The subluxation of the femoral head is one of important prognostic factors in LCPD and current treatment of LCPD is based on the premise that adequate containment of the vulnerable femoral head within the acetabulum during the process of repair should result in a more spherical femoral head and a more congruous joint than if treatments were not provided.We analised the arthrographic findings of 18 hips in unilateral LCPD in order to determine the changes of the femoral head and acetabulum, degree of the subluxation and containment of the femoral head in various position of hip. The results were as follows: 1. According to the result of sphericity, the femoral head was deformed mainly in coronal plane in LCPD. 2. Average medial joint space of normal hip was about 3.8mm in the AP view of hip, but it was more increased in any position of LCPD. 3. In abduction with internal rotation, average subluxation ratio was 7.5% in normal hip and 10.9% in LCPD. In abduction with external rotation, it was 8.3% in normal hip and 12.4% in LCPD. 4. In normal hip, the containment ratio was more than 1.0 in any position of hip, but the containment ratio was 1.03 in abduction with internal rotation and 0.95 in abduction with external rotation of hip in LCPD. 5. On the basis of these results, efficacy of the Scottish Rite orthosis was doubtful in most hips of LCPD.
Acetabulum ; Arthrography ; Containment of Biohazards ; Head ; Hip ; Joints ; Legg-Calve-Perthes Disease ; Orthotic Devices

No abstract available.
Pancreatic Pseudocyst*

No abstract available.
Aorta, Thoracic* ; Rupture*

PURPOSE: The purpose of this paper was to evaluate the treatment results according to bone union, union time, and complications, including infection of unreamed nailing of tibial fractures between closed and open fractures. MATERIALS AND METHODS: We reviewed 64 tibial shaft fractures that were treated with unreamed tibial nail. These included 42 closed fractures and 22 open fractures. RESULTS: Average union time of closed fractures was 19.8 weeks and that of open fractures was 20.2 weeks, nonunion rate were 4/42 and 3/22 in closed and open fractures. Average union time were 19.2, 20.4, 21.3 weeks in open grade I, II, llla fractures. According to the type of fractures, average union time were 18.5, 20.2, 24.6 weeks and nonunion rate were 2/29, 3/26, 2/9 in type A, B, C fractures. According to the level of fractures, average union time were 20.0, 20.3, 19.4 weeks and nonunion rate were 1/5, 4/37, 2/22 in proximal, middle, and distal fractures. There was no significant differences in average period of radiologic union, infection rate and nonunion rate between closed and open fracture group, but longer union time and higher nonunion rate in complex and comminuted fractures (P<0.05). CONCLUSIONS: We consider unreamed intramedullary nailing in the tibial shaft fractures as a good treatment modality for closed and open grade I, II, IIIa fractures
Fracture Fixation, Intramedullary ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Tibial Fractures*

Chronic hepatitis C (CHC) treatment has dramatically improved since direct-acting antiviral (DAA) therapy was introduced. However, the use of DAA therapy in CHC patients with hepatocellular carcinoma (HCC) remains controversial. We investigated the DAA treatment response in CHC patients with HCC. Methods: We retrospectively analyzed CHC patients treated with DAA from 2016 to 2018. Patients were divided into two groups based on their HCC-history before DAA therapy. Baseline characteristics, sustained virologic response at 12 weeks (SVR 12), and HCC recurrence after DAA therapy were evaluated. We also used propensity score matching (PSM) in a 2:1 ratio to reduce confounding variables. Results: A total of 192 patients were enrolled; 78.1% were treatment-naïve, and 34.9% had liver cirrhosis (LC). Among these patients, 168 did not have HCC, and 24 had HCC. The HCC group was older (57.0 years vs. 72.0 years, p < 0.001), had a higher incidence of LC (26.2% vs. 95.8%, p < 0.001), fibrosis-4 index (2.6 vs. 9.2, p < 0.001), liver stiffness measurement (7.0 kPa vs. 17.4 kPa, p = 0.012), and α-fetoprotein (4.4 ng/mL vs. 8.2 ng/mL, p ≤ 0.001). The SVR 12 rate was 97.0% in the non- HCC group and 91.7% in the HCC group (p = 0.213). HCC recurrence was observed in 14 patients (58.3%) in the HCC group. Conclusions: DAA treatment efficacy in CHC patients with or those without HCC were not significantly different, and HCC recurrence was relatively common.

