No abstract available.
Tuberculosis, Pulmonary*

STUDY DESIGN: A retrospective clinical study about problems in distal ends of long segment fusion to L5 and S1. Authors compared the incidence of fixation failure and analized the problematic cases. OBJECTIVES: To verify the causes and associated conditions for high incidence of fixation failure in distal ends of long segment fusion. SUMMARY OF LITERATURE REVIEW: In Degenerative lumbar diseases, degenerative kyphosis, degenerative scoliosis with revision surgery and multiple stenosis require long level fusion which is accompanied by various fixation problems extending to sacrum. Fusion to sacrum provides excellent correction of deformity. However, it results in the loss of movable segment and concentration of the force on lumbosacral region. Moreover it may foresee the problems of fixation or fusion and S-I joint problems. But long fusion to L5 leaving one movable segment below can result in early degenerative change of this segment. MATERIAL AND METHODS: Among 65 patients given long level fusion involving more than 3 segment in National Medical Center from January 1991 to may 2000, 45 patients were selected and were followed for more than 2 years. First group (G1) involving L5 were 14 cases. Second group (G2) involving S1 were 31 cases. We evaluated loosening of implant-hallo around screw, pull out screw, breakage of screw or rod, change of adjacent segment and pseudarthrosis by means of radiologic modality. RESULTS: Follow up radiologic findings showed 28.6% of loosening of implant on L5 in G1. G2 showed 41.9% of hallo around screw in S1. Among cases with more than 4 level fusion, G1 showed 33.3% lower segment screw loosening and G2 showed 57.9%. In G2, group performed more than 3 level fusion showed 16.7% lower segment screw loosening. More than 4 level fusion showed higher loosening rate (57.9%) with the statistical segmental corellation (P=0.023). Lower end screw loosening occured 16% in cases with interbody fusion and 55% in cases without interbody fusion and it showed statistical corellation (P=0.047). Also cases with deformity correction by posterior instrumentation showed higher loosening rate (60%) and showed 18.2% in situfusion cases and it showed statistical corellation (P=0.049). In second case, sacral screw loosening occured more frequently in patients of osteoporosis (54%), sagittal imbalance postoperatively (38%), correction loss (31%). Only 1 case of G1 showed an increased degenerative change between L5-S1. CONCLUSION: In fusion to S1 in degenerative lumbar disease, factors such as long level fusion more than 4 segments by posterior instrumented correction, correction loss, sagittal imbalance and accompanied osteoporosis is related to high incidense sacral implant loosening-hallo around screw, pull out screw, breakage of screw or rod. So if these kind of risk factor exist, it seems that the anteriorposterior interbody fusion in necessary. Postoperative L5-S1 degenerative change did not occur in follow up period in patient with well preserved sagittal balance postoperatively in this follow up periods.
Congenital Abnormalities ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Incidence ; Joints ; Kyphosis ; Lumbosacral Region ; Osteoporosis ; Pseudarthrosis ; Retrospective Studies ; Risk Factors ; Sacrum ; Scoliosis ; Spine*

Polyarteritis nodosa is one of the necrotizing vasculitis inv'olving small and medium sized arteries. Polyarteritis nodosa may affect many organs such as kidney, musculoskeletal system, gastrointestinal tract, skin, heart, and nerve. In Cupps and Fauci's autopsy studies, muscle involvement was found in 39% of the patients with polyarteritis nodosa. Commonly Polyarteritis nodosa may be presented clinically by myalgia. We experienced a case of polyarteritis nodosa presenting as myositis, diagnosed by muscle biopsy and renal angiography, which appear with unusual presentation of joint contracture in lt elbow and muscle crarnping pain rather than cornmonly presented myalgla.
Angiography ; Arteries ; Autopsy ; Biopsy ; Contracture ; Elbow ; Gastrointestinal Tract ; Heart ; Humans ; Joints ; Kidney ; Musculoskeletal System ; Myalgia ; Myositis* ; Polyarteritis Nodosa* ; Skin ; Vasculitis

Abnormalities in the number and function of platelets may contribute to thromboembolic complications in patients with essential thrombocythemia(ET). Physicians often use hydroxyurea which reduces the platelet count for the initial treatment of ET. A 74-year-old man with ET was presented with headache, dysarthria, and right hemiparesis 10 months after discontinuation of hydroxyurea. Initial platelet count was 450x103/microliter and we gave him heparin. However, his platelet count rised upto 1,019x103/microliter within 4 days. He was on hydroxyurea 1.5 g/day and his symptoms improved with decrease of platelet count. We report a case of left MCA(middle cerebral artery) multifocal infarction in ET after discontinuation of hydroxyurea.
Aged ; Cerebral Infarction* ; Dysarthria ; Headache ; Heparin ; Humans ; Hydroxyurea* ; Infarction ; Paresis ; Platelet Count ; Thrombocythemia, Essential*

