PURPOSE: To compare the clinical, radiologic results and complications between the patellar non-resur-faced and resurfaced cases in total knee arthroplasty. MATERIALS AND METHODS: From March 1998 to May 2003, the subjects were 37 patellar non-resurfaced and 45 patellar resurfaced cases followed up more than a year among the patients who had total knee arthroplasty in degenerative arthritis. The results were evaluated by the range of motion, Hospital for Spe-cial Surgery (HSS) knee rating score, and Laurin's and Merchant's congruence angle. Student t-test was used in statistical analysis in comparison of both groups. RESULTS: In non-resurfaced group, the range of motion was incrased from 90.6 degree preoperatively to 108.6 degree postoperatively and HSS score from 62.6 to 84.1 respectively, while in resurfaced group, range of motion was increased from 88.2 degree preoperatively to 110.4 degree postoperatively and HSS score from 59.3 to 85.3. There were no significant differences between two groups (p>0.05). There were some patella-asso-ciated complications in each group, and revision due to patella-associated complications were 1 case (3%) and 2 cases (4%) each. So, patella-associated complications and revision rates revealed no significant dif-ferences (p>0.05). CONCLUSION: There is no difference in the clinical results and complications between patella resurfacing and selective non-resurfacing with relatively good cartilage, More follow up is needed for the necessity of revision due to patella-associated complications.
Arthroplasty* ; Cartilage ; Follow-Up Studies ; Humans ; Knee* ; Osteoarthritis ; Patella ; Range of Motion, Articular

PURPOSE: For early diagnosis of sacroiliitis in spondyloarthropathy, the MRI findings of sacroiliitis, roles of MPGR (Multiplanar Gradient Recalled Acquisition in Steady State), and delayed post-contrast T1-weighted images were evaluated. MATERIALS AND METHODS: Twenty six patients with seronegative spondyloarthropathy (probable clinical diagnosis of ankylosing spondylitis) were grouped as either less than radiographic grade I (group A) or more than grade II (group B). The MRI findings of both sacroiliac joints were evaluated in every patient, and predominant sites were determined. The two groups were then compared. In 17 patients, the number of enhancing panni seen on early and delayed post-contrast T1-weighted images was counted and compared between the two groups. RESULTS: Panni were found in all cases, and in both groups, predominant patterns of involvement were the lower and iliac aspects of the sacroiliac joints in both groups; in group A, the synovial joints and punctate pannus were predominantly involved, and in group B, the ligamentous joints as well as the synovial joints and linear pannus. In group B, more periarticular fat accumulation than periarticular osteitis was found. For the evaluation of changes in joint space, MPGR images were superior to spin echo images. For the delineation of enhancing pannus less than radiographic grade I, delayed post-contrast images were statistically superior to those which were early post-contrast. CONCLUSION: MRI can detect early sacroiliitic change according to the predominant sites of involvement, and delayed post-contrast images play a role in the diagnosis of early sacroiliitis. MPGR imaging is good for the evaluation of joint space change.
Diagnosis ; Early Diagnosis ; Humans ; Joints ; Ligaments ; Magnetic Resonance Imaging* ; Osteitis ; Sacroiliac Joint ; Sacroiliitis* ; Spondylarthropathies ; Spondylitis ; Spondylitis, Ankylosing*

