Traffic accident leaves various traces on vehicle, road or pedestrians and these can be viewed as the failure mechanism of relatively moving obstacles. This paper introduces tribology and fractography, which are the parts of failure mechanics, as a means of theoretical analysis and approaching methods on the traffic accident. Actual specific traces are introduced as illustrations of tribology and fractogrphy. A verified traffic accident is also introduced as a case report.
Accidents, Traffic ; Mechanics

Fibroadenoma is a rare lesion of the vulva. It has been proposed that the origin of the tissue is either ectopic breast tissue or vulvar mammary-like glands (MLG). We report a case of vulvar fibroadenoma in a 33-year-old woman with a right vulvar mass presenting clinically as vulvar cyst. The cut surface of the tumor showed a white and homogenous appearance that was 2.5 cm in maximum dimension. Microscopically, the lesion was well-circumscribed but non-encapsulated. It revealed nodular, glandular and stromal proliferation, consistent with fibroadenoma of breast. Immunohistochemical staining for the estrogen receptor and progesteron receptor revealed nuclear positivity in the epithelium. Smooth muscle actin confirmed the presence of a myoepithelial cell layer. Staining for pancytokeratin showed epithelial cytoplasmic positivity.
Actins ; Adult ; Breast ; Cytoplasm ; Epithelium ; Estrogens ; Female ; Fibroadenoma* ; Humans ; Muscle, Smooth ; Vulva*

OBJECTIVE: The use of decompressive craniectomy for treating massive cerebral infarction is attracting much attention because conventional medical treatment is associated with high mortality. The aim of this retrospective study was to evaluate the surgical treatment results and prognostic factors for patients suffering with malignant cerebral infarction. METHODS: We analyzed 9 consecutive patients who underwent decompressive craniectomy with or without temporal lobectomy after malignant cerebral infarction from 2000 to 2008. We reviewed the medical records, the radiological finding and the pre-operative clinical assessment using the Glasgow Coma scale (GCS). The postoperative functional outcome was assessed as the Barthel-Index (BI) and the modified Rankin scale (mRS). RESULTS: The male to female ratio was 3.5:1. The mean age was 50 years (range: 36-68). Eight patients (89%) showed involvement of the entire middle cerebral artery (MCA) territory and the concomitant anterior cerebral artery (ACA) or posterior cerebral artery (PCA) territory. The preoperative mean GCS was 8.3 (range: 5-12) and the mean time to surgery after the onset of symptoms was 47.7 hours (range: 4-168 hours). All the patients underwent decompressive craniectomy and duroplasty. Among them, four patients (45%) underwent temporal lobectomy. The mean followup period was 7.3 months (range: 1-26 months) and five patients died within this period. CONCLUSION: Decompressive craniectomy with or without lobectomy for patients with malignant cerebral infarction decreases the mortality rate and it improves the functional outcome. In the survived group, comparison of the two surgical modalities didn't show any statistically significant difference. However, the decompressive craniectomy with lobectomy group demonstrated a high survival rate (75%). Future studies are needed to investigate the proper treatment modalities for malignant cerebral infarction.
Anterior Cerebral Artery ; Cerebral Infarction ; Decompressive Craniectomy ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Male ; Medical Records ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Retrospective Studies ; Stress, Psychological ; Survival Rate

PURPOSE: To evaluate the short-term clinical results and safety of Ultra Q neodymium-doped yttrium aluminium garnet (Nd:YAG) laser treatment for vitreous floaters. METHODS: The present study included 31 eyes of 31 patients with symptomatic floaters lasting more than 3 months. The vitreous floaters were photodisrupted using Ultra Q Nd:YAG laser. Preoperative and postoperative best corrected visual activity (BCVA) and intraocular pressure, change of the floater, patient satisfaction and postoperative complications were analyzed prospectively. RESULTS: There was no significant difference between preoperative and postoperative BCVA and intraocular pressure (p > 0.05). Vitreous floaters were not found in 9 eyes (29.03%), decreased floaters were observed in 19 eyes (61.29%) and definite change of floaters was not observed in 3 eyes (9.68%). Patient satisfaction after the laser treatment was very satisfied in 11 eyes (35.48%) and satisfied in 20 eyes (64.58%). Satisfaction in Weiss ring type of the floater was the highest, very satisfied in 6 of the 8 eyes (75%) and vitreous floaters were not observed in 7 of the 8 eyes (87.50%). Postoperative complications were not observed during a follow-up period of at least 3 months. CONCLUSIONS: Ultra Q Nd:YAG laser was an effective and safe treatment for the vitreous floaters in this short-term study.
Follow-Up Studies ; Humans ; Intraocular Pressure ; Patient Satisfaction ; Postoperative Complications ; Prospective Studies ; Yttrium

