A retrospective review was performed in 33 knees of 30 patients who had undergone arthroscopic debridement for degenerative osteoarthritis of the knee. The mean age of the patients at operation was 55 years and the mean follow-up after operation was 15 months. We divided the knec:s into 2 groups; meniscectomy group (23 knees) and non-meniscectomy group (10 knees). The preoperative radiographic findings were divided into 3 groups according to the classification systern by Lotke et al. The postoperative results were evaluated using the nine-point scale by Baumgaertner et al. Our study was conducted to: 1) assess the overall efficacy of arthroscopic debridement, 2) compare the results between the. Meniscectomy group and nonmeniscectomy group, and 3) identify the relationship between the preoperative radiographic findings and out- come at the final follow-up time. Overall excellent or good results were ac.hieved in 22 knees (67%) and the preoperative radiographic findings correlated with the outcome at the final follow-up time. But the results in the meniscectomy and non-meniscectomy poups showed no significant differences statistically. We believe that arthroscopic debridement is an effective option of treatments for mild I:o moderate degenerative arthritis of the knee after failure of conservative measures.
Classification ; Debridement* ; Follow-Up Studies ; Humans ; Knee* ; Osteoarthritis* ; Retrospective Studies

The purpose of the present study lied in examining the incidence, treatment and failure causes of peri-implantitis by analyzing medical charts of those patients who underwent implant placement for the past 2 years. The subjects included those patients who underwent implant placement at the present hospital from January 2001 to December 2002. 3i implants were used for the analysis for the comparison of significance. A total of 301 patients were examined, among whom 102 were females and 199, males. Implants were placed in a total of 578 cases. The number of peri-implantitis was present in a total of 29 cases (21 males and 8 females), giving the incidence at 9.6%. The evidence of peri-implantitis was seen in 60 cases, which was in 10.4% of the patients. Among those cases with peri-implantitis, 28 cases (47%) underwent bone graft and 22 cases (43%) underwent maxillary sinus lift. Furthermore, 4 of these patients had systemic diseases such as diabetes or hypertension. Regular management is important for the preven ion of peri-implantitis. In other words, early prevention through regular follow-ups to check the status of surrounding soft tissue would be needed to maintain implants.
Female ; Humans ; Hypertension ; Incidence ; Male ; Maxillary Sinus ; Peri-Implantitis* ; Retrospective Studies* ; Transplants

We retrospectively analysed plain radiographs and MR imaging of 16 conventional osteosarcoma cases(8 children, 8 adults) which underwent amputations or limb salvage operations. Pathologic correlation was performed with gross and microscopic sections to evaluate 1) whether the open epiphyseal plate can function as a barrier against transphyseal spread of osteosarcoma and 2) the diagnostic value of MR imaging for the detection of the detection of the epiphyseal involvement of osteosarcoma. In children with open epiphyseal plates, conventional radiographs suggested transphyseal tumor growth in one of eight cases(12.5% and MR imaging in seven cases(87.5%). Pathologic examination confirmed epiphyseal involvement in six of seven cases noted with MR imaging(75%). On the the other hand, in adult patients with closed epiphyseal plates, conventional radiographs showed transphyseal tumor growth in six of eight cases(75%), while MR imaging and pathologic exam demonstrated tumor invasion in all cases(100%). We conclude that open epiphyseal plate does not function as and effective barrier against tumor extension, and MR imaging is an excellent method in detecting the extent of transphyseal tumor growth.
Adult ; Amputation ; Child ; Growth Plate ; Hand ; Humans ; Limb Salvage ; Magnetic Resonance Imaging* ; Methods ; Osteosarcoma* ; Retrospective Studies

Voice changes developing after endotracheal intubation during right hemicolectomy with endotracheal intubation have been found to be due to a right recurrent laryngeal nerve palsy in 43-years-old male patient. It was likely that the inflated cuffed tube rode up to the level of the cricoid cartilage during the course of surgery as traction was placed on the endotracheal tube because the condenser humidifier and breathing circuit weighed heavy. Cuff overexpansion, in addition to muscle relaxation and decreased tracheal elasticity were considered as contributing factors of vocal cord palsy. We believe that tube traction and cuff overexpansion were the mechanism of vocal cord palsy in our patient. So we recommend the routine use of tube stand so that weigh of the breathing circuit does not transmit traction to the endotracheal tube. Concurrently, filling the cuff with a sample of the inspired mixture of gases, saline and 4% lidocaine in special cases or regular deflation of the cuff must be considered.
Cricoid Cartilage ; Elasticity ; Gases ; Humans ; Intubation, Intratracheal* ; Lidocaine ; Male ; Muscle Relaxation ; Respiration ; Traction ; Vocal Cord Paralysis* ; Vocal Cords* ; Voice

