Purpose: The goal of this study was to evaluate the efficacy of suction drains following total hip arthroplasties, by comparing the post-operative results between the group with suction drains and the group without suction drains. Materials and Methods: Eighty-six patients, who underwent primary total hip arthroplasties from June 2001 to June 2004, were divided into two groups: group 1 (48 patients), with suction drains; and group 2 (38 patients), without suction drains. We assessed the perioperative hemoglobin and platelet levels, the amount of total blood loss, the amount of post-operative blood transfusions, post-operative ranges of motion (ROMs, at 6 weeks), wound problems, and general conditions. Results: Although the postoperative hemoglobin level was greater in group 2 than in group 1, there was no statistically significant difference. The amount of total blood loss and blood transfusions in group 1 were statistically greater than in group 2 (p<0.05). There were no statistically significant differences in the post-operative ROMs and wound complications between groups 1 and 2. Conclusion: There were no limitations of hip motion and no wound complications in the patients without suction drains after total hip arthroplasties. However, they required fewer post-operative blood transfusions than did the patients with suction drains, due to less post-operative blood loss; and the absence of a suction drain might prevent retrograde tube infections. In addition, patients without suction drains after total hip arthroplasties seemed to recover better did than those with suction drains. Therefore, suction drains might provide no benefit in total hip arthroplasties.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Blood Platelets ; Blood Transfusion ; Hip ; Humans ; Suction* ; Wounds and Injuries

PURPOSE: To report the long term effects of intravitreal bevacizumab injection (IVAI) for the treatment of macular edema due to branch retinal vein occlusion (BRVO). METHODS: In this retrospective study, 47 consecutive patients (47 eyes) whose visual acuity under 20/40 and macular thickness over 250 microm from BRVO received IVAI (1.25 mg). All patients were observed over 12 months. The patients were classified into three groups: one, resolved macular edema after first injection, second, persistant, third, recurrant. At 12 months after injection, best corrected visual acuity (BCVA) and central macular thickness (CMT) were compared with one another. RESULTS: Comparing with baseline BCVA (0.96 +/- 0.32, 1.13 +/- 0.42, 0.85 +/- 0.24 log MAR unit), the mean at 12 months was significantly increased (0.50 +/- 0.30, 0.76 +/- 0.51, 0.55 +/- 0.35) in each group. The mean CMT at baseline was 510.84 (+/- 171.07), 538.5 (+/- 216.87), 522.6 (+/- 101.82) microm decreased to 211.58 (+/- 42.74), 232 (+/- 132.68), 270.6 (+/- 85.27). CONCLUSIONS: IVAI was a result of significant decrease of CMT with improvement of BCVA in patients with BRVO after a follow-up of 12 months.
Antibodies, Monoclonal, Humanized ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Macular Edema ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde ; Retrospective Studies ; Visual Acuity ; Bevacizumab

A primary sarcoma of the pulmonary artery is a rare disease. The symptoms of the disease are nonspecific, so it is very difficult to get an exact diagnosis in an emegency situation. A 48-year-old man was admitted to our emergency center with the history of syncope. The patient had no symptoms of a chest problem. During the diagnostic work up, we found an increased density in the left upper lung field on the chest PA, which was the only diagnostic clue to the patient 's illness. A chest CT, a chest MRI, and other studies were done to diagnose the undelying cause of syncope. We found a large intraluminal mass in the pulmonary artery and anterior mediastinal lymph node enlargement. A firm tumor, which arose from the main pulmonary artery and caused a near total obstruction of the left main pulmonary artery, was found during operation, and a partial resection of the tumor mass was done. Histologic and immunohistochemical staining revealed the tumor to be poorly differentiated spindle cell sarcoma. We report the case of a pulmonary artery sarcoma patient, along with a brief review of related literature.
Diagnosis ; Emergencies ; Hemangiosarcoma* ; Humans ; Lung ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Pulmonary Artery* ; Rare Diseases ; Sarcoma ; Syncope ; Thorax ; Tomography, X-Ray Computed