OBJECTIVE: The purpose of this study is to evaluate the vitality of the teeth in and adjacent to the mandibular fracture line according to variable conditions of fracture and to establish the protocol of treatment of fracture line teeth. MATERIALS AND METHODS: The vitality of 97 teeth in fracture line and 104 teeth adjacent to fracture line of 52 patients were invested preoperatively. Of these, 66 teeth in fracture line and 72 teeth adjacent to fracture line were monitored at least 6 months after operation. An electric pulp tester was used to measure pulpal response. The relationships between the vitality of teeth in variable time(preoperation, immediate post-operation; within 1 week after operation, and 6 months after operation) and variable conditions of fracture(horizontal, vertical gap of fracture line, the number of fracture line)were evaluated statistically. RESULT: The vitality of fracture line teeth in the 6 months after operation statistically differed by the vertical gap of fracture line and the number of fracture line. The vitality of fracture line adjacent teeth in the immediate post-operation only statistically differed by the vertical gap of fracture line. There were statistically differences between preoperative EPT value and vitality of fracture line teeth on 6 months after operation. There were 5 cases of complications including periapical and periodontal abscess. Of these, only one tooth was extracted and the others were well treated with endodontic treatment and subgingival curettage. CONCLUSION: It is recommended to retain teeth and to monitor the vitality of teeth in and adjacent to fracture line, unless there is an absolute indication for extraction.
Humans ; Mandibular Fractures* ; Periodontal Abscess ; Prognosis* ; Subgingival Curettage ; Tooth*

The diagnostic possibility and the incidence of ectopic pregnancy are increasing due to several factor. Furthermore, radioimmunoassay of serum β-HCG and US make it possible to diagnose early before the tubal rupture. A conventional surgical approach has been considered as a choice of treatments. Until recent years, however, surgery may have considerable risk of infertility and sugical hazard. In view of the natural tendency of some ectopic pregnancies to terminate in tubal abortion or complete resorption, we tried to cure ectopic pregnancy with nonsurgical transcervical intervention. Five of 8 patients with unruptured tubal pregnancies, it was possible to inject PGF2a into the tubes or gestational sac. 4 of them were ended up with satisfactory reduction of serum β-HCG level and improvement of symptoms & signs. In only one patient, β-HCG level remained a high level continuously, so salpingectomy was done. As a result, we consider that fluoroscopy-guided transcervical interventional procedure is a useful treatment modality for early unruptured ectopic pregnancy.
Abortion, Spontaneous ; Female ; Gestational Sac ; Humans ; Incidence ; Infertility ; Pregnancy ; Pregnancy, Ectopic* ; Pregnancy, Tubal ; Radioimmunoassay ; Rupture ; Salpingectomy

The diagnostic possibility and the incidence of ectopic pregnancy are increasing due to several factor. Furthermore, radioimmunoassay of serum β-HCG and US make it possible to diagnose early before the tubal rupture. A conventional surgical approach has been considered as a choice of treatments. Until recent years, however, surgery may have considerable risk of infertility and sugical hazard. In view of the natural tendency of some ectopic pregnancies to terminate in tubal abortion or complete resorption, we tried to cure ectopic pregnancy with nonsurgical transcervical intervention. Five of 8 patients with unruptured tubal pregnancies, it was possible to inject PGF2a into the tubes or gestational sac. 4 of them were ended up with satisfactory reduction of serum β-HCG level and improvement of symptoms & signs. In only one patient, β-HCG level remained a high level continuously, so salpingectomy was done. As a result, we consider that fluoroscopy-guided transcervical interventional procedure is a useful treatment modality for early unruptured ectopic pregnancy.
Abortion, Spontaneous ; Female ; Gestational Sac ; Humans ; Incidence ; Infertility ; Pregnancy ; Pregnancy, Ectopic* ; Pregnancy, Tubal ; Radioimmunoassay ; Rupture ; Salpingectomy