PURPOSE: To evaluate the shape and distal end level of the lumbosacral the cal sac in normal subjects on MR imaging. MATERIALS AND METHODS: One hundred and twelve normal lumbar MRIs were reviewed. The shape and distal endlevel of the lumbosacral thecal sac on T1-weighted midine sagittal image were evaluated. The thecal sac was divided into five types, according to shape and defined as follows : type I(pointed shape) : tapering contour, with rat tail appearance ; type II(ovoid shape) : tapering smoothly, with round end ; type III(round shape) : not tapering, with round end ; type IV(pointed ovoid shape) : ending in papilae ; type V(round pointed shape) : ending in papillae. The levels of the distal end of the thecal sac were also evaluated. RESULTS: Type I was the mostcommon(43/112, 38/4%) and the second most common form was type II(31/112, 27.7%). With regard to the distal end level of the sac, 33 cases were located at the distal one third of the S2 body and 28 were at the middle one third; 16 cases were at the distal one third of the S1 body, and 14 were at the S1-S2 intervertebral disc level. All lumbosacral thecal sacs terminated between the L5-S1 intervertebral body and the distal one third of the S3 body. CONCLUSION: Lumbosacral thecal sacs ended between the L5-S1 intervertebral disc and the S3 spinal body. Most commonly, the sac terminated at the proximal one third of the S2 body. The pointed shape(type I) was most common.
Animals ; Intervertebral Disc ; Magnetic Resonance Imaging ; Rats ; Tail

PURPOSE: To evaluate the hemostatic effect of N-butyl 2-cyanoacrylate(NBCA) injection and RF electrocauterization of the tract after fine needle biopsy of the liver, and the histopathologic changes of the liver. MATERIALS AND METHODS: Three lobes of rabbit liver were selected and separately punctured four times with 21 gauge biopsy needles. According to the hemostatic procedure on fine needle biopsy, three groups (1, 2, 3) were formed : group 1, in which there was no maneuver for bleeding control, was the control group ; group 2, in which NBCA was injected into the puncture tract while slowly removing the needle ; group 3, in which RF electrocauterization of the tract was carried out. After completely removing the needle, each group was evaluated for amount of bleeding and histologic change. RESULTS: The amount of bleeding was 0.407gm+/-0.245 in group 1,0.028gm+/-0.036 in group 2 and 0.035gm+/-0.028 in group 3. As compared with the control group(group 1), injecting NBCA into the biopsy tract(P=0.0002) and RF electrocauterization of the tract(P=0.0003) significantly reduced the amount of bleeding after liver biopsy. The amount of bleeding was not statistically different between group 2 and 3, however (P=0.58). In Group 1, the tract was fully filled with blood. Group 2 showed NBCA embolized in the biopsy tract, adhering to hepatocytes and mixed with blood; small vessels adjacent to the puncture tract were filled with NBCA. Group 3 showed tissue degeneration, including necrosis of hepatocytes, vacuolation and neutrophil infiltration. CONCLUSION: Injection of NBCA and RF electrocauterization of the tract after puncture of the liver for biopsy efficiently controlled bleeding. In particular, the efficiency of NBCA injection was due to its effect of plugging the tract and causing the embolization of adjacent small vessels. With regard to procedural handling, RF electrocauterization of the tract is superior to injection of NBCA.
Animals ; Biopsy* ; Biopsy, Fine-Needle ; Hemorrhage* ; Hepatocytes ; Liver* ; Necrosis ; Needles ; Neutrophil Infiltration ; Punctures

BACKGROUND: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates. METHODS: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. RESULTS: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital, 101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). CONCLUSION: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.
Death Certificates* ; Education ; Emergencies ; Mortality ; Retrospective Studies ; Seoul

BACKGROUND: The presence of cardiac metastasis from cervical cancer is very rare. Due to the rarity of this condition, clinical characteristics of the patients with cardiac metastasis from cervical carcinoma is not well known. This study is to investigate the clinical profiles and outcomes of patients with cardiac metastasis from the carcinoma of the uterine cervix. MATERIALS AND METHODS: From Jan. 1990 to May 1999, 4 patients with cardiac metastasis from cervical cancer during the course of the disease were registered in Korea Cancer Center Hospital. The clinical characteristics of these patients were reviewed retrospectively. RESULTS: Mean age of patients was 49 years, and median interval from initial diagnosis to recurrence was 27 months. Histologically, all 4 cases were squamous cell type carcinoma. The stage distribution is two patients with FIGO stage II, one with stage I and one with stage III. Clinical symptoms of patients were dyspnea and facial edema in 2 patients, facial edema in one patients, and dyspneas only in one patient. All patients were confirmed histologically by pericardiocentesis. Synchronous metastatic lesions were supraclavicular lymph node, lung parenchyme and paraaortic, mediastinal lymph node. Following pericardiocentesis or pericardiodesis, all patients were improved clinically and survived for mean interval of 5.3 months. CONCLUSIONS: The patients with pericardial metastasis from cervical carcinoma showed a short survival time, but could be managed by pericardiocentesis or pericardiodesis with improvement of clinical symptoms.
Cervix Uteri ; Diagnosis ; Dyspnea ; Edema ; Female ; Humans ; Korea ; Lung ; Lymph Nodes ; Neoplasm Metastasis* ; Pericardiocentesis ; Recurrence ; Retrospective Studies ; Uterine Cervical Neoplasms*

