The mechanism of the loosening after arthroplasty is considered that micromotion makes a gap between implant and bone, the subsidence of implant and osteolysis around the implant. The loosening of femoral component after total knee arthroplasty(TKA) might be related to the improper support of posterior condylar area, the causes of which may be inaccurate osteotomy, improper cementing technique and poor bone quality, etc. The authors found four cases of flexed displacement and osteolysis around the femoral component after TKA. The types of implant were one case of PS type and three cases of High Flex PS type. Revision arthroplasty was done in three patients who had severe clinical symptoms with diffuse bone loss around the distal femur. We evaluated the mechanism of the early loosening by clinical and radiologic assessment of four patients.
Arthroplasty* ; Femur ; Humans ; Knee* ; Osteolysis ; Osteotomy

Aerococcus viridans is a rare pathogen in humans, with only six cases of A. viridans urinary tract infections reported worldwide. Nosocomial urinary tract infections with bacteremia caused by A. viridians are even rarer, with no prior reports of urosepsis caused by A. viridans occurring in the Republic of Korea. Here we report a case of urosepsis caused by A. viridans in a 79 year-old female nursing home resident. The patient was admitted to the hospital presenting a fever of 39degrees C, chills, and oliguria for two days prior to admission. Urine culture yielded a robust growth of 105 CFU/mL of A. viridians, with blood culture positive for the same organism. Following diagnosis, the patient was treated with ciprofloxacin intravenously for 2 weeks, resulting in clearance of the infection and a full recovery from urosepsis. Although A. viridans is rarely associated with human infections, this case shows that, under the right conditions, it can be responsible for severe infections like urosepsis.
Aerococcus* ; Bacteremia ; Chills ; Ciprofloxacin ; Diagnosis ; Female ; Fever ; Humans ; Nursing Homes ; Oliguria ; Republic of Korea ; Urinary Tract Infections

Paradoxical embolism is a kind of stroke caused by embolism of thrombus of venous origin through a lateral opening in the heart, such as a patent foramen ovale (PFO). Although the most frequent manifestation of paradoxical embolism is cryptogenic stroke, noncerebral paradoxical embolism is also associated with PFO. We experienced a case of cryptogenic renal infarction in a previously healthy 70-year-old man. He had no cardiac thrombus on transthoracic echocardiography and electrocardiogram revealed a normal sinus rhythm. Because it was cryptogenic renal infarction, we performed transesophageal echocardiography with microbubble test. Microbubble test using agitated saline proved the presence of right-to-left shunt and patent foramen ovale was diagnosed. We also performed lower leg doppler ultrasonogram, but there was no evidence of deep vein thrombosis. Although only the presence of a right-to-left shunt is not enough to establish the diagnosis of paradoxical embolism, it is uncommon for the source of the embolism to be identified. In this case, we concluded that paradoxical embolism is the cause of renal embolism. We report paradoxical renal embolism through PFO with review of relevant literatures.
Aged ; Dihydroergotamine ; Echocardiography ; Echocardiography, Transesophageal ; Electrocardiography ; Embolism ; Embolism, Paradoxical ; Foramen Ovale, Patent ; Heart ; Humans ; Infarction ; Kidney ; Leg ; Microbubbles ; Stroke ; Thrombosis ; Venous Thrombosis

Intramural hematoma of the esophagus (IHE) is an uncommon form of esophageal injury, which may be an intermediate of mucosal tear (Mallory-Weiss syndrome) or transmural rupture (Boerhaave's syndrome). To date, the pathogenesis of IHE has not been well documented. IHE may occur within the submucosal layer of the esophagus following dissection of the mucosa. The most commonly presented symptoms are sudden retrosternal pain, dysphagia and hematemesis. The disorder can occur spontaneously or secondarily to trauma. In this report, we present a case of IHE which occurred after endoscopic biopsy and was recovered following conservative management in a patient who was taking long-term aspirin medication.
Aspirin ; Biopsy ; Deglutition Disorders ; Esophagus ; Hematemesis ; Hematoma ; Humans ; Mucous Membrane ; Rupture