BACKGROUND: Ropivacaine is an amide local anesthetic structurally related to bupivacaine. A randomized, double-blind study was performed to compare the clinical effectiveness of ropivacaine and bupivacaine in patients undergoing lower-extremity surgery. METHODS: Forty-nine patients (ASA I-II) were randomized to receive 15 ml of 0.5% ropivacaine or bupivacaine. Twenty patients received 15 ml of ropivacaine and 20 patients received 15 ml of bupivacaine at the L3,4 or L4,5 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, duration and degree of motor block, the quality of anesthesia and the heart rate and blood pressure profile during the block onset. RESULTS: Demographic characteristics were similar among the groups. Seven patients were excluded from the study due to technical failure of the block, two patients were excluded due to insufficient data. The onset and duration of analgesia at T10 dermatome (mean SD) was 18.9 7.0 minutes and 187.5 34.6 minutes respectively for ropivacaine, and was 15.2 8.8 minutes and 187.8 40.0 minutes respectively for bupivacaine. Maximum block height (mean SD) was T6.5 2.0 for ropivacaine and T6.4 2.0 for bupivacaine. The incidence of complete motor block (Bromage scale 3) was low in the ropivacaine group, being 3/20 for ropivacaine and 12/20 for bupivacaine. CONCLUSIONS: The sensory blockade profile of ropivacaine, administered epidurally, is similar to that obtained with an equal dose of bupivacaine. However motor blockade with ropivacaine is less intense, less frequent, and of shorter duration than with bupivacaine.
Analgesia ; Anesthesia ; Blood Pressure ; Bupivacaine* ; Double-Blind Method ; Heart Rate ; Humans ; Incidence ; Lower Extremity*

BACKGROUND: Ropivacaine is an amide local anesthetic structurally related to bupivacaine. A randomized, double-blind study was performed to compare the clinical effectiveness of ropivacaine and bupivacaine in patients undergoing lower-extremity surgery. METHODS: Forty-nine patients (ASA I-II) were randomized to receive 15 ml of 0.5% ropivacaine or bupivacaine. Twenty patients received 15 ml of ropivacaine and 20 patients received 15 ml of bupivacaine at the L3,4 or L4,5 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, duration and degree of motor block, the quality of anesthesia and the heart rate and blood pressure profile during the block onset. RESULTS: Demographic characteristics were similar among the groups. Seven patients were excluded from the study due to technical failure of the block, two patients were excluded due to insufficient data. The onset and duration of analgesia at T10 dermatome (mean SD) was 18.9 7.0 minutes and 187.5 34.6 minutes respectively for ropivacaine, and was 15.2 8.8 minutes and 187.8 40.0 minutes respectively for bupivacaine. Maximum block height (mean SD) was T6.5 2.0 for ropivacaine and T6.4 2.0 for bupivacaine. The incidence of complete motor block (Bromage scale 3) was low in the ropivacaine group, being 3/20 for ropivacaine and 12/20 for bupivacaine. CONCLUSIONS: The sensory blockade profile of ropivacaine, administered epidurally, is similar to that obtained with an equal dose of bupivacaine. However motor blockade with ropivacaine is less intense, less frequent, and of shorter duration than with bupivacaine.
Analgesia ; Anesthesia ; Blood Pressure ; Bupivacaine* ; Double-Blind Method ; Heart Rate ; Humans ; Incidence ; Lower Extremity*