Dislocation involving tarsal navicular is a extremely rare injury compare to dislocation of other tarsal bone. One case of the tarsal navicular dislocation associated with subluxation of the midtarsal joint treated by open reduction and arthrodesis was reported.
Arthrodesis ; Dislocations ; Joints ; Tarsal Bones

There are many procedures described for the treatment of acromioclavicular separation. Eleven cases were operated on by technique of Weaver and Dunn method and ten cases by modified Phemister method and four cases by Dewar and Barrington method, and one cases by Mumford method, Dept. of Orthopaedic Surgery, Capital Armed Forces General Hospital from March 1986 to March 1989. The following results were obtained. l. All patients were male and the peak incidence was in 3rd decade(77%). 2. The most common causes of the injuries were athletic accidents and followed by traffic accidents. 3. Twenty three patients were grade III by Allman's classification and grade II in three cases. 4. Clinical results were good in 19 cases(73.1%), fair in 5 cases(19.2%) and poor in 2 cases(7.7%). 5. The operative procedures in grade III may be good treatment of acromioclavicular separation.
Accidents, Traffic ; Arm ; Classification ; Hospitals, General ; Humans ; Incidence ; Joints ; Male ; Methods ; Sports ; Surgical Procedures, Operative

Forty five cases of adult tibial shaft fractures were treated with flexible intramedullary nails under image intensifier at the department of orthopaedic surgery, Capital Armed Forces General Hospital during between April 1986 to July 1988. The results were summarized as follows: 1. 45 cases were all male, the average age was 24.3 years and the most common cause of fractures was sports injury(20 cases) and the second most common cause was traffic accident(18 cases). 2. 11 cases out of 45 cases were open fracture and 34 cases were closed fracture. Eight cases of open fraeture were grade I and three cases were grade II. Twenty eight cases were comminuted fracture. The most common level of the fracture was middle third of the tibial shaft. 3. Average interval from injury to Ender nailing was 13.5 days and the mean duration of permission to full weight bearing was 9.2 weeks. 4. Out of 2 cases of delayed union, the average time of clinical bone union was 9.7 weeks and that of roentgenological bone union was 14 weeks. 5. 11 cases of complication were noted among the 45 cases of tibial shaft fracture which were treated by PGP nailing such as angulation, rotation, ankle joint stiffness, delayed union, shortening, and soft tissue infection. 6. PGP nailing is considered to be a valuable method in treating tibial shaft fracture because of their relative ease of nailing, allowing early weight bearing and decreased complication.
Adult ; Ankle Joint ; Arm ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Hospitals, General ; Humans ; Male ; Methods ; Soft Tissue Infections ; Sports ; Tibial Fractures ; Weight-Bearing

Dislocation of the clavicle at its sternal end is relatively rare, as compared with acromioclavicular dislocation. Among them, the posterior dislocation of the sternoclavicular joint was extremely rare. So, not more than fifty cases had been reported in the literature. Of these three main typesanterior, superior, and posterior-the anterior one is by far the most common. Most authors have stressed the difficulty in confirming the diagnosis with routine radiographs. We experienced a case of traumatic posterior dislocation of the sternoclavicular joint treated successfully by manipulative reduction. So, we report it with review of literature.
Clavicle ; Diagnosis ; Dislocations ; Sternoclavicular Joint