Enteroviruses are the most common agents of myocarditis and have been implicates in the pathogenesis of dilated cardiopmyopathy. There are still discrepancies in the association of enterovirus and myocardial disease, partially due to lack of data on detection of virus antigen or viral culture in the tissue. For the treatment of fulminant myocarditis, aggressive hemodynamic support is warranted because of its excellent long-term prognosis. This 16 year-old girl was admitted because of anterior chest pain for a day. She had flu-like symptoms such as fever, sore throat and cough at 2 weeks ago. Electrocardiogram showed sinus tachycardia and ST segment elevations in lead II, III, aVF and V1-V4. Troponin T was positive and creatinine phosphokinase was elevated (1323 IU/L) at emergency room. On emergency echocardiogram, inferior wall motion was decreased and the ejection fraction (EF) was 70%. Coronary angiogram showed no thrombus and no significant stenosis in coronary artery, and spasm was not induced with ergonovine. Conventional treatment for congestive heart failure with digoxin (0.25 mg daily) and furosemide (20 mg t.i.d) was started under the impression of myocarditis. On the first hospital day, pulmonary edema and signs of shock were developed. The whole left ventricular(LV) wall motion were markedly decreased and EF was less than 20% on echocardiogram. Despite of intra-aortic balloon pump (IABP) for 4 hours, shock and pulmonary edema was progressed. Mechanical circulatory support was started with left ventricular assist device (LVAD, Bio-pump, Medtronic Bio-Medicus, USA). At the time of operation, central venous pressure was 24cmH20, systolic blood pressure was 75mmHg, left atrium(LA) and LV was dilated and the whole wall of LV showed almost akinesia , and LA appendage was biopsied. After 126 hours of LVAD, LV wall motion was restored and EF was 79% on echocardiogram. LVAD was removed 10 days after operation and she was discharged on 23 days of hospitalization without any heart failure symptoms. Immunohistochemistry of LA showed enteroviral VP1 capsid protein (primary antibody; NoVo Castra Laboratory, UK) over the entire LA wall. Her serum neutralized coxsackievirus B3 (CVB3, H3 variant of Woodruff strain) in neutralization test using horse anti-CVB3 (Nancy strain) antibody (ATCC, V030-501-560) as a positive control. The titer of neutralization Ab in her serum of 21 days increased more than 4 times than that of 2 days.
Adolescent ; Blood Pressure ; Capsid Proteins ; Cardiomyopathies ; Central Venous Pressure ; Chest Pain ; Constriction, Pathologic ; Coronary Vessels ; Cough ; Creatinine ; Digoxin ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Enterovirus ; Ergonovine ; Female ; Fever ; Furosemide ; Heart Failure ; Heart-Assist Devices* ; Hemodynamics ; Horses ; Hospitalization ; Humans ; Immunohistochemistry ; Myocarditis* ; Neutralization Tests ; Pharyngitis ; Prognosis ; Pulmonary Edema ; Shock ; Spasm ; Tachycardia, Sinus ; Thrombosis ; Troponin T

