PURPOSE: The purpose of this study was to compare the results of treatment of distal tibial fractures between intramedullary (IM) nailing and minimally invasive plate osteosynthesis (MIPO). MATERIALS AND METHODS: Between January 2007 and February 2012, 57 patients (57 cases) were treated for distal tibial fractures. Thirty-two patients (32 cases) were treated with IM nailing (nail group) and the 25 patients (25 feet) were treated with MIPO (plate group). Clinical results were compared using range of motion (ROM) of the ankle joint, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Olerud-Molander score between nail group and plate group. Radiographic results were compared using mean bony union time, coronal and sagittal malunions, and shortening between the groups. RESULTS: Mean ROM of the ankle joint was significantly larger in nail group until 6 months after surgery; however, it was not different between two groups at the last follow-up. AOFAS score and Olerud-Molander score were not different between two groups at the last follow-up. In the nail group, two malunions more than 5 degrees were observed in coronal and sagittal planes, respectively. One case showed non-union in the plate group, however, bone union was obtained after autogeneous bone graft. CONCLUSION: Treatment using IM nailing is more advantageous in terms of postoperative rehabilitation than MIPO in distal tibial fractures.
Ankle ; Ankle Joint ; Follow-Up Studies ; Foot ; Fracture Fixation, Intramedullary* ; Humans ; Range of Motion, Articular ; Rehabilitation ; Tibia* ; Tibial Fractures ; Transplants

BACKGROUND: More laparoscopic low anterior resections (LAR) are being performed in recent years. There has been controversy around the hemodynamic changes affected by the Trendelenburg position and pneumoperitoneum during LAR. The goal of this study was to analyze the effect of nitroglycerin (NTG) on hemodynamic changes during LAR. METHODS: Forty ASA physical status I-II patients undergoing LAR were randomized into two groups: the NTG infused group (N group, n = 20) and the control group (C group, n = 20). Anesthesia was maintained with sevoflurane at 1-3 vol%, air/oxygen (50%/50%) and continuous infusion with remifentanil. The N group patients were given 0.5 microg/kg/min of NTG during anesthesia. Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), cardiac index (CI), stroke volume (SV) and systemic vascular resistance (SVR) were assessed 10 min after induction (T1), 5 min after pneumoperitoneum in the supine position (T2), 10 min after pneumoperitoneum in the Trendelenburg position (T3), 30 min after pneumoperitoneum in the Trendelenburg position (T4), 1 hr after pneumoperitoneum in the Trendelenburg position (T5) in addition to 5 (T6), 10 (T7) and 30 min (T8) after removal of the pneumoperitoneum in the supine position. RESULTS: The increases of MAP were milder in the N group (22.6-7.3%) than the C group (32.3-17.7%) during pneumoperitoneum and while in the Trendelenburg position. The significant decreases of HR were maintained in the C group, but the changes in HR were not significant in N group during the operation. The increases in CVP were less in N group than C group. The increases of SVR were milder in N group (19.4-1.4%) than C group (41.7-16.6%) during pneumoperitoneum in the Trendelenburg position. CONCLUSIONS: Intraoperative NTG infusions were effective to some degree in reducing the hemodynamic changes during pneumoperitoneum with Trendelenburg positioning for LAR.
Anesthesia ; Arterial Pressure ; Central Venous Pressure ; Head-Down Tilt ; Heart Rate ; Hemodynamics ; Humans ; Methyl Ethers ; Nitroglycerin ; Piperidines ; Pneumoperitoneum ; Stroke Volume ; Supine Position ; Vascular Resistance

Facet joint synovial cysts are usually associated with osteoarthritis of the adjacent facet joint and/or spondylolisthesis. In between the conservative and operative ends of the treatment spectrum lie minimally invasive techniques such as cyst rupture using epiduroscopy. In this report, we describe an 82-year-old male patient presenting with low back pain radiating to his lower left extremity and associated paresthesia. Magnetic resonance imaging of the lumbar spine revealed a synovial cyst at left L4/5 facet joint. Using epiduroscopy, the cyst was mechanically ruptured by popping it with the tip of the scope. The patient remained symptom-free at his successive visits until 12 months after the procedure, and was opened for desired follow up.
Aged, 80 and over ; Extremities ; Follow-Up Studies ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Osteoarthritis ; Paresthesia ; Rupture ; Spine ; Spondylolisthesis ; Synovial Cyst ; Zygapophyseal Joint*

