PURPOSE: We aimed to evaluate effect on maximum knee flexion by patellofemoral overstuffing after total knee arth- roplasty MATERIALS AND METHODS: As a prospective inspection we have measured anterior hump height of distal femur in the preoperative true lateral radiographic view in those who had taken total knee arthroplasty with Genesis II which is external rotation laden prosthesis allowing to be inserted parallel to femoral anterior cortex. We compared the thickness of anterior hump height resected during operation and thickness of anterior flange of femoral prosthesis and then considered post operative thickness of patella to estimate the effect of patellofemoral overstuffing in 55 cases comparing maximum knee flexion. RESULTS: The average thickness of resected femoral anterior hump was 7.14+/-1.91mm. Average in hump overstuffing was 1.32+/-1.09mm and postoperative maximum flexion angle was average of 125.6+/-15.5 degree with average decrease of 1.8 degree. In 29 cases, Average of 1.35mm of overstuffing occurred in patella overstuffing and postoperative maximum flexion angle was average of 131.0+/-16.4 degree with average increase of 2.1 degree. Considering change of anterior femoral hump height and thickness of patella, preoperative and postoperative average maximum flexion angle was 128.9+/-14.9, 128.0+/-14.5 degree, repectively in patellofemoral overstuffing with average decrease of 0.9 degree. CONCLUSION: We concluded that the patellofemoral overstuffing does affect the decrease of the angle of maximum flexion in total knee arthroplasty and the effect of hump overstuffing is superior than patellar overstuffing effect.
Arthroplasty* ; Femur ; Knee* ; Patella ; Prospective Studies ; Prostheses and Implants

Assistive listening devices (ALDs) refer to various types of amplification equipment designed to improve the communication of individuals with hard of hearing to enhance the accessibility to speech signal when individual hearing instruments are not sufficient. There are many types of ALDs to overcome a triangle of speech to noise ratio (SNR) problems, noise, distance, and reverberation. ALDs vary in their internal electronic mechanisms ranging from simple hard-wire microphone-amplifier units to more sophisticated broadcasting systems. They usually use microphones to capture an audio source and broadcast it wirelessly over a frequency modulation (FM), infra-red, induction loop, or other transmission techniques. The seven types of ALDs are introduced including hardwire devices, FM sound system, infra-red sound system, induction loop system, telephone listening devices, television, and alert/alarm system. Further development of digital wireless technology in hearing instruments will make possible direct communication with ALDs without any accessories in the near future. There are two technology solutions for digital wireless hearing instruments improving SNR and convenience. One is near-field magnetic induction combined with Bluetooth radio frequency (RF) transmission or proprietary RF transmission and the other is proprietary RF transmission alone. Recently launched digital wireless hearing aid applying this new technology can communicate from the hearing instrument to personal computer, phones, Wi-Fi, alert systems, and ALDs via iPhone, iPad, and iPod. However, it comes with its own iOS application offering a range of features but there is no option for Android users as of this moment.
Equipment Design ; Hearing Aids ; Hearing* ; Microcomputers ; MP3-Player ; Noise ; Telephone ; Television ; Wireless Technology*

PURPOSE: This study aimed to validate a recent officially approved Korean version of the International Knee Documentation Committee (IKDC) subjective knee form, to determine the standard basis values in a normal Korean population and to use the IKDC for determining the effectiveness of and recovery after an orthopedic procedure. MATERIALS AND METHODS: Five male subject and 5 female subjects (a total of 10 subjects per group) were included in group I (age of 20~30 years old) and Group II (age over 60 years old), respectively, and the patients were without knee joint disturbance and radiologic/clinical abnormality, and all the subjects were examined by an orthopedic knee surgeon. All the subjects were evaluated with the Korean version IKDC subjective knee form. Spearman's analysis was used to test for significant differences between each group. RESULTS: The overall result of the Korean version IKDC subjective knee form in group I was 98.3+/-3.7 (88.5~100.0) on average, and it was 100+/-0.0 for the males and 96.6+/-4.9 (88.5~100.0) for the females with no significant differences (p=0.189) between the two gender. The average score of the IKDC subjective knee form in group II was 86.6+/-5.8 (78.2~93.1) and this was 89.6+/-5.4 (80.1~93.1) for the males and 83.7+/-5.1 (78.2~92.0) for the females with no significant difference (p=0.113) between the two genders. But there was statistically significant differences of the score of the Korean version of the IKDC subjective knee form between group I and group II (p<0.0043). CONCLUSION: We have to consider age differences when using the Korean version of the IKDC subjective knee form, but there are no differences according to gender.
Female ; Humans ; Knee ; Knee Joint ; Male ; Orthopedic Procedures ; Orthopedics ; Reference Values