Acute coronary closure occurs 2-10% during the procedure of PTCA, 50-80% of those events are in the catheterization room. The causes of acute coronary closure are mainly due to dissection, thrombosis or spasm. We recently experienced a case of acute left main coronary artery closure due to guiding catheter induced embolization in the 56 year-old female, unstable angina patient complicated by diabetes mellitus and chronic renal failure. The patient received cardiopulmonary resuscitation shortly after acute closure because of cardiac arrest. During the resuscitation, we performed PTCA at the site of acute closure. The blood pressure maintained normaly after successful recanalization. And then we inserted IABP(intraaortic balloon pump) balloon and did PTCA of original stenosis sites. The patient removed IABP 24 hours later and discharged a month later without complication.
Angina, Unstable ; Blood Pressure ; Cardiopulmonary Resuscitation* ; Catheterization ; Catheters* ; Constriction, Pathologic ; Coronary Vessels ; Diabetes Mellitus ; Female ; Heart Arrest ; Humans ; Kidney Failure, Chronic ; Middle Aged ; Resuscitation ; Spasm ; Thrombosis

Human chorionic gonadotropin(HCG) is a member of the glycoproteins family synthesized by the placenta, which consists of 2 noncovalently joined subunits(alpha(alpha) and beta(beta)). The alpha- and beta-subunits have a structural homology with the alpha- and beta-subunits of TSH and LH. The thyrotropic action of HCG results from its structural similarity to TSH, so beta-HCG can bind to the TSH receptor in the thyroid gland. A high level of HCG accompanied by an increased thyroid hormone level, can be observed in gestational trophoblastic disease (GTD), such as a hydatidiform mole or a choriocarcinoma, but the clinical symptoms of hyperthyroidism are rarely observed. We experienced a case of Hashimoto's thyroiditis, where the patient was diagnosed with T3-thyrotoxicosis, which had initially been induced by excess beta-HCG due to an H-mole; after evacuation of the H-mole, the condition was diagnosed as hypothyroidism. It has been speculated that a patient with Hashimoto's thyroiditis could have hyperthyroidism, induced by beta-HCG, due to an H-mole
Choriocarcinoma ; Chorion ; Female ; Gestational Trophoblastic Disease ; Glycoproteins ; Humans ; Hydatidiform Mole* ; Hyperthyroidism ; Hypothyroidism ; Placenta ; Pregnancy ; Receptors, Thyrotropin ; Thyroid Gland* ; Thyroiditis*

PURPOSE: The purpose of this study is to evaluate the effect of axial shortening metatarsal osteotomy on the treatment of advanced rheumatoid arthritis patients with severe hallux valgus and claw toe deformity of lesser toes which is used for preserving the metatarsophalangeal joint. MATERIALS AND METHODS: From January 2005 to June 2009, 18 cases of axial shortening metatarsal osteotomy in advanced rheumatoid arthritis were reviewed ; all of them followed up for more than 2 years after surgical procedures and the mean follow up period was 3.4 years. We performed axial shortening Scarf osteotomy and Akin osteotomy for hallux valgus and Weil osteotomy with soft tissue release for claw toe of lesser toes, respectively. We measured preoperative and postoperative hallux valgus angle, each metatarsal shortening length and the range of motion of the metatarsophalangeal joints through radiographic and clinical examination and compared them each other. Clinical results were evaluated by American Orthopedic Foot and Ankle Society (AOFAS) score and subjective satisfaction of the patients. RESULTS: The hallux valgus angle was reduced from the preoperative mean value of 44.8 degree to 9.0 degree postoperatively and the range of motion of the metatarsophalangeal joint of great toe and lesser toes was increased from the mean of 21.7 degree and 11.0 degree preoperatively to 38.0 degree and 32.5 degree, respectively at postoperation. Also, the mean AOFAS score was improved from 26.5 points to 67.4 points. CONCLUSION: Axial shortening osteotomy is a useful method to correct the deformity and preserve the metatarsophalangeal joint for severe hallux valgus and claw toe deformity in advanced rheumatoid arthritis.
Animals ; Ankle ; Arthritis, Rheumatoid ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Hallux ; Hallux Valgus ; Hammer Toe Syndrome ; Hoof and Claw ; Humans ; Joints ; Metatarsal Bones ; Metatarsophalangeal Joint ; Orthopedics ; Osteotomy ; Range of Motion, Articular ; Toes

