No abstract available.
Anesthesiology* ; Education* ; Publications*

OBJECTIVES: The aim of this study was to compare endogenous plasma lithium concentrations among schizophrenic patients classified by DSM-IV subtype and control groups and to investigate the correlation of endogenous plasma lithium concentration and psychotic symptoms in schizophrenia. METHODS: Schizophrenic patients were selected among psychiatric inpatients without lithium medication and then classified by DSM-IV schizophrenia subtype. Schizophrenic patient groups were composed of 15 disorganized type, 15 paranoid type and 15 undifferentiated type schizophrenic patients. The control group was composed of 15 healthy subjects without any psychiatric disease. Endogenous plasma lithium concentrations were estimated by inductively coupled plasma atomic emission spectrometer. The psychotic symptoms in schizophrenic patients were classified as positive symptoms, negative symptoms and disorganized symptoms according to andreasen classification1 about SANS and SAPS items. Endogenous plasma lithium concentration among three subtypes of schizophrenia and control group was compared, and correlation between endogenous plasma lithium concentrations and psychotic symptoms was examined. RESULTS: 1) Schizoprenic patients showed higher endogenous plasma lithium concentration than control groups (p=0.033). Endogenous plasma lithium concentrations were significantly different among three subtypes of schizophrenia (p=0.001). Compared with the control group, disorganized type showed higher endogenous plasma lithium concentration, but paranoid type and undifferentiated type were not significantly different. 2) Disorganized symptoms correlated with endogenous plasma lithium concentration (r=0.416, p=0.004), but negative symptom and positive symptom did not significantly correlate with endogenous plasma lithium concentration (r=0.202, p=0.184. r=-0.216, p=0.155). CONCLUSION: These results suggested that schizophrenic patients with disorganized symptom show the differences in utilization or distribution of endogenous lithium.
Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Inpatients ; Lithium* ; Plasma* ; Schizophrenia*

PURPOSE: Chronic administration of anticonvulsants for children with epilepsy may cause multiple abnormalities in bone metabolism. The aim of this study was to evaluate the effects of anticonvulsants on bone mineral density(BMD) in children with epilepsy. METHODS: Seventy patients with epilepsy were enrolled in this study. All subjects had taken anticonvulsants for at least 1 year or more. Subjects were classified into three groups according to age(5-7 yrs, 8-11 yrs, >12 yrs). BMD was measured by Dual-energy X-ray Absorptiometry(DXA) on the lumbar spine and whole body. Statistical analysis for BMD of anticonvulsants-treated subjects were compared to results with the published data. RESULTS: BMD was significantly decreased in the anticonvulsants-treated group as compared with the control group of all age groups(P<0.05). But BMD among groups according to anticonvulsants was not significantly different(P>0.05). CONCLUSION: Because chronic administration of anticonvulsants for growing children leads to a decrease in BMD, early detection and management of abnormal BMD is important in monitoring of children with epilepsy.
Child ; Male ; Female ; Humans

STUDY DESIGN: Case report. OBJECTIVES: To report a case of epidural hematoma following cervical spinal fracture in a patient with ankylosing spondylitis. SUMMARY OF LITERATURE REVIEW: An early surgical intervention for acute epidural hematoma following cervical spinal fracture led to improvements in the patient's neurological deficits. MATERIALS AND METHODS: A 76-year-old male with ankylosing spondylitis presented with neck pain and motor weakness of both upper and lower extremities after falling. He sustained fractures of the C7 body and the spinous processes of C5 and C6. Magnetic resonance imaging showed an extensive epidural hematoma from C7 to T5. The authors performed decompression from C6 to T2, and posterior instrumentation and fusion from C4 to T3. RESULTS: An urgent surgical intervention was performed, and a good result was obtained. CONCLUSIONS: The authors describe an early surgical intervention in a case of acute epidural hematoma following cervical spinal fracture in a patient with ankylosing spondylitis.
Accidental Falls ; Aged ; Decompression ; Hematoma* ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Neck Pain ; Spinal Fractures* ; Spondylitis, Ankylosing*

