PURPOSE: Recently developed BMS(TM) (Zassi Bowel Management System(TM): Hollister Inc., Illinois, USA) can provide effective nonsurgical fecal diversion without the risks associated with colostomy creation and subsequent closure. Our aim is to evaluate the effectiveness of the BMS in diverting feces from the perianal wide surgical wound in patients with Fournier's gangrene. METHODS: BMS(TM) was applied in five patients (male: 2, median age; 44) with Fournier's gangrene from January 2000 to September 2001. The treatments consist of three times a day wound dressing after wide surgical debridement and intravenous antibiotic therapy. For evacuation of feces, twice daily warm saline irrigation was administered via BMS(TM) or low daily doses of polyethylene glycol solutions were orally taken in. An endoscopic and anorectal manometric study was done to evaluate possible mucosal complications and anorectal functional changes. RESULTS: The average duration of the BMS application was 41 (range, 22~63) days. The result of a manometric study after immediate removal of the BMS(TM) showed a decreased mean resting pressure (range: 22~36 mmHg) and a decreased mean squeezing pressure (range: 32~39 mmHg). After 3 days, the sphincter pressure had improved markedly: mean resting pressures of 38, 45, 60, and 63 mmHg and mean squeezing pressure of 78, 89, 91, and 101 mmHg respectively. Fecal incontience was not noted in any patient. Other possible mucosal complications were not noted. There were no mortalit. CONCLUSIONS: BMS(TM) application in Fournier's gangrene patients after surgery successfully avoids a defunctioning colostomy. Furthermore, no significant complications were noted over a prolonged period up to 63 days.
Bandages ; Colostomy ; Debridement ; Fasciitis, Necrotizing ; Feces ; Fournier Gangrene ; Humans ; Illinois ; Polyethylene Glycols

A 9-year-old boy showed orofacial dyskinesia and psychic symptoms shortly after open heart surgery with deep hypothemia and cardiopulmonary bypass for congenital cyanotic heart disease. The choreothetosis progressed to be generalized and accompanied by mental deterioration. This involuntary movement partially responded only to repetitive administration of sedatives. After 3 month the patient expired with sudden development of ventricular tachycardia and cardiogenic shock.
Cardiopulmonary Bypass* ; Child ; Dyskinesias ; Heart Diseases ; Humans ; Hypnotics and Sedatives ; Hypothermia* ; Male ; Movement Disorders ; Shock, Cardiogenic ; Tachycardia, Ventricular ; Thoracic Surgery

Intra-carotid urokinase (UK) infusion in 20 patients with acute internal carotid artery (ICA) territorial ischemic stroke achieved immediate recanalization in 45% and the clinical outcome in patients with recanalization was superior to that of patients without recanalization. The procedure was most effective in patients with smaller arterial occlusions: 7 of 10 patients with MCA branch occlusions (M2 to M4) achieved recanalization compared to only 2 of 10 with distal ICA or M1 occlusions, which should be an important issue for the critical evaluation of the efficacy of thrombolytic therapy (TT). Hemorrhagic transformation was observed in 9 patients on CT scan; petechial hemorrhage in 5 and intraparenchymal hematoma formation in 4. Among 4 patients with hematoma formation, clinical deterioration was seen in 3 cases and the angiography at the immediate end of the UK infusion showed recanalization in only one patient. The average dose of UK in patients with parenchymal hematoma formation was higher than that of patients without hemorrhagic transformation (123.3 x 10(4) units vs 101 x 10(4) units). The administration of a large dose of UK, probably more than 100 x 10(4) units, and the absence of immediate recanalization seemed to increase the risk of parenchymal hematoma formation. Despite the effort of investigators, the in-hospital time delay for the TT was significant which was mainly related to the time consuming preparation for angiography especially during night. A more effective system for the earlier intervention of acute ischemic stroke needs to be developed.
Adult ; Aged ; Angiography ; Brain Ischemia/*drug therapy/radiography ; Carotid Artery Thrombosis/*drug therapy/radiography ; Female ; Human ; Male ; Middle Age ; Support, Non-U.S. Gov't ; Thrombolytic Therapy/*methods ; Tomography, X-Ray Computed ; Urinary Plasminogen Activator/*administration & dosage