A 20 years old male patient was transferred to the operating room for mandibulo-maxillary reconstruction. We planned general anesthesia with nasotracheal intubation. Reinforced endotracheal tube was inserted through right nasal os and progressed to the epiglottic region. But the first trial was not successful because of the profuse bleeding from the nasal cavity. After suctioning, the second trial through the same route was successful. But at the time of skin incision, we found the lips of the patient were becoming pale, the SpO2 was falling down to lower than 70%. We found the patients left chest wall was motionless. The chest A-P film showed total atelectasis of the left lung. When a large blood clot was removed by the flexible bronchoscopy, the chest wall started to move well and the SpO2 came up to 99%. The following chest A-P film confirmed the resolution of the atelectasis.
Anesthesia, General ; Bronchoscopy ; Epistaxis* ; Hemorrhage ; Humans ; Intubation* ; Lip ; Lung ; Male ; Nasal Cavity ; Operating Rooms ; Pulmonary Atelectasis* ; Skin ; Suction ; Thoracic Wall ; Thorax ; Young Adult

BACKGROUND: Recently, laparoscopic cholecystectomy becomes more favorite method than traditional open cholecystectomy. But postoperative pain control is still remaining problem. METHOD: Patients scheduled for elective laparoscopic cholecystectomy were assigned to two groups by simple randomization (15 patients per group). Group C (control) had no specific treatment and group B (bupivacaine) received 20 ml of 0.5% bupivacaine with epinephrine 1:200,000 before surgery. Immediately after the creation of a pneumoperitoneum, the surgeon sprayed the bupivacaine near and above the operation field. Operation was started 10 minutes after then. We attempted to investigate that the degree of postoperative pain which was assessed using the visual analogue scale (VAS) and the verbal rating scale (VRS) in the recovery room at postoperative 1 h., as well as the analgesic requirements during the first 24 h. postoperatively. RESULT: VRS of group B was significantly lower than group C (p<0.05), but VAS was not significantly different. Six patients in group B and only one in group C requested no analgesics. Group C had statistically more frequent request for analgesics than group B (p<0.05). CONCLUSION: The topical intraperitoneal anesthesia of 20 ml of 0.5% bupivacaine with epinephrine 1 : 200,000 before laparoscopic cholecystectomy is effective on the postoperative pain control. So, we recommmend that this simple and effective management is routinely treated in patients undergoing laparoscopic cholecystectomy.
Analgesics ; Anesthesia* ; Bupivacaine* ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Epinephrine ; Humans ; Pain, Postoperative* ; Pneumoperitoneum ; Random Allocation ; Recovery Room

Tracheo-innominate artery fistula (TIF) is a life-threatening complication of tracheostomy that manifests with acute and massive bleeding. We present a patient who deveoloped a TIF and underwent a division of the fistula, interrupting the innominate artery. Successful management of a patient with TIF requires the rapid institution of specific resuscitative and operative measures. The patient arrived at the emergency room with acute massive tracheal bleeding, respiratory difficulty, decreased consciousness and ensuing cardiac arrest. After the tracheal cuff was fully inflated, cardiopulmonary resuscitation was started. Fortunately, the bleeding was stopped and heart rate and blood pressure were normalized. Before performing the cerebral angiography, the patient was intubated orally for rebleeding. The patient was admitted to the intensive care unit and stayed for 29 days due to weaning failure from the ventilator. After repair of tracheal stenosis, a permanent tracheostomy was instituted. The patient had no respiratory difficulty or massive tracheal bleeding during the 2 months after discharge except one episode of minor bleeding.
Arteries* ; Blood Pressure ; Brachiocephalic Trunk ; Cardiopulmonary Resuscitation ; Cerebral Angiography ; Consciousness ; Emergency Service, Hospital ; Fistula* ; Heart Arrest ; Heart Rate ; Hemorrhage ; Humans ; Intensive Care Units ; Tracheal Stenosis ; Tracheostomy* ; Ventilators, Mechanical ; Weaning

