed. The urine volume was normally maintained. She was treated for pulmonary edema, which was completely absorbed after 20 hours. And the blood pressure was also normalized. We has experienced a case of pulmonary edema developed after intraarterial injection of the iodinated contrast medium without underlying cardiac, renal and hepatic problems, and reviewed the literatures on mechanisms of pulmonary edema caused by intravascular injection of the iodinated contrast materials.
Abdomen ; Adult ; Angiography ; Aorta, Abdominal ; Blood Pressure ; Contrast Media ; Creatinine ; Cyanosis ; Diatrizoate Meglumine ; Dyspnea ; Electrocardiography ; Female ; Head ; Heart Rate ; Humans ; Injections, Intra-Arterial ; Liver Function Tests ; Lung ; Physical Examination ; Pulmonary Edema ; Vital Signs

No abstract available.
Drug Therapy*

For the successful autologous chondrocyte transplantation, it is important to maximize the number of chondrocyte and maintain its original morphology and phenotypic change of the chondrocyte in the culture. In this study, the effect of ascorbic acid and human serum which are known to promote cell proliferation and collagen synthesis was observed in the culture of human chondrocyte. Media were prepared with the conditions of fetal bovine Serum(FBS) treated group, FBS +ascorbic acid(asc) treated group, human serum(HuS) treated group, and HuS+asc treated group, respectively. Proliferation was measured by cell counting using trypan-blue staining method. We used to determine the degree of expression of aggrecan of mRNA and type II collagen using RT-PCR. Type II collagen in cultured cell and medium was measured by western blot analysis and proteoglycan synthesis by DMB (Dimethylene Blue) assay. Under all conditions, aggrecan on mRNA level was well expressed. On the other hand, expression of type II collagen was reduced on HuS treated group than FBS treated group, and ascorbic acid treated groups showed decreased expression of type II collagen. Western blot analysis showed increased expression of type II collagen on HuS treated group than FBS treated group, and ascorbic acid treated groups showed increased level. HuS+asc treated group showed the most significant effect than the other groups. The increased effects of ascorbic acid on the proliferation and collagen synthesis were more prominent in the culture with human serum. It might be due to the synergic effect with some growth factors which were present in human serum.
Aggrecans ; Ascorbic Acid* ; Blotting, Western ; Cell Count ; Cell Proliferation ; Cells, Cultured ; Chondrocytes* ; Collagen ; Collagen Type II ; Hand ; Humans* ; Intercellular Signaling Peptides and Proteins ; Phenotype* ; Proteoglycans ; RNA, Messenger

PURPOSE: To compare the outcomes of phacovitrectomy and vitrectomy only for treatment of primary rhegmatogenous retinal detachment. METHODS: The anatomical success, functional success, and complications between Group I patients who underwent vitrectomy only and Group II patients who underwent phacovitrectomy for primary rhegmatogenous retinal detachment were retrospectively compared. RESULTS: Twenty-one eyes (84.0%) in Group I had reattachment after vitrectomy only, and 27 eyes (90.0%) in Group II had reattachment after phacovitrectomy. However, the differences in the measures attributes were not statistically significant (p = 0.271). The logMAR visual acuity improved in both groups with no statistically significant difference between the two groups (p = 0.102). Postoperative complications included cataract progression in 20 eyes (80.0%) in Group I and 17 of the 20 eyes (68.0%) underwent cataract surgery within one year after the first surgery. CONCLUSIONS: Phacovitrectomy, irrespective of severe lens opacity, is a relatively effective combined surgical procedure in older patients with primary rhegmatogenous retinal detachment and impending presbyopia. The procedure allows for easy access to the periphery during vitreous shaving and prevents the need for a second cataract operation.
Cataract ; Eye ; Humans ; Phacoemulsification ; Postoperative Complications ; Presbyopia ; Retinal Detachment ; Retinaldehyde ; Retrospective Studies ; Visual Acuity ; Vitrectomy