BACKGROUND: Eosinophilic pustular folliculitis (EPF) is characterized by erythematous patches of follicular papules and pustules that mainly involve the face. Although various treatments have been attempted for EPF, including systemic and topical steroids, dapsone and indomethacin, there is no consensus on the first choice for treatment. OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy and safety of naproxen treatment for EPF patients. METHODS: We retrospectively reviewed the clinical records of 16 biopsy-proven EPF patients who were treated with naproxen. Initial dose of oral naproxen was 500 mg to 1,000 mg. Therapeutic effects were evaluated by 3 grades: NR (no response), PR (partial remission, >50% improvement), CR (complete remission). RESULTS: Of the 16 EPF patients, 11 patients (69%) showed either complete remission (50%) or partial remission (19%). The median time to response for good responders (CR+PR) was 1.5 weeks. Two patients (13%) had mild gastrointestinal side effects, such as indigestion, but the symptoms disappeared soon after use of a gastrointestinal protectant. CONCLUSION: Oral naproxen may be an effective and safe treatment modality for EPF.
Consensus ; Dapsone ; Dyspepsia ; Eosinophilia ; Eosinophils ; Folliculitis ; Humans ; Indomethacin ; Naproxen ; Retrospective Studies ; Skin Diseases, Vesiculobullous ; Steroids

PURPOSE: The purpose of this study was to observe and compare the changes in the patterns of hemodynamic and blood profiles on the circuit of Extra-corporeal life support system (ECLS) by using a dual pulsatile pump (T-PLS). METHODS: An acute heart failure model using partial pulmonary artery banding was constructed in 12 piglets (20 -25kg). The animals were divided into centrifugal (n=6) and dual pulsatile pump (n=6) group. Each animal was placed on an ECLS system with a membrane oxygenator bypassing the right atrium and the aorta for 2 hours under general anesthesia. The parameters mainly observed were intra-circuit pressure changes, arterial pulsatility (pulse pressure), plasma free hemoglobin, hemodynamic changes, and other blood profiles. The parameters obtained just prior to the bypass were compared with the corresponding parameters obtained two hours after the bypass. RESULTS: Before bypass, the parameters were statistically the same between the groups. Two hours after the bypass, no significant differences were observed between the groups in ABGA, VBGA, AST/ALT, BUN/Cr, and electrolytes; the plasma free hemoglobin was 14.8+/-4.7 g/dl in the dual pulsatile group and 19.1+/-9.1 g/dl in the centrifugal group (p=NS). The pulse pressure was higher in the dual pulsatile pump than in the centrifugal pump group (35+/-8 vs. 11+/-7 mmHg, p=0.0253 mmHg). The highest circuit pressure was generated at the inlet of the membrane oxygenator and was higher in the dual pulsatile group than in the centrifugal group (173+/-12 mmHg vs. 222+/-8 mmHg, p=0.0000). CONCLUSION: The results demonstrate that a dual pulsating mechanism lessens blood cell trauma while providing physiologic pulsatile blood flow. The ECLS system using a dual pulsatile pump (T-PLS) can be useed as an effective and safe driving motor for an ECLS.
Anesthesia, General ; Animals ; Aorta ; Bays ; Blood Cells ; Blood Pressure ; Cardiopulmonary Resuscitation ; Electrolytes ; Heart Atria ; Heart Failure ; Hemodynamics ; Life Support Systems* ; Oxygenators, Membrane ; Plasma ; Pulmonary Artery