PURPOSE: We analyzed and classified the patterns of meniscal injuries by age groups and tried to find the statistical meanings. MATERIALS AND METHODS: We reviewed 217 cases with meniscal injuries of 340 patients who received knee arthroscopy from January 1996 to June 2000. We analyzed the statistical significances of them by age groups and classified injury patterns of site, shape and combined injuries. RESULTS: Medial meniscal injuries, especially in posterior horn, were more common, and degenerative tears have higher incidence in elderly groups. In younger groups, longitudinal and flap tears were more common. More prevalent associated injuries were ACL tears in younger groups and loose bodies in elderly groups. CONCLUSION: In knee arthroscopy, to find out the patterns of meniscal injuries by age groups is important to determine the method of treatment and prognosis.
Aged ; Animals ; Arthroscopy ; Horns ; Humans ; Incidence ; Knee ; Prognosis

PURPOSE: To investigate postoperative incidence of complications and functional results between two groups, primary bipolar hemiarthroplasty and internal fixation with compression hip screw on unstable intertrochanteric fractures of the femur with severe osteoporosis in elderly patients. MATERIALS AND METHODS: 78 cases treated under unstable intertrochanteric fractures of the femur with severe osteoporotic elderly patients from March 1997 to August 2001 who have been followed up for more than a year were evaluated retrospectively between the group of bipolar hemiarthroplasty, 38 cases out of 60 cases and group of compression hip screw, 40 cases out of 59 cases. The incidence of complications and functional ability according to Merle d'Aubigne scale and the mortality rate were compared using student t-test. RESULTS: The means of Merle d'Aubigne scale for the hemiarthroplasty group and the compression hip screw group were at the last follow up, 15.0 and 13.6 respectively. The differences were statistically significant (p=0.04). Bipolar group revealed significant differences in general (18%) and mechanical complications (5%) between two groups (p<0.05). The mortality rates were 28% and 22% respectively and there were no significant differences statistically (p>0.05). CONCLUSION: We consider that primary bipolar hemiarthroplasty would be better method in the treatment of the unstable femoral intertrochanteric fracture with severe osteoporosis but we need much longer follow up.
Aged* ; Femur* ; Follow-Up Studies ; Hemiarthroplasty* ; Hip Fractures* ; Hip* ; Humans ; Incidence ; Mortality ; Osteoporosis ; Retrospective Studies

PURPOSE: Single incision laparoscopic appendectomy (SILA) is a widely used surgical procedure for treatment of appendicitis with better cosmesis. However, many surgeons generally tend to choose conventional multiport laparoscopic appendectomy regarding with complicated appendicitis. The aim of this study is to demonstrate the safety and feasibility of SILA for treatment of complicated appendicitis by comparison with 3-ports conventional laparoscopic appendectomy (CLA). METHODS: Retrospective chart review of patients diagnosed appendicitis at single hospital during January 2015 to May 2017 collected 500 patients. Among 134 patients with complicated appendicitis, we compared outcomes for 29 patients who got SILA and 105 patients who got CLA. RESULTS: 179 and 321 patients were treated by SILA and CLA, respectively. 134 (26.8%) patients were treated for complicated appendicitis, 29 patients by SILA and 105 patients by CLA, respectively. There was no case converted to open or added additional trocar in both groups. There were no differences in demographics with regard to age, sex, body mass index (BMI), and American society of anesthesiologists (ASA) scores. There was no difference in mean operating time (58.97±18.53 (SILA) vs. 57.57±21.48 (CLA), p=0.751). The drain insertion rate (6.9% vs 37.1%, p=0.001) and the length of hospital stay (2.76±1.41 vs. 3.97±2.97, p=0.035) were lower in SILA group with significance. There was no significant difference in the rate of surgical site infection (6.9% vs. 6.7%, p=1.000). CONCLUSION: This study demonstrates that SILA is a feasible and safe procedure for treatment of complicated appendicitis.
Appendectomy* ; Appendicitis* ; Body Mass Index ; Demography ; Humans ; Length of Stay ; Retrospective Studies ; Surgeons ; Surgical Instruments ; Surgical Wound Infection