The reliability and validity of the Cognitive Impairment Diagnosing Instrument (CIDI) were studied in 67 nursing home elderly subjects and 251 elderly psychiatric patients. Its possible highest score is 77 and covers 10 subscales: short-term memory, long-term memory, concentration/calculation, abstract thinking, judgement, memory registration, higher cortical functions, orientation in time, orientation in place and object naming. Test-retest correlations were between 0.827 and 0.990 for the subscale scores and 0.984 for the total score. Inter-tester kappas for each item ranged from 0.200 to 1.000 with a mean of 0.698. Concordance rates were between 50.0 and 100.0% with a mean of 87.2%. Cronbach's alphas for the items of the individual subscales ranged from 0.702 to 0.915. Inter-subscale and subscale-total correlations ranged from 0.503 to 0.820 with a mean of 0.684 and from 0.721 to 0.883, respectively. Cronbach's alpha of the subscales was 0.934. Sensitivity and specificity were 93.3% and 93.8% at the cut-off point of 57.0/57.5 for dementia. Subscale and total scores were significantly different between the demented and non-demented. The total CIDI score was significantly correlated with scores of the Blessed Dementia Rating Scale and the Korean version of the Mini-Mental State Examination.
Aged ; Aged, 80 and over ; Cognition Disorders/*diagnosis ; Female ; Human ; Male ; Middle Age ; Sensitivity and Specificity ; Support, Non-U.S. Gov't

Cryptococcosis of central nervous system in uncommon, but fatal if untreated. We experienced a case of cryptococcal ventriculitis with hydrocephalus. The symptom was an increased intracranial pressure without meningeal irritation sign. It was confirmed by pathology and cytology taken from fibrous material, which caused an obstruction of shunt catheter in the lateral ventricle. We report a case of cryptococcal ventriculitis in 6 years old male child.
Catheters ; Central Nervous System ; Child ; Cryptococcosis ; Humans ; Hydrocephalus ; Intracranial Pressure ; Lateral Ventricles ; Male ; Pathology

Some variables can influence the efficiency of leukocyte removal filter for red cell concentrates. We performed this study to evaluate whether the filtration efficiency for platelet concentrates(PCs) can be influenced by bedside filter(PXL8K, Pall Corporation, USA) used, platelet storage time and transient stopping of platelet agitation, and to measure the amount of cytokines released from donor leukocytes in PCs during the storage time. In addition, we examined the effect of leukocyte reduction by filtration before the storage of PCs on the subsequent generation of cytokines. Any of the above mentioned variables did not make significant differences. From day 1 to day 5, there were significant increases in IL-1 beta (<1 vs. 8.6 pg/mL, p<0.05), IL-8 (<10 vs. 455.3 pg/mL, p<0.05) and TNF-alpha (<4 vs. 16.6 pg/mL, p<0.05) in unflltered PCs, whereas no increased revels of cytokines were found in the cases of prestorage filtration.
Blood Platelets* ; Cytokines ; Dihydroergotamine ; Filtration* ; Humans ; Interleukin-1beta ; Interleukin-8 ; Leukocytes* ; Tissue Donors ; Tumor Necrosis Factor-alpha

PURPOSE: The purpose of the study was to compare clinical, oncological outcomes between chondroblastoma and giant cell tumor. MATERIALS AND METHODS: This retrospective study reviewed 25 patients with histologically confirmed chondroblastoma of bone between 1998 and 2012. During the same period, 42 patients diagnosed as a giant cell tumor were also reviewed. We then analyzed clinical and oncological results of chondroblastoma compared with giant cell tumor. In chondroblastoma, 17 cases were male, and 8 cases were female, with a mean age of 20.6 years (range from 11 to 38 years). In giant cell tumor, 20 cases were male, and 22 cases were female, with a mean age of 39.26 years (from 17 to 75 years). All patients underwent surgical treatment that extended curettage with electrocauterization. After curettage, bony cavity was filled with autogenous bone, allogenic bone chip, bone cement, tricalcium phosphate, and so on. The results were compared in recurrence and metastatic rate. The minimum follow-up period was 1 year. RESULTS: In chondroblastoma, mean size was 2.18 cm (0.3 to 9.5 cm). Local recurrence and metastasis were absent. In giant cell tumors, mean size was 3.71 cm (0.3 to 11 cm). Local recurrence rate was 9.5% (4 of 42 cases) and there was one lung metastasis. CONCLUSION: Chondroblastoma is less invasive with better prognosis than giant cell tumor. Treatment of chondroblastoma and giant cell tumor is surgery. Electrocauterization as an adjuvant therapy showed good results.
Chondroblastoma* ; Curettage ; Female ; Follow-Up Studies ; Giant Cell Tumors* ; Giant Cells* ; Humans ; Lung ; Male ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies

PURPOSE: This study was designed to investigate the clinical and oncological results of the unplanned excision group, and to compare the results with those of the planned excision group. MATERIALS AND METHODS: A total of 41 patients who underwent re-excision of sarcoma in Yeungnam University Medical Center, from January 2000 to December 2012, after unplanned excision in local medical centers were reviewed retrospectively. We analyzed the clinical and oncological results according to age, gender, tumor size, depth, and locations. As a control group of planned excision, 81 patients with a similar state, were selected and reviewed among the group of 480 patients who underwent planned excision during the same period. We then compared the results of the two groups. RESULTS: In the unplanned excision group, only the age factor was statistically significant to survival (p=0.048). In comparison of clinical and oncological results of the unplanned and planned excision groups, recurrence rate was 11.1% in the unplanned group, 10.5% in the planned group and did not show statistical significance (p=0.18). Survival rate was 74% in the unplanned group, 76.6% in the planned group and did not show statistical significance (p=0.06). Necessity of additional surgery for coverage of soft tissue defects was 46% in the unplanned group, 14% in the planned group and showed statistical significance (p=0.00). CONCLUSION: No significant difference in survival and local recurrence rate was observed between the groups of re-excision with microscopic remnant tumor after unplanned excision and planned excision. However, unplanned excision might lead to unnecessary additional surgery like skin-graft, skin-flap if it were planned.
Academic Medical Centers ; Age Factors ; Humans ; Recurrence ; Retrospective Studies ; Sarcoma* ; Survival Rate

Creutzfeldt-Jakob disease (CJD) is a fatal neurodegenerative disorder in which accumulation of the pathogenic prion protein induces neuronal damage and results in distinct pathologic features. This abnormal prion is an infectious protein and resistant to methods of sterilization currently being used. Therefore, management of definite, or suspected CJD patients requires additional precautions. We report our experience of a patient who had undergone brain biopsy for suspected of CJD. The patient was confirmed to have sporadic CJD.
Anesthesia ; Biopsy ; Brain ; Creutzfeldt-Jakob Syndrome ; Encephalopathy, Bovine Spongiform ; Humans ; Neurodegenerative Diseases ; Neurons ; Sterilization

OBJECTIVE: It has been suggestes that various mechanism of fetal loss are associated with anticardiolipin(ACA) and humoral immunity in the patients with recurrent spontaneous abortion. Thus we have investigated the relationship between ACA and chromosomal anomaly to know the clinical impact of ACA to early fetal loss as comparing to the chromosomal anomaly in the patients of recurrent spontaneous abortions. MATERIALS AND METHODS: Patients(n=88) with a history of recurrent spontaneous abortion (2 or more) between January 1, 1994 and June 30, 1999 were included in this study. Quantitative measurement of serum ACA was performed by ELISA and chromosomal analysis of chorionic villi obtained from aborted conceptuses was done by using standard G-banding technique. RESULTS: The incidence rate of ACA positive was 27%(24/88) and that of chromosomal abnormality was 57%(50/88). The incidence rate of abnormal karyotype was 54% (13/24) in ACA positive. Among 24 ACA positive, 10 had IgG-ACA positive, 10 had IgM-ACA positive and 4 had both types of ACA. The incidence rate of chromosomal anomalies was 30% (3/10) in IgG-ACA positive, 90%(9/10) in IgM-ACA positive and there was significant difference between these two groups (p=0.02). The incidence rate of chromosomal trisomy was 59% (23/37) in ACA negative, 62% (8/13) in ACA positive and there was no significance between two groups. CONCLUSIONS: The significantly low incidence of chromosomal abnormalities in conceptal products of patients with IgG-ACA comparing that of patients with IgM-ACA suggests that this isotype of antibody have influence on the genesis of spontaneous abortions in genetically normal pregnancy. In further studies, additional trials are mandatory for obtaining a definitive conclusions about relationship between pathologic changes of conceptal products and pathophysiologic effects of IgG-ACA.
Abnormal Karyotype ; Abortion, Spontaneous ; Antibodies, Anticardiolipin* ; Chorionic Villi ; Chromosome Aberrations ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunity, Humoral ; Incidence ; Pregnancy ; Trisomy