PURPOSE: To evaluate the use of post-arthrography computed tomography in examining wrist ligament injuries. MATERIALS AND METHODS: Thirty consecutive patients who had a history and clinical findings suggestive of ligamentous injuries of the wrist were examined. Fourteen men and sixteen women (average age 35 years) were enrolled in this study. The evaluation concentrated on the detection and precise localization of the ligament lesions in the triangular fibrocartilage (TFC), the scapholunate ligament (SLL) and the lunotriquetral ligament (LTL). RESULTS: For TFC, SLL and LTL lesions, arthro-CT showed a sensitivity 96%, 90% and 85.7%, and a specificity 80%, 90% and 91.3%, and an accuracy 93.3%, 90% and 93.3%, respectively. CONCLUSION: Arthro-CT may be a useful imaging method for evaluating intra-articular ligament injuries of the wrist.
Female ; Male ; Humans

PURPOSE: This study was designed to evaluate the usefulness of 3T-TOF MR angiography (3T-TOF MRA) compared with transcranial Doppler sonography (TCD) and conventional angiography (CA) in patients with suspected cerebral infarction. MATERIALS AND METHODS: Fifty four patients with clinical symptoms of cerebral infarction were involved in this study, and had undergone 3T-TOF MRA and TCD, with CA in 11 patients. On the basis of divisions of the carotid artery, four groups were designated: group I, both vertebral arteries and basilar artery; group II, segment between 2 cm below bifurcation of common carotid artery and genu portion of internal carotid artery; group III, segment between petrous portion of internal carotid artery and bifurcation of anterior and middle cerebral artery; group IV, from bifurcation of anterior and middle cerebral artery to thier distal branches. Two radiologists retrospectively reviewed the vascular imaging and stenosis in 3T-TOF MRA, TCD, and CA. RESULTS: A total of 432 arteries, 108 in each group, were available. The assessment of vascular imaging quality in 3T-TOF MRA is scored 2.98, 2.96, 2.91, 2.88 in 4 groups, respectively. Agreement among 3TTOF MR angiography, TCD, and CA was high. CONCLUSION: 3T-TOF MR angiography may be useful method for the assessment of stenotic lesions of cranial vasculature in patients with cerebral infarction.
Angiography* ; Arteries ; Basilar Artery ; Carotid Arteries ; Carotid Artery, Common ; Carotid Artery, Internal ; Cerebral Infarction* ; Constriction, Pathologic ; Humans ; Middle Cerebral Artery ; Retrospective Studies ; Ultrasonography, Doppler, Transcranial ; Vertebral Artery

PURPOSE: Arterial stiffness is a major independent risk factor for cardiovascular morbidity and mortality in hemodialysis patients. It is hypothesized that arterial stiffness factor is attributable to the structural and functional changes of left ventricle (LV) caused by increased cardiac workload. So we investigated the relationship between brachial-ankle pulse wave velocity (baPWV) and diastolic dysfunction of left ventricle using echoardiographic transmitral blood flow pattern. METHODS: For 96 subjects (48 control patients, 48 hemodialysis patients), baPWV and echocardiographic indices for diastolic function, i.e. transmitral E, A, E/A, DT, IVRT were measured just before hemodialysis session. Role of baPWV was tested in a multiple regression model including age, gender, body mass index, predialysis blood pressure, heart rate, LV mass index and interdialysis weight gain. RESULTS: In the control group, LV mass index (beta=-0.350) and rbaPWV (beta=-0.403) had an independently correlation with E/A ratio. Rt-baPWV was independently correlated with DT (beta=-0.410) and IVRT (beta=0.500). In the hemodialysis group, systolic blood pressure (beta=-0.389) and heart rate (beta=-0.403) were the factors of E/A ratio. Rt-baPWV (beta=-0.557) was the factor determining E/A ratio only in female hemodialysis patients. CONCLUSION: PWV is independently correlated with E/A ratio only in female hemodialysis patients. Their relationship is limited or weak compared to normal control group.
Blood Pressure ; Body Mass Index ; Compliance ; Echocardiography ; Female ; Fibrinogen ; Heart Rate ; Heart Ventricles ; Humans ; Mortality ; Pulse Wave Analysis* ; Renal Dialysis* ; Risk Factors ; Vascular Stiffness ; Ventricular Function, Left ; Weight Gain