OBJECTIVES: There remains controversy over osteoporotic feature of the ankle. Therefore, we investigated the possibility of the existence of a relationship between axial bone mineral density (BMD) in patients with ankle fracture group with that of the normal population in Korea under control of other confounding factors such as body mass index (BMI). METHODS: This study retrospectively reviewed medical records of patients who were treated in our institution from 2005 to 2015. A comparative analysis was carried out between 116 patients with ankle fracture (ankle fracture group) and 113 patients admitted with other orthopedic reasons (control group). Sex, age, energy level of trauma, and BMI were analyzed as variables affecting axial BMD. RESULTS: Age and sex of ankle fracture group were not different from them of control group (P = 0.968 and P = 0.870, respectively). BMI of ankle fracture group was higher than that of control (P = 0.029). The other variables showed no differences between the 2 groups. The energy level of trauma in ankle fracture group was related to only BMI (P = 0.013). CONCLUSIONS: Axial BMD of ankle fracture patients showed no difference from that of a control group in Korean population. The occurrence of ankle fracture is affected by only BMI rather than axial BMD. Evaluation of osteoporosis for patients with ankle fracture should be considered separately.
Ankle Fractures* ; Ankle* ; Body Mass Index ; Bone Density* ; Humans ; Korea ; Medical Records ; Orthopedics ; Osteoporosis* ; Retrospective Studies ; Risk Factors*

PURPOSE: The purpose of this study was to evaluate the effect of steroid injection according to the stage of Finkelstein's test and the severity of tenderness on radial styloid in de Quervain's disease. METHODS: Between January 2011 and December 2012, a total of 57 patients (57 wrists) treated with steroid injection in de Quervain's disease were enrolled on this study. The severity of tenderness, the stage of Finkelstein's test and pain score using visual analogue scale (VAS) were assessed before steroid injection. And the effect of steroid injection was assessed until one year after steroid injection. The relationship between the recurrence of de Quervain's disease after steroid injection and pre-injection findings including tenderness, Finkelstein's test and VAS was assessed. RESULTS: The success rate of steroid injection was 71.9% (41/57 patients). The outcome of steroid injection was not significantly related to the severity of tenderness (p=0.648), the stage of Finkelstein's test (p=0.530) and VAS score (p=0.607). CONCLUSION: The tenderness on radial styloid and the Finkelstein's test are important physical findings for the diagnosis of de Quervain's disease. However, the severity of tenderness and the stage of Finkelstein's test were not showed as predictive factors for the outcome.
De Quervain Disease* ; Diagnosis ; Humans ; Recurrence*

Atypical fractures have been reported as a complication of long-standing bisphosphonate therapy and occur commonly in the subtrochanteric region or shaft of the femur showing typical radiographic features. We encountered a case of atypical fracture of the proximal one-third of the shaft of the ulna. Radiographic findings of this case differed from previously reported cases of ulnar fracture in terms of showing a transverse fracture line with cortical thickening and an oblique fracture line with anterior cortical spike. On the other hand, these findings were similar to radiographic features of atypical femoral fractures. The present case was managed surgically and union of fracture was achieved after 6 months. As there are possibilities of occurrence of atypical fractures in sites other than the femur, the physicians should cautiously examine the patients' history and radiographic findings.
Femoral Fractures ; Femur ; Forearm ; Hand ; Ulna*