Stevens-Johnson syndrome is considered to be a severe type of erythema exsudativum multiforme. It is characterized by erythema with vesicobullous and eroded lesions of skin and mucous membranes. The importance in anesthetic management of Stevens-Johnson syndrome is preventing injury of the oropharyngeal and tracheal membrane at intubation because soft oral airways may cause bleeding and push tissue debris into the pharynx and larynx. In addition, anesthesiologist should take care of complications such as transitory atrial fibrillation, interstitial myocarditis, pericarditis, pneumothrax, acute renal insufficiency and conjunctivitis. A 5-year-old male, previously diagnosed with Stevens-Johnson syndrome and treated with a steroid, was noted as having dyspnea on rest, coughing, jaundice, and fever. Even after aggressive medical management for status asthmaticus during the preoperative period, dyspnea and expiratory wheezing did not improve. He underwent a resection of the gall bladder, lung and liver biopsy in spite of a great risk of perioperative pulmonary complications. After treatment with epinephrine, and aminophylline, the peak inspiratory pressure was 40 cmH2O with mild hypercarbia (PaCO2 45 50 mmHg). We report the anesthetic considerations for a case of Steven-Johnson syndrome with status asthmaticus.
Acute Kidney Injury ; Aminophylline ; Atrial Fibrillation ; Biopsy ; Child, Preschool ; Conjunctivitis ; Cough ; Cytochrome P-450 CYP1A1 ; Dyspnea ; Epinephrine ; Erythema ; Fever ; Hemorrhage ; Humans ; Intubation ; Jaundice ; Larynx ; Liver ; Lung ; Male ; Membranes ; Mucous Membrane ; Myocarditis ; Pericarditis ; Pharynx ; Preoperative Period ; Respiratory Sounds ; Skin ; Status Asthmaticus* ; Stevens-Johnson Syndrome* ; Urinary Bladder

Anterior cervical fusion has enjoyed an increasing acceptance and frequency of utilization in the treatment of symptomatic degenerative, traumatic, and neoplastic disorders. Since the introduction of plate systems, cervical fusion with fixation has become popularized. We present our experiences of 152 cases of cervical fusion in degenerative and traumatic lesions, focusing on their surgical results and complications, along with our opinions about the various plate systems we used. Between March 1993 and May 1996, 152 patients with symptomatic degenerative and traumatic cervical lesions between C3-4 and C7-T1 levels were treated with anterior cervical fusions. These patients were retrospectively studied according to their medical records and radiological studies. A comparison between various plate systems were also done. There were 110 men and 42 women, aged from 21 to 77 years. Mean follow up period was 17 months. Mean fused segments were 1.4. Various plate systems were used: Caspar plate system in 14 patients; Top plate in 102; Orion plate in 21; and none in 15. Dislodgement of bone graft, screw loosening, and fusion failure that required reoperation were occurred in 8 cases. None of them were initially treated with unicortical type screws. Asymptomatic esophageal perforation was developed in one case among them. In conclusion, anterior cervical fusion with screw plate system can be carried out with acceptable complication rate. Although relative follow up period was short, we concluded that the locking type screw plate system was superior than the classic bicortical screw system in their procedural simplicity, unnecessary penetration of posterior cortex, and elimination of the fear for the neurological complication.
Esophageal Perforation ; Female ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Reoperation ; Retrospective Studies* ; Transplants