A seventy-two year old male patient who had degenerative osteoarthritis due to acetabular dysplasia on the left hip joint was operated upon for cementless total hip arthroplasty. Sudden left hemiparesis developed on the day after the operation, so we immediately carried out brain computed tomography and magnetic resonance imaging. This showed multiple occlusions of the brain vessels at the right cerebral hemisphere. There was no arterial-venous shunt on the preoperative echocardiogram, yet the ultrasonogram of the right carotid artery showed over 70% postoperative stenosis. There was no evidence of pulmonary embolism on the chest computed tomography. We report here on a case of cerebral infarction that was caused by multiple microemboli after cementless total hip arthroplasty and we review the related medical literature.
Arthroplasty ; Brain ; Carotid Arteries ; Cerebral Infarction ; Cerebrum ; Constriction, Pathologic ; Hip ; Hip Joint ; Humans ; Magnetic Resonance Imaging ; Male ; Osteoarthritis ; Paresis ; Pulmonary Embolism ; Thorax

BACKGROUND: The most important acute complication of percutaneous transluminal coronary angioplasty (PTCA) is abrupt closure by dissection and thrombus, which account for the majority of deaths and emergency coronary artery bypass procedures associated with PTCA. We sought to determine the relationship between clinical, angiographic characteristics and abrupt thrombotic closure related to coronary intervention. METHODS: One hundred thirty two patients (61.6+/-8.0 year, 98 male) underwent PTCA or stenting under the diagnosis of acute myocardial infarction were analyzed at Chonnam University Hospital between Jan '97 and Jun '98. Patients were divided into two groups, one, 14 patients (Group A, 61.7+/-8.0 year, 9 male), who developed thrombotic occlusion, and the other, 118 patients (Group B, 61.5+/-8.0 year, 89 male) who did not develop abrupt closure related to the coronary intervention. RESULT: There were no significant differences in age, sex, risk factors, activated partial thromboplastin time, fibrinogen, erythrocyte sedimentation rate, C-reactive protein, location of lesion, branch involvement, lesion severity, AHA/ACC morphology between two groups. The incidence of intra-coronary thrombus was greater in Group A than in Group B (44% vs. 2%, p=0.025). Acute thrombotic occlusion related to the coronary interventions developed more frequently in the lesions within two days after the symptomatic onset (55% vs. 19%, p=0.035) and in the right coronary artery (RCA) lesions (55% vs. 24%, p=0.041). CONCLUSION: Predictors of abrupt thrombotic occlusion during coronary intervention in patients with acute myocardial infarction are intracoronary thrombus, earlier intervenion within 2 days after onset of aucte myocardial infarction and RCA lesion.
Angioplasty, Balloon, Coronary ; Blood Sedimentation ; C-Reactive Protein ; Coronary Artery Bypass ; Coronary Vessels ; Diagnosis ; Emergencies ; Fibrinogen ; Humans ; Incidence ; Jeollanam-do ; Myocardial Infarction* ; Partial Thromboplastin Time ; Risk Factors ; Stents ; Thrombosis

PURPOSE: Doxylamine is commonly used for relief of insomnia; in addition, it is also a drug that is freguently used for intoxication in Korea. This drug is relatively safe; however, it is known to occasionally induce rhabdomyolysis. We have seen many cases of alcohol ingestion in doxylamine intoxications; however, few previous studies have documented the effects of alcohol on rhabdomyolysis. Therefore, the purpose of this study is to determine the effect of alcohol on rhabdomyolysis in doxylamine intoxicated patients. METHODS: This study was conducted on 91 patients admitted to an emergency department after doxylamine intoxication during the period from January 2001 to March 2012. Using the protocol developed beforehand, the amount of drug ingestion, past history, laboratory results, and whether or not alcohol was ingested were recorded. Rhabdomyolysis was defined as serum creatine kinase (CK) over 1,000 U/L. The SPSS package with logistic regression, t-test, and Fisher's test was used for analysis of data. RESULTS: Alcohol ingestion was detected in 52% of the study patients. The presence of hematuria and alcohol ingestion showed a significant association with development of rhabdomyolysis. CONCLUSION: Doxylamine intoxicated patients with alcohol ingestion may have a high rate of incidence of rhabdomyolysis. Therefore, doxylamine intoxicated patients who drink alcohol at the same time should be aware of rhabdomyolysis.
Creatine Kinase ; Doxylamine ; Eating ; Emergencies ; Hematuria ; Humans ; Incidence ; Korea ; Logistic Models ; Rhabdomyolysis