PURPOSE: To compare high-resolution CT (HRCT) findings of bronchiectasis caused by tuberculosis and due tocauses other than tuberculosis. MATERIALS AND METHODS: We retrospectively evaluated the HRCT findings of 93patients with bronchiectasis (in 40 patients caused by tuberculosis, and in 53 due to nontuberculous causes).Diagnostic bases for tuberculous bronchiectasis were positive sputum AFB or the presence of radiological findingsof pulmonary tuberculosis, plus a history of antituberculous chemotherapy. HRCT findings were analyzed andcompared in terms of disease extent, site, type, distribution of bronchiectasis, severity of bronchial dilatation,and bronchial wall thickening . RESULTS: Compared with nontuberculous bronchiectasis, the tuberculousbronchiectasis group showed more frequent upper lobe involvement, varicose type bronchiectasis, fibrotic band andcalcification, adjacent pleural thickening, bronchovascular distortion, and paracicatricial emphysema (p<0.05).The nontuberculous bronchiectasis group more frequently involved the lower lobe and showed a higher frequency ofcystic type bronchiectasis (p<0.05). The two groups showed no differences in the frequency of bilateral orwidespread involvement and in the severity of bronchial wall thickening and bronchial dilatation. CONCLUSION: Inpatients with bronchiectasis, HRCT findings of upper lobar distribution, fibrotic changes and calcification,traction or varicose type bronchiectasis, bronchovascular distortion, paracicatricial emphysema, and adjacentpleural thickening suggesta tuberculous origin.
Bronchiectasis* ; Dilatation ; Drug Therapy ; Emphysema ; Humans ; Inpatients ; Retrospective Studies ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary

A 14-month-old boy was transferred because of dilated and hypertrophied left ventricle, neutropenia, and developmental delay. After checking computed tomographic angiography with contrast-dye, the patient showed acute exacerbation and finally died from multi-organ failure despite intensive cares. From genetic analysis, we revealed that the patient had Barth syndrome and found a novel hemizygous frame shift mutation in his TAZ gene, c.227delC (p.Pro76LeufsX7), which was inherited from his mother. Herein, we report a patient with Barth syndrome who had a novel mutation in TAZ gene and experienced unexpected acute exacerbation after contrast dye injection for computed tomographic angiography.
Acidosis/etiology ; Acute Disease ; Adolescent ; Barth Syndrome/diagnosis/*genetics ; Contrast Media/adverse effects/*diagnostic use ; Frameshift Mutation ; Heart Failure/etiology ; Homozygote ; Humans ; Male ; Mutation ; Pedigree ; Sequence Analysis, DNA ; Tomography, X-Ray Computed ; Transcription Factors/*genetics

PURPOSE: To evaluate the sensitivity and specificity of conventional CT of abdomen in the detection of esophageal varices, and to correlate CT grade of esophageal varices with prognosis and risk for bleeding. MATERIALS & METHODS: Both CT and endoscopy were performed in 100 patients. Endoscopy revealed that while 54 patients had varices, 46 did not. CT criteria of variceal grading were follows : (1) wall thickening of more than 5mm or irregular wall contour(grade I) ; (2) intraluminal protruding tubular structures with contrast enhancement(grade II) ; (3) confluent varices in the wall of esophagus or multiplied paraesophageal collaterals(grade III). CT were reviewed by three radiologists without reference to clinical and endoscopic data. RESULTS: Sensitivity and specificity of CT in the detection of esophageal varices were 80%, retrospectively. CT and endoscopic grades agreed with each other in 68% of patients, and there was high correlation between CT and endoscopy.(Gamma statistics, p=0.828). No history or endoscopic evidence of variceal bleeding was present on gradeI, but there was a high incidence on grade II(35%) and on grade III(50%)(MH Chi-Square, Ridit scores=50.561,p=0.000). CONCLUSION: Abdominal CT is useful in the detection of esophageal varices, and can predict the risk factors of bleeding in patients with chronic liver diseases.
Abdomen ; Diagnosis* ; Endoscopy* ; Esophageal and Gastric Varices* ; Esophagus ; Hemorrhage ; Humans ; Hypertension, Portal ; Incidence ; Liver Diseases* ; Liver* ; Prognosis* ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Varicose Veins