The object of this paper is to determine the clearance of amphotericin B from the rabbit vitreous. In vitro susceptability of Candida guilliermondi to amphotericin B in antibiotic medium 20(Difco) provided the lowest values of the minimal inhibitory concentration(MIC) among several Candida strains and showed the same MIC afteir incubation at either 30 degrees C or 35 degrees C for 48 hours. A volume of 0.05 ml of solution containing 5 microgram of amphotericin B was injected into the rabbit vitreous, and animals were killed at various intervals. Both eyes were immediately enucleated and frozen to prevent further diffusion of the amphotericin B out of the vitreous. The vitreous was removed intact while it was still frozen. After the vitreous had thawed, its volume was measured. Sterile saline was added and total volume was adjust to 2 ml. The mixture was homogenized and then centrifuged at 2,000 rpm for 20 minutes. One ml of supernatant was removed from the sediment, and the concentration of amphotericin B was determined by broth dilution technique with Candida guilliermondi. The clearance studies indicated that 5 microgram of amphotericin B injected intravititreally, maintained an antibiotic level of greater than 1 microgram/ml for longer than 96 hours, with a half-life of 12 hours. If all factors are considered equal, presumed clearance data for intravitreal injection of 10 microgram of amphotericin B in humans may be calculated from the result in rabbit vitreous. Therapeutic levels of amphotericin B(1 microgram/ml) may be maintained at least 48 hours after the initial intravitreal injection of antibiotic in human eyes.
Amphotericin B* ; Animals ; Candida ; Diffusion ; Half-Life ; Humans ; Indicator Dilution Techniques ; Intravitreal Injections

We tried to evaluate the possibility that the radionuclide imaging of the knee with 99mTc-pyrophosphate be the diagnostic tool for the patients with the suspected tear of the meniscus of the knee. Among the 142 cases in which 99mTc-pyrophosphate scan was performed, both arthrogram and knee scintigraphy were performed in 60 cases, but only 25 cases were done arthroscopy & arthrotomy for identification to intraarticular legion. We observed 4 types of abnormally increased uptake in the scintigraphy from 16 cases of 19 cases that identified to the meniscus tear. These patterns were seen with 1) diffuse increased uptake, 2) focal increased uptake, 3) plate-like increased uptake in or near the joint space, 4) diffuse increased uptake with plate-like accentuation. Among the 25 cases, 18 cases were found to have consistent scintigraphy & operative findings, 3 cases were observed not tear of meniscus but other legions in the knee joint. And only 4 cases were seen differented to findings of arthrotomy & scintigraphy. We could conclude that the knee scintigraphy with 99mTc-pyrophosphate could be used as a helpful method of the initial evaluation of the internal derangement of the knee in the patients with the suspected tear of the meniscus of the knee.
Arthroscopy ; Humans ; Joints ; Knee Joint ; Knee ; Methods ; Radionuclide Imaging ; Tears ; Technetium Tc 99m Pyrophosphate

BACKGROUND AND OBJECTIVES: To evaluate the 3 dimensional geometric changes and the effect of revascularization in patients with ischemic mitral regurgitation (IMR), using cardiac magnetic resonance imaging (MRI). SUBJECTS AND METHODS: Twenty-three patients with IMR, 10 with dilated cardiomyopathy with MR (DCM-MR) and 7 control subjects were enrolled. Hemodynamic indices, severity of MR, geometric parameters of mitral apparatus and myocardial viability were evaluated in all patients, and re-evaluated in the IMR patients 6 months after the revascularization. RESULTS: The mitral tenting area (TAA) (334.1+/-11.7 mm2 vs. 222.9+/-23.0 mm2, p=0.16) and the sum of the tenting angles (TA) (72.9+/-2.9degreevs. 51.5+/-1.1degree p<0.001) at the mid-systolic phase were increased in the IMR compared to the DCM-MR patients. In the IMR patients, the MR severity was positively correlated with the sum of the tethering lengths (r=0.522, p=0.011), LVESV (r=0.551, p=0.006), TAA (r=0.613, p=0.002) and TA (r=0.713, p<0.001). Of the 10 patients with viable myocardium, who had been revascularized without surgical repair of the mitral apparatus, the MR severity was decreased (28.3+/-0.4% vs. 16.5+/-.6%, p=0.009) in 7 patients, with decreases in the sum of the tethering distances (51.2+/-3.9 mm vs. 40.2+/-.1 mm, p=0.034), tenting area (299.2+/-3.8 mm2 vs. 215.0+/-3.6 mm2, p=0.036) and sum of the tenting angles (72.9+/-2.9degreevs. 56.2+/-4.8degree, p=0.015) 6 months after the revascularization. CONCLUSION: IMR was related with the geometric change in the mitral apparatus. Cardiac MRI can be an effective tool for evaluating these geometric changes and when formulating a treatment plan.
Cardiomyopathy, Dilated ; Hemodynamics ; Humans ; Magnetic Resonance Imaging* ; Mitral Valve Insufficiency* ; Myocardial Ischemia ; Myocardium