BACKGROUND: This study evaluated the clinical results of arthroscopically assisted single and double bundle tibial inlay reconstructions of an isolated posterior cruciate ligament (PCL) injury. METHODS: This study reviewed the data for 14 patients who underwent a single bundle tibial inlay PCL reconstruction (Group A) and 16 patients who underwent a double bundle tibial inlay PCL reconstruction (Group B) between August 1999 and August 2002. The mean follow-up period in groups A and B was 90.5 months and 64 months, respectively. RESULTS: The Lysholm knee scores in groups A and B increased from an average of 43.3 +/- 7.04 and 44.7 +/- 5.02 preoperatively to 88.1 +/- 7.32 and 88.7 +/- 9.11 points at the final follow-up, respectively. In group A, stress radiography using a Telos device showed that the preoperative mean side-to-side differences (SSDs) of 9.5 +/- 1.60 mm at 30degrees of flexion and 9.8 +/- 1.70 mm at 90degrees of flexion were improved to 2.8 +/- 1.19 mm and 3.0 +/- 1.1 mm, respectively. In group B, the preoperative SSDs of 10.4 +/- 1.50 mm at 30degrees of flexion and 10.7 +/- 1.60 mm at 90degrees of flexion improved to 2.7 +/- 1.15 mm and 2.6 +/- 0.49 mm, respectively. There was no significant difference in the clinical scores and radiologic findings between the two groups. CONCLUSIONS: Single bundle and double bundle PCL reconstructions using the tibial inlay technique give satisfactory clinical results in patients with an isolated PCL injury, and there are no significant differences in the clinical and radiological results between the two techniques. These results suggest that it is unnecessary to perform the more technically challenging double bundle reconstruction using the tibial inlay technique in an isolated PCL injury.
Adolescent ; Adult ; *Arthroscopy ; Female ; Humans ; Male ; Middle Aged ; Orthopedic Procedures/*methods ; Posterior Cruciate Ligament/*injuries/*surgery ; Reconstructive Surgical Procedures/methods ; Tendons/transplantation ; Tibia/*surgery ; Young Adult

PURPOSE: We wanted to evaluate the mid-term (8 to 10 years) clinical and radiologic results of total knee arthroplasty. MATERIALS AND METHODS: We evaluated 71 knees in 45 patients after they had undergone total knee arthroplasty between January 1996 and April 1998. All the procedures were performed by a single-surgeon using the PFC (Press Fit Condylar) system. The clinical and radiologic results were evaluated using the American Knee Society Scoring System and the American Knee Society Roentgenographic Evaluation and Scoring System. Survivorship analysis was performed using the Kaplan-Meier method with revision for any reason as the end point. RESULTS: The average range of motion of the knee joint was 102.7degrees (55-130degrees) preoperatively and 116.4degrees (90-140degrees) at the last follow-up. The average knee and functional scores were improved from 46.2 and 42 preoperatively to 88.7 and 82.9, respectively, at the last follow-up. The tibiofemoral angle changed from varus 6.5degrees preoperatively to valgus 4.6degrees at the last follow-up. The total radiolucecy rate was 34% and the total radiolucency score was 1.9. Reimplantations were performed in 5 cases and the survival rate was 94.7% at 8 years. No differences was found in the survival rate according to PCL preservation. CONCLUSION: The mid-term results of PFC total knee arthroplasty were reliable and satisfactory because there was an increased range of motion, decreased pain, restoration of function and a relatively low complication rate.
Arthroplasty ; Follow-Up Studies ; Humans ; Knee ; Knee Joint ; Range of Motion, Articular ; Replantation ; Survival Rate