BACKGROUND: We conducted this study to determine the optimal length of patellar and tibial bone blocks for the modified transtibial (TT) technique in anterior cruciate ligament (ACL) reconstruction using the bone-patellar tendon-bone (BPTB) graft. METHODS: The current single-center, retrospective study was conducted in a total of 64 patients with an ACL tear who underwent surgery at our medical institution between March 2015 and February 2016. After harvesting the BPTB graft, we measured its length and that of the patellar tendon, patellar bone block, and tibial bone block using the arthroscopic ruler and double-checked measurements using a length gauge. Outcome measures included the length of tibial and femoral tunnels, inter-tunnel distance, length of the BPTB graft, patellar tendon, patellar bone block, and tibial bone block and graft-tunnel length mismatch. The total length of tunnels was defined as the sum of the length of the tibial tunnel, inter-tunnel distance and length of the femoral tunnel. Furthermore, the optimal length of the bone block was calculated as (the total length of tunnels − the length of the patellar tendon) / 2. We analyzed correlations of outcome measures with the height and body mass index of the patients. RESULTS: There were 44 males (68.7%) and 20 females (31.3%) with a mean age of 31.8 years (range, 17 to 65 years). ACL reconstruction was performed on the left knee in 34 patients (53%) and on the right knee in 30 patients (47%). The optimal length of bone block was 21.7 mm (range, 19.5 to 23.5 mm). When the length of femoral tunnel was assumed as 25 mm and 30 mm, the optimal length of bone block was calculated as 19.6 mm (range, 17 to 21.5 mm) and 22.1 mm (range, 19.5 to 24 mm), respectively. On linear regression analysis, patients' height had a significant correlation with the length of tibial tunnel (p = 0.003), inter-tunnel distance (p = 0.014), and length of patellar tendon (p < 0.001). CONCLUSIONS: Our results indicate that it would be mandatory to determine the optimal length of tibial tunnel in the modified TT technique for ACL reconstruction using the BPTB graft. Further large-scale, multi-center studies are warranted to establish our results.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Body Mass Index ; Bone-Patellar Tendon-Bone Grafts ; Female ; Humans ; Knee ; Linear Models ; Male ; Outcome Assessment (Health Care) ; Patellar Ligament ; Retrospective Studies ; Tears ; Transplants*

Intramedullary spinal cord metastases occurring from any malignant tumor are usually accompanied by frequent metastases in the intracranium. The clinical features of this disease have been described as the rapid progression of neurologic deficit that can lead to complete paraplegia. In this case, the authors treated a 76-year-old woman, who was diagnosed with an intramedullary spinal cord metastasis arising from a small cell lung cancer without an invasion of the brain, with decompressive surgery and posterior instrumentation. The patient suffered from weakness of her legs, walking difficulties, and urinary and fecal incontinence. Her preoperative neurologic symptoms were improved significantly after surgery. The patient did not want to have further treatment for the primary cancer, and she died from pneumonia caused by aggravation of the underlying disease 3 months after surgery. We report this rare case, which was diagnosed as a metastasis of a small cell lung cancer postoperatively, with a review of the relevant literature.
Aged ; Brain ; Fecal Incontinence ; Female ; Humans ; Leg ; Neoplasm Metastasis ; Neurologic Manifestations ; Paraplegia ; Pneumonia ; Small Cell Lung Carcinoma ; Spinal Cord ; Walking

PURPOSE: Certain pitching mechanics is thought to lead pitchers in danger of surgical risk and decrease performance. The objective of this study is to analyze the effect of shoulder hyperabduction position during early cocking phase in association with surgical risk and performance in professional baseball players.METHODS: From 2009 to 2013, total of 93 candidates reached minimum inning qualification. After exclusion criteria (overlapped players, foreign players, age over 31 years, proceed to other league and retirement), 19 players were analyzed with slow-motion pitching video for hyperabduction of the shoulder and hyperpronation of forearm in cocking-phase. Also players were analyzed with innings pitched, earned run average (ERA), walks and hits divided by innings pitched (WHIP) and surgical history with database offered by official Korean Baseball Organization website.RESULTS: Out of total 19 players, nine players had hyperabduction arm movement and 10 players did not. Group with hyperabduction had average age of 24.3 years old, average inning/ERA/WHIP for 5 years were 55 innings/yr, 6.52 ERA/yr and 1.33 WHIP/yr, respectively, and seven players (77%) had surgeries eventually. Group without hyperabduction arm movement had average age of 25.4 years old; average inning, ERA/WHIP for 5 years were 127 1/3 innings/yr, 4.84 ERA/yr, and 1.32 WHIP/yr, respectively and five players (50%) went for surgeries. Player performance (ERA, p=0.66; WHIP, p=0.14) was not statistically influenced by the certain arm position at cocking phase but average inning pitched was statistically affected (p<0.01).CONCLUSION: Hyperabduction of shoulder in early cocking phase of throwing motion does not lead to decrease in performance (ERA, WHIP) but will result in tremendous decline of average IP. Also, risk of surgery is not associated to hyperabduction motion of the shoulder.
Arm ; Baseball ; Forearm ; Mechanics ; Shoulder