OBJECTIVE: To analyze characteristics of depressive symptom manifestation in Korean elderly by use of the Psychogeriatric Assessment Scale-Korean Version (PAS-K). METHOD: In the two epidemiological studies conducted in Yoncheon and Ulsan separately, PAS-K (Psychogeriatric Assessment Scale-Korean Version) was used as a common screening tool for depression in aged persons (65+). We analyzed the symptom characteristics in total subjects (n=1.641) by factor analysis and compared depressive symptomatology between male and female, urban and rural, educated and uneducated persons. Chi-square method was used to evaluated the differences in positive response rates of each depressive symptoms, and also item response theory was used to compare depressive symptomatology between male and female subject groups. RESULTS: Two factor structure that comprises 'combined emotional, cognitive and somatic factor' and 'sleep factor' was found in female, rural and uneducated groups. While, three factor structure composed of 'emotional factor', 'combined cognitive and somatic factor' and 'sleep factor' was found in male, urban and educated groups. Women endorsed significantly more depressive symptoms than men. Depressive mood, fatigue, restlessness, thoughts mixed up and suicide idea were more prevalent in female group. However, women reported their symptoms, especially emotional symptoms like depressive mood, restlessness, suicide idea, in less severe state of depression than men. In the evaluation of each item characteristics, most items were relevant in their item characteristics for the assessment of depressive symptoms in Korean elderly. However, 'hypnoticsalcohol use' item had very low correlation coefficient with total symptom score and it was less discriminative than other symptom items. CONCLUSION: Symptom characteristics of depression in Korean aged persons were different between groups according to sex, urbanicity and education level. An influence of Confucian culture on different symptom expression between male and female groups should be considered.
Aged* ; Depression* ; Education ; Epidemiologic Studies ; Factor Analysis, Statistical ; Fatigue ; Female ; Humans ; Male ; Mass Screening ; Psychomotor Agitation ; Suicide ; Ulsan

Acute mediastinitis is a life threatening disorder that causes severe morbidity in affected patient. We experienced a case of acute mediastinitis in a 56 year-old man as a result of swallowing a fish bone (Order Perciformes, Family Pomacentridae). Conservative treatment, including starvation therapy and the injection of antibiotic drugs, were successful in treating this patient. Although the optimal treatment for acute mediastinitis remains controversial, it is important to choose the appropriate strategies when encountering cases of acute mediastinitis.
Male ; Humans

Transcatheter aortic valve implantation (TAVI) is an alternative treatment modality for surgical aortic valve replacement in patients at high surgical risk. Transfemoral access is not feasible in many cases with unfavorable iliofemoral anatomy or severe peripheral arterial disease (PAD). Elderly patients with severe aortic valve stenosis have a higher prevalence of PAD due to atherosclerotic degenerative changes in the large and small vessels. Transsubclavian, transapical, and direct access to the ascending aorta by thoracotomy are alternative routes for the TAVI procedure. In this case, we describe a patient with a previous coronary artery bypass graft and bilateral iliac artery stenosis who successfully underwent TAVI using a CoreValve(R) by transfemoral approach after balloon angioplasty of iliac artery stenosis.
Aged ; Angioplasty, Balloon ; Aorta ; Aortic Valve ; Aortic Valve Stenosis ; Constriction, Pathologic ; Coronary Artery Bypass ; Heart Valve Prosthesis ; Humans ; Iliac Artery ; Peripheral Arterial Disease ; Prevalence ; Thoracotomy ; Transplants