BACKGROUND: In patients with severe chronic lung diseases even a small pneumothorax can result in life-threatening respiratory distress. It is important to treat the attack by chest tube drainage until the lung expands. Pneumothorax with a persistent air leak that does not resolve under prolonged tube thoracostomy suction is usually treated by open operation to excise or oversew a bulla or cluster of blebs to stop the air leak. Pleurodesis by the instillation of chemical agents is used for the patient who has persistent air leak and is not good candidate for surgical treatment. When the primary trial of pleurodesis with common agent fails, it is uncertain which agent should be used f or stopping the air leak by pleurodesis. It is well known tbat inappropriate drainage of hemothorax results in severe pleural adhesion and thickening. Based on this idea, some reports described a successful treatment with autologous blood instillation for pneumothorax patients with or without residual pleural space. We tried pleurodesis with autologous blood for pneumothorax with persistent air leak and then we evaluated the efficacy and safety. METHODS: Fifteen patients who had persistent air leak in the pneumothorax complicated from the severe chronic lung disease were enrolled. They were not good candidates for surgical treatment and doxycycline pleurodesis failed to stop up their air leaks. We used a mixture of autologous blood and 50% dextrose for pleurodesis. Effect and complications were assessed by clinical outcome, chest radiography and pulmonary function tests. RESULTS: The mean duration of air leak was 18.4 :1:6.16 days before ABP (autologous blood and dextrose pleurodesis) and 5.2 ± 1.68 days after ABP, The mean severity of pain was 2.3 ± 0.70 for DP(doxycycline pleurodesis) and 1.7 ± 0.59 for ABDP (p<0.05). There was no other complication except mild fever. Pleural adhesion grade was a mean of 0.6 ± 0.63. The mean dyspnea scale was 1.7 ± 0.46 before pneumothrax and 2.0 ± 0.59 after ABDP (p>0.05). The mean FEV1 was 1.47 ± 1.01 before pneumothorax and 1.44 ± 1.00 after ABDP (p>0.05). Exɡpt in 1 patient, 14 patients had no recurrent pneumothorax. CONCLUSION: Autologous blood pleurodesis (ABP) was successful for treatment of persistent air leak in the pneumothorax. It was easy and inexpensive and involved less pain than doxycycline pleurodesis. It did not cause complications and severe pleural adhesion. We report that ABP can be considered as a useful treatment for persistent air leak in the pneumothorax complicated from the severe chronic lung disease.
Blister ; Chest Tubes ; Doxycycline ; Drainage ; Dyspnea ; Fever ; Glucose ; Hemothorax ; Humans ; Lung ; Lung Diseases ; Pleurodesis* ; Pneumothorax* ; Radiography ; Respiratory Function Tests ; Suction ; Thoracostomy ; Thorax

No abstract available.
Dust* ; Humans

PURPOSE: To report the treatment results of anatomical reduction of all fracture fragments and internal fixation using an inter-fragmentary screw and plate in displaced mid-shaft clavicle fracture with comminution. MATERIALS AND METHODS: Between June 2005 and August 2011, 13 consecutive displaced clavicle fractures with comminution (Edinburgh classification IIB2) treated by anatomic reduction and internal fixation using inter-fragmentary screw and plate were retrospectively evaluated. There were 11 male and 2 female patients with a mean age of 37.4 years (15~55 years). The right clavicle was injured in 4 patients and the dominant arm was involved in 46%. The mean duration from trauma to surgery was 7.0 days. The cause of injury was a traffic accident in three, a fall in two, and sports activity or direct injury in eight patients. All of the fracture pieces were anatomically reduced and fixed with inter-fragmentary screws. An additional plate was applied to maintain and reinforce the reduction of the fracture. Radiographic assessments for the numbers of fragments and the amount of shortening and displacement were performed. To verify the fracture healing and determine the time from fracture surgery to union and complications, all of the radiographs taken after surgery were evaluated. RESULTS: The number of fragments was 2 in 7 cases, 3 in 5 cases, and 6 in one case. The mean shortening of the clavicle was 1.1 cm (0.3~2.1 cm) and mean displacement between the main fragments was 2.6 cm (1.3~4.5 cm). The mean duration of follow-up was 16.5 months (8~26 months). Radiographic union was achieved in all patients with a mean time to union of 10.8 weeks (8~14 weeks). There were no complications including metal failure, nonunion, or infection. CONCLUSION: Anatomical reduction of all the fracture fragments and fixation using inter-fragmentary screws in addition to the usual plate fixation showed good fracture healing in displaced clavicle fracture with comminution.
Accidents, Traffic ; Arm ; Clavicle ; Displacement (Psychology) ; Female ; Follow-Up Studies ; Fracture Healing ; Fractures, Comminuted ; Humans ; Male ; Retrospective Studies ; Sports