PURPOSE: We examined the success rate and adverse effects of ultrasound-guided axillary and supraclavicular approach brachial plexus block. METHODS: From December 2013 to February 2014, 580 cases of patients received ultrasound-guided axillary approach or supraclavicular approach brachial plexus block. All blocks were performed by one anesthesiologist under ultrasound visualization using 0.2% or 0.75% ropivacaine 1% lidocaine with epinephrine in 1:200,000 as the anesthetic mixture. RESULTS: Failure rate of ultrasound-guided brachial plexus block was 1.2% and 0.2% in axillary and supraclavicular approach, respectively. In supraclavicular approach brachial plexus block, Honer's syndrome was observed in 17.9%, chest discomfort in 14.9%, and arterial puncture in 1%. There was no adverse effect in axillary approach brachial plexus block. CONCLUSION: Ultrasound-guided brachial plexus block serves higher success rate and lower occurrence rate of adverse effect and makes it useful for hand and upper extremity surgery. Supraclavicular approach has relatively higher success rate and lower rate of adverse effect than axillary approach.
Brachial Plexus* ; Epinephrine ; Hand ; Humans ; Lidocaine ; Punctures ; Thorax ; Ultrasonography ; Upper Extremity

OBJECTIVE: To evaluate the effect of hyaluronidase in patients with failed back surgery syndrome (FBSS) treated with interlaminar lumbar epidural injection (ILEI). METHOD: Sixty patients suffering from severe low back pain and sciatica were randomly allocated into three groups. Group T received ILEI with 2 ml triamcinolone 40 mg/ml and 5 ml bupivacaine 0.25%. Group H received ILEI with 1500 IU hyaluronidase and 5 ml bupivacaine 0.25%. Group TH received interlaminar lumbar epidural injection (ILEI) with 1500 IU hyaluronidase, 2 ml triamcinolone 40 mg/ml and 5 ml bupivacaine 0.25%. The effect was evaluated using Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) at pre-injection, 2 weeks, 6 weeks and 12 weeks after ILEI. RESULTS: After 2 weeks and after 6 weeks, patients in both Group T and Group TH had significant effectiveness more than Group H in decrease of VAS and ODI. After 12 weeks, only patients in Group TH had significant effectiveness in decrease of VAS and ODI (p<0.05). In every period, Group TH had the most effectivess in decrease of VAS and ODI after ILEI. CONCLUSION: ILEI for FBSS with triamcinolone and hyaluronidase is considered to have more long term effectiveness to reduce pain and improve function after ILEI than injection with triamcinolone alone or hyaluronidase alone.
Bupivacaine ; Failed Back Surgery Syndrome ; Humans ; Hyaluronoglucosaminidase ; Injections, Epidural ; Low Back Pain ; Sciatica ; Stress, Psychological ; Triamcinolone

Spinal epidural abscesses are uncommon, but potentially devastating and often fatal. They can be found in normal patients, but they are more prevalent in immunocompromised patients, such as intravenous drug users, diabetics, chronic renal failure patients, pregnant women, and others. Timely diagnosis and treatment are the keys to optimizing outcome. Traditionally, treatment has comprised parenteral antibiotics and possible surgical intervention, such as decompression by pus drainage. We treated a long level (T4-L1) epidural abscess in a diabetic patient who had to undergo emergent long level decompression and drainage due to complete paralysis of the lower extremities and progression of neurologic deficit toward the upper thoracic level. Although lower extremity paralysis has not improved, the patient has completely recovered from lower extremity anesthesia. Further follow-up was not done because the patient expired due to sepsis eight month after surgery.
Anesthesia ; Anti-Bacterial Agents ; Decompression ; Drainage ; Drug Users ; Epidural Abscess ; Female ; Follow-Up Studies ; Humans ; Immunocompromised Host ; Kidney Failure, Chronic ; Lower Extremity ; Neurologic Manifestations ; Paralysis ; Pregnant Women ; Sepsis ; Suppuration