PURPOSE: Due to its rapidity and easy accessibility, the fingerstick blood glucometer has been used in almost all hospitals and private clinics, and even by patients themselves. We also have used it even in shock patient care, but shock shows global tissue hypoperfusion, especially in peripheral tissue. The changes of peripheral circulation have an influence on the results for fingerstick glucose. To evaluate the accuracy of the glucometer for patients with poor peripheral perfusion, we designed this study. METHODS: A prospective, nonrandomized comparison group study was done. A hypotensive group and a normotensive group were compared. We obtained three data from each patient: venous blood glucose level (clinicopathologic laboratory), venous blood glucose level (by glucometer) and fingerstick glucose level (by glucometer). RESULTS: We saw a significant difference between the fingerstick glucometer results and the laboratory glucose levels in hypotensive patients: 131.67+/-55.33 mg/dl vs. 1 4 7 . 2 3+/-62.06 mg/dl (paired t-test, p<0.05). There was no significant difference between fingerstick and laboratory glucose in normotensive patients: 101.75+/-20.14 mg/dl vs. 1 0 5 . 6 0+/-21.95 mg/dl (paired t-test, p>0.05). There was no significant difference between the results of venous glucometer and laboratory test in either group: 142.37+/-61.27 mg/dl vs. 147.23+/-62.06 mg/dl (paired t-test, p>0.05) and 102.98+/-17.02 mg/dl vs. 105.60+/-21.95 mg/dl (paired t-test, p>0.05). Although some statistical differences existed between the results, all of the error rates were in an acceptable range (within 15%, accepted by American Diabetes Association consensus). CONCLUSION: These results suggest that the blood glucose level of the glucometer with venous blood is more accurate than that with peripheral blood in patients with poor peripheral circulation.
Blood Glucose* ; Glucose ; Humans ; Patient Care ; Perfusion ; Prospective Studies ; Shock

PURPOSE: The purpose of our study is to evaluate the initial diagnostic value of magnetic resonance imaging (MRI) and electroencephalogrphy (EEG) in children who visit the emergency department (ED) with first afebrile seizure attacks. METHODS: We reviewed the medical records of children who visited the emergency department of Inha University Hospital with first afebrile seizure attacks and who underwent the diagnostic procedures of MRI & EEG during their visits. The study duration was for the 72 months from January 1997 to December 2002. One year after the study, we followed up the patients by using a telephone survey and by reviewing their medical records. RESULTS: The records of 46 patients, 23 boys and 23 girls, were reviewed. Generalized tonic clonic seizures appeared in 37 (80%) of the children and focal seizures in 9 (20%) of the children. Twenty nine (63%) of the children had two or more seizures during a single episode. There were 8 (17%) cases in which the seizures lasted for over 30 minutes. MRI abnormalities were found in only a small portion (9 cases, 20%) of the patients, but all of the MRI abnormalities were significant. The MRI abnormalities were as follows: brain atrophy (n=2), leptomeningeal enhancement (n=2), aneurysm (n=1), arachnoid cyst (n=1), ventriculomegaly (n=1), demyelinating disease (n=1), and hypoxic damage (n=1). Abnormal EEG findings were found in 15 (33%) of the children: Eleven showed partial seizures and 4 showed cerebral dysfunctions. CONCLUSION: Even though abnormal MRI & EEG findings were revealed in only a small portion of the patients, all of the revealed abnormal findings were very serious and were associated with significant problems. In conclusion, we suggest that initial MRI & EEG evaluations are valuable diagnostic procedures for children who visit the emergency department with first attacks of afebrile seizures.
Aneurysm ; Arachnoid ; Atrophy ; Brain ; Child* ; Demyelinating Diseases ; Electroencephalography* ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Magnetic Resonance Imaging* ; Medical Records ; Seizures* ; Telephone