PURPOSE: This study was performed to evaluate the clinical outcomes of operative treatment using mini-open sinus tarsi approach for displaced intraarticular calcaneal fractures. MATERIALS AND METHODS: We studied 18 cases (16 patients) of intraarticular calcaneal fractures who were treated with sinus tarsi approach by same surgeon. The mean age of patients was 44.8 years, and mean follow-up period was 17.2 months. The measurement of Bohler angle, Gissane angle, the degree of articular surface depression, and the period to union were performed through preoperative and postoperative radiographs. The clinical evaluation was performed according to hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and scale of the Creighton-Nebraska health foundation (CNHF). RESULTS: Bohler angle and Gissane angle had improved significantly from preoperative average 9.8degrees, 117.6degrees to average 22.4degrees, 113.4degrees immediate postoperatively, and had maintained to average 21.8degrees and 114.2degrees at the last follow-up. The degree of articular surface depression had improved significantly from preoperative average 5.2 mm to 1.2 mm at the last follow-up. All cases achieved bone union, and the period to union was average 10.5 weeks. AOFAS score was average 86.2 points at the last follow-up. There were 7 excellent, 9 good, and 2 fair results according to the CNHF scale. Therefore, 16 cases (88.8%) achieved satisfactory results. CONCLUSION: The minimally invasive sinus tarsi approach using headless compression screw seems to be an effective surgical method for displaced intraarticular calcaneal fractures, because of the possibility of accurate restoration of articular surface and the low risk of postoperative soft tissue complications.
Animals ; Ankle ; Calcaneus ; Depression ; Follow-Up Studies ; Foot ; Humans ; Intra-Articular Fractures

BACKGROUND: In spite of initial intensive and long-term chemotherapy for pulmonary tuberculosis, many problems remain in the treatment of the residual lesion. The role of surgical intervention for pulmonary tuberculosis is getting rid of such residual lesion of pulmonary tuberculosis to support the healing process and to induce bacteriologically negative conversion in the end. METHOD: We experienced 30 cases of pulmonary resection for pulmonary tuberculosis from Aug. 1994 through Apr. 1995 in National Masan Tuberculosis Hospital. We conducted retrospective study to analyze several variables for the cases. RESULTS: 1) The ratio between male and female was 4:l(male 24, female 6) and the age of peak incidence was in 3rd and 4th decades. 2) Indications for pulmonary resection in the radiographic findings were cavitary lesions of 19 cases(63.3%), destroyed one side of 8 cases(26.7%) and destroyed one lobe of 3 cases(10%). 3) 16 of 20 cases with unilateral lesions and all of 10 cases with bilateral lesions on chest X-ray films showed AFB positive on preoperative sputum smears. 14 cases(87.5%) of unilateral lesions and 9 cases(90%) of bilateral ones were converted into AFB negative postoperatively. Negative conversion rates of pneumonectomy and lobectomy cases were 100% and 85.7%, respectively. 4) Preoperative combined disease was 3 cases(10%) of DM and postoperative complications were 2 cases(6.7%) of dead space and no death. CONCLUSION: Chemotherapy only has some limitation in treatment of all tuberculosis. So, surgical intervention for pulmonary tuberculosis is an effective method as partner of chemotherapy.
Drug Therapy ; Female ; Hospitals, Chronic Disease ; Humans ; Incidence ; Male ; Pneumonectomy ; Postoperative Complications ; Retrospective Studies ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary* ; X-Ray Film