Emphysematous pyelonephritis (EPN) is a life-threatening suppurative infection of the renal parenchyma, with formation of gas within the collecting system, renal parenchyma, or perirenal tissues. Since Kelly and MacCullum reported the first case of pneumaturia from a gas-forming renal infection, several terms have been used to describe the condition, such as renal emphysema, pneumonephritis, and emphysematous pyelonephritis. We describe a case of emphysematous pyelonephritis, which presented as an acute abdomen with pneumoperitoneum and pneumomediastinum in a diabetic patient. A subsequent exploratory laparotomy did not identify the site of visceral perforation or the source of infection, and an ensuing nephrectomy with intensive antibiotic therapy was lifesaving. Occasionally, retroperitoneal infection can contaminate the peritoneal cavity and produce gas to create pneumoperitoneum, and retroperitoneal air can migrate to the mediastinum to create a pneumomediastinum. Therefore, we recommend that a differential diagnosis of a pneumoperitoneum or a pneumomediastinum should also include retroperitoneal infection, such as emphysematous pyelonephritis.
Abdomen, Acute ; Diagnosis, Differential ; Emphysema ; Humans ; Laparotomy ; Mediastinal Emphysema* ; Mediastinum ; Nephrectomy ; Peritoneal Cavity ; Pneumoperitoneum* ; Pyelonephritis*

PURPOSE: We performed this study to assess pain in patients seen in member outpatient orthopaedic clinics of the Korean Knee Society (KKS). MATERIALS AND METHODS: We organized a committee for the study of knee joint pain. The committee designed a questionnaire form consisting of 11 items related to pain. One hundred thirty-five regular members of the KKS asked all patients visiting their respective outpatient clinics during May 2007 to complete the questionnaire form. Although 12,418 patients agreed to fill out the questionnaire form, we only analyzed the questionnaire forms of 9,578 patients who answered completely. RESULTS: 1. Approximately 85% of patients visiting outpatient orthopaedic clinics complained of pain. 2. The average degree of pain was more than moderate, and 72% of patients simply desired to be free of pain. 3. Seventeen percent of patients thought their physicians underestimated their pain. 4. Regarding agreement in the assessment of pain between physicians and patients, there was low level of agreement by numeric rating scale, but a high level of agreement based on a mild/moderate/severe grading scale. 5. Approximately one-third (36.2%) of patients had used additional treatments for pain relief on top of their prescribed medications. CONCLUSION: Eighty-five percent of patients complained of pain, and two-thirds of them were primarily focused on its relief in their visit to the outpatient clinic. Hence, we should heed pain management itself as an important goal in treating orthopaedic patients.
Ambulatory Care Facilities ; Humans ; Knee ; Knee Joint ; Outpatients ; Pain Management ; Surveys and Questionnaires

BACKGROUND: Doxylamine is the most commonly intoxicated drug in the emergency room. This drug is relatively safe but is known to induce rhabdomyolysis and acute renal failure in rare occasions. We found the presence of microscopic hematuria in doxylamine intoxicated patients. But no previous studies have documented this hematuria. Our objectives of this study were to determine the incidence of microscopic hematuria after doxylamine overdose and to find the prognostic factors that contribute to this complication. METHODS: This study was conducted from 22 patients admitted to Kyung Hee Medical Center after doxylamine intoxication during the period from January 2001 to December 2003. Using the protocol made beforehand, the amount ingested, past history and laboratory results were recorded. Rhabdomyolysis was defined as serum myoglobin over 300 ng/mL or serum creatine phosphokinase (CK) over 1, 000 IU/L. Data were analyzed using SPSS program with t- test, Fisher's exact test and discriminant analysis. RESULTS: The microscopic hematuria was detected in 63.6% of patients. The amount ingested per body weight, presence of rhabdomyolysis and the time when the muscle enzymes reach highest level were related to the hematuria. CONCLUSION: The incidence of microscopic hematuria was higher when more than 30 mg per body weight of doxylamine was ingested than less this amount. Microscopic hematuria suggests the presence of kidney and urinary tract injury. Urine pH of hematuria is over 7.5. Our findings provide no support for the belief that the ferrihemate injures the kidney of doxylamine ingested patients.
Acute Kidney Injury ; Body Weight ; Creatine Kinase ; Doxylamine* ; Emergency Service, Hospital ; Hematuria* ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Kidney ; Myoglobin ; Rhabdomyolysis* ; Urinary Tract