No abstract available.
Fetus*

There is still discussion concerning the methods for treating Tossy type 3 dislocations of the acromioclavicular joint. Since 1995, the authors have treated 10 patients of type 3 dislocations by arthroscope-assisted modified Weaver and Dunn operation with favorable results. The operation consisted of diagnostic shoulder arthroscopy, arthroscopic resection of acromial end of coracoacromial ligament with bone block, excision of distal end of clavicle, bone block transfer of coracoacromial ligament into the medullary canal of clavicle, and augmentation between coracoid process and resected distal end of clavicle with the Mersilene tape. The advantages of this arthroscope-assisted modified Weaver and Dunn operation are as follows: (1) Using the shoulder arthroscope, associated patholgy in the shoulder joint can be found and treated appropriately. (2) Arthroscopic resection of the acromial end of coracoacromial ligament can give the small incision and least damage to the deltoid muscle so that immediate post-operative range of motion exercise can be possible. (3) Bone block transfer of coracoacromial ligament and augmentation between coracoid process and resected clavicular end can prevent displacement of the resected clavicular end.
Acromioclavicular Joint ; Arthroscopes ; Arthroscopy ; Clavicle ; Deltoid Muscle ; Dislocations ; External Fixators* ; Hand* ; Humans ; Ligaments ; Range of Motion, Articular ; Shoulder ; Shoulder Joint

External fixation was improved in its devices and techniques as a specific method of fracture treatment. It was possible to immobilize the fractures firmly with the use of Vidal modified Hoffmann external fixation and could be used effectively in difficult fractures with severe soft tissue injury. From October 1981 to December 1983, 28 patients of tibial fracture who had been treated with Hoffman external fixation at Severence Hospital, Yonsei University College of Medicine were studied. The results are summerized as follows: 1. The age of patients varied from 14 to 66 years old, the majority (53.6%) being between 20 to 39 years old and males comprized 89.3%. 2. Traffic accidents and machinary injuries comprized 96.4%. 3. Average duration with Hoffmann frame was 16.6 weeks and average time of bone union was30.1 weeks. 4. Many complications were noticed but majority were related to personalities of the fractures, not due to Hoffmann external fixation itself. 5. Hoffmann device was relatively easy and quick to apply: sufficient stability was obtained: reasonable anatomic reduction of major fragments was possible: facilitated treatment and care of polytr- aumatized patients. 6. Secondary operations, e,g., bone grafting and even plastic surgery, had been possible without necessitating removal of the device. 7. It was useful in open fractures with severe soft tissue tissue injury and also in taking care of further necessary managements.
Accidents, Traffic ; Bone Transplantation ; Fractures, Open ; Humans ; Male ; Methods ; Soft Tissue Injuries ; Surgery, Plastic ; Tibia ; Tibial Fractures

Primary carcinoma arising in the diverticular wall of the urinary bladder is the most serious complication. The clinical importance is that the carcinoma is difficult to diagnose early, widespread at diagnosis and has poor prognosis. Recently, vigilant studies including bladder mapping reveal premalignant changes and carcinoma in situ adjacent to carcinoma and suggest these premalignant changes evolve to flank carcinoma. For early detection and improving the prognosis, be required through cystoscopic examination including diverticular wall and multiple punch biopsies as well as consecutive urine cytologic examination. Author report two cases of primary carcinoma arising in bladder diverticulum. One revealed carcinoma in situ accompanied with adjacent atypical hyperplasia in diverticula mucosa incidentally found at the pathologic examination on the divertiuclectomy specimen. The other case showed invasive transitional cell carcinoma(Grade IV, Stage D) of diverticulum. The two cases described suggest that vesical diverticulum should be removed into to with a good amount of surrounding bladder wall.
Biopsy ; Carcinoma in Situ ; Diagnosis ; Diverticulum* ; Hyperplasia ; Mucous Membrane ; Prognosis ; Urinary Bladder

BACKGROUND: Xerosis is a relatively common disorder, especially in the elderly. The condition is characterized by fine scaling and is associated with generalized pruritus. OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy, safety and tolerability of Zalsming cream in patients with xerosis and pruritus. METHODS: Thirty patients were treated with Zalsming cream. Clinical efficacy, as measured by the score of subjective symptom and objective signs, transepidermal water loss(TEWL) and electron microscopic finding, were asessed at 2, 4, and 6 weeks after topical application of the cream. RESULTS: The scores of clinical signs and TEWL showed statistically significant improvements. No one developed any local or systemic side effects. CONCLUSION: Topical application of Zalsming cream was found to be effective and safe for patients suffering from xerosis and pruritus.
Aged ; Humans ; Pruritus*

No abstract available.
Spine*