From July, 1989 to June, 1998 forty-two patients with malignant germ cell tumors of the ovary treated in the department of Obstetrics and Gynecology, University of Ulsan, Asan Medical Center, were identified. Demographic characteristics, symptoms, signs, stage, tumor grade, mode of therapy and results of follow-up of those patients were reviewed retrospectively. The patients with malignant germ cell tumor constituted 11.1% of all ovarian malignancies and 5.6% of all ovarian germ cell tumors ecountered during this period. The most common histologic subtype was dysgerminoma (26.2%) followed by endodermal sinus tumor (23.8%) and immature teratoma (19.0%). The age of the patients ranged from 8 to 64 years (mean+/-S.D.; 26.0+/-12.9) and the mean parity was 0.8 (+/-1.6). The most frequent initial symptoms were adbominal pain (33.3%) or abdominal distension (31.0%). Most had stage I(25 cases, 59.9%) or II(6 cases, 14.3%) diseases. Elevated level of serum alpha-FP was observed in all cases of endodermal sinus tumor and embryonal cell carcinoma, CA 125 was elevated in 63.9% of all malignant germ cell tumors. Thirty-one patients (73.8%) were treated by surgery and chemotherapy and 10 patients (23.8%) by surgery only. The major chemotherapeutic regimens were BEP (bleomycin +etoposide +cisplatin) and VAC (vincristine +actinomycin-D +cytoxan). The mean follow-up duration was 24.6 (+/-23.5) months and 2-year survival rate was 88.6% (+/-0.6).
Chungcheongnam-do ; Drug Therapy ; Dysgerminoma ; Endodermal Sinus Tumor ; Female ; Follow-Up Studies ; Germ Cells* ; Gynecology ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Obstetrics ; Ovary* ; Parity ; Retrospective Studies ; Survival Rate ; Teratoma ; Ulsan

In 2016 and 2017, there were earthquakes greater than 5.0 in magnitude on the Korean Peninsula, which has previously been considered an earthquake-free zone. Patients with chronic kidney disease are particularly vulnerable to earthquakes, as the term “renal disaster” suggests. In the event of a major earthquake, patients on hemodialysis face the risk of losing maintenance dialysis due to infrastructure disruption. In this review, we share the experience of an earthquake in Pohang that posed a serious risk to patients on hemodialysis. We review the disaster response system in Japan and propose a disaster preparedness plan with respect to hemodialysis. Korean nephrologists and staff in dialysis facilities should be trained in emergency response to mitigate risk from natural disasters. Dialysis staff should be familiar with the action plan for natural disaster events that disrupt hemodialysis, such as outages and water treatment system failures caused by earthquakes. Patients on hemodialysis also need to be educated about disaster preparedness. In the event of a disaster situation that results in dialysis failure, patients need to know what to do. At the local and national government level, long-term preparations should be made to handle renal disaster and patient safety logistics. Moreover, Korean nephrologists should also be prepared to manage cardiovascular disease and diabetes in disaster situations. Further evaluation and management of social and national disaster preparedness of hemodialysis units to earthquakes in Korea are needed.
Cardiovascular Diseases ; Dialysis ; Disasters ; Earthquakes ; Emergencies ; Federal Government ; Gyeongsangbuk-do ; Humans ; Japan ; Korea ; Organization and Administration ; Patient Safety ; Renal Dialysis ; Renal Insufficiency, Chronic ; Water Purification